Symptoms of Fibromyalgia

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Fibromyalgia is not a new condition. Initial attempts at characterizing it began around 1843 with Froriep [1]. In 1904, Gowers [2] coined the term Fibrositis to describe the syndrome - a term no longer in favor because it focuses on tender sites, and there are at least two very different syndromes which include tender sites: referred pain syndromes, and nonrestorative sleep syndromes (although, both are involved here). Tender points are clumped in the former, and diffuse in the latter. Furthermore, inflammation, implied in the term, is absent. As a result, the term Fibromyalgia, put forth by Hench in 1976 [3], is currently the preferred name.

Near the beginning of the 1900s, Osler [4] wrote of "muscular rheumatism (myalgia)" presciently stating, "it is by no means certain that the muscular tissues are the seat of the disease." Many studies have been done since that time, and amongst the most important are those of Lewis and Kellgren and their investigations [5-8] of referred pain in the 1930's. It was that work, and the studies of Smythe and Moldofsky [9-12], that finally determined the etiology of Fibromylagia. Studies by Robert M. Bennett, Frederick Wolfe, and Muhammad B. Yunus have also been critical in categorizing symptoms and tender points.

We will delve into the causes of Fibromyalgia and solutions for it in the Etiology of Fibromyalgia section. But first, let's look at some of the symptoms sufferers often experience. As we shall see, the often-used term, "Irritable Everything Syndrome" is appropriate.

Descriptions of the following symptoms can be found in References 13-16.

Fibromyalgia disproportionately affects women (80 to 90%), and usually in mid-life (30 to 60 years of age), although it can be seen at any age, including childhood.

Tender Points

Perhaps the most etiologically significant symptom of Fibromyalgia patients is the presence of tender points which, upon palpation, are extremely sore. Biopsies of these locations consistently fail to reveal pathology. The position of the tender points is precisely the same in all Fibromyalgia patients and, as we shall see in the Etiology of Fibromyalgia section, were essential in eventually uncovering the cause of Fibromyalgia. Smythe states [14],

"Because the points are localized, prospectively predictable in location, and largely unknown to the patient, they rule out exaggeration operating at the psychologic level." On one study, he comments [16], "A striking feature of the ... study was right-left asymmetry, matching patterns of symptoms with patterns of tender points. This ... emphasizes the importance of segmentally determined factors, rather than cerebral and psychological factors, as primary determinants of symptoms and signs."

Illustration taken from: Wolfe F, Smythe HA, Yunus MB, et al, The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia, Report of the Multicenter Criteria Committee, Arthritis & Rheumatism, 1990; 33(2):160-172

Sleep Disturbance

Likely equal in etiological significance to the tender points, is sleep disturbance. On the surface, it would appear to result in chronic, profound fatigue and feelings of being un-refreshed upon waking in the morning; an unpleasant, but seemingly unhelpful clue. Yet as we shall see in the Etiology of Fibromyalgia section, the sleep disturbance is key to understanding the underlying reasons for Fibromyalgia.

Neck Pain

Fibromyalgia patients usually experience chronic, diffuse, aching pain in the back of the neck and shoulders. The muscles are usually tense as well as sore.

Temporomandibular Joint Disorder (TMJ)

Patients often complain of jaw aches and bruxism (involuntary clenching and grinding of teeth during sleep). This usually leads to headaches and further aggravates the generalized neck pain.

Back Pain

Fibromyalgia patients usually experience chronic, diffuse, aching pain in the back. The muscles are usually tense as well as sore. This pain also strangely radiates ("refers") to other areas such as the bladder, testicles in men, thighs, tops of feet, etc. The patient is invariably unaware that the source of pain is the same in each of these instances.

Chest Pain

Breast (anterior chest) heaviness and discomfort is often reported. There is usually significant tenderness deep in the breast, in the origin of the pectoralis minor muscle, and not in the breast itself. The pain is often misinterpreted to be disease of the breast, ribs, pleura, or viscera.

Muscle Stiffness and Fatigue

Muscle stiffness and fatigue are always present, but are particularly severe in the morning upon waking.

Irritable Bladder

Sufferers often experience increased frequency of urination or increased urgency to urinate in the absence of a bladder infection. Women with Fibromyalgia may have more painful menstrual periods or experience worsening of their Fibromyalgia symptoms during this time. Sexual intercourse may be quite painful for women.

Gastrointestinal Disturbance

A common complaint of Fibromyalgia sufferers is diarrhea, gas, bloating, and difficulty swallowing. Fibromyalgia patients have been shown to be much more sensitive to radial extension of the intestines than normal subjects. As a result, even small amounts of gas and the normal passage of solids through the intestines can be excruciatingly painful. Constipation becomes extremely painful. This sensitivity and malfunction of the gut has been given the generic label Irritable Bowel Syndrome (IBS). Unfortunately, a diagnosis of IBS is of little help in solving the patient's problems; one must dig deeper.

Environmental Sensitivity

This can include extreme sensitivity to light, cold, weather changes, loud sounds, chemicals, certain foods, and exaggerated response to medications. An irritable cough is common as well. A gritty sensation in the eyes is commonly reported.

Paresthesia

A skin sensation, such as burning, prickling, itching, or tingling.

