FIBROMYALGIA SYNDROME

The fibromyalgia syndrome (FMS) is a chronic painful condition of unknown cause. The American College of Rheumatology (ACR) has created a set of criteria for diagnosis which include the presence of at least nine of eighteen symmetrical tender points that must be present for at least three months, which must also be both above and below the waist. There should also be a sleep disorder and no other obvious illness to explain them, although the presence of another painful disease does not rule out the diagnosis of FMS. The sleep disorders can sometimes be documented in sleep laboratories but these studies are generally confined to research, and are not clinically useful.

FMS patients frequently remain undiagnosed for long periods of time due to the fact that there are no specific diagnostic tests or x-rays. This fact, plus the frequently vague character of the complaints, leads to a poor understanding of the condition by many physicians, further delaying the diagnosis in many cases. These delays can often contribute to anxiety, insomnia, and depression that usually accompany the problem to a greater or lesser degree anyway. The circle is then completed because these emotional overlays help convince many specialists in certain "hard science" fields like neurology and orthopedics that the complaints are spurious.

The diagnostic dilemma is complicated by the reluctance of insurance companies to recognize conditions that may lack definitely recognizable radiographic or laboratory abnormalities.

FMS can develop de novo or can result from trauma if chronic pain is allowed to occur. Although the emotional problems are well documented in FMS patients, there is a large and growing body of research which demonstrates that the pre-morbid distribution of psychiatric abnormalities in FMS patients is no different from that of the general population.

Treatment consists of normalizing the sleep disorder by using medications which restore the deficient delta wave (deep, dreamless) sleep.  These are anti-depressants, usually used in doses lower than those required
for clinical depression. Anti-inflammatory agents, analgesics, topical agents, and physical therapy modalities may also be employed. Periodic injections into persistent tender points with various mixtures of anesthetics, steroids, and plant or bacterial products are also employed with varying degrees of success.