# fibro...what is it?



## sadone (Dec 17, 2003)

hey,just wondering how you guys would define fibro??what are your symptoms?


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## M&M (Jan 20, 2002)

Here is some information I stole from old threads on this forum. Hope it helps! *Diagnostic Criteria for Fibromyalgia * <http://www.fmnetnews.com/pages/criteria.html> For the most part, routine laboratory testing reveals nothing about fibromylagia or chronic fatigue syndrome. However, upon physical examination, the fibromyalgia patient will be sensitive to pressure in certain areas of the body called tender points. To meet the diagnostic criteria, patients must have: A. Widespread pain in all four quadrants of their body for a minimum of three monthsB. At least 11 of the 18 specified tender points(see diagram)These 18 sites used for diagnosis cluster around the neck, shoulder, chest, hip, knee and elbow regions. Over 75 other tender points have been found to exist, but are not used for diagnostic purposes. ï¿½Although the above criteria focuses on tender point count, a consensus of 35 FMS experts published a report in 1996 saying that a person does not need to have the required 11 tender points to be diagnosed and treated for FMS. This criteria was created for research purposes and many people may still have FMS with less than 11 of the required tender points as long as they have widespread pain and many of the common symptoms associated with FMSMap of the pain sites of Fibromyalgia: http://www.fibromyalgia.com/tender_points.htm A few more links with a little more information: www.myalgia.com http://www.fibromyalgia.com/home.htm Here is a really long article with the link at the end:Fibromyalgia Syndrome----------------------------------Kathleen D. Johnson, MDVolume 2530, No 8, pp. 4391-4455, June 1, 2003I. Introduction-------------------A. Definition1. Fibromyalgia syndrome (FMS) is characterized bymusculoskeletal aching and tenderness on palpation oftendinomusculoskeletal sites called tender points.2.Frequently associated with a sleep disorder and daytimefatigue.3.May be associated with several other organ specificsyndromes.B. Classification1. Primary - Fibromyalgia syndrome occurring in absence of anyunderlying or concomitant condition.2. Concomitant - Fibromyalgia syndrome occurring inassociation with another rheumatic condition.a. Concomitant FMS is clinically identical to primary fibromyalgiasyndrome.3. Secondary - FMS caused by rheumatic or other disease.4. Localized - pain and tenderness in a few (1-4) contiguousanatomic sites.a. Usually above the waist, especially around the neck andshoulder.b. Frequently precipitated by injury or trauma.c. Similar to myofascial pain syndromes.d. May develop into generalized FMS over time.II. Etiology and Pathogenesis-----------------------------------------A. FMS1.Primary FMS - no specific etiology has been identified.a. Neurohormonal abnormality.(1) Insulin-like growth factor-1 (IGF-1) deficiency?(2) Serotonin deficiency.(3) Increased substance P in CSF.(4) Altered thalamic blood flow.(5) Abnormal hypothalamic-pituitary-adrenal axis homeostasis.b. Result of initial insult is stage 4 sleep anomaly.2. Etiological factors causing stage 4 sleep anomaly leading toFMS.a. Musculoskeletal pain.b. Physical trauma and/or Emotional trauma.(1) No cause and effect relationship established.(2) Possible relationship to physical and sexual abuse.c. Sleep apnea. d. Nocturnal myoclonus/periodic limb movementdisorder (PLMD).e. Drugs.f. Exogenous causes of sleep disturbance - noise.g. No evidence of infectious cause, ie, Lyme disease, EBV.B. Pathogenesis1. Stage 4 sleep anomaly.a. Normal non-REM/stage 4 (restorative) sleep shows I cps deltapattern on EEG.b. FMS patients showed baseline delta pattern with 8-10 cpsalpha intrusion in original investigations.c. This is similar to normal healthy sleep with stage 4deprivation, ie, noise.d. More recent studies have not found any consistentabnormalities in sleep EEG.2.Stage 4 sleep anomaly in predisposed patient results in apositive feedback cycle:a. Abnormal neurohormonal homeostasis.b. Poor restorative sleep.c. Daytime fatigue.d. Muscle microtrauma, inactivity, deconditioning.e. Musculoskeletal pain.3. Final result- FMS.4. Patients frequently exhibit depressive symptoms, poor paincoping mechanisms.C. Spectrum of FMS and related disorders.1. Several disorders with similar etiopathogenesis andoverlapping clinical manifestations.2. Stage 4 sleep anomaly unifying underlying pathogenicmechanism.3. Often associated with musculoskeletal pare and fatigue.4. Fibromyalgia Syndrome (FMS)/Chronic Fatigue Syndrome(CFS).5. Tension headaches, TMJ syndrome, noncardiac chest pain.6. Irritable bowel syndrome, chronic cystitis, primarydysmenorrhea.7. Others:a. Periodic