Fibromyalgia has been diagnosed as a widespread muscular pain, with pain re-produced, when pressing distinctive tender points, lasting at least 3 months and with an associated sleep disorder.
However, it has been broadened to become a syndrome, FMS, and includes a wide variety of symptoms including fatigue, stiffness, Irritable Bowel Syndrome, headaches, cold sensitivity, unusual patterns of altered sensation, inability to tolerate exercise, anxiety, depression, painful periods and irritable bladder. There is often a daily and/ or seasonal variation, worsened by cold damp weather and by stress.
Studies have found no obvious changes in the muscles such as inflammation and no response to taking anti-inflammatories, rather that some people have found help from taking a low dose of anti-depressants and/or using biofeedback and psychotherapeutic techniques.
Some researchers feel that the syndrome is too broad and is including people who may have other distinguishable problems. Fibromyalgia syndrome should be diagnosed as a last resort, after first screening for other problems.
Some studies found that some people diagnosed with FMS once screened thoroughly were found to have other diseases such as anaemia, hypothyroidism, inflammatory arthritic conditions, auto-immune diseases, multiple sclerosis and malignancies. The symptoms of hypothyroidism or low thyroid function for example can include weakness, fatigue, cold intolerance, weight changes usually gain, depression and muscle stiffness and cramping, which are commonly experienced by those with FMS.
Other symptoms which may get confused with those of FMS are vitamin, mineral and enzyme deficiencies such as low vitamin B and magnesium. Others may have gut toxicity.
Another area of confusion may surround those who have muscular or skeletal problems such as prolapsed discs, joint or facet injury. This is because referral of pain from these tissues, especially if there is more than one cause, can appear to give widespread pain, which can confuse it with the symptoms of FMS. Researchers have found that some patients have had their symptoms disappear once they’ve been treated with manual or nutritional therapy whereas others have not responded. Their reasoning is that some people never had FMS in the first place but instead had another treatable condition.
It is therefore very important that people are screened thoroughly to rule out other conditions and to establish where exactly their pain is and if it can be reproduced on palpation. If it can then it shouldn’t be diagnosed as FMS but should be treated by a manual therapist such as an Osteopath. Studies found that those suffering from FMS do not experience relief from manual therapy. Many studies conclude that FMS is not a soft-tissue or muscular condition but is a reduced sensitivity to pain caused by an abnormality of the central nervous system.
David M Brady, Michael J Schneider :Journal of Manipulative & Physiological Therapeutics: "Fibromyalgia Syndrome: A Paradigm for differential diagnosis and treatment" Vol 24 Number 8 October 2001