Fibromyalgia is an intense, crippling, nagging, constant, chronic pain syndrome that continues to take a toll on the population. Fibromyalgia is one of the most prevalent rheumatic disorders in the world. About 6% of the population or 16 million people are estimated to have fibromyalgia. Fibromyalgia mainly affects women aged 25 to 75 years (female to male ratio is 5:1). It bears a remarkable resemblance to Chronic Fatigue Syndrome (CFS).


Often there is a familial pattern to FM, and the predisposition to develop this syndrome may be inherited. A broad spectrum of physical and emotional symptoms is characteristic of both syndromes, and both are receiving increased attention in the medical community, especially pain practitioners.

Fibromyalgia (FM) is usually classified as a soft tissue musculoskeletal condition. FM resembles CFS in some ways.

Symptoms of Fibromyalgia

• Tenderness of at least 11 of 18 specific anatomical points
• Stiffness, especially in A.M. upon awakening
• Sleep disturbances/insomnia

• Muscle spasms and trigger
• Chronic aching points/muscle jerking
• Pain

• Fluid retention
• Anxiety

• Poor memory
• Depression

• Chronic fatigue

• Tightening sensations
• Gastrointestinal disturbances

• Restless legs
• Irritable bowel syndrome

• Irritable bladder
• Subjective soft tissue

• Dry mouth swelling

• Hyperventilation
• Cardiovascular problems

• Paresthesia (dizziness, palpitations)


American College of Rheumatology 1990 Classification Criteria

Symptoms of stiffness, chronic musculoskeletal pain, aching, disturbed sleep, depression, anxiety, and fatigue plague patients with both syndromes. (See Table 1) Patients do not experience all of the symptoms, but patients with FM have many specific tender points in the body.


Specific diagnostic points have become the primary diagnostic factor for FM. A patient must have at least 11 of 18 tender points at specific locations. The tender points assist physicians to differentiate FM from CFS. (See chart for points.) Tender points are located over muscles and end insertions, and can extend from mildly irritating to completely disabling. An increased level of muscle tissue breakdown has been suggested as one of the main reasons for aching, pain, and fatigue.


The onset of FMS can be gradual or very sudden. FM symptoms may suddenly appear, but more often appear after an illness or a traumatic, stressful episode. Traumatic experiences leave indelible memories on the brain. The memories can be played back at any time causing the body to re-experience the physical trauma and pain over again. If you suffer from post traumatic stress disorder, you have a very high serum cortisol level that causes anxiety and



Tender Pts. For Diagnosis of Fibromyalgia (Diagnostic Criteria from American College of Rheumatology)


Muscle tenderness to examination in at least 11 of 18 points when about 10 pounds of
pressure is applied to the following sites. Assessment should include each site on the
both, the right and left.

panic. If this is your problem, consult a behavior therapist for a good therapeutic approach. FM patients are more sensitive to environmental factors such as temperature and weather changes. FM has been called irritable everything and hypersensitivity syndrome. But once established, FM syndrome seems to continue although symptoms may become better or worse. FM patients never remain static. Complete remissions are rare.

Other Symptoms of Tension Myalgia of FM

  • Tension and stress – Poor posture, rapid repetitive motions, or incorrectly using your muscles to push, lift, or pull making you hold your muscles tightly when you should permit them to relax. This causes you aches, pains, and stiffness characteristic of FM. Anxiety and depression always follow. Many people with FM constantly hunch their shoulders and neck. Emotional tension or stress exacerbates FM. You think you are relaxed, but you must be reminded to loosen your shoulders. Only then are you able to relax.
  • Difficulty sleeping – Greater than 75% of FM sufferers have trouble falling asleep or awaken during the night with aching muscles. Clinical studies demonstrate FM patients have a low serotonin level, a major neurotransmitter in the brain.
  • Fatigue – Most people with FM are physically out of condition. The pain cycle, inactivity, and further deconditioning are aggravated each time you attempt something out of the ordinary. Continuously tensing your muscles can make everyday tasks painful or exhausting.
  • Sensitivity to temperature and weather changes – Often a hot shower relieves aches and pains temporarily. Cold draft or changes in barometric pressure make symptoms worse. Do not use a heating pad as you only promote inflammation and edema.
  • Sensitivity to loud noise and lights – FM sufferers report increased sensitivity to noise and bright light or sun.

FM can occur after a series of minor injuries, overuse, or abuse of muscles. This sort of micro injury occurs when numerous stresses and injuries cause the muscle to become tightened, bandlike, and painful.

Scientists in Sweden conducted several studies on patients with FM to better understand the source of the disease. Muscle morphology, chemistry, and physiology were carefully examined. The most prominent symptoms include muscle fatigue, muscle pain, and muscle stiffness. The studies found victims of the syndrome appear to have microcirculation disturbances along with mitochondrial damage and abnormally low phosphate


This strongly suggests an energy deficient state in the muscle tissues. The scientists hypothesized FM results from any condition leading to constant muscle hypoxia, specifically through

the establishment of abnormal motor patterns.

Despite many years of research and studies, the management and treatment of FM is still not adequate. Amitriptyline, a tricyclic antidepressant, has been shown to provide little longterm relief. Amitriptyline is known to have adverse side effects including myocardial infarction stroke, arrhythmia, coma, seizure, and alopecia. The long-term effects of the drug are many. Other controlled studies have tested the effects of ibuprofen and found it to be no more helpful than a placebo! Of the cross-section of conventional modalities tested on FM patients, all have yielded unsatisfactory results.

Recent research indicates that FM patients may be deficient in certain compounds required for the synthesis of adenosine triphosphate (ATP). ATP synthesis requires the presence of magnesium, oxygen, substrate, ADP, and phosphate. Optimal concentrations of each of these allow healthy mitochondrial respiration and the concomitant production of biological entry.

Deficiencies conversely can seriously slow the Krebs cycle and increase anaerobic glycolysis, increase lactic acid formation causing a reduction of maximum V02. This combination of factors clearly leads to the symptoms of depression, fatigue, muscle pain, and anxiety. Chronic anxiety sufferers have high lactic acid levels.

One of the most crucial elements for ATP synthesis is magnesium. Recent research suggests FM patients have below normal levels of magnesium. Mitochondrial uptake and accumulation of magnesium are directly related to the uptake of phosphate required for ADP phosphorylation. The entire Krebs cycle is a magnesium dependent mechanism, and even a slight deficiency hinders its optimal function. Other problems related to magnesium deficiency include increased permeability, mitochondrial swelling, decreased selectivity of mitochondrial inner membrane, uncoupling of oxidative phosphorylation, and possibly, aluminum toxicity.