The cause of fibromyalgia is not known. Patients experience pain in response to stimuli that are normally not perceived as painful. In the United States, approximately 2% of the population have fibromyalgia. It predominantly affects women between the ages of 35 and 55 although it may rarely affect men, children, and the elderly. It can occur independently or can be associated with another disease, such as systemic lupus or rheumatoid arthritis.
The universal symptom of fibromyalgia is pain. Patients seem to have an increased sensitivity to many different sensory stimuli and an unusually low pain threshold: pain can be aggravated by noise, weather change, and emotional stress. It usually affects the neck, buttocks, shoulders, arms, upper back and chest. Tender points, or pressure points, are commonly found around the elbows, shoulders, knees, hips, back of the head, and the sides of the breastbone. Fatigue occurs in 90% of patients, and mental and/or emotional disturbances occur in over half of fibromyalgia patients.
There is no blood or X-ray test to determine whether someone has fibromyalgia, so diagnosis is made purely on clinical grounds based on history and physical examination. In patients with widespread body pain, the diagnosis of fibromyalgia can be made by identifying point tenderness areas (typically, patients will have at least 11 of the 18 classic tender points), by finding no accompanying tissue swelling or inflammation, and by excluding other medical conditions.
Since the symptoms of fibromyalgia are diverse and vary among patients, treatment programs must be individualized for each patient. Treatment programs combine patient education, stress reduction, regular exercise, and medications. Recent studies have verified that the best outcome for each patient results from a combination of approaches that involves the patient in customization of the treatment plan. Exercise regimens are most beneficial when performed on an every-other-day basis, in the morning. How exercise benefits fibromyalgia is unknown. Exercise may exert its beneficial effect by promoting a deep level of sleep (non-REM sleep). Similarly, avoiding alcohol and caffeine before bedtime can also help promote a more restful sleep. The most effective medications in the treatment of fibromyalgia have been the tricyclic antidepressants, medications traditionally used in treating depression. Studies have shown that adding fluoxetine (Prozac), or related medications, to low-dose Elavil further reduces muscle pain, anxiety, and depression. Local injections of analgesics and/or cortisone medication into the trigger-point areas can also be helpful in relieving painful soft tissues, while breaking cycles of pain and muscle spasm.
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