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Info FM Pain Fatigue & accompanying disorders

Fibromyalgia Informationtaken from the website

Clinical Features


The core symptom of the FM syndrome is chronic widespread pain (3) . The pain is usually perceived as arising from muscle, however many fibromyalgia patients also report joint pain (4) . Stiffness, worse in the early morning, along with the perception of articular pain this may reinforce the impression of an arthritic condition. Fibromyalgia pain and stiffness typically have a diurnal variation, with a nadir during the hours of about 11.00 am to 3.00 pm (5) . Symptoms also wax and wane in intensity over days and weeks; with flares occurring with increased exertion, systemic infections, soft tissue injuries, lack of sleep, cold exposure, and psychological stressors.


Easy fatigability from physical exertion, mental exertion and psychological stressors are typical of fibromyalgia. The etiology of fatigue in fibromyalgia is multifaceted and is thought to include non-restorative sleep, deconditioning, depression, poor coping mechanisms and secondary endocrine dysfunction involving the hypothalamic pituitary adrenal axis and growth hormone deficiency (6,7,8,7) . Patients with the chronic fatigue syndrome (CFS) have many similarities with FM patients (9) . Characteristically, patients with CFS have an acute onset of symptoms after an infectious type illness, with subsequent persistence of debilitating fatigue and post-exertional malaise. About 75% of patients meeting the diagnostic criteria of CFS also meet the criteria for diagnosis of FM (10) .

Disordered sleep

Fibromyalgia patients invariably report disturbed sleep (11) . Even if they report 8 to 10 hours of continuous sleep they wake up feeling tired. Most relate to being light sleepers, being easily aroused by low-level noises or intrusive thoughts. Many exhibit an alpha-delta EEG pattern (12) but this is not an invariable in fibromyalgia and nor is it specific (13,14,15) . The experimental induction of alpha-delta sleep in healthy individuals has been reported to induce musculoskeletal aching and/or stiffness as well as increased muscle tenderness (16) .

Associated disorders

It is not unusual for fibromyalgia patients to have an array of somatic complaints other than musculoskeletal pain (17,18) . It is now thought that these symptoms are in part a result of the abnormal sensory processing – as described elsewhere.

Restless leg syndrome: This refers to daytime (usually maximal in the evening) symptoms of (1) unusual sensations in the lower limbs (but can occur in arms or even scalp) that are often described as paresthesia (numbness, tingling, itching, muscle crawling) and (2) a restlessness, in that stretching or walking eases the sensory symptoms. This symptomatology is nearly always accompanied by a sleep disorder - now referred to as periodic limb movement disorder (formerly nocturnal myoclonus) (19) . Restless leg syndrome has been reported in 31% of fibromyalgia patients compared to 2% of controls (20) .

Irritable bowel syndrome:This common syndrome of GI distress that occurs in about 20% of the general population is found in about 60% of fibromyalgia patients (21,22) . The symptoms are those of abdominal pain, distension with an altered bowel habit (constipation, diarrhea or an alternating disturbance). Typically the abdominal discomfort is improved by bowel evacuation.

Irritable bladder syndrome: This is found in 40-60% of fibromyalgia patients (23) . The initial incorrect diagnoses are usually recurrent urinary tract infections, interstitial cystitis or a gynecological condition. Once these possibilities have been ruled out a diagnosis of irritable bladder syndrome (also called female urethal syndrome) should be considered. The typical symptoms are those of suprapubic discomfort with an urgency to void, often accompanied by frequency and dysuria.

Cognitive dysfunction: This is a common problem for many fibromyalgia patients (24) . It adversely affects the ability to be competitively employed and may cause concern as to an early presentation of a neurodegenerative disease. The cause of cognitive dysfunction is in part related to the distracting effects of chronic pain, mental fatigue and psychological distress (25) .

Cold intolerance:About 30% of fibromyalgia patients complain of cold intolerance (3,11) . Some patients develop a true primary Raynaud’s phenomenon, which may lead to misdiagnoses such as SLE or scleroderma (26) .

Multiple sensitivities: One result of disordered sensory processing is that many sensations are amplified in fibromyalgia patients. Thus patients with fibromyalgia are more likely to receive other diagnoses such as multiple chemical sensitivity (MCS), sick building syndrome and drug intolerance. One report cites a prevalence of 52% of MCS in fibromyalgia (27) . Buchwald found a large overlap between fibromyalgia, chronic fatigue syndrome and MCS (28) .

Dizziness:This is a common complaint of fibromyalgia patients (3) . In many cases no obvious cause is found, despite sophisticated testing. Treatable causes related to fibromyalgia include: proprioceptive dysfunction secondary to muscle deconditioning, proprioceptive dysfunction secondary to myofascial trigger points in the sterno-cleido-mastoids and other neck muscles, neurally mediated hypotension and medication side effects.

Neurally mediated hypotension (NLM):This syndrome is a lesser variant of “neurocardiogenic syncope”. Its prevalence in one report was 60% (29) . NLM results from a paradoxical reflex when venous pooling reduces filling of the heart (right ventricle). In predisposed patients, this causes an inappropriately high secretion of catecholamines. This in turn leads to a vigorous contraction of the volume depleted ventricle – leading to an over-stimulation of ventricular mechanoreceptors which signal the midbrain to reduce sympathetic tone and increase vagal tone, with resulting syncope or presyncope. In fibromyalgia patients this may be manifest by severe fatigue after exercise, on prolonged standing or in response to stressful situations
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