1. FIBROMYALGIA SYNDROME by. Gari Glaser

2. What is Fibromyalgia? It is defined as a widespread musculoskeletal pain and fatigue disorder for which the cause is still unknown. FIBROMYALGIA is derived from the latin roots – “fibros” = fibrous tissue “myo” = muscle “al” = pain “gia” = condition of

3. A few things to ponder. FMS is most common in people between the ages of 20 and 50. This disorder affects more women than men. Up to 5% of the population is affected. Nearly everyone with FMS exhibits reduced coordination skills and decreased endurance abilities. You may also hear it called: fibrositis, fibromyositis, myofascial pain syndrome or psychogenic rheumatism. It is NOT considered life threatening and does NOT cause permanent damage.

4. What are the symptoms? Defining symptom is pain in the connective tissues of the body such as: muscles tendons ligaments

5. Where is the pain felt? Patients complain of pain in the: Neck Back Shoulders Pelvic girdle Hands Note: Fibromyalgia symptoms are different from rheumatoid arthritis and osteoarthritis because they do NOT involve the joints.

6. Symptoms. Generalized achiness most often in axial locations, accompanied by stiffness that tends to be worse in the morning.

7. More Symptoms.  Patients with FMS may at times interpret touch, light or even sound as pain. Some patients may experience a strong sensitivity to:  odors  sounds  lights  vibration that others don’t even notice

8. Aggravating Factors. The condition may be aggravated or brought on by things such as:  cold or humid weather  physical or mental fatigue  excessive physical activity  anxiety or stress

9. Additional problems. Patients can experience additional problems associated with FMS, including:  irritable bowel syndrome  tension headaches, beginning with neck discomfort  parasthesia (sensation of numbness or tingling) of upper extremities with normal nerve conduction studies  sensation of edematous hands with no visible edema  sleep disturbances

10. How is it diagnosed? Currently there are no lab tests available for diagnosing this condition. Diagnosis depends on self-reported symptoms, a physical exam and an accurate manual tender point exam.

11. Diagnosing a patient. It can only be diagnosed after other diseases with similar symptoms are ruled out and the individual experiences: widespread pain in all 4 quadrants of the body for a minimum of 3 months tenderness or pain in at least 11 of the 18 specified tender points when pressure is applied

12. Something interesting. A physician may perform a blood chemistry screening, a complete blood count or an erythrocyte sedimentation rate, and they will all be NORMAL in patients with FMS. A sleep study may also be ordered, but are typically found normal as well.

13. Let’s try to relate. Do you remember that feeling? The severity of symptoms fluctuate from person to person with FMS, but they very much resemble a post-viral state (like having the flu!) Think back to the last time you had a bad flu.. every muscle in your body shouted out in pain. you felt devoid of energy – like someone had unplugged your power supply.

14. Medical Management. Primary treatment approach is patient education and reassurance. Patient must fully understand disease process. Patient must be informed that this is not a psychiatric disturbance and that the symptoms they are experiencing are NOT uncommon in the general population. Patient must be taught about importance of sleep habits. Maintain regular sleep patterns by going to bed and awaking at the same time each day. Avoid long naps. Recognize the effects of drugs on sleep such as nicotine, alcohol and caffeine. Avoid large meals 2- 3 hours before bedtime. Exercise regularly each day.

15. Medications. There is no SINGLE treatment for FMS, but it is shown that combining certain meds can be helpful. Meds that boost your body’s level of seratonin and norepinephrine (nuerostransmitters that control sleep, pain and immune system function) are commonly prescribed in low doses: Amitriptyline (Elavil) Cyclobenzaprine (Flexeril) Why? These meds are TCA’s (Tricyclic Anti-depressants) and can diminish local pain and stiffness, improve sleep patterns & can decrease the number of tender points.

16. Medications. Along with TCA’s patients may be prescribed :  Sedatives or Hypnotics to help with sleep: Zolpidem tartrate (Ambien) Eszopiclone (Lunesta)  Muscle relaxants to help decrease symptoms of leg movements – especially during the night: Clonazepam (Klonopin)

17. Nursing Interventions. Focus on functional goals that empower the patient as they may feel powerless to the condition. Encourage exercise to maintain function and provide relaxation techniques for comfort.  exercise should include low-impact such as swimming, or stationary cycling.  stretching can be helpful to relieve tight muscles.  relax by taking a warm bath or getting in the spa which also can relieve tight muscles.

18. Prognosis. This condition is chronic, but the symptoms may come and go. The impact of FMS on daily living activities differs among patients, but has proven to be as equally disabling as rheumatoid arthritis. Books say prognosis is excellent - but if you ask someone with the condition – there’s nothing excellent about it.