Typically, patients with fibromyalgia have widespread chronic achiness and/or certain areas that are exquisitely painful to the touch. These "tender points" occur within muscles, tendons or joints, distinguishing them from arthritis pain, which affects only the joints. They are clustered around the neck, shoulders, chest, hips, knees and elbows. Patients with fibromyalgia may also suffer periodic bouts of irritable bowel syndrome, marked by constipation and diarrhea, as well as severe, recurrent headaches.

Fibromyalgia is now widely recognized by the medical community. But in the late seventies and early eighties, patients were viewed with considerable skepticism - just as CFS patients are today. Like CFS, fibromyalgia lasts for years, is still often misdiagnosed, and cannot be readily cured. The difference between the two disorders: Fatigue is the dominant symptom of CFS, and muscular and joint pain is most often mentioned in fibromyalgia cases. "I suspect fibromyalgia and CFS are overlapping conditions," says Seattle internist Dedra Buchwald. "Most people with CFS also have tender points, and over ninety percent of patients with fibromyalgia report chronic fatigue."

Efforts to identify a cause are in their infancy. Because fibromyalgia often follows an injury or accompanies an unrelated disease, such as lupus or multiple sclerosis, some experts believe it may occur when the body's chemical balance is thrown out of whack. There are also indications that stress triggers the illness and that a genetic predisposition may be involved.

As with CFS, behavioral strategies consist of avoiding exercise and undue stress, and improving sleep. Low-dose antidepressants taken at bedtime ease sleep disturbances, fatigue and pain; aspirin or ibuprofen may temporarily lessen the aches. Physical therapy, ice packs, heat treatment and injections of anesthetic at the tender points also may help. Buchwald recommends reconditioning the muscles with physical therapy and by stretching. "Patients can then progress to walking and swimming at a slow pace for a limited amount of time. In some cases, they may be able to build up to aerobic activities, like biking," she says.

"I urge patients to exercise at least three times a week for twenty minutes, beginning with walking at a slow pace," says Nabih Abdou, M.D., a rheumatologist and immunologist with the University of Missouri, in Kansas City. "Just loosening up the muscles makes a big difference." Counseling and support groups are also crucial to assure patients that fibromyalgia isn't crippling or progressive and to help them adjust to this chronic condition.

Fibromyalgia
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