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The puzzle of Fibromyalgia

Friday 27 May 2011

From Psychology Today:


Statue of a womanThe puzzle of Fibromyalgia

The chronic pain of fibromyalgia. Millions of Americans suffer from it. But who knows the causes? Or if there is even a cure.

By Mirinda J. Kossoff, published on May 01, 1999 - last reviewed on May 23, 2011

"I hurt all over." That's the cry of millions of Americans who are afflicted with fibromyalgia, the latest buzz diagnosis in the epidemic of chronic pain sweeping the U.S. What do we know about this mysterious ailment—and how to control it?

Wendy Hunter's troubles began her senior year of high school, when she began experiencing pangs in her joints and chest and feeling tired all the time. The problems grew so severe that she had to drop out of class and be tutored at home. Her doctor diagnosed her as having Lyme disease and treated her with intravenous antibiotics. But Hunter continued to suffer, so much so that she had to defer entering college. Her physician could find nothing wrong with her, and, indeed, Hunter looked normal and healthy. Eventually he gave up on her case, launching her on a quest for relief. She dragged herself from doctor to doctor, only to be told that she really didn't have a physical problem and what she actually needed was a psychiatrist. Friends deserted her. "They didn't know how to act around me," says Hunter of the ordeal that began nine years ago. "I started to wish I had cancer or something to show for my symptoms." Finally, she landed in the office of a sympathetic physician who gave her a new diagnosis: fibromyalgia.

Fibromyalgia is the latest buzzword in the epidemic of chronic pain sweeping the nation. More than a third of Americans will suffer from persistent pain at some point in their lives, studies suggest, and the U.S. now has close to 1,000 public and private centers dedicated to treating pain. The financial toll is enormous as well. According to the National Institutes of Health, pain costs the U.S. economy more than $100 billion annually in health care and lost productivity.

Pain has always been an elusive phenomenon. It is the mind-body conundrum writ large, an amalgam of emotional perception and physical sensation. And no one knows where one leaves off and the other begins. That is especially evident in fibromyalgia, an enigmatic ailment with no known cause, no simple diagnostic test and no easy treatment or cure. Its hallmark and only certainty is suffusing pain. "I hurt all over" is sufferers' common cry.

Complaints of diffuse pain have been documented since Biblical days and no doubts were voiced earlier. But it was not until the start of the 20th century that the condition acquired a scientific label, fibrositis, when a Scots pathologist claimed to have detected under the microscope signs of inflammation in fibrous tissue—muscles, ligaments and tendons—taken from the bodies of hurting patients. The term stuck, even though other scientists failed to confirm the findings, and in the 1930s, it was joined by another similar term, fibromyositis, to describe generalized musculoskeletal pain. But interest in understanding the condition itself languished until 1977 when rheumatologist Hugh Smythe and psychologist Harvey Moldofsky published a seminal paper in the Bulletin of Rheumatic Diseases. The pair, who are now affiliated with the Western Hospital in Toronto, Canada, detailed the painful condition and proposed a definitive set of diagnostic criteria.

Today, there is general agreement that, unlike other rheumatisms that it can mimic, the illness is not an inflammatory condition, hence the term fibromyalgia, which simply means pain in the body's fibrous tissues. It is an ailment known worldwide. Studies from diverse nations, including Norway, Germany and South Africa, put the number of the afflicted at between 3% and 10% of the general population, making fibromyalgia more common than rheumatoid arthritis. In the U.S., estimate the American College of Rheumatology and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, there are between three and six million sufferers.

The medical establishment has tended to regard generalized pain with skepticism, especially in the absence of a physiological explanation for the hurting. Another reason: the vast majority of complainants are women. In the U.S., where 85% of sufferers are female, doctors have sometimes dismissively termed the ailment "tender lady syndrome."

That attitude is now slowly changing, thanks to a cadre of researchers, ranging from psychologists to neurologists and rheumatologists, who have launched intensive investigations into the condition. As of now, however, it's still easier to define what fibromyalgia is not than what it is: it is not a disease, it is not progressive and it is not life threatening. Medically, fibromyalgia is a syndrome (FMS), a collection of symptoms, including widespread pain, which can vary from one individual to the next in type and severity.

It's a slippery syndrome with symptoms—headache, morning stiffness, numbness and tingling in the hands and feet, pain of the chest, lower back or jaw, insomnia, mental fuzziness—that are associated with a host of other ailments, including depression, lupus, rheumatoid arthritis, migraine and irritable bowel syndrome. That makes diagnosis a confusing prospect. In fact, says a report in Arthritis and Rheumatism, patients typically suffer symptoms for nearly eight years before getting a diagnosis of FMS.

Without a CAT scan, blood measure or other conclusive laboratory test, physicians in making the diagnosis rely on a patient's assessment of pain and their own observations during a physical examination. FMS patients tend to have an exaggerated pain reaction to pressure in certain parts of the body. According to guidelines issued earlier this decade by the American College of Rheumatology (ACR) and a world congress of specialists, there are 18 such tender points, nine on either side of the body, symmetrically paired. A patient meets the criteria for FMS if she or he has 11 tender points and also pain above and below the waist on either side of the body for longer than three months.


The full article can be found here.


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