FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

CAUSE OF FIBROMYALGIA STILL STYMIES MEDICAL PROFESSION

Question: I have a bit of arthritis in my neck, but my biggest problem is pain in my shoulders, neck, chest, arms and legs. My doctor says I have fibromyalgia. The medication he has prescribed doesn't make me much better. I can't find much information about my condition. Can you tell me more about it?

Answer: Despite its unusual sounding name, fibromyalgia is not rare. In fact, fibromyalgia is the third most common rheumatic condition; only osteoarthritis and rheumatoid arthritis afflict more people. In this condition, there is widespread pain and tenderness in the muscles and bones what we doctors call the musculoskeletal system. Areas in the neck, chest, arms, legs and back are involved. And, in contrast to arthritis where movements makes pain worse, in fibromyalgia the pain and stiffness is worse after sitting or other inactivity and it improves with movement.

In order to establish the diagnosis of fibromyalgia, the symptoms must be present for three months and have no other identifiable cause. As an example, pain in the neck and shoulder by themselves would not satisfy this definition, even though a burning pain in this region is characteristic of the condition. Pain in only a limited area has a different cause.

In addition to pain, sufferers of fibromyalgia also often have symptoms of chronic headaches, difficulty sleeping, chronic fatigue during the day, numbness and tingling particularly in the hands and feet and irritable bowel complaints. And to compound the complexity of providing effective treatment for individuals with this illness, they usually have a great deal of nervousness and anxiety. No one is sure if these emotional reactions are an intimate part of this illness or if they are just a response to chronic pain.

Now if you have been reading carefully, you will have noticed that I've described the signs of the condition without a good explanation for the cause. That is because we don't understand the cause. We know this condition by its symptoms and by the diseases that are not present. We doctors call this a diagnosis made by exclusion. Once examinations and tests have shown that other conditions that produce similar symptoms aren't present, we can apply the label fibromyalgia. This is another example showing that there is still much to learn about the way the human body works.

Question: Are there any treatments for fibromyalgia?

Answer: Yes, and the most important treatment is education. The patient must understand that the pain of fibromyalgia is serious, it is not imaginary, and it is not associated with any permanent disability from damage to muscles or joints. Physical therapy treatments with local heat and stretching or cold and stretching are often helpful. Ultimately, the individual is helped by getting into top physical condition. Medications, particularly amitriptyline or cyclobenzaprine at bedtime, are helpful to decrease pain and improve the chronic fatigue that is present in those with this condition. The non-steroidal anti-inflammatory medications that provide relief for headaches, arthritis and other conditions with inflammation are of no benefit for fibromyalgia.

Fibromyalgia is a chronic condition. Therefore, expect to be treated for it for years. Your family doctor may be able to help you establish the proper treatment, but don't be surprised if he or she asks you to get a consultation from a physician who specialized in treating individuals with rheumatic diseases a rheumatologist.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.