Fibromyalgia is a common chronic condition that can be challenging to manage. Although the etiology remains unclear, characteristic alterations in the pattern of sleep and changes in neuroendocrine transmitters such as serotonin, substance P, growth hormone and cortisol suggest that there is a dysregulation of autonomic and neuroendocrine systems. The diagnosis is clinical and is characterized by widespread musculoskeletal pain, tender points, chronic fatigue, insomnia, gastrointestinal symptoms, urinary incontinence and depression. Making the diagnosis of fibromyalgia depends on findings from the history and the physical examination rather than on diagnostic testing. Fibromyalgia can be perplexing for physicians and patients because of the lack of associated abnormalities on available diagnostic tests. While no laboratory testing confirms fibromyalgia, most cases present with a history of widespread muscle pains, physical finding and associated symptoms.

The estimate of prevalence of fibromyalgia is about 3.4% for women and 0.5% for men. While the cause of fibromyalgia remains elusive, there are findings that can show a disturbance in the neuroendocrine axis. If a patient is sent for a test called a sleep EEG (electroencephalogram) one would see disturbances of the non-REM sleep phase by intrusions of alpha waves with infrequent progression to stage 3 and stage 4 sleep. These findings correlate with people reporting awakening repeatedly and feeling unrefreshed when sleeping. One-third of patients with fibromyalgia have a low insulin growth factor level (IGF), an indication of low growth hormone secretion. There is also an elevation of cerebrospinal fluid substance P (a neurotransmitter associated with enhanced pain perception) and alterations in the hypopituitary adrenal axis with a low overall production of cortisol.

Since the symptoms of fibromyalgia wax and wane, treatment is an on-going process rather than management of a single episode. The goals of treatment are to control pain and improve one’s function and quality of life. Studies have documented that patients who undergo aerobic and strength training activities, low does of tricyclic or SSRI medications, muscle relaxant (Flexeril) dietary counseling, chiropractic and acupuncture treatment (if there is no contraindication) will benefit the most. Treating fibromyalgia is a group effort. It is important for a patient to work with a facility that has a group approach towards treating this condition. Supportive groups exist for fibromyalgia. A local chapter of the Arthritis Foundation can help give information about fibromyalgia. One location is the Arthritis Foundation, 1330 West Peat Street , Atlanta , GA , 30309 , or if one visits the web site at www.arthritis.org.