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Fibromyalgia (FM) is stated to be a disorder classified by the presence of chronic widespread pain and tactile allodynia.^[1] An example of tactile allodynia is when a person perceives light pressure or the movement of clothes over the skin as painful, whereas a healthy individual would not feel pain. Fibromyalgia patients are often affected by a number of symptoms other than pain, including debilitating fatigue, abnormal sleep architecture ^[2] meaning the brain does not reach all the restorative levels of sleep necessary for overall health, functional bowel disturbances^[3] and a variety of neuropsychiatric problems including cognitive dysfunction ^[4] which can mean short and/or long term memory problems, slowed information processing ability, diminished attention span and anxiety and depressive symptoms^[5]. While the criteria for such an entity have not yet been thoroughly developed, the recognition that fibromyalgia involves more than just pain has led to the frequent use of the term “fibromyalgia syndrome.” It is not contagious, and recent studies suggest that people with fibromyalgia may be genetically predisposed.^[6] It affects more females than males, with a ratio of 9:1 by American College of Rheumatology (ACR)criteria.^[7] Fibromyalgia is seen in about 2% of the general population.^[8] It is most commonly diagnosed in individuals between the ages of 20 and 50, though onset can occur in childhood. Image File history File links Broom_icon. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // M00-M99 - Diseases of the musculoskeletal system and connective tissue (M00-M25) Arthropathies (M00-M03) Infectious arthropathies (M00) Pyogenic arthritis (M01) Direct infections of joint in infectious and parasitic diseases classified elsewhere (M02) Reactive arthropathies (M023) Reiters disease (M03) Postinfective and reactive arthropathies in diseases classified elsewhere (M05-M14... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Look up Pain in Wiktionary, the free dictionary. ... Allodynia, meaning other pain, is an exaggerated response to otherwise non-noxious stimuli and can be either static or mechanical. ... ... In medicine, the term syndrome is the association of several clinically recognizable features, signs, symptoms, phenomena or characteristics which often occur together, so that the presence of one feature alerts the physician to the presence of the others. ... This false-colored electron micrograph shows a malaria sporozoite migrating through the midgut epithelia. ... This article is about the general scientific term. ...

The disorder is not directly life-threatening. The degree of symptoms may vary greatly from day to day with periods of flares (severe worsening of symptoms) or remission; however, the disorder is generally perceived as non-progressive.^[9]

The validity of fibromyalgia as a unique clinical entity is a matter of some contention among researchers in the field. For example, it has been proposed that the pathophysiology responsible for the symptoms that are collectively classified as representing "fibromyalgia" is poorly understood, thereby suggesting that the fibromyalgia phenotype which is the difference between an individual’s heredity and what that heredity produces, may result from several different disease processes that have global hyperalgesia - an increased sensitivity to pain - and allodynia in common, ^[10][11][12] an observation that has led to the proposition that current diagnostic criteria are insufficient to differentiate patient groups from each other.^[13] Alternatively, there is evidence for the existence of differing pathophysiological - which is the study of the disturbance of normal mechanical, physical, and biochemical functions of the body - within the greater fibromyalgia construct^[14][15], which may be interpreted to represent evidence for the existence of biologically distinct "sub-types" of the disorder akin to conditions such as epilepsy, schizophrenia and major depressive disorder. In a January 14, 2008 article in the New York Times, the controversy of the reality of the disease and its proposed cures are discussed, while citing that the American College of Rheumatology, the Food and Drug Administration and insurers recognize fibromyalgia as a diagnosable disease. Drug companies are aggressively pursuing fibromyalgia treatments, seeing the potential for a major new market.^[16] Individuals in the mollusk species Donax variabilis show diverse coloration and patterning in their phenotypes. ... It is common to feel sad, discouraged , or down once in a while, and anyone in this state might say they are suffering from depression. ... “FDA” redirects here. ...

History

Fibromyalgia has been studied since the early 1800s and referred to by a variety of former names, including muscular rheumatism and fibrositis.^[17] The term fibromyalgia was coined in 1976 to more accurately describe the symptoms, from the Latin fibra (fiber)^[18] and the Greek words myo (muscle)^[19] and algos (pain).^[20] For other uses, see Latins and Latin (disambiguation). ...

In 1981, Dr. Muhammad B. Yunus published the "first controlled study of the clinical characteristics" of the fibromyalgia syndrome, for which he is considered "the father of our modern view of fibromyalgia."^[21][22] His work was the "first controlled clinical study" of fibromyalgia with validation of known symptoms and tender points, and he also proposed "the first data-based criteria." In 1984, he proposed the important concept that the fibromyalgia syndrome and other similar conditions are interconnected. In 1986, he showed serotonergic and norepinephric drugs to be effective.^[23] In health care, including medicine, a clinical trial (synonyms: clinical studies, research protocols, medical research) is a process in which a medicine or other medical treatment is tested for its safety and effectiveness, often in comparison to existing treatments. ... A symptom is a manifestation of a disease, indicating the nature of the disease, which is noticed by the patient. ... Serotonergic means related to, capable of producing, altering, or releasing serotonin, a neurotransmitter, and can refer to the following classes of chemicals: Selective serotonin reuptake inhibitor - A common class of serotonergic antidepressants Noradrenergic and specific serotonergic antidepressant - Another class of serotonergic antidepressants serotonergic psychedelics - The serotonergic hallucinogenic drugs This is... For other uses, see Drug (disambiguation). ...

Yunus later emphasized a "biopsychosocial perspective" of fibromyalgia, which is considered the "only way to synthesize the disparate contributions of such variables as genes and adverse childhood experiences, life stress and distress, posttraumatic stress disorder, mood disorders, self-efficacy for pain control, catastrophizing, coping style, and social support into the evolving picture of central nervous system dysfunction vis-a-vis chronic pain and fatigue."^[21][22] please be mindful of the scientific process - if you are going to edit, hold you bias in check and provide citations! The biopsychosocial model is a general model that posits that biological, psychological (which entails thoughts, emotions, and behaviors) and social factors (abbreviated BPS) all play a significant role in...

Fibromyalgia was recognized by the American Medical Association as an illness and a cause of disability in 1987.^{[citation needed]} In an article the same year, in the Journal of the American Medical Association, a physician named Dr. Don Goldenberg also called the disorder fibromyalgia.^{[citation needed]} The ACR published a criteria for fibromyalgia in 1990, and developed neurohormonal mechanisms with central sensitization in the 1990s.^[23] JAMA, published continuously since in 1883, is an international peer-reviewed general medical journal published 48 times per year. ... A neurohormone is any hormone produced by neurosecretory cells, usually in the brain. ... This article is about neurobiologic sensitization. ...