Skinfold tenderness

Usually unknown to Fibromyalgia patients is skinfold tenderness in the upper scapular region (upper shoulder blades). Testing for skinfold tenderness in this location often results in a reactive hyperemia (sudden in-rush of blood to the area being tested).

Other Dermatological Disturbances

Skin dryness and itchiness is often experienced, as well as rashes or other skin conditions such as Rosacea. Bleeding gums are sometimes observed. Patients often experience an overall skin sensitivity.

Cognitive Disorder

Complaints include: poor short term memory, inability to concentrate, and a generalized "spaciness".

Allergy-like Reactions

Excessive post-nasal drip is commonly seen in Fibromyalgia patients, and it is unresponsive to antihistamine treatment. Other symptoms of this type can easily fall under the Environmental Sensitivity heading as well.

Impaired Coordination

Sufferers often report a dizziness, closer to a unsteadiness or "swimming" feeling than rotational vertigo. Patients also often describe a general clumsiness, not normally experienced.

Depression and Anxiety

Often Fibromyalgia patients are incorrectly told that the cause of their problems is depression or anxiety disorders. This unfortunate circumstance stems from misguided research studies using a standardized psychological test which was not meant for conditions or diseases characterized by chronic pain. However, Fibromyalgia patients often do experience depression and anxiety as a result of the intense neurological disturbance they are experiencing. But again, the depression or anxiety is not the cause, as we shall see in the Etiology of Fibromyalgia section.

Headaches and Migraine

Most sufferers cite frequent headaches and increased susceptibility to migraine is commonly reported.

Resistance to Standard Treatments

Although not strictly a symptom, Smythe points out [13] another clinical feature of Fibromyalgia, "The meager effects of the most intensive multidisciplinary efforts at rehabilitation of these apparently fit patients is in striking contrast to the relative ease with which major functional improvement can be effected in most patients with RA [rheumatoid arthritis]."

Miscellaneous

Interestingly, it has been noted [17] that pregnancy or jaundice completely and consistently relieved the symptoms of Fibromyalgia.

Subjective swelling of limbs and fingers is often described.

References

    1. Froriep R, On the Therapeutic Application of Electro-Magnetism in the Treatment of Rheumatic and Paralytic Affections, Translated by Lawrence RM, London, Henry Renshaw, 1850
    2. Gowers WR, A Lecture on Lumbago: Its Lessons and Analogues, British Medical Journal, 1904; 1:117-121
    3. Hench PK, Nonarticular Rheumatism, Twenty-Second Rheumatism Review: Review of the American and English Literature for the Years 1973 and 1974, Arthritis and Rheumatism, 1976; Supplement 19:1081-1089
    4. Osler W, The Principles and Practice of Medicine, Fourth Edition, New York, London, D. Appleton and Co., 1901; 406
    5. Kellgren J.H., Observations on Referred Pain Arising From Muscle, Clinical Science, 1938; 3:175-190
    6. Kellgren J.H., On the Distribution of Pain Arising from Deep Somatic Structures with Charts of Segmental Pain Areas, Clinical Science, 1939; 4:35-46
    7. Lewis T., Kellgren J.H., Observations Relating to Referred Pain, Visceromotor Reflexes and Other Associated Phenomena, Clinical Science, 1939; 4:47-71
    8. Kellgren JH, Deep Pain Sensibility, The Lancet, 1949; 1:943-949
    9. Moldofsky H, Scarisbrick P, England R, Smythe HA, Musculoskeletal Symptoms and Non-REM Sleep Disturbance in Patients with "Fibrositis Syndrome" and Healthy Subjects, Psychosomatic Medicine, 1975; 37:341-351
    10. Moldofsky H, Scarisbrick P, Induction of Neurasthenic Musculoskeletal Pain Syndrome by Selective Sleep Stage Deprivation, Psychosomatic Medicine, 1976; 38:35-44
    11. Hugh A. Smythe, Harvey Moldofsky, Two Contributions to Understanding of the “Fibrositis” Syndrome, Bulletin on the Rheumatic Diseases, 1977; 28(1):928-931
    12. Smythe, H.A., 'Fibrositis' as a Disorder of Pain Modulation, Clinics in Rheumatic Diseases, 1979; 5(3):823-832
    13. Hugh A. Smythe, “Nonarticular Rheumatism and Psychogenic Musculoskeletal Syndromes”, in Arthritis and Allied Conditions A Textbook of Rheumatology, 11th Ed., Daniel J. McCarty editor, Lea & Febiger, 1989, pp. 1241-1254
    14. Hugh A. Smythe, “Cervical Spine Syndromes”, in Arthritis and Allied Conditions A Textbook of Rheumatology, 11th Ed., Daniel J. McCarty editor, Lea & Febiger, 1989, pp.1413-1421
    15. Smythe HA, Studies of Sleep in Fibromyalgia; Techniques, Clinical Significance, and Future Directions, British Journal of Rheumatology, 1995; 34:897-899
    16. Hugh A. Smythe, Rheumatologists and neck pain, Scandinavian Journal of Rheumatology, 2000; 29:8-12
    17. Hench, PS, Effect of Jaundice on Chronic Infectious (atrophic) Arthritis and on Primary Fibrositis, Arch. Intern. Med., 1938;61:451-480

This page last updated October 19, 2003