Fibromyalgia and Chronic Myofascial Pain: A Survival Manual, ed 2.

Starlanyl D, Copeland ME. Oakland, CA 94609, New Harbinger Publications Inc, 2001, paperback, 410 pp, illus, ISBN: 1-57224-238-8, $19.95.

In the introduction to this large, comprehensive manual, the primary author, Devin Starlanyl, indicates that the book is written primarily for people who have fibromyalgia syndrome (FMS) or chronic myofascial pain (CMP), and she welcomes them to her "family." She indicates that this second edition is more comprehensive than the first, and that the primary objective of this edition is to help the reader or patient achieve a point of self-sustaining function.

The book is divided into 28 chapters. There are the comprehensive resource section, a wide reading list (with an additional reading list for health care providers), and an extremely detailed index that concludes the volume. The chapters are well referenced, and the author explains how to use the reference system. Throughout the book, the author uses a series of boxed comments that link a real-life experience to the information being discussed in the chapter. Chapter 3, "One Little, Two Little, Three Little Trigger Points," and chapter 8, "Signs and Symptoms," contain good, easy-to-understand diagrams that show the location of trigger points.

Each chapter is well organized and titled appropriately, starting with chapter 1 on fibromyalgia and chapter 2 on myofascial pain. It is interesting to note that one of the authors' stated goals for this edition was to make it more reader-friendly. The majority of the book is written in a style more suited to the layperson; for example, her description of fascia in chapter 2 is appropriately basic. However, the inclusion of words such as "peripheral," "neurotransmitters," "interleukins," and "cytokines" without a definition makes these first 2 chapters difficult for a patient to read and may make people wary of continuing to read the book.

Trigger points, perpetuating factors, and support systems are the primary emphasis throughout the book. All of these subjects are covered in their own chapters but are also referred to regularly in subsequent areas. Further chapters have appropriate titles, which allow readers to select the areas they wish to explore. For example, chapter 22, "Complementary Medicine," covers numerous options currently available. These options include familiar interventions such as acupuncture and homeopathy as well as some lesser known interventions such as Native American healing traditions and Ayurveda, a practice originating in ancient India. All of these interventions are discussed neutrally, and the authors are careful to indicate that insurance programs may not cover these interventions. Chapter 27, "Ability and Disability," is a comprehensive review of benefits that may be available if the reader chooses to pursue them. These benefits include Social Security services (eg, disability programs and emergency and short-term assistance programs) and vocational rehabilitation services. This chapter also includes a copy of the Fibromyalgia and Myofascial Pain Functional Questionaire, which was created to reveal specific disabilities common to FMS and CMP, and which often helps improve the chances of successful benefit applications.

Throughout the book, the author offers excellent suggestions to make life easier for readers, including adapting the environment and choosing an exercise program that most suits their symptoms. The author also warns patients to avoid overwhelming their caregivers and advises them take as much personal responsibility as their symptoms allow. Chapter 16, on a wellness recovery action plan (WRAP), gives some sound advice, including eliminating perpetuating factors, learning early warning signs, and having a personal crisis plan prepared. This chapter occassionally is too heavily detailed; for example, the list of things needed to create the plan includes the need for a writing instrument, and the advice includes avoiding people who treat you badly.

This, however, is not an objectively written book. It is obviously written by someone who has experienced not only the pain and discomfort of FMS and CMP but also the frustrations of poor diagnosis, management, and advice. As such, it is often heavily biased toward the patient and against the entire medical profession. Throughout the text, there are many scathing remarks against the health care professions: "Most physicians today still lack the skills to diagnose and treat it [FMS] effectively." (p5) "Their [the medical team's] lack of training doesn't mean that your pain isn't real." (p24) "Schools that teach physical therapy need to understand that they must teach their students about myofascial trigger points for their care to be effective." (p315)

In addition, the book raises many issues, including postnatal depression, inability to sleep, and irregular or painful menstrual cycles, that are not unique to people who have FMS and CMP, even though the implication is that these issues are unique to these patients. The list of possible coexisting conditions that may "be a perpetuating factor" is frightening in its immensity. The list includes Gulf War syndrome, human immunodeficiency virus, attention deficit disorder, multiple sclerosis, postpolio syndrome, and posttraumatic stress disorder. Although the advice that patients must improve any other existing conditions in order to alleviate their FMS or CMP symptoms is well intended, the implication that patients may have these other conditions could be extremely disconcerting to them.

In an attempt to cover all aspects of the conditions, the book is sometimes full of heavy scientific information. For example, the writing style used in chapter 23, "Nutrition: You Are What Your Eat--Don't Be a Twinkle," is easy enough for a non-medical person to read, but is not scientific enough for the health care professional. At times, the authors seem confused about who their audience is.

As a physical therapist, I find it extremely difficult to recommend this book. If a clinician wants to recommend it to a patient, he or she should be willing to have the patient return with serious doubts about his or her clinical skills. The criticism by the author would make any reader very unsure of the competence of the medical profession. If this note of caution is observed, however, the book does have some excellent suggestions and support services for people with FMS and CMP.

It is also very difficult to recommend the book to clinicians. It is insufficiently detailed for clinical application, because the book is specifically written for patients. I would recommend this book for students or new clinicians interested in FMS or CMP who want insight into the personality of this patient group. This book clearly demonstrates not only their personal frustrations and problems, but also the person inside the condition, which is an essential component of understanding FMS and CMP.

Christine Childers, PT Salt Lake City, Utah 

Ms Childers is Rehabilitation Director for Mountain Land Rehabilitation.