Symptoms

The defining symptoms of fibromyalgia are chronic, widespread pain and tenderness to light touch. There is also typically moderate to severe fatigue. Those affected may also experience heightened sensitivity of the skin (also called allodynia), tingling of the skin (often needle-like), achiness in the muscle tissues, prolonged muscle spasms, weakness in the limbs, and nerve pain. Chronic sleep disturbances are also characteristic of fibromyalgia. Indeed, studies suggest that sleep disturbance are related to a phenomenon called alpha-delta sleep, a condition in which deep sleep (associated with delta EEG waves) is frequently interrupted by bursts of brain activity similar to wakefulness (i.e. alpha waves). Deeper stages of sleep (stages 3 & 4) are often dramatically reduced. The sensitivity or insensitivity of a human, often considered with regard to a particular kind of stimulus, is the strength of the feeling it results in, in comparison with the strength of the stimulus. ... Allodynia, meaning other pain, is an exaggerated response to otherwise non-noxious stimuli and can be either static or mechanical. ... Neuropathy is usually short for peripheral neuropathy, meaning a disease of the peripheral nervous system. ...

In addition, many patients experience cognitive dysfunction (known as "brain fog" or "fibrofog"), which may be characterized by impaired concentration and short-term memory consolidation, impaired speed of performance, inability to multi-task, and cognitive overload.^[24][25] Many experts suspect that "brain fog" is directly related to the sleep disturbances experienced by sufferers of fibromyalgia.^{[citation needed]}

Other symptoms often attributed to fibromyalgia that may possibly be due to a comorbid disorder include myofascial pain syndrome, diffuse non-dermatomal paresthesias, functional bowel disturbances and irritable bowel syndrome (possibly linked to lower levels of ghrelin[2], genitourinary symptoms and interstitial cystitis), dermatological disorders, headaches, myoclonic twitches, and symptomatic hypoglycemia. Although fibromyalgia is classified based on the presence of chronic widespread pain, pain may also be localized in areas such as the shoulders, neck, low back, hips, or other areas. Many sufferers also experience varying degrees of facial pain and have high rates of comorbid temporomandibular joint disorder. Not all patients have all symptoms. In medicine and in psychiatry, comorbidity is either The presence of one or more disorders (or diseases) in addition to a primary disease or disorder; or The effect of such additional disorders or diseases. ... CambridgeBayWeather 02:48, 23 September 2005 (UTC) Categories: Possible copyright violations ... Paresthesia or paraesthesia (in British English) is a sensation of tingling, pricking, or numbness of a persons skin with no apparent long-term physical effect, more generally known as the feeling of pins and needles or of a limb being asleep (but not directly related to the phenomenon of... Ghrelin is a hormone produced by P/D1 cells lining the acer of the human stomach that stimulate appetite. ... The urinary system is the organ system that produces, stores, and eliminates urine. ... Interstitial cystitis (commonly abbreviated to IC) is a urinary bladder disease of unknown cause characterised by urinary frequency (as often as every 10 minutes), urgency, pressure and/or pain in the bladder and/or pelvis. ... Dermatology (from Greek δερμα, skin) is a branch of medicine dealing with the skin and its appendages (hair, sweat glands, etc). ... A headache (cephalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... Myoclonus is brief, involuntary twitching of a muscle or a group of muscles. ... Hypoglycemia (hypoglycaemia in British English) is a medical term referring to a pathologic state produced by a lower than normal level of glucose (sugar) in the blood. ... This article is about the body part. ... For other uses, see Neck (disambiguation). ... Look up Back in Wiktionary, the free dictionary. ... Bones of the Hip In anatomy, the hip is the bony projection of the femur, known as the greater trochanter, and the overlying muscle and fat. ... Temporomandibular joint disorder (TMJD, TMJ or TMD), or TMJ syndrome, is an umbrella term covering acute or chronic inflammation of the temporomandibular joint, which connects the lower jaw to the skull. ...

Symptoms can have a slow onset, and many patients have mild symptoms beginning in childhood, that are often misdiagnosed as growing pains.^{[citation needed]} Symptoms are often aggravated by unrelated illness or changes in the weather.^{[citation needed]}They can become more tolerable or less tolerable throughout daily or yearly cycles; however, many people with fibromyalgia find that, at least some of the time, the condition prevents them from performing normal activities such as driving a car or walking up stairs. The disorder does not cause inflammation as is characteristic of rheumatoid arthritis, although some NSAIDs may temporarily reduce pain symptoms in some patients. Their use, however, is limited, and often of little to no value in pain management.^[26] For other uses, see Growing Pains (disambiguation). ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... Rheumatoid arthritis (RA) is traditionally considered a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. ... Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. ...

Variability of symptoms

The following factors have been proposed to exacerbate symptoms of pain in patients:

• Increased psychosocial stress^{[citation needed]}
• Excessive physical exertion (exercise seems to decrease the pain threshold of people with fibromyalgia but increase it in healthy individuals)^[27]
• Lack of slow-wave sleep
• Changes in humidity and barometric pressure^{[citation needed]}

Psychosocial refers to ones psychological development in the context of a social environment. ... In medical terms, stress is the disruption of homeostasis through physical or psychological stimuli. ... Polysomnogram demonstrating SWS. High amplitude EEG is highlighted in red. ...

Proposed causes and pathophysiology

The cause of fibromyalgia is unknown. Fibromyalgia can, but does not always, start as a result of some trauma such as a traffic accident, major surgery, or disease. Some evidence shows that Lyme Disease may be a trigger of fibromyalgia symptoms.^[28] Another study suggests that more than one clinical entity may be involved, ranging from a mild, idiopathic inflammatory process to clinical depression^[29] In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... Lyme disease, or borreliosis, is an emerging infectious disease caused by bacteria from the genus Borrelia. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... On the Threshold of Eternity. ...

Genetics

By using self-reported "Chronic Widespread Pain" (CWP) as a surrogate marker for fibromyalgia, the Swedish Twin Registry found that a modest genetic contribution may exist:^[30][31]

• Monozygotic twins with CWP have a 15% chance that their twin sibling has CWP
• Dizygotic twins with CWP have a 7% chance that their twin sibling has CWP

It has been suggested that this article or section be merged with Twin. ... Fraternal twin boys in the tub The term twin most notably refers to two individuals (or one of two individuals) who have shared the same uterus (womb) and usually, but not necessarily, born on the same day. ...

Stress

Studies have shown that stress is a significant precipitating factor in the development of fibromyalgia,^[32] and that PTSD is linked with fibromyalgia.^[33][34] The Amital study found that 49% of PTSD patients fulfilled the criteria for FMS, compared with none of the controls. In medical terms, stress is the disruption of homeostasis through physical or psychological stimuli. ... Posttraumatic stress disorder (PTSD), is a term for the psychological consequences of exposure to or confrontation with stressful experiences, which involve actual or threatened death, serious physical injury or a threat to physical integrity and which the person found highly traumatic. ...

