Fibromyalgia's cause unknown pain's certain


November 30, 1993|By Dr. Simeon Margolis | Dr. Simeon Margolis,Contributing Writer

Q : I have suffered from pains all over my body for about thre years. Several doctors who examined me and did numerous tests failed to pinpoint the problem, and my husband thinks I am just neurotic. Several weeks ago I saw an arthritis specialist who made the diagnosis of fibromyalgia. It would help me and my family if you would explain fibromyalgia.

A: Fibromyalgia, once called fibrositis, is a common condition that affects women about 10 times more often than men, most often between the ages of 30 and 60. The hallmark of the disorder is chronic pain in the muscles and tendons (fibrous tissues connecting muscles to bones) that may begin in one area but then spreads to involve most of the body. Different individuals describe the pain as aching, burning, gnawing or stiffness. Some have said their discomfort is like a case of unending flu. The pain is almost always present, but it may vary with time of day or season of the year. The cause of fibromyalgia is unknown, and diagnosis is difficult because there are no abnormalities in blood tests or X-rays. Most victims appear well.

The diagnosis depends on recognition by the doctor of considerable tenderness to deep pressure over many of 14 to 18 characteristic "tender points" located symmetrically over the body. About 90 percent of people with fibromyalgia complain of chronic fatigue and lack of energy that may be more troublesome than the pain.

Many people with fibromyalgia suffer from a chronic "blue" mood, difficulty in concentrating, anxiety and tingling sensations in the hands and feet. Other common complaints are migraine or tension headaches, abdominal pain and bloating, diarrhea alternating with constipation and urinary frequency.

Although a complete cure for fibromyalgia is unusual, much can be done to alleviate discomfort. A first step is for you and your family to understand that fibromyalgia is a real illness, not some form of neurosis or malingering, and that it is not crippling or likely to get worse with time. Aspirin or nonsteroidal anti-inflammatory drugs may lessen your pain. Don't take prednisone or other adrenal steroids that can cause long-term adverse effects. Regular exercise and the use of techniques to relax tense muscles may prove helpful. Low, bedtime doses of amitriptyline or doxepin can improve sleep and relax muscles.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

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