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Fibromyalgia: a painful diagnosis

MagazineAugust 2007 (Vol. 18 Issue 5)Fibromyalgia: a painful diagnosis

According to the textbooks, fibromyalgia (FM) is the name given to a collection of chronic symptoms of widespread pain for which no clear physiological cause can be found

According to the textbooks, fibromyalgia (FM) is the name given to a collection of chronic symptoms of widespread pain for which no clear physiological cause can be found. A term first introduced in 1981, it literally means pain ('algia') in the muscles ('my') and connective tissues ('fibro'). For years, the lack of an obvious cause condemned fibromyalgia patients to be often dismissed out of hand as hypochondriacs. In addition, it hasn't helped male doctors' understanding of the condi-tion that over 90 per cent of FM sufferers are women.

In 1990, however, the American College of Rheuma-tology finally acknowledged FM as a genuine condition
with a specific constellation of symptoms: widespread musculoskeletal pain persisting for at least three months, with no evidence of inflammation or muscle abnormality.

A key feature is a multiplicity of tender points at specific sites of the body (Arthritis Rheum, 1990; 33: 160-72).
Since then, the symptom of fatigue has been added to the list as there's a huge overlap with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Clinicians now say that it's only by counting the number of tender points that doctors can distinguish the two conditions-although one US expert, Dr Kerry Bone, has found that
FM patients suffer far more sleep disturbance than people who have CFS/ME. There's also an overlap with multiple chemical sensitivity (MCS). This allergic-type reaction to environmental chemicals shares many of the same symptoms as FM and CFS/ME.

Whatever the label, it's clear that those who suffer from any of these conditions are still being given the run-around by conventional medical practitioners.

But it's not just that medicine fails in these cases - FM patients can actually be harmed by conventional doctors handing out conventional treatments. A recent survey by Dr Peter Dawes, of the UK's North Staffordshire Royal Infirmary, revealed that many FM patients end up having to endure multiple operations: arthroscopy, endoscopy, unnecessary appendectomy, bladder suspensions for urinary retention, laparotomy for seeking causes of pain, and spinal surgery for back pain. "One of the problems is that a lot of specialists work within their own environment," says Dawes. They ought to be able to recognize the features of a more generalized pain disorder-but they often don't (Rheumatology, 2004; 43 [suppl 2]: ii72).
Although a number of alternatives are on offer, they're rather a mixed bag.

Traditional Chinese medicine

Acupuncture has a long proven history of offering pain relief, and the pain of fibromyalgia turns out to be no exception. In the US, doctors at the highly conservative Mayo Clinic in Rochester, Minnesota, recently ran a placebo-controlled trial involving 50 FM patients, half of whom received genuine acupuncture, while the rest were given fake acupuncture (needles were inserted in the wrong places).

The patients' progress was tracked for up to seven months after treatment, and revealed clear differences between the
two groups of patients. Those who had been treated with the real acupuncture "significantly improved symptoms of fibro-myalgia", said the researchers, with the treatment reducing not only pain, but also fatigue and anxiety (Mayo Clin Proc, 2006; 81: 749-57).

As this wasn't the only trial to show the benefits of acu-puncture, this may well be the treatment of choice for FM.

Homeopathy

Homeopathy is not known for the robustness of its evidence-based research, but doctors at the University of Arizona struck gold with fibromyalgia. They recently concluded a full-blown double-blind trial in which half of the participating FM patients were given an individually tailored homeopathic remedy and the rest, a placebo.

When tested three months later, the treated patients were significantly better than those taking the placebo: they had less pain and tenderness, less depression, and better health and quality of life in general (Rheumatology [Oxford], 2004; 43: 577-82).

Supplements

FM patients have been found to have abnormal levels of magnesium, and there is evidence that taking a supplement of 300 mg/day of magnesium can improve some of the symptoms of fibromyalgia (J Rheumatol, 1995; 22: 953-8).
A daily dose of Ginkgo biloba (200 mg) and coenzyme Q10 (200 mg) in combination may also help (J Int Med Res, 2002; 30: 195-9).

Mind-body therapies

Intense physical exercise has been found to be helpful (Curr Opin Rheumatol, 2007; 19: 111-7), as have more mind-related treatments. Cognitive behavioural therapy and mindfulness meditation, for example, have both shown promise, too (Altern Ther Health Med, 1998; 4: 67-70).

What doesn't work

  • Static magnetic-field therapy. In a recent placebo-controlled trial comparing the effects of genuine magnets with fake ones, there were no differences in skin tenderness or quality of life, and only a marginally significant decrease in pain (J Altern Complement Med, 2001; 7: 53-64).
  • Chlorella pyrenoidosa. This fresh-water species of green algae is rich in proteins, vitamins and minerals, but has had disappointing results in clinical trials of FM (Altern Ther Health Med, 2001; 7: 79-91).
  • Osteopathy. So far, the data from clinical trials using this treatment for FM have been unconvincing (Curr Pharm Des, 2006; 12: 47-57).

Tony Edwards

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