Fibromyalgia: Managing the Pain.

This is a unique, patient-centered, easy-to-understand book written by a physiatrist who treats individuals with fibromyalgia, and has this condition himself. The author states this book grew out of a detailed handout that he gave to patients newly diagnosed with fibromyalgia. He also states that he has the unique opportunity of bridging both personal and professional interests in this condition. Fibromyalgia is described as a common, condition of the soft tissues, mainly muscles, that causes widespread pain, stiffness, fatigue, and poor sleeping patterns. Pellegrino states that fibromyalgia shows no objective evidence of disease and that there is no basis for the individual's chronic pain associated with this poorly understood condition.

A positive strategy of taking control and a self-help approach are advocated. Thirty short chapters, ranging from one to four pages each, contain good use of white space and blocks of text to highlight the most important information. Chapters focus on the condition of fibromyalgia, including causes (currently unknown), symptoms, diagnosis, treatment, adjusting lifestyle, and prognosis (also unknown). The author also reviews the role of various professions, such as physical therapy, occupational therapy, and psychology, in the treatment of this condition.

Unfortunately, the chapter on physical therapy is disappointing. It sates that heat, cold, massage, electrical stimulation, whirlpool, soft tissue mobilization, stretching, and aerobic exercises may be helpful. The author does not say why these modalities may be helpful or when they may be appropriate. To his credit, the author does state that various forms of physical therapy are not to be continued indefinitely just because the person feels good at the time of therapy.

The advantages of this indexed book are that it is written for people with fibromyalgia by an author who has this condition himself. As a result, he is able to relate to various symptoms and effective treatments for fibromyalgia. As an example, he describes minimizing psychosocial factors to avoid flare-ups and complications.

The disadvantages of this book are that it contains no scientific information to support the author's views, tells us little that is new, and often contains information that is of little use. The author offers a reference list only upon request. Pellegrino states that sleep studies, electron microscopy, and muscle oxygenation studies have been shown to be abnormal in patients with fibromyalgia, but does not give evidence for this, nor does he explain how these studies are abnormal. Some of the terminology is misleading, such as describing a fetal postion as one with the spine in a neutral position, or stating that if pain symptoms last longer than 4 months after an injury, they are likely to be permanent. Further misleading statements include stating that too much or too little activity can aggravate symptoms, and describing situations that could be caused by normal muscle fatigue or vascular insufficiency as being attributed to fibromyalgia. The author gives only three references for newsletters or organizations concerning fibromyalgia.

This book may be helpful for those individuals newly diagnosed with fibromyalgia. The book is accessible enough for a physical therapist to lend to those patients wanting more information concerning this condition. A reference list of relevant scientific literature and a more complete list of organizations should also be given to these individuals.

Ron Seymour, PhD, PT Health Science Center at Syracuse Syracuse, NY