Understanding Fibromyalgia Syndrome
2, Number 1
C. Jessie Jones, PhD & Lynne Matallana, MA
medical wellness community professionals
participate in efforts to improve health and functional status of
people with various medical conditions, one of the most
misunderstood conditions, yet increasing in prevalence among all age
groups is fibromyalgia syndrome (FMS).
While the best diagnostic procedures
and treatment options to manage symptoms are being debated it is now
evident that an increasing number of people are being diagnosed with
FMS (between 6-10 million Americans) with the prevalence increasing
The purpose of this article is to
discuss the (1) definition of FMS, (2) causes, symptoms and triggers
that worsen symptom of FMS, (3) potential consequences of FMS, and
(4) need for a multidisciplinary team
effort to provide symptom management strategies for people with FMS.
The diagnostic criteria for
fibromyalgia was established in 1990 by the American College of
Rheumatology (ACR).2 ACR defined fibromyalgia as “a painful, but not
articular [not present in the joints], condition predominantly
involving muscles and is the most common cause of chronic widespread
musculoskeletal pain”(p.160). The criteria
for fibromyalgia established by the ACR was based on a blinded,
multi-center study that evaluated 11 symptom variables including
sleep disturbances, frequent headaches, and stress levels.
For diagnosis the patient must have a
history of widespread pain for more than
three months and pain in at least 11 or more tender points upon
digital palpation during physical examination. Tender points are
areas of muscle or other soft tissues that are extremely sensitive
to pressure stimulation. Unlike people with FMS most healthy
individuals experience pain in only a small number of tender points.
Although these criteria for diagnosis
lack a specific “marker” for laboratory testing (e.g., blood test,
urine test, x-ray) and have been described as subjective in nature,
most researchers agree that the ACR criteria is a beneficial tool
for diagnosis of FMS until more highly sophisticated tools are
available in the future. It should be noted that many diseases lack
specific diagnostic markers (migraine headaches, depression),
however this does not negate the existence of these conditions. In
the case of FMS, the lack of a marker should only encourage
researchers to continue a diligent search for such a tool.
Fibromyalgia is classified as a syndrome because it is a collection
of symptoms and overlapping conditions.
Because FMS can mimic and overlap
other illnesses (e.g., myofascial pain syndrome, chronic fatigue
syndrome, irritable bowel syndrome, irritable bladder syndrome) or
coexist with other some of the inflammatory rheumatic diseases such
as systemic lupus erythematosus and rheumatoid arthritis, FMS can be
hard to diagnose. 3, 4
Most researchers agree that there are a large number of potential
causes of FMS including a genetic component. It is generally
accepted that FMS symptoms are the result of disordered sensory
processing in the central nervous system.
Many people report that their symptoms
developed after a triggering event such as an accident or injury,
viral infection, surgery, emotional or physical stress, or even
exposure to certain drugs or chemicals. Fibromyalgia
that has a quick onset after a car accident or physical injury is
referred to as post-traumatic fibromyalgia. A large portion of the
medical community accepts the current evidence that indicates that
35-65% of people develop fibromyalgia symptoms after experiencing a
Whatever the cause, the latest
research has identified physiological abnormalities in
neurotransmitter and neuroendocrine function which interferes with
how the central nervous system processes sensory information for
people with FMS.,4, 5
The main symptom or chief complaint of
FMS is constant widespread pain, above and below that waist and on
both sides of the body. Other symptoms include:
Muscle spasms (clustered in neck,
shoulders, upper chest wall, and lower back)
Paresthesia (numbness or tingling)
Decreased exercise endurance
intensity of these FMS symptoms are different for people and
fluctuates on a daily basis which makes treatment outcomes more
difficult to document. Symptoms are aggravated by extreme weather
changes, exposure to certain chemicals, emotional and physical
stress, hormonal deficiencies, sleep problems, acute illnesses/
infections, too little or too much physical exertion, and
FMS is costly in terms of human dignity and socioeconomic impact.
The emotional stress associated with the fluctuating symptoms of FMS
is taxing even for the strongest of people. Having been diagnosed
with FMS several years ago, we are both personally familiar with the
struggle. A search for the “magic” treatment to “cure” FMS or at
least minimize symptoms is neverending. Typical consequences for
people with FMS include an increased risk for emotional distress,
work and family problems, and reduced quality of life. Also, because
people with FMS often find it difficult to be physically active,
they are at risk for a host of sedentary behavior medical problems
(e.g., obesity, sarcopenia, diabetes, cardiovascular disease),
difficulty with activities of daily living, and physical
Every year in the United States at least ten million people seek
medical help for pain and it is estimated that $85 billion is spent
annually to diagnose and treat chronic pain. It is extremely
difficult to accurately report the direct medical costs associated
with FMS, however it has been estimated to be approximately $9
billion per year in the US.14). Using a large US health insurance
claims database for the year 2000, Berger,
Dukes, & Oster (2004)8 reported that health care charges for people
with neuropathic disorders (which included people diagnosed with
fibromyalgia) were 3-fold higher ($17,355 vs $5,715, respectively)
than patients without neuropathic disorders. This cost does not
include the thousands of out-of-the-pocket dollars for medical care
beyond what the insurance company covers for medications,
co-payments, etc., and complementary and alternative therapies for
symptom management.9, 10
Symptom management is critical in order to reduce the onset of
physical frailty and to promote an active life expectancy. The
optimal treatment for symptom management for people with FMS is
unclear and comprehensive evidence-based guidelines have not been
reported by experts in the field.10
However, current evidence suggests
that the most efficacious approach to symptom management at this
time is based on a biopsychosocial model (a multifaceted
pharmaceutical and nonpharmaceutical
approach) including certain pharmacological medications, patient
education, physical and occupational therapy, exercise (e.g., yoga,
tai chi, aerobic, strength conditioning, aquatic programs),
cognitive-behavioral therapy, dietary modifications, stress
management techniques, (e.g., relaxation training, coping
strategies, meditation, electomyographic biofeedback training,
activity pacing, guided imagery, hypnosis), and certain alternative
therapies (e.g., acupuncture, massage therapy, chiropractic or
osteopathic manipulation, herbal remedies and dietary
FMS is a serious chronic medical condition that warrants research
will guide us to a better understanding and new treatment
modalities. Current off-label
pharmacological therapies are often ineffective, and people with
fibromyalgia tend to experience drug sensitivities and intolerable
adverse reactions. In order to address these issues, patients need
to work closely with their health-care professionals to evaluate at
what dosage level and what kind of medications are going to be not
only tolerable, but also helpful in symptom reduction.
However, with the increase of new research evidence regarding the
neurobiology of chronic pain, hopefully new, safe medications will
be developed to complement an integrated
approach to symptom management for people with FMS, with an emphasis
on having the person with FMS be actively involved with decision
concerning the therapeutic regimen by health care providers.
In closing, we would be remiss
not to share our keys to easing FMS symptoms which include having a
strong support system; staying educated about FMS; taking care of
the mind, body, and spirit; living a balanced lifestyle; keeping
faith and hope; and maintaining a positive attitude—the brain has an
amazing effect on the body!
American College of
American Academy of Pain
American Fibromyalgia Syndrome
American Pain Foundation
International Myopain Society
National Fibromyalgia Association
National Fibromyalgia Research
Oregon Fibromyalgia Foundation
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