Symptoms of fibromyalgia
The presenting symptoms and complaints of fibromyalgia
are common and non-specific. Still the constellation
of features can often suggest a diagnosis.
Main features of fibromyalgia
The four cardinal features of fibromyalgia include:
- Pain
The "pain" is typically widespread or
generalized and often axial (such as low back pain).
It is interpreted to be deep and muscular in origin
and the patient may also report subjective weakness.
Approximately 25% of patients report "poor circulation"
or numbness and tingling which is not in a radicular
pattern and typically involves arms and hands. However,
a physical examination reveals normal muscle strength
and sensory testing, with no inflammatory or arthritic
features.
- Stiffness
Stiffness is also a reported and is generally
widespread and diffuse. As in other rheumatic diseases,
the stiffness is typically worse in the morning, may
improve as the day progresses, but is exacerbated
the day after physical exertion or exercise. Unlike
some rheumatic diseases, however, the pain seldom
limits one's ability to get out of bed (3).
- Fatigue
Fatigue is often the problem that the patient
first describes to the physician. It may be interpreted
as a lack of physical endurance or a dearth of psychic
energy or initiation (4). The patient may experience
short periods of energy (such as for 24 to 48 hours),
only to rebound into feeling fatigued and tired again.
While this symptom is common, it is not universal.
- Non-restorative sleep
Fibromyalgia patients typically wake up in the
morning feeling tired. While this symptom is rarely
offered as a complaint by the patient, it is often
readily acknowledged upon questioning (e.g. "Do
you feel refreshed upon awakening?"). Again,
while this symptom is common, it is not universal.
Modulating factors of fibromyalgia
All of these symptoms are further highlighted by
typical modulating factors. Fibromyalgia patients generally
note exacerbation with some or all of the following
factors:
- Cold, damp weather
- Stress
- Overexertion
The reverse is also true – patients feel better
with warm weather, hot baths, or even vacations from
home or work. Almost all patients have tried a variety
of non-steroidal
anti-inflammatory medications (NSAID’s), but
without benefit.
In a study of 50 matched controls, certain associated
conditions were found to be unusually common for fibromyalgia
patients. This study showed that a relatively high percent
of fibromyalgia patients also had:
- Anxiety disorders – 70%
- Irritable bowel syndrome (IBS) – 34%
- Migraine headaches – 22%
Additionally, Raynaud’s syndrome, dysmenorrhea
and irritable bladder were common findings (16).
By: Thomas
K. Van Sistine, MD
January 20, 2000
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