It's difficult to diagnose. X-rays and routine blood work show no abnormalities.
"It's really a diagnosis of exclusion," Malamet says.
There is one thing that separates fibromyalgia from other conditions - "tender points." A careful examination of the muscles will reveal very tender areas at as many as 18 specific locations. A diagnosis of fibromyalgia usually includes pain in at least 11 of the tender points.
Renner's fibromyalgia diagnosis came in August of 1995 after months of wondering why she was experiencing extreme fatigue. Although she always needed her "eight hours," she was tired despite two-hour naps in the daytime and still was falling asleep at 9 p.m. Blood work came back slightly abnormal, and her doctor - leaning toward a diagnosis of lupus - was ready to prescribe steroids.
"It's very frustrating," said Renner, 44, a resident of Rohrersville.
The cause of fibromyalgia is not known. There is no known cure. But there are ways of coping.
"Education is essential," Malamet says.
A self-help course is being offered in Hagerstown from 6 to 8:30 p.m. Wednesdays beginning March 12 at the Hagerstown Police station on Burhans Boulevard. The class is sponsored by Arthritis Foundation and will be co-taught by Jennifer Robertson, a physical therapy assistant, and Virginia Powers, a Hagerstown resident who has fibromyalgia. The $30 fee includes a manual.
The course helps its participants learn to cope with fibromyalgia. It covers setting goals, exercise, relaxation, pain management, energy conservation, doctor-patient communication and issues of self-esteem.
People with fibromyalgia often feel like no one is listening to them, Robertson says.
There is a waiting list for the class. The course will be offered in the Frederick area later in the spring.
Exercise, physical therapy
Exercise can help. Renner spends 45 minutes a day, seven days a week doing aerobics to three videos she owns.
"The more I do it, the better I feel," she says.
Susan Bryant of Middletown, Md., 53, was diagnosed with fibromyalgia seven years ago. "Even the seams of my jeans hurt my legs," she says. Low-impact aerobics have helped her. It's frustrating, she says, and it took a long time to build up to the 18 minutes of exercise that helps her. She started off with one or two minutes on a ski machine, adding one or two minutes a week.
Physical therapists can help design exercise programs for people with fibromyalgia, helping to improve posture and fitness. They also teach self-managment techniques, including relaxation and ways to improve sleep, and may recommend treatments such as heat, ice, massage and biofeedback to help control pain.
Narcotic drugs have been shown to be ineffective for treatment of fibromyalgia, and because of their side effects, should be avoided, according to the Arthritis Foundation. Anti-inflammatory medications such as aspirin, acetaminophen or ibuprofin may provide some pain relief and reduce stiffness.
Low doses of anti-depressants are sometimes prescribed - not for depression - but to help with sleep, Malamet says.
Support groups can be helpful. Because the syndrome doesn't show - you can't tell a person has it by looking at them - it's difficult for family members, friends and co-workers to understand how the person with fibromyalgia feels.
"You feel like you're losing your mind," says Powers, who was diagnosed in November of 1995.
Susan Chamblin leads a local Fibromyalgia/ Chronic Fatigue Syndrome support group. She says about 35 people have been attending the monthly meetings since the group began in September.