A non-mainstream hypothesis that fibromyalgia may be a psychosomatic illness has been described by John E. Sarno's "tension myositis syndrome". He believes many cases of chronic pain result from changes in the body caused by the mind's subconscious strategy of distracting painful or dangerous emotions. Education, attitude change, (and in some cases, psychotherapy) are treatments proposed to stop the brain from using that strategy.^{[35][36][37][38]} This article or section is in need of attention from an expert on the subject. ... John E. Sarno, MD, (1923-) is Professor of Clinical Rehabilitation Medicine, New York University School of Medicine, and attending physician at the Howard A. Rusk Institute of Rehabilitation Medicine, New York University Medical Center. ... Tension myositis syndrome (TMS) is a condition described by Dr. John E. Sarno in his books Healing Back Pain: The Mind-Body Connection (ISBN 0-446-39230-8), The Mindbody Prescription: Healing the Body, Healing the Pain (ISBN 0-446-67515-6), and The Divided Mind: The Epidemic of Mindbody... Chronic pain was originally defined as pain that has lasted 6 months or longer. ... See also: Unconscious mind. ...

Dopamine abnormality

Dopamine is a catecholamine neurotransmitter perhaps best known for its role in the pathology of schizophrenia, Parkinson's disease and addiction. There is also strong evidence for a role of dopamine in restless leg syndrome ^[39], which is a common co-morbid condition in patients with fibromyalgia. ^[40] In addition, dopamine plays a critical role in pain perception and natural analgesia. Accordingly, musculoskeletal pain complaints are common among patients with Parkinson's disease ^[41], which is characterized by drastic reductions in dopamine owing to neurodegeneration of dopamine-producing neurons, while patients with schizophrenia, which is thought to be due (in part) to hyperactivity of dopamine-producing neurons, have been shown to be relatively insensitive to pain.^[42][43] Interestingly, patients with restless legs syndrome have also been demonstrated to have hyperalgesia to static mechanical stimulation.^[44] For other uses, see Dopamine (disambiguation). ... tyrosine is the precursor of catecholamines epinephrine norepinephrine dopamine Synthesis Catecholamines are chemical compounds derived from the amino acid tyrosine containing catechol and amine groups. ... Chemical structure of D-aspartic acid, a common amino acid neurotransmitter. ... Heroin bottle An addiction is a recurring compulsion by an individual to engage in some specific activity, despite harmful consequences to the individuals health, mental state or social life. ... Wittmaack-Ekbom or restless legs syndrome is a disorder of the nervous system that affects sensation and movement in the legs and causes the limbs to feel uncomfortable. ... Hyperalgesia is an extreme sensitivity to pain, which in one form is caused by damage to nociceptors in the bodys soft tissues. ...

Fibromyalgia has been commonly referred to as a "stress-related disorder" due to its frequent onset and worsening of symptoms in the context of stressful events.^[45][46] It was therefore proposed that fibromyalgia may represent a condition characterized by low levels of central dopamine that likely results from a combination of genetic factors and exposure to environmental stressors, including psychosocial distress, physical trauma, systemic viral infections or inflammatory disorders (e.g. rheumatoid arthritis, systemic lupus erythematosus).^[47] This conclusion was based on three key observations: (1) fibromyalgia is associated with stress; (2) chronic exposure to stress results in a disruption of dopamine-related neurotransmission^[48]; and (3) dopamine plays a critical role in modulating pain perception and central analgesia in such areas as the basal ganglia^[49] including the nucleus accumbens^[50], insular cortex^[51], anterior cingulate cortex^[52], thalamus^[53], periaqueductal gray^[54], and spinal cord^{[55] [56]}. Rheumatoid arthritis (RA) is traditionally considered a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. ... Systemic Lupus Erythematosus (SLE or lupus) is a chronic autoimmune disease that can be fatal, though with recent medical advances, fatalities are becoming increasingly rare. ... For other uses of painkiller, see painkiller (disambiguation) An analgesic (colloquially known as painkiller) is any member of the diverse group of drugs used to relieve pain. ... The basal ganglia (or basal nuclei) are a group of nuclei in the brain interconnected with the cerebral cortex, thalamus and brainstem. ... The nucleus accumbens (NAcc), also known as the accumbens nucleus or as the nucleus accumbens septi (Latin for nucleus leaning against the septum), is a collection of neurons located where the head of the caudate and the anterior portion of the putamen meet just lateral to the septum pellucidum. ... The insular cortex (also often referred to as just the insula) is a structure of the human brain. ... Grays FIG. 727– Medial surface of left cerebral hemisphere. ... The thalamus (from Greek θάλαμος = bedroom, chamber, IPA= /ˈθæləməs/) is a pair and symmetric part of the brain. ... Periaqueductal gray (PAG; also called the central gray) is the midbrain grey matter that is located around the cerebral aqueduct within the midbrain. ... The Spinal cord nested in the vertebral column. ...

In support of the 'dopamine hypothesis of fibromyalgia', a reduction in dopamine synthesis has been reported by a study that used positron emission tomography (PET) and demonstrated a reduction in dopamine synthesis among fibromyalgia patients in several brain regions in which dopamine plays a role in inhibiting pain perception, including the mesencephalon, thalamus, insular cortex and anterior cingulate cortex.^[57] A subsequent PET study demonstrated that, whereas healthy individuals release dopamine into the caudate nucleus and putamen during a tonic experimental pain stimulus (i.e. hypertonic saline infusion into a muscle bed)^[58], fibromyalgia patients fail to release dopamine in response to pain and, in some cases, actually have a reduction in dopamine levels during painful stimulation. ^[59] Moreover, a substantial subset of fibromyalgia patients respond well in controlled trials to pramipexole, a dopamine agonist that selectively stimulates dopamine D2/D3 receptors and is used to treat both Parkinson's disease and restless legs syndrome.^[60] Trials of other dopamine agonists are currently ongoing. Look up Hypothesis in Wiktionary, the free dictionary. ... Image of a typical positron emission tomography (PET) facility Positron emission tomography (PET) is a nuclear medicine medical imaging technique which produces a three-dimensional image or map of functional processes in the body. ... In biological anatomy, the mesencephalon (or midbrain) is the middle of three vesicles that arise from the neural tube that forms the brain of developing animals. ... Grays Fig. ... The putamen is a structure in the middle of the brain, forming the striatum together with the caudate nucleus. ... Pramipexole (INN, trade names Mirapex® and Sifrol®) is a medication indicated for treating Parkinsons disease and restless legs syndrome (RLS). ... Dopamine agonist is a synthetic drug that mimics the effect of the neurotransmitter dopamine. ...

