FMS
FIBROMYALGIA SYNDROME

Fibromyalgia syndrome (FMS) is characterized by generalized pain, fatigue and tenderness at various points on the body. The cause of FMS is poorly understood, which makes the condition difficult to treat. However, recent research is leading to some potentially effective new treatments.

The mainstay of treatment for FMS is light aerobic exercise. This seems to reduce pain and fatigue, perhaps by increasing the brain's production of pain-relieving neurochemicals. Some patients do best with a treadmill or light jogging program; others benefit most from aquatic exercise in a warm therapy pool. Intensive exercise such as weightlifting, high-impact aerobics or heavy isometrics is not recommended for FMS and often makes the pain worse.

Many FMS patients have underlying postural problems that contribute to their pain. A physical therapy program that's aimed at stretching the tight muscles and improving posture is often very useful.

A number of medications have been used for FMS with varying benefit. Certain antidepressants may help restore sleep, reduce depressive symptoms and ease pain. Examples are tricyclic drugs (amitriptyline, nortriptyline and related agents), a class of drugs known as selective serotonin reuptake inhibitors, or SSRIs (paroxetine, sertraline and others), and newer agents such as venlafaxine. Nonsteroidal drugs such as ibuprofen are often used, but they usually just "take the edge off" the pain. The use of morphine and other narcotics for FMS is highly controversial.

Newer treatments have evolved as we have come to understand more about FMS. Some patients have difficulty maintaining adequate blood pressure when standing or changing positions. That condition, called neurally mediated hypotension, is diagnosed using a tilt-table test to evaluate blood pressure control. FMS patients with positive test results may benefit from increased fluid and salt intake, the use of elastic supportive garments such as stockings and abdominal binders, and drugs that boost blood pressure.

A small subgroup of FMS patients has structural problems in the head or neck that compress the brainstem or spinal cord. Such problems can be detected during a careful physical examination and confirmed with magnetic resonance imaging (MRI), if necessary.

Many FMS patients suffer from severe anxiety or depression related to their chronic pain. For those individuals, psychological counseling, often coupled with behavioral techniques such as relaxation training and biofeedback, can be very helpful.

Although no perfect treatment for FMS exists, many options are available. Talk to your physician to see what tests and treatments are right for you. Physicians who routinely manage FMS include rheumatologists (arthritis specialists) and physiatrists (rehabilitation specialists).