The Copenhagen official Fibromyalgia Syndrome
definition states that you must have at least 11 out of 18 specified
tender points to qualify for entry into a clinical study of FMS. Tender
points hurt 
where
pressed, but do not refer pain elsewhere -- that is, pressing a tender
point does not cause pain in some other part of the body.(Note that when
examining yourself for tender points, you must use enough pressure to
whiten the thumbnail.)
The official definition for patients to be admitted to a clincal study on FMS further requires that tender points must be present in all four quadrants of the body -- that is, the upper right and left and lower right and left parts of your body. Furthermore, you must have had widespread, more-or-less continuous pain for at least three months.
Tender points occur in pairs on various parts of the body. Because they occur in pairs, the pain is usually distributed equally on both sides of the body.
On your back, they are present in the following places:
along the spine in the neck, where the head and neck meet on the upper line of the shoulder, a little less than halfway from the shoulder to the neck three finger widths, on a diagonal, inward from the last pointsOn the back fairly close to the "dimples" above the buttocks, a little less than halfway in toward the spine
Below the buttocks , very close to the outside edge of the thigh, about three finger widths
On the front of your body, tender points are present in the following places:
On the neck, just above inner edge of the collarbone
Still on the neck, a little further out from the last points, about four finger widths downOn the inner (palm) side of the lower arm, about three finger widths below the elbow crease
On the inner side of the knee, in the "fat pad"
The tender point locations are not "written in stone." They can vary from person to person, which can cause further problems with diagnosis. In traumatic FMS, for example, tender points are often clustered around an injury instead of, or in addition to, the 18 "official" points. These clusters can also occur around a repetitive strain or a degenerative and/or inflammatory problem, such as arthritis.
FIBROMYALGIA SYMPTOMS: |
Persistant Pain in muscles and ligaments |
| Unrefreshing Sleep, Poor sleep | Fatigue (mild or totally drained feeling) |
| Recurrent Headaches | Morning Stiffness |
| Cognitive/Memory Impairments | Irritable Bowel Syndrome |
| Environmental Sensitivity | Irritable Bladder |
| Numbness and Tingling Sensations | Muscle Spasms/Twitching |
| Dizziness | Impaired Coordination |
| Chest Pain | Intolerance to Heat or Cold |
| Frequent Abdominal Pain | Breathlessness |
| Frequent Eye Prescription Changes | Dry Eyes and Mouth |
| Skin Rashes | Sinus and Allergies |
| Subjective Swelling | Mood Swings/Disorders |
Other conditions frequently seen with FMS: These conditions themselves are commonly present without FM, but are seen frequently enough with FM that there may be an overlapping link. The following conditions have been reported or observed to be commonly associated with FM. Allergies. The majority of FM pations have some history of allergies, either themselves or family members. The offending allergenic substance may be any type of environmental allergen, such as dust or pollen. It may be a medication. We are not even certain what is the specific relationship between allergies and FM, but it may reflect involvement of the immune system. Anxiety disorder and panic attacks. Many FM patients experience episodes of extreme anxiety and near-panic. They may feel their heart racing, their chest become tight, and find it difficult to get their breath. There may be a feeling of impending doom. An extreme sensitivity to adrenaline may be part of FM that causes the associated condition. Concentration and memory problems. Studies have not shown any true pathology in one's thinking and memory with FM. However, many people with FM report difficulty retaining facts and, at times, become very frustrated and concerned by this. It appears that there is a problem with attention to specifics. The chronic pain may divert our attention that would otherwise be used to initiate the process of forming memory. When conciously attending to a specific task or specific information, people with FM demonstrate normal learning and memory. Depression. Depression is commonly seen in conditions that cause chronic pain, including FM. Usual symptoms of depression include low self-esteem, feeling of helplessness, thoughts of suicide, poor appetite, frequent crying spells, and more. People with FM who become clinically depressed need treatment of both the depression and the FM to get well again. Dry Eyes Syndrome. Up to a third of patients with FM report dry eyes. Many have to use eye drops to prevent painful reddened eyes. Headaches: tension, migraine, and combination. Tension headaches are also called muscle contraction headaches, which usually begin at the base of the neck and extend upward to the temples, often forming what is described as a band-like squeezing headache. Migraine headaches are vascular headaches in which some event triggers the blood vessels to the brain to constrict and then dilate, leading to a severe headache, nausea, vomiting, eye pain, and other symptoms. Many people have headaches which have both tension and migraine features. Irritable Bladder. The individual may feel like he or she has a bladder infection with frequent painful urination, but urine tests do not reveal any evidence of infection. Irritable Bowel Syndrome or Spastic Colon. Nearly half of patients with FM have frequent bowel cramping, diarrhea, and constipation. Mitral Valve Prolapse (MVP). MVP is a condition where one of the heart valves, the mitral valve, bulges excessively during the heartbeat. It can be diagnosed by listening with a stethoscope for the characteristic click-murmur, or it can be detected with a soundwave test called an echocardiogram. This condition can cause problems such as abnormal heart rhythm, but rarely so. In fact, most cardiologists feel that MVP is a benign condition that does not mean a bad heart disease is present. Mark Pellegrino, M.D. conducted a study at the Ohio State University that showed that the majority of people with fibromyalgia also have MVP. Since the mitral valve is mostly connective tissue, it is possible that FM affects connective tissue other than the muscles, tendons, and ligaments. Restless Legs Syndrome and Nocturnal Myoclonus. These related conditions are most prominent at night. Restless legs syndrome causes leg cramps, especially in the calves, and an intense feeling of restlessness in the leg, that is not relieved until the individual moves the leg, as in walking around. Nocturnal myoclonus is involuntary jerking that occurs during sleep. A neurologic mechanism, perhaps signals that don't get "turned off," may be responsible for both of these similar conditions. Raynaud's phenomenon. This is characterized by intermittent attacks of white or blue discolorations of the fingers or toes. Cold or stress usually brings on these vascular changes. Scoliosis. Curvature of the spine commonly develops in teenage girls for no apparent reason. Scoliosis is also seen in a number of neuromuscular diseases. Dr. Pellegrino has observed a number of patients who have scoliosis and FM. Temporomandibular joint dysfunction (TMJD). This condition is characterized predominantly by painful jaws. Other symptoms of TMJ dysfunction include headaches, ringing in the ears, face numbness and dizziness. Chronic Fatigue Syndrome. Many physicians believe chronic fatigue syndrome and fibromyalgia are actually the same thing. Chronic fatigue syndrome causes fatigue and pain, and it may be triggered by a virus. It is also associated with mild fever, sore throat, and swollen, painful lymph nodes, but severe fatigue and muscle pains are the predominant complaints. Fibrocystic breast disease and endometriosis. Painful cysts in the breast and uterus are a frequent occurence in women. Although these cysts are benign, they can become so painful and prevalent that they ultimately require surgical removal. Both these conditions are also commonly seen in women with FM.
TreatmentThere is no "accepted" or agreed upon treatment for fibromyalgia. The only one that is moderately agreed upon is amitriptyline, or elavil. Elavil is a try-cyclic antidepressant used to help promote sleep, especially stage 4 REM sleep which is sparse in FMS patients. This stage is where soft tissue and muscle repair are done. Therefore, if this stage's time is reduced, the individual will experience more pain. click here to return to my main page> | |
