The only thing unusual about this case is the fact that the patient is male
Fibromyalgia is a widespread disorder. Its symptoms wax and wane; it almost defies description; and so far it has no laboratory or radiological identifiers. In other words, even after many tests, your doctor does not usually discover a definitive answer. Moreover, early on, the patient may ask: “Is it all in my head?”
I received a Christmas card from an 85-year-old former patient in whom the diagnosis was made 30 years ago. He was a music/piano teacher who found it difficult to concentrate or play the piano. He had various aches and pains in the neck, shoulders, arms, and fingers. He slept poorly most of the time and was becoming more anxious. He and I jumped through all of the testing hoops without any positive results. Two different rheumatologists also saw him. They agreed with the diagnosis of fibromyalgia and with the fact that he could not perform his job. He retired. In addition, every year for six years the insurance company had him examined by an out-of-town specialist to see if anything had changed.
The only thing unusual about this case is the fact that the patient is male. Nearly 80-90% of fibromyalgia patients are female. Over time, the patient became less sensitive to the recurrence of symptoms, and his requests for office visits decreased in frequency, but early on I sometimes wondered about the many times I saw him. He never pressed me for heavy-duty drugs and was willing to try the many treatment alternatives I proposed.
I was very upfront about treatment and discussed it at length with him. We experienced both short-term and long-term failures. Nothing really worked. However, as time went on, he was less anxious about his symptoms, mostly, I believe, because there was somebody to pay attention to him. When finally I decided and he agreed that there was nothing else to try, he seemed somewhat disappointed. I assured him that in spite of our spectacular lack of success, he could always make an appointment when needed, and, in any event, I wanted to see him yearly.
Fibromyalgia may be known by other names, e.g. fibrositis, tension myalgia, or psychogenic rheumatism. It is a chronic condition characterized by fatigue, muscle-joint aches and pains and sensitivity to pressure in these areas. It does not lead to crippling, nor is it life-threatening.
The symptoms may be aggravated by weather changes, stress, or physical activity. Different people have different signs and symptoms. These include:
What are the causes? No one knows. Some factors may include:
- Sleep disturbance and fatigue are usual. One may wake up tired even though one slept well enough. Night cramps in the legs and restless leg syndrome may be part of the picture.
- Irritable Bowel Syndrome is common.
- Head and face pains are common, as is TMJ.
- Other symptoms include depression, numbness or tingling in the hands and feet, difficulty concentrating, mood changes, chest pains (there are muscles in the chest) and anxiety.
Each of these factors may have a degree of responsibility, but no one can yet determine how much. Predisposing factors:
- Changes in neurotransmitters in the brain
- Changes in sleep patterns
- Injury to the upper spinal cord or brain
- Bacterial or viral infection
- Abnormalities of the sympathetic nervous system
- Changes in muscle metabolism
- Psychological stress
- Hormonal changes
None of its symptoms identifies fibromyalgia. In general, the symptoms would make a physician think of a number of other disorders first- disorders that are diagnosable and treatable. The result is examination, re-examination, blood work, x-rays, maybe re-examination, or consultation with another physician. If you are currently on medication for another condition, expect that consideration will be given to those medications as causing symptoms.
- More women are affected than men
- Young to midlife age is usually when it starts
- Having a rheumatic disease pre-disposes
- Having a positive family history pre-disposes
- It is unclear whether a disturbed sleep pattern is a cause, or an effect
- FOR PAIN, Tylenol or NSAID’s may or may not work. If one does not work, it is worthwhile to try another because not everyone responds to the same pain reliever.
- FOR DEPRESSION, there are a number of medications available by prescription. These work on serotonin levels in the brain.
- FOR MUSCLE SPASMS, muscle relaxants, with or without pain relievers.
- FOR ANXIETY, anxiety relievers do not work well and could lead to medication dependence. Cognitive behavioral therapy, which teaches methods of dealing with stress, may be helpful. Biofeedback and relaxation techniques also may be helpful.
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C. Robert Meloni, M.D., FACP, FACE, is board certified in both internal medicine and endocrinology. He is a graduate of Harvard College (BS), Georgetown University (MS), and New York Medical College (MD). The former Chairman and President of the Nort...