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So often babyboomers complain of muscle and joint pain. Doctors will often tell us that we have something called Fibromyalgia (fi-bro-my-AL-ja). But what is this condition?
Fybromyalgia is a very common condition of widespread muscular pain and fatigue. Seven to ten million Americans suffer from fibromyalgia (FM). It affects women much more than men in an approximate ratio of 20:1. It is seen in all age groups from young children through old age, although in most patients the problem begins in their 20s or 30s. Recent studies have shown that fibromyalgia occurs worldwide and has no specific ethnic predisposition.
The Symptoms of Fibromyalgia
Fibromyalgia patients have widespread body pain which often seems to arise in the muscles. Some FM patients feel their pain originates in their joints. Pain that emanates from the joints is called arthritis; extensive studies have shown FM patients do not have arthritis. Although many fibromyalgia patients are aware of pain when they are resting, it is most noticeable when they use their muscles, particularly during repetitive activities. Their discomfort can be so severe it may significantly limit their ability to lead a full life. Patients can find themselves unable to work in their chosen professions and may have difficulty performing everyday tasks. As a consequence of muscle pain, many FM patients severely limit their activities including exercise routines. This results in their becoming physically unfit, which eventually makes their fibromyalgia symptoms worse.
In addition to widespread pain, other common symptoms include a decreased sense of energy, disturbances of sleep, night sweats, hot flashes and varying degrees of anxiety and depression related to patients' changed physical status. Furthermore, certain other medical conditions are commonly associated with fibromyalgia, such as: tension headaches, migraine, irritable bowel syndrome, irritable bladder syndrome, premenstrual tension syndrome, cold intolerance, and restless leg syndrome. Patients with estalished rheumatoid arthritis, lupus (SLE), and Sjogren's syndrome often develop FM during the course of their disease. The combination of pain and multiple other symptoms often leads doctors to pursue an extensive course of investigations, which are nearly always normal.
There are no blood tests or X-rays that show abnormalities diagnostic of FM. This initially led many doctors to believe that the problems suffered by FM patients were "all in their heads," or that fibromyalgia patients had a form of masked depression or hypochondriasis. Extensive psychological tests have shown these impressions were unfounded. A physician's diagnosis of FM is based on taking a careful history and the finding of tender areas in specific areas of muscle. These locations are called "tender points." They are tender to palpation and often feel somewhat hardened if the muscle is stroked.
The Treatment of Fibromyalgia
The treatment of FM is frustrating for both patients and their physicians. In general, drugs used to treat musculoskeletal pain, such as aspirin, non-steroidals (e.g. ibuprofen), and cortisone, are not particularly helpful in this situation. As in any chronic pain condition, education is an essential component that helps patients understand what can or can't be done as well as teaching them to help themselves.
It is important for a patient's physician to discover whether there is a cause for sleep disturbances. Such sleep problems include sleep apnea, restless legs syndrome, and teeth grinding. If the cause for a patient's sleep disturbance cannot be determined, low doses of an anti-depressive group of drugs, called tricyclic anti-depressants or short acting sleeping medications such as zolpidem (Ambien) may be beneficial. Patients need to understand these medications are not addictive when used in low dosages (eg., amitriptyline 10 mg at night) and have very few side effects. In general, routine use of sleeping pills such as Halcion, Restoril, Valium, etc., should be avoided as they impair the quality of deep sleep. It is claimed that Ambien (zolpidem) avoids this problem.
There is increasing evidence that a regular exercise routine is essential for all fibromyalgia patients. The increased pain and fatigue caused by repetitive exertion makes regular exercise quite difficult. However, those patients who do develop an exercise regimen experience worthwhile improvement and are reluctant to give up. In general, FM patients must avoid impact loading exertion such as jogging, basketball, aerobics, etc. Regular walking, the use of a stationary bicycle, and pool therapy utilizing an Aqua Jogger (a floatation device that allows the user to walk or run in the swimming pool while remaining upright) seem to be the most suitable activities for FM patients. Supervision by a physical therapist or exercise physiologist is of benefit wherever possible. In general, 20 minutes of physical activity three times a week at 70% of maximum heart rate (220 minus your age) is sufficient to maintain a reasonable level of aerobic fitness.