Serotonin

Serotonin is a neurotransmitter that is known to play a role in regulating sleep patterns, mood, feelings of well-being, concentration and descending inhibition of pain. Accordingly, it has been hypothesized that the pathophysiology underlying the symptoms of fibromyalgia may be a dysregulation of serotonin metabolism, which may explain (in part) many of the symptoms associated with the disorder. This hypothesis is derived in part by the observation of decreased serotonin metabolites in patient plasma ^[61] and cerebrospinal fluid.^[62] However, selective serotonin reuptake inhibitors (SSRIs) have met with limited success in alleviating the symptoms of the disorder, while drugs with activity as mixed serotonin-norepinephrine reuptake inhibitors (SNRIs) have been more successful^[63]. Accordingly, duloxetine (Cymbalta), a SNRI originally used to treat depression and painful diabetic neuropathy, has been demonstrated by controlled trials to relieve symptoms of some patients. Eli Lilly and Company, the manufacturer of duloxetine has submitted a supplementary new drug application (sNDA) to the FDA for approval of it use in the treatment of FM. The relevance of dysregulated serotonin metabolism to the pathophysiology is a matter of debate.^[64] Ironically, one of the more effective types of medication for the treatment of the disorder (i.e. serotonin 5-HT3 antagonists) actually block some of the effects of serotonin.^[65] For the professional wrestling stable, see Ravens Nest#Serotonin. ... Chemical structure of D-aspartic acid, a common amino acid neurotransmitter. ... Pathophysiology is the study of the disturbance of normal mechanical, physical, and biochemical functions, either caused by a disease, or resulting from a disease or abnormal syndrome or condition that may not qualify to be called a disease. ... Look up Hypothesis in Wiktionary, the free dictionary. ... Look up plasma in Wiktionary, the free dictionary. ... Cerebrospinal fluid (CSF), Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space in the brain (the space between the skull and the cerebral cortex—more specifically, between the arachnoid and pia layers of the meninges). ... Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants. ... Serotonin Norepinephrine Serotonin-norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressant used in the treatment of clinical depression and other affective disorders. ... Duloxetine (brand names Cymbalta, Yentreve, and in parts of Europe, Xeristar or Ariclaim) is a drug which primarily targets major depressive disorder (MDD), generalized anxiety disorder (GAD), pain related to diabetic peripheral neuropathy and in some countries stress urinary incontinence (SUI). ... Categories: Medicine stubs | Chemistry stubs | Serotonin-norepinephrine reuptake inhibitors ... Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. ... The United States Food and Drug Administration is the government agency responsible for regulating food, dietary supplements, drugs, cosmetics, medical devices, biologics and blood products in the United States. ... Skeletal formula of ondansetron, the prototypical 5-HT3 antagonist The 5-HT3 antagonists are a class of medications which act as receptor antagonists at the 5-hydroxytryptamine-3 receptor (5-HT3 receptor), a subtype of serotonin receptor found in terminals of the vagus nerve and certain areas of the brain. ...

Sleep disturbance

Electroencephalography studies have shown that people with fibromyalgia lack slow-wave sleep and circumstances that interfere with stage four sleep (pain, depression, serotonin deficiency, certain medications or anxiety) may cause or worsen the condition.^[66] According to the sleep disturbance hypothesis, an event such as a trauma or illness causes sleep disturbance and possibly initial chronic pain that may initiate the disorder. The hypothesis supposes that stage 4 sleep is critical to the function of the nervous system, as it is during that stage that certain neurochemical processes in the body 'reset'. In particular, pain causes the release of the neuropeptide substance P in the spinal cord which has the effect of amplifying pain and causing nerves near the initiating ones to become more sensitive to pain. Under normal circumstances, areas around a wound to become more sensitive to pain but if pain becomes chronic and body-wide this process can run out of control. The sleep disturbance hypothesis holds that deep sleep is critical to reset the substance P mechanism and prevent this out-of-control effect. EEG redirects here. ... Polysomnogram demonstrating SWS. High amplitude EEG is highlighted in red. ... This article is about state anxiety. ... The nervous system is a highly specialized network whose principal components are nerves called neurons. ... A Neuropeptide is any of the variety of peptides found in neural tissue; e. ... In neuroscience, Substance P is a neuropeptide: a short-chain polypeptide that functions as a neurotransmitter and as a neuromodulator. ... The Spinal cord nested in the vertebral column. ...

The sleep disturbance/substance P hypothesis could explain "tender points" that are characteristic of fibromyalgia but which are otherwise enigmatic, since their positions don't correspond to any particular set of nerve junctions or other obvious body structures.^{[citation needed]} The hypothesis proposes that these locations are more sensitive because the sensory nerves that serve them are positioned in the spinal cord to be most strongly affected by substance P. This hypothesis could also explain some of more general neurological features of fibromyalgia, since substance P is active in many other areas of the nervous system. The sleep disturbance hypothesis could also provide a possible connection between fibromyalgia, chronic fatigue syndrome (CFS) and post-polio syndrome through damage to the ascending reticular activating system of the reticular formation. This area of the brain, in addition to apparently controlling the sensation of fatigue, is known to control sleep behaviors and is also believed to produce some neuropeptides, and thus injury or imbalance in this area could cause both CFS and sleep-related fibromyalgia. Chronic fatigue syndrome (CFS) is one of several names given to a poorly understood, highly debilitating disorder of uncertain cause/causes, which is thought to affect approximately 4 per 1,000 adults[1] in the United States and other countries, and a smaller fraction of children. ... Post-polio syndrome (PPS) is a condition that frequently affects survivors of poliomyelitis, a viral infection of the nervous system, after recovery from an initial paralytic attack of the virus. ... The reticular formation is a part of the brain which is involved in stereotypical actions, such as walking, sleeping, and lying down. ...

Critics of the hypothesis argue that it does not explain slow-onset fibromyalgia, fibromyalgia present without tender points, or patients without heightened pain symptoms, and a number of the non-pain symptoms present in the disorder.^{[citation needed]}

Human growth hormone

An alternate hypothesis suggests that stress-induced problems in the hypothalamus may lead to reduced sleep and reduced production of human growth hormone (HGH) during slow-wave sleep. People with fibromyalgia tend to produce inadequate levels of HGH. Most patients with FM with low IGF-I levels failed to secrete HGH after stimulation with clonidine and l-dopa.^{[citation needed]} The hypothalamus links the nervous system to the endocrine system via the pituitary gland (hypophysis). ... Human growth hormone can refer to: For physiology of human growth hormone, see growth hormone. ... Polysomnogram demonstrating SWS. High amplitude EEG is highlighted in red. ...

This view is supported by the fact that those hormones under the direct or indirect control of HGH, including IGF-1, cortisol, leptin and neuropeptide Y are abnormal in people with fibromyalgia,^[67] In addition, treatment with exogenous HGH or growth hormone secretagogue reduces fibromyalgia related pain and restores slow wave sleep^{[68][69][70][71]} though there is disagreement about the proposition.^[72] The insulin-like growth factors (IGFs) are polypeptides with high sequence similarity to insulin. ... Cortisol is a corticosteroid hormone produced by the Zona fasciculata of the adrenal cortex (in the adrenal gland). ... RNA expression pattern Orthologs Human Mouse Entrez Ensembl Uniprot Refseq Location Pubmed search Leptin (from the Greek word leptos, meaning thin) is a 16 kDa protein hormone that plays a key role in regulating energy intake and energy expenditure, including the regulation (decrease) of appetite and (increase) of metabolism. ... Neuropeptide Y (NPY) is a 36 amino acid peptide neurotransmitter found in the brain and autonomic nervous system. ...

