Q: What is Fibromyalgia Syndrome (FMS)?
A: The condition can affect people in many different ways, however the major symptoms include diffuse muscular pain, ache, soreness and stiffness. Frequently waking during sleep and rising unrefreshed are companion symptoms. Memory loss and irritable bowel complaints are other symptoms that often accompany fibromyalgia syndrome.
Q: Why is syndrome used in the diagnosis?
A: Syndrome is used because the condition presents as a constellation of symptoms to the patient. Fibromyalgia is a syndrome in evolution. What a doctor or patient learns this year about Fibromyalgia Syndrome may be placed in disrepute next year. At least a recognized diagnostic criteria of the condition has now been established. This occurred in 1990 when The American College of Rheumatology developed the classification criteria.
Q: What is the cause of FMS?
A: The etiology remains a mystery despite the research. Some authorities propose deprivation of specific growth hormones produced during stage 4 sleep. Other studies point to poorly conditioned muscles and their failure to store adequate glycogen, as an underlying cause. The truth is no one really knows.
Q: Since the etiology is unknown are there any episodes that may trigger its onset?
A: There are many events that propose to trigger the syndrome. A few examples would be infection, sudden trauma [emotional or physical], or the development of a primary disorder such as rheumatoid arthritis, lupus or hyperthyroidism.
Q: Is FMS a form of arthritis?
A: Some research experts in the past have referred to the condition as nonarticular rheumatism or fibrositis. To date no inflammatory process has been documented and this has caused the scientific community to drop the suffix “itis” and replace it with “algia”. By the way, for those of you who think fibromyalgia is a new term, history indicates that it was first used by Sir William Gowers in 1904.
Q: Is there more than one type of FMS?
A: Some authorities classify the syndrome as primary or secondary and others include post-traumatic as a third classification. It is very difficult to classify the syndrome and most diagnoses simply omit same.
Q: Is FMS difficult to diagnose?
A: Since the official criteria for diagnosis were established in 1990, it is said that FMS can be identified with an 88% accuracy.
Q: How does the healthcare practitioner diagnose FMS?
A: By performing a thorough history and examination. The diagnosis of FMS does not rely on laboratory findings or radiographic studies, but on a physical examination that must demonstrate diagnostic pain in at least 11 of 18 characteristic tender point sites. The tender point locations are actually 9 on each side of the body to total 18. The patient history must document widespread pain of at least 3 months duration. Widespread refers to right and left side of the body, above and below the waist, including the anterior and posterior axial skeleton.
Q: What is meant by diagnostic pain?
A: As the examiner presses or palpates the tender point site, diagnostic pain will occur with roughly 4 kilograms of pressure. If you press down with your thumb until you notice a blanching of your nail, then you have applied roughly 4 kilograms of pressure. This is known as the “Yunus Rule of Thumb”, from Muhammad Yunus, MD who published the first controlled study on Fibromyalgia in 1981.
Q: Are tender points and trigger points the same thing?
A: A safe and easy way to differentiate between the two is by pain patterns. Remember, the pain of fibromyalgia syndrome is widespread, hence the tender points will also be widespread. Trigger point pain is found in a condition known as myofascial pain syndrome which may be highly localized or regional. An active trigger point will also refer pain when deeply palpated, while a tender point is more likely to just cause more pain at the local site. Also, the prognosis for trigger points is more favorable than tender points.
Q: Do muscle spasms occur in Fibromyalgia Syndrome?
A: When examining muscles of the FMS patient they often feel tight and like a rope that is twisted and knotted. These shortened muscles and twisted fascia biomechanically compromise blood supply to the area. Remember that fascia has a tensile strength of 2000 pounds per square inch; it’s no wonder noncompliant muscles feel so tight when they are palpated. Without a copious blood supply muscles can not relax enough to recover, therefore the FMS patient exhibits a persistent low energy level regardless of their dietary habits. Remember it takes as much energy to relax a muscle as it does to work a muscle.
Q: What does noncompliant muscle mean to the FMS patient?
A: In order to understand the role of noncompliant or unhealthy muscle it is necessary to discuss complaint or healthy muscle. Compliant muscle can be stretched, shortened, twisted or compressed without restriction or pain. It exhibits good circulation, flexibility, strength and endurance. On the other hand non-compliant tissue is stiff, tender and sore with a feeling of painful knots or tight bands in the muscle. Noncompliant muscle also exhibits poor circulation, reduced flexibility, weakness and it easily fatigues. It is susceptible to injury in the same way a worn tire invites a blowout. Remember, the way we diagnose the FMS patient is by compressing noncompliant muscle at characteristic spots.
Q: Does therapeutic massage or myofascial release help the FMS patient?
A: Frequent use of myofascial release or therapeutic massage is the secret to the management of symptoms. The Intracell Stick allows the FMS patient to self-manage symptoms, between clinic visits, with a high degree of accuracy. Waiting for an appointment to get help, often triggers an unnecessary flare up for the patient.
Q: What sex is most prone to FMS?
A: The condition strikes 8 times more women than men. Mid-life is the targeted age, however it does occur at any age.
Q: Can Fibromyalgia Syndrome be cured?
A: At present there is no cure for the syndrome. Dr. Stuart Silverman is quoted as saying, “Tricyclic drugs can be used to improve the quality of sleep or reduce pain sensitivity, but they are only mildly effective in alleviating the symptoms.” On the brighter side, Dr. Andrew Bonci, Professor, Department of Diagnoses at Cleveland College states,” advances in exercise science and manual medicine are evolving practical and promising solutions for the fibromyalgia patient.”
Q: How does the healthcare practitioner attract FMS patients to his or her office?
A: One of the best ways is to contact a local support group and request to speak at one of the meetings. If you don’t speak, go listen . . . you can learn a great deal about this condition from the ones who have it.
Q: Is FMS a workers’ compensation issue?
A: Most of the time when we think of compensable muscular injuries we associate them with an acute onset, however an exception we now see is carpal tunnel syndrome which of course is a chronic manifestation. According to noted ergonomist and chief editor of Occutrax magazine, Patrick Venditti, “fibromyalgia syndrome may be the next industrial epidemic.”