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For millions suffering from Fibromyalgia Syndrome, diagnosis and effective treatment have been elusive, until now

For millions suffering from Fibromyalgia Syndrome, diagnosis and effective treatment have been elusive, until now

June 03, 2002

When Wendy Radonivich-Crum was a young college student, some 12 years ago, she began having headaches. Some were migraine and some were those constant nagging headaches that wouldn't go away.

"Then I woke up one morning with equilibrium problems. The doctors couldn't figure out what the problem was. They took an MRI and found some weird stuff there, and thought it might be MS [multiple sclerosis] because there were a couple of suspicious spots. That's how my problem was first classified."

Inconclusiveness is not uncommon on the path to a diagnosis of fibromyalgia by excluding other conditions with similar symptoms.

Now an occupational therapist working in the Fibromyalgia Therapy Program at Total Rehab Care, a department of the Washington County Hospital, Radonivich-Crum's personal experience with FMS makes her a particularly effective therapist.

When the disorder first struck, Radonivich-Crum kept getting worse.

"I kept having equilibrium problems, kept having the headaches, started getting leg weakness and tremors in my muscles when I worked for too long or did too much. My speech started to slur and I sometimes had word-finding problems when I got tired."

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For the next five years, Radonivich-Crum continued to suffer with worsening symptoms. When her insurance changed, she started going to a different neurologist who found that her neurological test results weren't consistent with the MS diagnosis. She was referred to another specialist, this time at the Cleveland Clinic in Ohio. After more testing, doctors ruled out MS.

"At that point I was using an electric scooter to get around and used a cane to walk," Radonivich-Crum said. "Eventually, I was so bad off that I would come home from work and wouldn't be able to get out of the car; my husband would have to help me out and walk me in. He would have to help me shower. I really had no social life.

"I would work, come home, and go right to bed. My jaw was so sore that I couldn't eat regular meals and I ended up drinking milkshakes with a straw. I lost a lot of weight.

"As my symptoms got worse I had to drop to a 30-hour work week and finally I couldn't do the 30, lost my benefits and had to go out under disability in 1995."

This is the all-too-familiar experience of people some doctors have called malingerers as they tried to describe what was happening to them.

When someone at the Cleveland Clinic suggested she might have fibromyalgia, Radonivich-Crum did her own research on fibromyalgia.

"I found, happily, that fibromyalgia can be treated and managed."

Her treatment consisted of exercise and low doses of antidepressant medication.

"Exercise is the hardest piece of the treatment for fibromyalgia because it's so painful, but it's the most important piece," Wendy said.

Now, with the right medications and exercise, she says she has regained her life.

What is Fibromyalgia?

Fibromyalgia, or Fibromyalgia Syndrome (FMS), according to the American College of Rheumatology, affects from 3 to 6 million Americans, 80 percent of whom are women. Symptoms are long-lasting and include chronic pain, stiffness, and tenderness in muscles, joints, and tendons.

Unlike similar muscle and joint pain disorders, fibromyalgia pain occurs without swelling. Specific trigger points at joints are particularly sensitive and diagnosis of FMS is based partially on sensitivity at these points.

Some patients show a history of a traumatic or stressful event just before symptoms of FMS started.

Dr. Nathan Wei, a rheumatologist in Frederick, Md. and clinical director of the Arthritis and Osteoporosis Center of Maryland, says because there are so many other possible causes of the same symptoms, diagnosis is done by exclusion only after all other explanations are ruled out.

The criteria for FMS also must be satisfied and medical history is considered before FMS is considered the most likely diagnosis.

Typically, patients with FMS usually report other symptoms in addition to chronic pain of fibromyalgia. Sleep disruption, chronic fatigue, restless leg syndrome, migraine headaches, irritable bowels, depression, post-traumatic stress syndrome, and Persian Gulf syndrome are often reported by FMS sufferers.

But a new concept in medicine, "disease spectrum," suggests that certain disorders that occur together may have a cluster of co-existing symptoms and may have a common cause.

Dr. Wei said that FMS seems to fall in that category. There is no hard evidence that these disorders share the same cause, but since they often occur together (they are comorbid) or have similar symptoms, some physicians and medical researchers are looking for connections.

Treatment

Dr. Wei typically recommends three modalities of treatment for people suffering with FMS:

n Exercise:

Non-impact aerobic exercise serves to increase the body's own pain-fighting endorphins and reduces norepinepherine, while improving muscle tone.

n Medications:

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