What is Fibromyalgia Syndrome?
FMS (fibromyalgia syndrome) is a widespread musculoskeletal pain and fatigue disorder for which the cause is still unknown. Fibromyalgia means pain in the muscles, ligaments and tendons - the fibrous tissues in the body.

Most patients with fibromyalgia say that they ache all over. Their muscles may feel like they have been pulled or overworked. Sometimes the muscles twitch and at other times they burn. More women than men are afflicted with fibromyalgia, but it shows up in people of all ages.

Symptoms and Associated Syndromes
Pain:  The pain of fibromyalgia has no boundaries. People describe the pain as deep muscular aching, burning, throbbing, shooting and stabbing. Quite often, the pain and stiffness are worse in the morning and you may hurt more in muscle groups that are used repetitively.

Fatigue:  This symptom can be mild in some patients and yet incapacitating in others. The fatigue has been described as "brain fatigue" in which patients feel totally drained of energy. Many patients depict this situation by saying that they feel as though their arms and legs are tied to concrete blocks, and they have difficulty concentrating.

Sleep disorder:  Most fibromyalgia patients have an associated sleep disorder called the alpha-EEG anomaly. If you wake up feeling as though you have just been run over by a truck - what doctors refer to as un-refreshed sleep - it is reasonable for your physician to assume that you have a sleep disorder.

Irritable Bowel Syndrome:  Constipation, diarrhoea, frequent abdominal pain, abdominal gas and nausea represent symptoms frequently found in roughly 40% to 70% of fibromyalgia patients.

Chronic headaches:  Recurrent migraine or tension-type headaches are seen in about 50% of fibromyalgia patients and can pose as a major problem in coping for this patient group.

Temporomandibular Joint Dysfunction Syndrome:  This syndrome, sometimes referred to as TMJD, causes face and head pain in one quarter of FMS patients. Most of the problems associated with this condition are thought to be related to the muscles and ligaments surrounding the joint and not necessarily the joint itself.

Multiple Chemical Sensitivity Syndrome:  Sensitivities to odours, noise, bright lights, medications and various foods is common in roughly 50% of FMS or CFS patients.

Other common symptoms:  Painful menstrual periods (dysmenorrhea), chest pain, morning stiffness, cognitive or memory impairment, numbness and tingling sensations, muscle twitching, irritable bladder, the feeling of swollen extremities, skin sensitivities, dry eyes and mouth, frequent changes in eye prescription, dizziness, and impaired coordination can occur.

Aggravating factors:  Changes in weather, cold or drafty environments, hormonal fluctuations (premenstrual and menopausal states), stress, depression, anxiety and over-exertion can all contribute to symptom flare-ups.

Possible Causes
The cause of fibromyalgia and chronic fatigue syndrome remains elusive, but there are many triggering events thought to precipitate its onset. A few examples would be an infection (viral or bacterial), an automobile accident or the development of another disorder, such as rheumatoid arthritis, lupus, or hypothyroidism. These triggering events probably don't cause FMS, but rather, they may awaken an underlying physiological abnormality that's already present in the form of genetic predisposition. They may also spark off a period of muscle inactivity resulting in severe muscle weakness.

Common Treatments
Traditional treatments are geared toward improving the quality of sleep, as well as reducing pain. Medicines that boost your body's level of serotonin and norepinephrine - neurotransmitters that modulate sleep, pain and immune system function - are commonly prescribed. Examples of drugs in this category would include Citalopram, fluoxetine and paroxetine. In addition, nonsteroidal, anti-inflammatory drugs (NSAIDs) like ibuprofen may also be beneficial. Most patients will probably use other treatment methods as well, such as , physiotherapy, acupuncture, relaxation techniques, osteopathic manipulation, chiropractic care, therapeutic massage, or a gentle exercise programme.

What is the Prognosis?
Long term follow-up studies on fibromyalgia syndrome have shown that it is chronic, but the symptoms may wax and wane. However as many as 40%of people may significantly improve but few are thought to completely recover from this syndrome.

Self-help Strategies
Lifestyle modifications may help you conserve your energy and minimize your pain. Learn what factors aggravate your symptoms and avoid them if possible. Join your local support group and become informed about your condition by subscribing to Fibromyalgia Network newsletter . Contact Royal Leamington Spa Rehabilitation Hospital for information about local groups.

Try the internet - a useful site from which some of this information was taken is http://www.fmnetnews.com/pages/basics.html

Fibromyalgia and postviral syndromes graduated exercise programme (01/05 RMD)

Patients with Post viral syndrome fibromyalgia have significant weakness of the muscles responsible for maintaining body tone as well as weakness of leg and arm muscles. Weak muscles can hurt when they are used above a certain amount and this is the source of much of the back, neck, shoulder, arm and leg pain. This pain is due to the same mechanism that causes pain in fit people who "work out" too much and so it is evidence of muscle strengthening NOT of something seriously wrong.

Many patients have ups and downs in their pain levels and tend to do too much on a good day and then suffer for it the next few days when they do too little. Muscles get stronger on the good days but weaker on the bad rest days and so the patient's weakness and pain persist or even worsen.

The way around this is to use graduated exercise regimes. Walking is great exercise for the legs arms back and neck. Most people can do it; it is free; gentle; improves the spirit; and can be measured.

Graduated exercise programmes use walking as the main exercise and walking distance as the measure.

The aim is first to establish how far you can walk on an average symptom day without getting an increase in pain.  Then it is important that this amount of walking is done every day whether you feel like it or not. It should not in general be exceeded and must never be missed out. Muscles can loose the strength in one day what they gain in two.

This regime should be continued for a month after which the walking distance is increased by a quarter and the walking exercise continued for a further month. On stepping up the walking distance some aching may be experienced for 2 to 3 days and will often respond well to ibuprofen. On no account must the walking exercise be missed on any day. The distance is increased each month according to the advice of your GP and so stamina and ability is gradually ratcheted up towards normal levels. This can take from 12 to 18 months.

This graduated regime is best assessed by your GP to encourage and offer advice in areas of difficulty. An initial appointment is needed to work out the baseline walking distance and then monthly review to discuss progress and problems as long as needed and is useful. It helps to keep a diary of activity and symptom scores so that progress can be measured and referred back to in times of difficulty.

Most people respond well to slow graduated walking regimes and over a period of a 12-18 months are able to live a much more normal and useful life. Some people recover well enough to be considered cured, others enough to hold down a job but with some limitations due to fatigue. All have improved stamina and pain reduction and some are able to abolish pain completely.

Graduated exercise regimes offer real hope to those with fibromyalgia.

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