Deposition disease

The 'deposition hypothesis of fibromyaglia' posits fibromyalgia is due to intracellular phosphate and calcium accumulations that eventually reaches levels sufficient to impede the ATP process, possibly caused by a kidney defect or missing enzyme that prevents the removal of excess phosphates from the blood stream. Accordingly, proponents of this hypothesis suggest that fibromyalgia may be an inherited disorder, and that phosphate build-up in cells is gradual but can be accelerated by trauma or illness. Calcium is required for the excess phosphate to enter the cells.^{[citation needed]}The additional phosphate slows down the ATP process; however the excess calcium prods the cell to continue producing ATP.^[73] A phosphate, in inorganic chemistry, is a salt of phosphoric acid. ... For other uses, see Calcium (disambiguation). ... Adenosine 5-triphosphate (ATP) is a multifunctional nucleotide that is most important as a molecular currency of intracellular energy transfer. ... The kidneys are the organs that filter wastes (such as urea) from the blood and excrete them, along with water, as urine. ... Ribbon diagram of the enzyme TIM, surrounded by the space-filling model of the protein. ...

Diagnosis is made with a specialized technique called mapping, a gentle palpitation of the muscles to detect lumps and areas of spasm thought to be caused by an excess of calcium in the cytosol of the cells. The mapping technique is notably different from the manual tenderpoint examination^[74] upon which a diagnosis of fibromyalgia depends and is purportedly different from the detection of trigger points that characterize the myofascial pain syndrome.^{[citation needed]} In general, diagnosis (plural diagnoses) has two distinct dictionary definitions. ... For other uses of Muscles, see Muscles (disambiguation). ... For other uses, see Calcium (disambiguation). ... The cytosol (cf. ... Trigger points are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. ... CambridgeBayWeather 02:48, 23 September 2005 (UTC) Categories: Possible copyright violations ...

While this hypothesis does not identify the causative mechanism in the kidneys, it proposes a treatment known as guaifenesin therapy. This treatment involves administering the drug guaifenesin to a patient's individual dosage, avoiding salicylic acid in medications or on the skin. Often products for salicylate sensitivity are very helpful. If the patient is also hypoglycemic, a diet is designed to keep insulin levels low. Guaifenesin protocol is a popular, experimental, alternative treatment for fibromyalgia proposed in the 1990s by R. Paul St. ... Salicylic acid (from the Latin word for the willow tree, Salix, from whose bark it can be obtained) is a beta hydroxy acid (BHA) with the formula C6H4(OH)CO2H, where the OH group is adjacent to the carboxyl group. ... Salicylate sensitivity, also known as salicylate intolerance, is a chemical reaction that occurs when too much salicylate (salicylic acid) is introduced into a persons system. ... Not to be confused with inulin. ...

The phosphate build-up hypothesis explains many of the symptoms present in fibromyalgia.^{[citation needed]}and proposes an underlying cause. The guaifenesin treatment, based on this hypothesis, has received mixed reviews, with some practitioners claiming many near-universal successes^{[citation needed]} and others reporting no success. Of note, guaifenesin is also a central acting muscle relaxant used in veterinary anaesthesia^[75] that is structurally related to methocarbamol, a property that might explain its utility in some fibromyalgia patients. A controlled trial of guaifenesin for the treatment of fibromyalgia demonstrated no evidence for efficacy of this medication. ^[76] However, this study has been criticized by the chief proponent of the deposition hypothesis for not limiting salicylic acid exposure in patients, and for studying the effectiveness of only guaifenesin, not the entire treatment method.^[77] As of 2005, further studies to test the protocol's effectiveness are in the planning stages, with funding for independent studies largely collected from groups which advocate the hypothesis. It should be noted that nothing in the scientific literature supports the proposition that fibromyalgia patients have excessive levels of phosphate in their tissues. A muscle relaxant is a drug which decreases the tone of a muscle. ... Methocarbamol (chemical formula: ) is a central muscle relaxant for skeletal muscles, used to treat spasms. ... 2005 is a common year starting on Saturday of the Gregorian calendar. ...

Other hypotheses

Other hypotheses have been proposed related to various toxins from the patient's environment, viral causes such as the Epstein-Barr Virus, growth hormone deficiencies possibly related to an underlying (maybe autoimmune) disease affecting the hypothalamus gland, an aberrant immune response to intestinal bacteria,^[78][79] neurotransmitter disruptions in the central nervous system, and erosion of the protective chemical coating around sensory nerves. A 2001 study suggested an increase in fibromyalgia among women with extracapsular silicone gel leakage, compared to women whose implants were not broken or leaking outside the capsule.^[80][81] This association has not repeated in a number of related studies,^[82] and the US-FDA concluded "the weight of the epidemiological evidence published in the literature does not support an association between fibromyalgia and breast implants."^[83] Due to the multi-systemic nature of illnesses such as fibromyalgia and chronic fatigue syndrome (CFS/ME), an emerging branch of medical science called psychoneuroimmunology (PNI) is looking into how the various hypotheses fit together. For other uses, see Toxin (disambiguation). ... This article is about biological infectious particles. ... The Epstein-Barr virus (EBV), also called Human herpesvirus 4 (HHV-4), is a virus of the herpes family (which includes Herpes simplex virus and Cytomegalovirus), and is one of the most common viruses in humans. ... Growth hormone (GH) or somatotropin (STH) is a protein hormone which stimulates growth and cell reproduction in humans and other animals. ... Gut flora, or intestinal bacteria, are the bacteria that normally live in the digestive tract and perform a number of useful functions involving digestion for their hosts. ... Chemical structure of D-aspartic acid, a common amino acid neurotransmitter. ... A diagram showing the CNS: 1. ... Chronic fatigue syndrome (CFS) is one of several names given to a poorly understood, highly debilitating disorder of uncertain cause/causes, which is thought to affect approximately 4 per 1,000 adults[1] in the United States and other countries, and a smaller fraction of children. ... Psychoneuroimmunology (PNI) investigates the relations between the psychophysiological and immunophysiological dimensions of living beings. ...

Another hypothesis on the cause of symptoms in fibromyalgia states that patients suffer from vasomotor dysregulation causing improper vascularflow and hypoperfusion (decreased blood flow to a given tissue or organ).^[84] Vasodilation is where blood vessels in the body become wider following the relaxation of the smooth muscle in the vessel wall. ... f you all The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... In medicine, shock (hypoperfusion) is a life-threatening medical emergency characterized by inability of the body to supply enough oxygen to meet tissue requirements. ...

Always a comorbid disease?

