Fibromyalgia is a chronic syndrome affecting approximately 175,000 people in Ontario. Eighty percent are women between the ages of 20 and 50 years of age.

Characterized by widespread muscle pain and debilitating fatigue, fibromyalgia can be a devastating condition. Although fibromyalgia was identified as early as 1904, doctors have only recently begun to diagnose and understand the syndrome. It is often mistaken for other conditions and many people affected are subjected to a costly battery of unrevealing tests. Rheumatologists have determined that there are two criteria which must be met for a diagnosis of fibromyalgia:

• Widespread pain in combination with
• Tenderness at 11 or more of the 18 specific tender points sites.

The criteria for the classification of fibromyalgia were internationally agreed upon in 1990. Symptoms include generalized pain in muscles and joints in at least three different parts of the body, sleep disturbance, anxiety or depression, chronic headaches, intense fatigue, irritable bowel syndrome, discoloured spots on the skin, morning stiffness, numbness and tingling, sensitivity to weather and temperature changes, stress and physical activity, skin-fold tenderness, or numbness in the hands or feet without evidence of edema and diminished blood flow to the fingers and toes. The cause is still not certain and there is no cure. Although most of those affected will have to live with pain the rest of their lives, symptoms can be reduced with appropriate medical intervention and lifestyle changes.

THE IMPACT

Fibromyalgia can be an overwhelming condition. Researchers have found in preliminary studies that fibromyalgia affects twice as many people as rheumatoid arthritis, is more painful and is a major cause of disability and lost work time.

Psychologically the syndrome can be devastating. Those affected can live for years with "mystery" pain that doesn't show up in tests or x-rays. In the ongoing search for a diagnosis, they are often told that the pain is "all in their heads". Uncontrolled symptomology causes loss of employment, reduced quality of life and psychological distress. The implications for family life and relationships are serious and difficult to overcome.

The chronic nature of the condition and the daily chronic severe pain that is faced make it imperative that physicians and patients work together to develop a coping strategy that is tailored to the individual's needs. Early diagnosis improves prognosis. Exercise, medication, physiotherapy, and motivation to develop an overall lifestyle change to reduce stress, improve function and diminish the impact of pain are all critical to improving the quality of life.