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Fibromyalgia; Diagnosis.

Fibromyalgia syndrome (FS), a chronic disorder characterized by widespread musculoskeletal pain, fatigue, multiple tender points and poor sleep, is difficult to diagnose because many of the symptoms are shared by other diseases. A health care professional will review your medical history and make a diagnosis of fibromyalgia based on a history of chronic widespread pain that persists for more than three months. The American College of Rheumatology (ACR) has developed criteria for diagnosing fibromyalgia: A person is considered to have fibromyalgia if he or she has widespread pain above and below the waist, on both sides of the body for at least three months, in combination with tenderness in at least 11 of 18 specific tender point sites. In practice, a person may have fibromyalgia even if she has fewer than 11 tender points as long as the pain is chronic and widespread.

Although the diagnosis of fibromyalgia has been controversial, the condition is now recognized as a legitimate clinical entity. But despite greater acceptance of the disorder by the medical community in recent years, fibromyalgia continues to be under-diagnosed or misdiagnosed.

Diagnosis of FS is difficult in part because symptoms are variable and tend to come and go and because standard laboratory tests and x-rays are not able to detect the syndrome. Lab tests may be ordered, however, to determine whether you have another condition with similar symptoms, such as rheumatoid arthritis, lupus, or hypothyroidism.

For an accurate diagnosis of fibromyalgia, look for a health care professional with experience identifying the syndrome. Many other illnesses share some of the same symptoms, including lupus, low thyroid, myositis and chronic fatigue syndrome. Rheumatologists or physiatrists are often experienced in diagnosing fibromyalgia. A rheumatologist is a doctor who specializes in disorders that affect the joints, muscles, tendons, ligaments and bones. A physiatrist is a physical medicine specialist who specializes in diagnosing and treating injuries and diseases causing pain, loss of function and disability.

In addition to the pain, sleeping difficulty and fatigue experienced by most fibromyalgia victims, FS patients also have extreme hypersensitivity, including:

* hypersensitivity to cold, especially in the hands and feet, often accompanied by color changes; this condition is known as Raynaud's phenomenon

* hypersensitivity to distension of the bladder with even a tiny amount of urine, leading to irritable bladder

* hypersensitivity to the menstrual cycle, when hormonal changes in pain perception occur

* hypersensitivity to sound, touch, light and odor

* hypersensitivity to vulvular stimulation, called vulvar vestibulitis or vulvodynia, characterized by a painful vulvar region and painful sexual intercourse

Other symptoms include:

* stiffness, particularly in the early morning, after prolonged sitting or standing, or with changes in temperature or relative humidity

* increased headaches or facial pain, including frequent migraine, tension or vascular headaches, or pain behind the eyes

* light-headedness and/or balance problems

* abdominal discomfort, often referred to as irritable bowel syndrome, which can include abdominal pain, bloating, constipation and/or diarrhea (some of this discomfort may be due to bacterial overgrowth)

* paresthesia (numbness or tingling), often in the hands or feet. Sometimes called "neuropathy," a condition described as a prickling or burning sensation, although in FS, unlike diabetes, there is no evidence of nerve damage.

* skin problems, including blotchy or itchy skin; also, a sensation of swelling, particularly in the extremities--such as a ring suddenly not fitting--is a common symptom

Other symptoms include cognitive disorders, most often short-term memory lapses and difficulty concentrating, as well as anxiety and depression related to the chronic pain and fatigue of fibromyalgia.

Of course, many of these symptoms can apply to a variety of diseases. To resolve the ambiguities, the American College of Rheumatology (ACR) in 1990 developed two specific criteria for diagnosing FS:

* chronic, widespread, musculoskeletal pain of longer than three months duration in all four quadrants of the body

* multiple tender points throughout the body--18 have been identified by the ACR and a patient must have 11 of the 18 for a diagnosis of fibromyalgia to be considered. A tender point is found by palpation--applying approximately nine pounds of pressure to the area with the fingers; an area that hurts when the health care professional palpates it is a tender point. An illustration that shows the various tender point sites on the human body can be viewed on the National Fibromyalgia Partnership, Inc. Web site, located at http://www.fmpartnership.org/FMPartnership.htm.

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Editorial Staff of the National Women's Health Resource Center 2002/07/31 2005/06/08 Fibromyalgia syndrome (FS) is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, multiple tender points and poor sleep. "Tender points" refers to tenderness that occurs in precise, localized areas, particularly in the neck, spine, shoulders and hips. Chronic pain,Corticosteroids,Fibromyalgia,Nonsteroidal anti-inflammatory drugs,NSAIDs,Parenthesia,Raynaud's phenomenon,Tender points
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Publication:NWHRC Health Center - Fibromyalgia
Geographic Code:1USA
Date:Jun 8, 2005
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