limb movement disorder/nocturnal myoclonus(PLMD).b. Restless leg syndrome (RLS).c. Repetitive strain injury (RSI).d. Multiple drug sensitivities (MDS).III. Clinical manifestations------------------------------------A. Epidemiology1. Probably the most common rheumatic disease.2. Prevalence of FMS in typical rheumatology practice is 20%.3. Prevalence of FMS in typical primary care practice is 2-5%.4. Prevalence of FMS in general population is probably about 2%.a. Females - 3.5%, Males - 0.5%.5. Mean age of patients - 44 years.a. Increasing prevalence with increasing age.6. Female predominance- 90%.7. Caucasian predominance - 94% (may be selection bias).8. Duration of symptoms before diagnosis - 6 years.B. Clinical manifestations.1. Musculoskeletal symptoms.-------------------------------------------------------Pain at multiple sites``````````````````100%-------------------------------------------------------Morning stiffness > 15 minutes```````78%-------------------------------------------------------"Pain all over"````````````````````````````64%-------------------------------------------------------2. Non-musculoskeletal symptoms.------------------------------------------------------Fatigue``````````````````````````````````````86%------------------------------------------------------Sleep disturbance````````````````````````65%-------------------------------------------------------Paresthesias````````````````````````````````54%------------------------------------------------------3. Associated symptoms.-------------------------------------------------------Self-assessed anxiety -`````````````````62%-------------------------------------------------------Headaches -````````````````````````````````53%-------------------------------------------------------Dysmenorrhea -```````````````````````````43%-------------------------------------------------------Irritable bowel syndrome -`````````````40%-------------------------------------------------------Self-assessed depression -`````````````34%-------------------------------------------------------Urinary urgency -```````````````````````````26%-------------------------------------------------------Sicca symptoms -``````````````````````````15%-------------------------------------------------------Raynaud's phenomenon -````````````````13%-------------------------------------------------------4. Physical findings.a. Tenderness to palpation particularly in neck, shoulder andlower back area.(1) Tender points are reliable and reproducible to a moderate tohigh degree.(2) In most patients, tender points are consistent in location.b. No synovitis, full range of motion of all joints.(1) May be abnormal due to concomitant rheumatic disease.c. Normal muscle strength.d. Normal neurologic examination.5.Females have more tender points and more associatedsymptoms of fatigue, sleep disorder, pain all over, irritable bowelsyndrome than males.6.Laboratory tests are all normal. Laboratory abnormalities arenot due to FMS.IV. Diagnosis------------------A. Diagnostic criteria for FMS.1. History of widespread pain for at least 3 months.2. Pain in 11 of 18 tender sites.a. Classic tender points.3. Diagnosis also supported by a history of a sleep disorder anddaytime fatigue.4. Differential diagnosis: Must rule out other possible causes ofsymptoms.a. Connective tissue disease - prodrome of SLE, Sï¿½jgren'ssyndrome, RA.b. Hypothyroidism.c. Other rheumatic problems - PMR, OA, tendinitis/bursitis,overuse syndromes.d. Hyperparathyroidism.e. Myofascial pain syndrome.(1) Regional pain syndromes with local symptoms similar toFMS.(2) Commonly involve shoulder, neck or low back.(3) Some patients evolve into generalized FMS over time.(4) Symptoms often begin after injury or trauma.(5) Trigger points - muscle areas-tender to palpation withreferred pain distally.(a) Poor scientific evidence for trigger points.(6) Unlike FMS, males are equally affected, symptoms of painand stiffness are localized with regional tenderness, fatigue isunusual, sleep disorder occurs occasionally secondary to pain,response to treatment is generally good.f. Psychogenic pain.(1) Unlike FMS, pain and tender points are widespread andvariable.(2) Patient response to question are inappropriate.(3) Response to therapy inconsistent.(4) General demeanor is affected.