Arthritis and Rheumatism Associates, P.C.

Rebecca Wagner, PT

FM – Turn Down the Volume

Fibromyalgia (FM) is defined as widespread musculoskeletal pain that can include achiness, tenderness, and stiffness. It often is accompanied by fatigue and psychological changes, such as depression. Current theory states this condition is caused by central sensitization; that is, increased sensitivity in the brain to pain signals. This sensitization includes a change in the levels of the neurotransmitters resulting in amplification by pain receptors in the brain. Normal stimuli are perceived as painful. Think of a radio with the volume blasting that needs to be turned down.

So far, the exact cause of fibromyalgia is not known. There are several theories regarding what can trigger the onset: physical trauma, surgery, viral or bacterial infection, significant psychological stress, hypermobility, immune system dysfunction, abnormal brain function during sleep. Symptoms can accumulate gradually over time without a triggering event. Women are more likely than men to develop this condition

Fibromyalgia is diagnosed by ruling out other conditions. A diagnosis of fibromyalgia includes widespread pain longer than three months and pain and tenderness at 11 or more of the 18 identified tender points on the body. In addition to the widespread pain, some of the frequent signs and symptoms include headache, TMJ disorder, irritable bowel syndrome and other GI disturbances, fatigue and sleep disturbances, poor concentration and memory problems.

Treatment for fibromyalgia includes managing it with medication and elements of self-care: exercise, stress management, healthful eating and good quality sleep.

Treatment for fibromyalgia includes managing it with medication and elements of self-care: exercise, stress management, healthful eating and good quality sleep. Medication that is managed by a health care provider can include analgesics, antidepressants, and anti-seizure drugs. Exercise should consist of a gentle program incorporating stretching, strengthening and aerobic activity with a gradual progression. Stress management can include coping skills and strategies: pacing oneself by modifying a schedule and/or breaking down activities, taking breaks, removing stressor(s), exercising and meditation. Utilizing sleep hygiene elements to ensure getting proper rest is an important component for managing the symptoms of fibromyalgia.

Successful management of fibromyalgia involves active participation and a take-charge attitude. Utilizing modalities (ice/heat) for symptom relief, developing coping skills and strategies to reduce stress and getting adequate rest and nutrition are key for successful management. As stated by a former patient, it can simply entail “resting when you’re tired; eating when you’re hungry.”

If you have fibromyalgia, consider consulting a physical therapist. Ask your rheumatologist more about physical therapy at ARTS in order to teach you how to better manage fibromyalgia and similar conditions.

David G. BBorenstein, MD MACP MACR

David G. Borenstein, MD MACP MACR

David G. Borenstein, MD MACP MACR

Having one illness is more than any patient wants to bear, but, often, patients may have more than one medical problem affecting their musculoskeletal system. In those circumstances, treating only one of those problems may explain why patients are not improving as much as they desire. This situation may occur in individuals who, for example, have both ibromyalgia and ankylosing spondylitis.





Fibromyalgia is a condition characterized by chronic widespread pain in the upper and lower parts of the body and frequently is associated with symptoms including fatigue, restless sleep, mental fogginess, irritable bowel syndrome, interstitial cystitis, and unstable blood pressure. Optimal treatment for fibromyalgia includes a multidisciplinary approach including non-pharmacologic interventions such as patient education, aerobic exercise, and cognitive behavioral therapy. Also used is pharmacologic therapy such as nonnarcotic analgesics that increase neurochemicals like serotonin and norepinephrine, which increase the tone in each individual’s [**is it individual’s or individual??**] pain inhibitory pathway that travels from the brain to structures throughout the body. Up to about 8% of people in the United States have fibromyalgia

ankylosing spondylitis

Ankylosing spondylitis is an autoimmune-related chronic inflammation of the structures of the spine that can destroy tissues and, in the setting of spondyloarthritis, ultimately results in the calcification of spinal structures and spinal fusion. Ankylosing spondylitis is associated with prolonged morning stiffness that is exacerbated by sitting for variable lengths of time and is improved by exercising. The goals of therapy for ankylosing spondylitis are to control inflammation, decrease pain, maintain function, and prevent deformity with non-pharmacologic (exercise and physical therapy) and pharmacologic (nonsteroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and biologics) interventions. The estimate for ankylosing spondylitis and other inflammatory spinal disorders in the United States is about 4% of the population.

The question arises as to how many individuals have both fibromyalgia and ankylosing spondylitis. A recent survey reviewed medical literature to determine the frequency of individuals with both conditions. The prevalence of fibromyalgia in ankylosing spondylitis patients is reported to be 4-25%, more women than men. These individuals tend to have more subjective complaints of pain in the spine and other areas than those ankylosing
spondylitis patients without fibromyalgia. [**Please check – the original had “… other areas than those AS patients without AS”, so I want to make sure it was AS to FM and not FM to AS**] The clinical importance of this fact is that the usual therapies effective for ankylosing spondylitis may not be adequate to control pain in these individuals. The addition of effective therapy for fibromyalgia will be required to fully treat these individuals.

For more information about these conditions, please go to where ARA partner David Borenstein, MD, MACP, MACR, is executive editor.

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