Cutting across several of the above hypotheses is the proposition that fibromyalgia is almost always a comorbid disorder, occurring in combination with some other disorder that likely served to "trigger" the fibromyalgia in the first place. Two possible triggers are gluten sensitivity and/or irritable bowel. Irritable bowel is found at high frequency in fibromyalgia,^[85] and a large coeliac support group survey of adult celiacs revealed that 7% had fibromyalgia and also has a co-occurrence with chronic fatique.^[86] In medicine and in psychiatry, comorbidity is either The presence of one or more disorders (or diseases) in addition to a primary disease or disorder; or The effect of such additional disorders or diseases. ... 4 different commercial forms of Triticeae cultivars. ...

According to this hypothesis, some other disorder (or trauma) occurs first, and fibromyalgia follows as a result. In some cases, the original disorder abates on its own or is separately treated and cured, but the fibromyalgia remains. This is especially apparent when fibromyalgia seems triggered by major surgery. In other cases the two disorders coexist.

Diagnosis

There is still debate over what should be considered essential diagnostic criteria. The most widely accepted set of classification criteria for research purposes were elaborated in 1990 by the Multicenter Criteria Committee of the the American College of Rheumatology. These criteria, which are known informally as "the ACR 1990" define fibromyalgia according to the presence of the following criteria:

• A history of widespread pain lasting more than three months—affecting all four quadrants of the body, i.e., both sides, and above and below the waist.
• Tender points—there are 18 designated possible tender or trigger points (although a person with the disorder may feel pain in other areas as well). During diagnosis, four kilograms-force (39 newtons) of force is exerted at each of the 18 points; the patient must feel pain at 11 or more of these points for fibromyalgia to be considered.^[87] Four kilograms of force is about the amount of pressure required to blanch the thumbnail when applying pressure. This set of criteria was developed by the American College of Rheumatology as a means of classifying an individual as having fibromyalgia for both clinical and research purposes. While these criteria for classification of patients were originally established as inclusion criteria for research purposes and were not intended for clinical diagnosis, they have become the de facto diagnostic criteria in the clinical setting. It should be noted that the number of tender points that may be active at any one time may vary with time and circumstance.

The unit kilogram-force (kgf, often just kg) or kilopond (kp) is defined as the force exerted by one kilogram of mass in standard Earth gravity. ... For other uses, see Newton (disambiguation). ... For other uses, see Force (disambiguation). ...

Differentials

A number of other disorders can produce similar symptoms to fibromyalgia:

Chronic fatigue syndrome (CFS) is one of several names given to a poorly understood, highly debilitating disorder of uncertain cause/causes, which is thought to affect approximately 4 per 1,000 adults[1] in the United States and other countries, and a smaller fraction of children. ... On the Threshold of Eternity. ... Ehlers-Danlos syndrome is a group of rare genetic disorders affecting humans and domestic animals caused by a defect in collagen synthesis. ... Gulf War syndrome (GWS) or Gulf War illness (GWI) is the name given to an illness with symptoms including increases in the rate of immune system disorders and birth defects, reported by combat veterans of the 1991 Persian Gulf War. ... Flu redirects here. ... Lead poisoning is a medical condition, also known as saturnism, plumbism or painters colic, caused by increased blood lead levels. ... Systemic Lupus Erythematosus (SLE or lupus) is a chronic autoimmune disease that can be fatal, though with recent medical advances, fatalities are becoming increasingly rare. ... Lyme disease, or borreliosis, is an emerging infectious disease caused by bacteria from the genus Borrelia. ... It has been suggested that Acrodynia be merged into this article or section. ... CambridgeBayWeather 02:48, 23 September 2005 (UTC) Categories: Possible copyright violations ... Tendonitis (also tenonitis or tendinitis) is an inflammation of a tendon. ... The thyroid gland and its relations The thyroid is one of the larger endocrine glands in the body. ... B12 deficiency can potentially cause severe and irreversible damage, especially to the brain and nervous system. ... Vitamin D is a fat soluble vitamin that contributes to the maintenance of normal levels of calcium and phosphorus in the bloodstream. ... Whiplash is the common name for a hyper extension/flexion injury to the cervical, thoracic or lumbar spines. ... Multiple chemical sensitivity (MCS) is described as a chronic condition characterized by a patients belief that they are experiencing several adverse and variable affects from exposure to otherwise low levels of multiple chemicals in modern human environments. ...

Treatment

As with many other syndromes, there is no universally accepted cure for fibromyalgia, though some physicians claim to have found cures.^[88] However, a steady interest in the disorder on the part of academic researchers as well as pharmaceutical interests has led to improvements in its treatment, which ranges from symptomatic prescription medication to alternative and complementary medicine. Alternative medicine has been described as any of various systems of healing or treating disease (as chiropractic, homeopathy, or faith healing) not included in the traditional medical curricula taught in the United States and Britain.[1] Alternative medicine practices are often based in belief systems not derived from modern science. ... Complementary medicine refers to a group of therapeutic and diagnostic disciplines that exist largely outside the institutions where conventional health care is taught and provided. ...

Medications

Many medications are used to treat specific symptoms of fibromyalgia, such as muscle pain and insomnia.

Pain Relief

A number of pain relievers have been prescribed for fibromyalgia. This includes NSAID medications over the counter, COX-2 inhibitors, and tramadol in prescription form for more advanced cases. Recently, pregabalin (marketed as Lyrica) has been given FDA approval for the treatment of diagnosed Fibromyalgia.^[16] Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. ... Tramadol (INN) (IPA: ) is an atypical opioid which is a centrally acting analgesic, used for treating moderate to severe pain. ... Pregabalin (brand name: Lyrica®) is a new anticonvulsant drug indicated as an add on therapy for partial onset seizures and for certain types of neuropathic pain. ...

Muscle Relaxants

Muscle relaxants, such as cyclobenzaprine (Flexeril) or tizanidine (Zanaflex), may be used to treat the muscle pain associated with the disorder.^[89][90][91] Cyclobenzaprine is a skeletal muscle relaxant and a central nervous system (CNS) depressant. ... Tizanidine (Zanaflex, Sirdalud) is a centrally acting α-2 adrenergic agonist. ...

Tricyclic antidepressants (TCAs)

Traditionally, low doses of sedating antidepressants (e.g. amitriptyline and trazodone) have been used to reduce the sleep disturbances that are associated with fibromyalgia and are believed by some practitioners to alleviate the symptoms of the disorder. Because depression often accompanies chronic illness, these antidepressants may provide additional benefits to patients suffering from depression. Amitriptyline is often favoured as it can also have the effect of providing relief from neuralgenic or neuropathic pain.^{[citation needed]} It is to be noted that Fibromyalgia is not considered a depressive disorder; antidepressants are used for their sedating effect to aid in sleep. Amitriptyline (or Amitryptyline) hydrochloride (sold as Elavil, Tryptanol, Endep, Elatrol, Tryptizol, Trepiline, Laroxyl) is a tricyclic antidepressant drug. ... Trazodone (trade names Desyrel, Molipaxin, Trittico, Thombran, Trialodine) is a psychoactive compound with sedative, anxiolytic, and antidepressant properties. ... Amitriptyline (or Amitryptyline) hydrochloride (sold as Elavil, Tryptanol, Endep, Elatrol, Tryptizol, Trepiline, Laroxyl) is a tricyclic antidepressant drug. ... Neuropathy is usually short for peripheral neuropathy, meaning a disease of the peripheral nervous system. ...