(5) Response to treatment is poor- emotional problems andsecondary gain.5. Helpful to obtain several laboratory tests such as CBC, ESR,TSH and occasionally ANA and RF in order to rule out otherdiagnostic possibilities.V. Prognosis-----------------A. Poor prognostic indicators.1. Symptoms for long period; >2 years.2. Severe symptoms that have resulted in limitation of activities.3. Work disability - often related to "non medical" factors.4. FMS starting after physical injury; automobile or work related.B. FMS generally remains symptomatic for long periods of time.1. In many patients, symptoms can be improved modestly withtreatment.2. In occasional patients significant improvement or rarelyremission is achieved.3. Children with FMS appear to have a better outcome thanadults.VI. Management----------------------A. Firm diagnosis ruling out other possible causes of symptoms.1.Patients are often relieved to learn that their symptoms are notcaused by a progressive, crippling or fatal disease.2.Obtain a panel of laboratory tests to-rule out other diagnosticpossibilities.3.Avoid ordering more tests on subsequent visits; -this willincrease patient anxiety.B. Patient education and support.1. Patient cooperation is important for a good therapeuticoutcome.2. FMS is not progressive, is not crippling and is not fatal.3. Encourage patient to continue working and keep physicallyactive.4. Outcome is in patient's hands - try to minimize dependence onphysician.5. Educate patient about the pathophysiology of FMS and itstreatment.a. Importance of restorative sleep.b. Understand factors that affect symptoms.c. Importance of physical conditioning.d. Role of medical therapy - benefits and side effects.C. Behavior modification1. Avoidance of factors which aggravate symptoms.2. Learn to live with chronic pain.a. Occasional patient may benefit from input of psychologist orpsychiatrist.D. Physical therapy1.Improve physical fitness with mild to moderate regularexercises.a. Walking, swimming, cardiovascular fitness training program.2. Use of heat with stretching exercises.3. Periodic rest periods during physical activity.E. Medical therapy1. Paina. Analgesics - acetaminophen, propoxyphene HCI, NSAIDs.b. Local injection of tender points with lidocaine +/-corticosteroids.2. Sleep disorder.a. Tricyclic antidepressants(1) Cyclobenzaprine (Flexeril) 10-40 mg po qhs.(2) Amitriptyline (Elavil) 10-50 mg po qhs.(3) Nortriptyline (Pamelor) 10-50 mg po qhs.b. Specific serotonin reuptake inhibitors (SSRIs)(1) Sertraline (Zoloft) 50-100 mg po qhs.(2) Paroxetine (Paxil) 20-40 mg po qhs.(3) Fluoxetine (Prozac) 20-40 mg po q day (not effective alone, ?in combination).c. Hypnotics(1) Alprazolam (Xanax) 0. 5-1 mg po. qhs.(2) Zolpidem (Ambien) 10 mg po qhs.Reference--------------1. Aaron LA, Bradley I_A, Alarcon GS, etal. Psychiatricdiagnoses in patients with fibromyalgia are related to healthcare-seeking behavior rather than to illness. Arthritis Rheum2002; 39:436-445.2. Bennett RM, Burckhardt CS, Clark SR, O'Reitly CA, WeinsAN, Campbell SM. Group treatment of fibromyalgia: a 6 monthoutpatient program. J Rheumatol 2002; 23:521528.3. Bennett RM. The Fibromyalgia Syndrome. In: Kelley WN,Harris ED, Jr., Ruddy S, Sledge CB, eds. Textbook ofRheumatology. Philadelphia: W. B. Saunders, 2002:511-520.4. Bradley I_A, Alarc6n GS. Fibromyalgia. In:. Koopman W J, ed.Arthritis and Allied Conditions. Baltimore: Williams and Wilkins,2002:1619-1640.5. Carette S, Oakson G, Guimont C, Steriade M. Sleepelectroencephalography and the clinical response toamitriptyline in patients with fibromyalgia. Arthritis Rheum 1995;38:12111217.6. Crofford L J, Pillemer SR, Kalogeras KT, et al.Hypothatamic-pituitary-adrenal axis perturbations in patientswith fibromyalgia. Arthritis Rheum 1994; 37:1583-1592.7. Griep EN, Boersma JW, de Kloet ER. Pituitary release ofgrowth hormone and prolactin in the primary fibromyalgia syndrome.J Rheumatol 1994; 21:2125-2130.8. Hudson JI, Pope HG, Jr. Does childhood sexual abuse causefibromyalgia? Arthritis Rheum 1995; 38"161-163.9. Kennedy M, Felson DT. A prospective long-term study offibromyalgia syndrome. Arthritis Rheum 2002; 39:682-685.10. Lapossy E, Maleitzke R, Hrycaj P, Mennet W, Muller W. Thefrequency of transition of chronic low back pain to fibromyalgia.Scand J Rheumatol 1995; 24:29-33.11. Mountz JM, Bradley I_A, Modell JG, et al. Fibromyalgia inwomen:, abnormalities of regional cerebral blood flow in thethalamus and the caudate nucleus are associated with low painthreshold levels. Arthritis Rheum 1995; 38:926-938.12. Simms RW. Fibromyalgia syndrome: current concepts inpathophysiology, clinical features, and management. ArthritisCare Res 2002; 9:315-328.13.Wolfe F, Ross K, Anderson J, Russell I J, Hebert L. Theprevalence and charactersitics of fibromyalgia in the generalpopulation. Arthritis Rheum 1995; 38:19-28.47 https://www.medical-library.org/journals/se...ibromyalgia.HTM Hope this helps!


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## SusanLawton (Dec 23, 2003)

> quote:just wondering how you guys would define fibro??


Dr. Lowe - Metabolic Health - this site has another approach to FM. Thought you might like to see it...







Susan


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