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Fibromyalgia: Diagnosing and Treating General Aches and Pains


Larry Leventhal, MD, FACP, FACR

Graduate Hospital, Philadelphia PA

Medically Reviewed On: October 18, 2013

"You're overly emotional, take a Tylenol."
"Learn to live with it."
"Aches and pains are just part of getting old."

People living with generalized musculoskeletal aches and pains put up with a barrage of such statements. For them, activities usually taken for granted -- lifting a gallon of milk, peeling potatoes, or washing dishes -- may cause diffuse pain. What if you suffer such aches, and your physician is having difficulty coming up with an explanation? Could you have fibromyalgia?

Definition and Diagnosis
Fibromyalgia syndrome is a common condition associated with widespread aching, stiffness and fatigue. (A syndrome is defined as several signs and symptoms which occur together.) Although many patients feel that pain originates in the joints, fibromyalgia mainly affects muscles, ligaments and tendons. Despite the symptoms, inflammation is not an important part of this condition.

A diagnosis of fibromyalgia is based on patient complaints; unfortunately, no laboratory tests are helpful. Generalized pain is the most prominent feature. Most patients complain of aching and stiffness in areas around the neck, shoulders, upper back, lower back and hip areas. Discomfort may start on one area, then spread to others over time. The pain is often affected by weather conditions, sleep patterns, activity level, and stress. The general physical examination is usually normal, but careful musculoskeletal examination reveals specific localized "tender points." Tender points are usually found on both sides and in the upper and lower portions of the body. The presence and pattern of tender points, in association with widespread pain, distinguish fibromyalgia from other generalized musculoskeletal conditions.

Several complaints may be seen in association with fibromyalgia, including tension and migraine headaches, abdominal pain, bloating, with alternating constipation and diarrhea suggestive of irritable bowel syndrome, as well as bladder spasms and irritability causing urinary urgency or frequency.

Changes in mood and thinking are common in fibromyalgia. Some people may feel anxious and depressed. It is important to remember that people with many chronic illnesses suffer "reactive" depression. People with fibromyalgia may report difficulty concentrating when performing simple mental tasks. Many experience a sleep disorder in which they wake up feeling unrefreshed, even though they may fall asleep without difficulty. Frequent awakenings with a non-restorative quality to the sleep are commonplace. Research has shown that disruption of deep sleep alters many body functions and pain perceptions.

Occasionally, fibromyalgia patients may feel the sensation of numbness and tingling in various body parts, specifically the hands and the feet.

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