Selective serotonin reuptake inhibitors (SSRIs)

Research data consistently contradict the utility of agents with specificity as serotonin reuptake inhibitors for the treatment of core symptoms of fibromyalgia. ^[92][93][94] Moreover, SSRIs are known to aggravate many of the comorbidities that commonly affect patients with fibromyalgia including restless legs syndrome and sleep bruxism^[95][96][97].

Anti-seizure drugs

Anti-seizure drugs are also sometimes used, such as gabapentin^[98] and pregabalin (Lyrica). Pregabalin, originally used for the nerve pain suffered by diabetics, has been approved by the American Food and Drug Administration for treatment of fibromyalgia. A randomized controlled trial of pregabalin 450 mg/day found that a number needed to treat of 6 patients for one patient to have 50% reduction in pain.^[99] Gabapentin (brand name Neurontin) is a medication originally developed for the treatment of epilepsy. ... Pregabalin (brand name: Lyrica®) is a new anticonvulsant drug indicated as an add on therapy for partial onset seizures and for certain types of neuropathic pain. ... Pregabalin (brand name: Lyrica®) is a new anticonvulsant drug indicated as an add on therapy for partial onset seizures and for certain types of neuropathic pain. ... “FDA” redirects here. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ... Pregabalin (brand name: Lyrica®) is a new anticonvulsant drug indicated as an add on therapy for partial onset seizures and for certain types of neuropathic pain. ... The number needed to treat (NNT) is an epidemiological measure that indicates how many patients would require treatment with a form of medication to reduce the expected number of cases of a defined endpoint by one. ...

Dopamine agonists

Dopamine agonists (e.g. pramipexole (Mirapex) and ropinirole(ReQuip)) have been studied for use in the treatment of fibromyalgia with good results. ^[100] A trial of transdermal rotigotine is currently on going ^[101]. A dopamine agonist is a compound that activates dopamine receptors, mimicking the effect of the neurotransmitter dopamine. ... Pramipexole (INN, trade names Mirapex® and Sifrol®) is a medication indicated for treating Parkinsons disease and restless legs syndrome (RLS). ... Requip (ropinirole) is so far the only medication in the United States with an FDA approved indication for the treatment of Restless Legs Syndrome. ... Rotigotine [trade name: Neupro®] is a non-ergolinic dopamine agonist and is currently approved for the treatment of the signs and symptoms of early-stage Parkinson’s disease in Europe. ...

Combination therapy

A controlled clinical trial of amitriptyline and fluoxetine demonstrated utility when used in combination.^[102] Amitriptyline (or Amitryptyline) hydrochloride (sold as Elavil, Tryptanol, Endep, Elatrol, Tryptizol, Trepiline, Laroxyl) is a tricyclic antidepressant drug. ... Prozac redirects here. ...

Cannabis and cannabinoids

Fibromyalgia patients frequently self-report using cannabis therapeutically to treat symptoms of the disorder.^[103] Writing in the July 2006 issue of the journal Current Medical Research and Opinion, investigators at Germany's University of Heidelberg evaluated the analgesic effects of oral THC (∆⁹-tetrahydrocannabinol) in nine patients with fibromyalgia over a 3-month period. Subjects in the trial were administered daily doses of 2.5 to 15 mg of THC, but received no other pain medication during the trial. Among those participants who completed the trial, all reported a significant reduction in daily recorded pain and electronically induced pain.^[104] Previous clinical and preclinical trials have shown that both naturally occurring and endogenous cannabinoids hold analgesic qualities,^[105] particularly in the treatment of cancer pain and neuropathic pain,^[106][107] both of which are poorly treated by conventional opioids. As a result, some experts have suggested that cannabinoid agonists would be applicable for the treatment of chronic pain conditions unresponsive to opioid analgesics such as fibromyalgia, and they propose that the disorder may be associated with an underlying clinical deficiency of the endocannabinoid system.^[108][109] Cannabis, also known as marijuana[1] or ganja (Hindi: गांजा),[2] is a psychoactive product of the plant Cannabis sativa. ... THC redirects here. ... The endocannabinoid system (also endogenous cannabinoid system) consists of two transmembrane cannabinoid receptors, endogenous cannabinoids, a transporter protein (anandamide transporter), and the metabolic enzymes inactivating the endocannabinoids (MGL and FAAH). ...

Topical Remedies

Users of Epsom Salts in the gel form (Magnesium Sulfate), have reported significant and lasting relief from pain associated with fibromyalgia. Epsom Salts have long been touted for its ability to reduce pain and swelling. ^[110] Magnesium sulfate (or sulphate) is a chemical compound containing magnesium and sulfate, with the formula MgSO4. ...

Non-drug treatment

Physical treatments

Studies have found exercise improves fitness and sleep and may reduce pain and fatigue in some people with fibromyalgia.^[111] Many patients find temporary relief by applying heat to painful areas. Those with access to physical therapy, massage, or acupuncture may find them beneficial.^[112] Most patients find exercise, even low intensity exercise to be extremely helpful.^[113] Osteopathic manipulative therapy can also temporarily relieve pain due to fibromyalgia.^[114] Physical therapy (or physiotherapy[1]) is the provision of services to people and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. ... Massage in Tarifa, Spain. ... Osteopathic Manipulative Medicine (abbreviated as OMM) is a manual modality of treatment used to improve the impaired or altered function of the musculo-skeletal system (somatic dysfunction). ...

A holistic approach—including managing diet, sleep, stress, activity, and pain—is used by many patients. Dietary supplements, massage, chiropractic care, managing blood sugar levels, and avoiding known triggers when possible means living as well as it is in the patient's power to do.^{[citation needed]}

Psychological/Behavioral Therapies

As the nature of fibromyalgia is not well understood, some physicians believe that it may be psychosomatic or psychogenic.^[115] Although there is no universally accepted cure, some doctors have claimed to have successfully treated fibromyalgia when a psychological cause is accepted.^[116] This article or section is in need of attention from an expert on the subject. ... A psychogenic disease is a physical disease that originates in the mind or in mental or emotional conflict. ...

Cognitive behavioral therapy has been shown to improve quality of life and coping in fibromyalgia patients and other sufferers of chronic pain.^[8] Neurofeedback has also shown to provide temporary and long-term relief. A Cognitive Behavioral Therapy (CBT) is a psychotherapy based on modifying cognitions, assumptions, beliefs and behaviors, with the aim of influencing disturbed emotions. ... Neurofeedback (NFB), also called neurotherapy, neurobiofeedback or EEG biofeedback (EEGBF) is a therapy technique that presents the user with realtime feedback on brainwave activity, as measured by sensors on the scalp, typically in the form of a video display, sound or vibration. ...

