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.
Click here: Second Opinion Arthritis Treatment Kit
Fibromyalgia can occur either as a primary condition or it may be secondary to another problem such as rheumatoid arthritis.
One needs to be aware of this clinical problem when treating patients with rheumatoid arthritis. It is frequently a complicating condition. Many times, patients will confuse the pain from it with a flare-up of their arthritis. One needs to aggressively treat the fibromyalgia flare. If this problem is ignored, the likelihood of successfully treating the arthritis is significantly diminished.
Fibromyalgia is a very common problem. Some experts believe that 5% of people are affected with it. Over 12% of the patients at the Mayo Clinic's Department of Physical Medicine and Rehabilitation have this problem. It is the third most common diagnosis by rheumatologists in the outpatient setting. Fibromyalgia affects women five times as frequently as men.
One of the main features of fibromyalgia is the morning stiffness, fatigue, and multiple areas of tenderness in typical locations. Most patients with fibromyalgia complain of pain over many areas of the body, with an average of six to nine locations. Although the pain is frequently described as being all over, it is most prominent in the neck, shoulders, elbows, hips, knees, and back.
Tender points are generally symmetrical and on both sides of the body. The areas of tenderness are usually small (less than an inch in diameter) and deep within the muscle. They are often located in sites that are slightly tender in normal people.
Patients with fibromyalgia, however, differ in having increased tenderness at these sites than normal persons. Firm palpation with the thumb (just past the point where the nail turns white) over the outside elbow will typically cause a vague sensation of discomfort. Patients with fibromyalgia will experience much more pain and will often withdraw the arm involuntarily.
More than 70% of patients describe their pain as profound aching and stiffness of the muscles. Often it is relatively constant from moment to moment, but certain positions or movements may momentarily worsen the pain.
Sharp or intermittent pain is relatively uncommon. Patients with fibromyalgia often complain that sudden loud noises or bright lights worsen their pain. The generalized stiffness of fibromyalgia does not diminish with activity, unlike the stiffness of rheumatoid arthritis, which usually lessens as the day progresses.
Despite the lack of abnormal lab tests, patients can suffer considerable discomfort. The fatigue is often severe enough to adversely affect activities of work and recreation. Patients commonly experience fatigue on arising and complain of being more fatigued when they wake up then when they went to bed.This is referred to as non restorative sleep. Patients will say that when they wake up in the morning they feel like they've "been hit by a truck" or they feel "beaten up."
More than 90% of patients believe the pain, stiffness, and fatigue are made worse by cold, damp weather. Overexertion, anxiety and stress are also factors. Many people find that localized heat, such as hot baths, showers, or heating pads, give them some relief. There is also a tendency for pain to improve in the summer with mild activity or with rest.
Some patients will date the onset of their symptoms to some initiating event. This is often an injury, such as a fall, a motor vehicle accident, or a vocational or sports injury. Others find that their symptoms began with a stressful or emotional event, such as a death in the family, a divorce, a job loss, or similar occurrence.
Memory is often affected as well.
Other systemic symptoms can occur and be very confusing for both the patient as well as the clinician. For example fibromyalgia patients will complain of feeling cold all over. They may have headaches, subjective joint swelling, visual disturbances, ringing in the ears, shortness of breath, fleeting chest pains, alternating diarrhea and constipation, abdominal pain, urinary tract symptoms, and so on.
Patients with fibromyalgia have pain in at least 11 of the following 18 tender point sites (one on each side of the body):
1. Base of the skull where the occipital muscles inserts.
2. Back of the low neck
3. Midpoint of the upper shoulders (trapezius).
4. On the back in the middle of the scapula.
5. On the chest where the second rib attaches to the breastbone (sternum).
6. One inch below the outside of each elbow (lateral epicondyle).
7. Upper outer quadrant of buttocks.
8. Just behind the swelling on the upper leg bone below the hip (trochanteric prominence).
9. The inside of both knees (medial fat pads proximal to the joint line).
Get more information about symptoms fibromyalgia and related topics as well as...
• Insider arthritis tips that help you erase the pain and fatigue of rheumatoid arthritis almost overnight!
• Devastating ammunition against low back pain... discover 9 secrets!
• Ignored remedies that eliminate fibromyalgia symptoms quickly!
• Obsolete treatments for knee osteoarthritis that still are used... and may still work for you!
• The stiff penalties you face if you ignore this type of hip pain...
• 7 easy-to-implement neck pain remedies that work like a charm!
• And much more...
Second Opinion Arthritis Treatment Kit
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