fibromyalgia neck and shoulder pain

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Fibromyalgia is a syndrome (group of symptoms) that is characterized mostly by pain.

The pain may occur as both pain experienced in certain precise locations called tender points and more widespread, generalized pain. The pain of fibromyalgia is described as:

• Tender point pain occurs in local sites (trigger points), usually in the neck and shoulders, and then radiates out. It occurs specifically in areas where the muscles attach to bone or ligaments. (The joints themselves are not affected, however, so they are not deformed nor do they deteriorate as they may in arthritic conditions.) There are no lumps or nodes associated with these points and no signs of inflammation (swelling, redness, heat).
• The experience of widespread pain is similar to that of arthritis and has been described as stiffness, burning, radiating, and aching. Most patients report feeling some pain all the time, and many describe it as "exhausting." The pain can vary, depending on the time of day, weather changes, physical activity, and the presence of stressful situations. The pain is often more intense after disturbed sleep.

The location of the pain often is in the neck and shoulder area. Many patients with fibromyalgia also will have cervical spondylosis which further aggravates the symptoms of fibromyalgia.

Another major complaint is fatigue, which some patients report as being more debilitating than the pain. Sleep disturbances, particularly restless legs syndrome, are also very common.

Other symptoms that occur more often than average in fibromyalgia patients are the following:

• Up to a third of patients experience depression, and disturbances in mood and concentration are very common.
• Dizziness.
• Tension or migraine headaches.
• Tingling or numbness in the hands and feet.
• Gastrointestinal problems, including irritable bowel syndrome with gas and alternating diarrhea and constipation.
• Urinary frequency caused by bladder spasms.
• Painful menstrual periods in women.

Criteria for Classifying Fibromyalgia (American College of Rheumatology)

Criteria for fibromyalgia have been established to enable researchers to study patients with similar symptoms and to help diagnose individuals.

A. There are at least 11 of 18 specific areas called tender points on the body. The pain experienced when pressing on a tender point is very localized and intensely painful (not just tender). Tender points are found in the following areas:

• The left or right side of the back of the neck, directly below the hairline.
• The left or right side of the front of the neck, above the collar bone (clavicle).
• The left or right side of the chest, right below the collar bone.
• The left or right side of the upper back, near where the neck and shoulder join.
• The left or right side of the spine in the upper back between the shoulder blades (scapula).
• The inside of either arm, where it bends at the elbow.
• The left or right side of the lower back, right below the waist.
• Either side of the buttocks right under the hip bones.
• Either knee cap.
(Some people also experience tender points at the bottom of their feet.)

B. Widespread pain, which is experienced in upper and lower and left and right parts of the body and in the spine, must persist for at least three months. This pain must appear in all of the following locations:

• Pain on both sides of the body.
• Pain above and below the waist.
• Pain along the length of the spine.

The criteria were not intended for use in diagnosing specific individuals, since they are not completely reliable and miss about 10% of patients. Some experts believe that fibromyalgia is likely to be present if only eight to 10 tender points are identified but the patient also has at least three other relevant symptoms, including:

• morning stiffness,
• fatigue,
• sleep disturbance,
• numbness or tingling in the hands and feet, and • headache.

Concomitant osteoarthritis of the neck may be a confounding factor in separating the cause of neck and shoulder pain.

Two modalities that seem to help are ultra high frequency (more than 20,000 megahertz) and cold laser.

Fibromyalgia neck and shoulder pain