Treatment for the "brain fog" has not yet been developed, however biofeedback and self-management techniques such as pacing and stress management may be helpful for some patients. The use of medication to improve sleep helps some patients, as does supplementation with folic acid and ginkgo biloba.^{[citation needed]} Folic acid and folate (the anion form) are forms of the water-soluble Vitamin B9. ... Binomial name Ginkgo biloba L. The Ginkgo (Ginkgo biloba), sometimes also known as the Maidenhair tree, is a unique tree with no living relatives. ...

Dietary treatment

In a 2001 review of four case studies, symptom alleviation was found by minimizing consumption of monosodium glutamate.^[117] This article is about monosodium glutamate as a food additive. ...

Investigational treatments

Milnacipran, a serotonin-norepinephrine reuptake inhibitor (SNRI), is available in parts of Europe where it has been safely prescribed for other disorders. On May 22nd, 2007, a Phase III study demonstrated statistically significant therapeutic effects of Milnacipran as a treatment of fibromyalgia syndrome. At this time, only initial top-line results are available and further analyses will be completed in the coming weeks. If ultimately approved by the FDA, Milnacipran could be distributed in the United States as early as summer, 2008.^[118] Milnacipran is an antidepressant of the serotonin-norepinephrine reuptake inhibitor class. ... Serotonin Norepinephrine Serotonin-norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressant used in the treatment of clinical depression and other affective disorders. ... 2007 is a common year starting on Monday of the Gregorian calendar. ... Milnacipran is an antidepressant of the serotonin-norepinephrine reuptake inhibitor class. ... The United States Food and Drug Administration is the government agency responsible for regulating food, dietary supplements, drugs, cosmetics, medical devices, biologics and blood products in the United States. ... Milnacipran is an antidepressant of the serotonin-norepinephrine reuptake inhibitor class. ... 2008 (MMVIII) will be a leap year starting on Tuesday of the Gregorian calendar. ...

Among the more controversial therapies involves the use of guaifenesin; called St. Amand's protocol or the guaifenesin protocol^[73] the efficacy of guaifenesin in treating fibromyalgia has not been proven in properly designed research studies. Indeed, a controlled study conducted by researchers at Oregon Health Science University in Portland failed to demonstrate any benefits from this treatment,^[76] and the lead researcher has suggested that the annecdotaly reported benefits where due to placebo suggestion.^[119] The results of the study have since been contested by Dr St. Amand, who was a co-author or the original research report.^[120] Guaifenesin (IPA: ) (INN) or guaiphenesin (former BAN) is an expectorant drug usually taken orally to assist the expectoration (bringing up) of phlegm from the airways in acute respiratory tract infections. ... Guaifenesin protocol is a popular, experimental, alternative treatment for fibromyalgia proposed in the 1990s by R. Paul St. ...

Dextromethorphan is an over-the-counter cough medicine with activity as an NMDA receptor antagonist. It has been used in the research setting to investigate the nature of fibromyalgia pain^[121][122]; however, there are no controlled trials of safety or efficacy in clinical use. Dextromethorphan (DXM or DM) is an antitussive (cough-suppressant) drug found in many over-the-counter cold and cough medicines. ... NMDA receptor antagonists are a class of anesthetics that work to antagonize, or inhibit the action of, the NMDA receptor (NMDAR). ...

Living with fibromyalgia

Fibromyalgia can affect every aspect of a person's life. While neither degenerative nor fatal, the chronic pain associated with fibromyalgia is pervasive and persistent. FMS can severely curtail social activity and recreation, and as many as 30% of those diagnosed with fibromyalgia are unable to maintain full-time employment.^{[citation needed]} Like others with disabilities, individuals with FMS often need accommodations to fully participate in their education or remain active in their careers.

In the United States, those who are unable to maintain a full-time job due to the condition may apply for Social Security Disability benefits. Although fibromyalgia has been recognized as a genuine, severe medical condition by the government, applicants are often denied benefits, since there are no formal diagnostic criteria or medically provable symptoms. Because of this, if an applicant does have a medically verifiable condition that would justify disability benefits in addition to fibromyalgia, it is recommended that they not list fibromyalgia in their claim. However, most are awarded benefits at the judicial level; the entire process often takes two to four years.^{[citation needed]}

In the United Kingdom, the Department for Work and Pensions recognizes fibromyalgia as a condition for the purpose of claiming benefits and assistance.^[123] The Department for Work and Pensions is a department of the Government of the United Kingdom, created on June 8, 2001 from the merger of the Employment part of the Department for Education and Employment and the Department of Social Security. ...

Fibromyalgia is often referred to as an "invisible" illness or disability due to the fact that generally there are no outward indications of the illness or its resulting disabilities. The invisible nature of the illness, as well as its relative rarity and the lack of understanding about its pathology, often has psychosocial complications for those that have the disorder. Individuals suffering from invisible illnesses in general often face disbelief or accusations of malingering or laziness from others that are unfamiliar with the disorder.

There are a variety of support groups on the Web that cater to fibromyalgia sufferers.

References

eMedicine is an online clinical medical knowledge base that was founded in 1996. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 6th day of the year in the Gregorian calendar. ... The New York Times is an internationally known daily newspaper published in New York City and distributed in the United States and many other nations worldwide. ... Science Daily is an online news source. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 298th day of the year (299th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... John E. Sarno, MD, (1923-) is Professor of Clinical Rehabilitation Medicine, New York University School of Medicine, and attending physician at the Howard A. Rusk Institute of Rehabilitation Medicine, New York University Medical Center. ... This article is about the television show. ... The American Broadcasting Company (ABC) is an American television network. ... Events of 2008: (EMILY) Me Lesley and MIley are going to China! This article is about the year. ... is the 206th day of the year (207th in leap years) in the Gregorian calendar. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 92nd day of the year (93rd in leap years) in the Gregorian calendar. ... Arthritis Research Campaign is a British medical research charity dedicated to curing arthritis. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 174th day of the year (175th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 298th day of the year (299th in leap years) in the Gregorian calendar. ... John E. Sarno, MD, (1923-) is Professor of Clinical Rehabilitation Medicine, New York University School of Medicine, and attending physician at the Howard A. Rusk Institute of Rehabilitation Medicine, New York University Medical Center. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 6th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 174th day of the year (175th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

Further reading

• Fibromyalgia for Pharmacists, a medication guide

See also

• Somatosensory Amplification

External links

• American College of Rheumatology Fibromyalgia factsheet
• US Food and Drug Administration Living with Fibromyalgia, First Drug ApprovedJune 21, 2007
• Fibromyalgia at the Open Directory Project
• National Institute of Arthritis and Musculoskeletal and Skin Diseases. Questions and Answers About Fibromyalgia. Retrieved on 2008-03-18.
• The National Fibromyalgia Association U.S (2007). Retrieved on 2007-06-01.
• Fibromyalgia Resource Information (2005). Retrieved on 2007-06-01.