Diagnosis of exclusion

April 05, 2004|by KATE COLEMAN

On Saturday, April 17, there will be a conference on taking control of fibromyalgia at Robinwood Medical Center in Hagerstown.

It is designed to provide people with fibromyalgia - and their friends and families - an introduction to managing fibromyalgia and strategies for treating the condition.

Educating people is the focus, said the conference's keynote speaker, Dr. Mara Vucich.

With no visible symptoms accompanying fibromyalgia and its cause unknown, diagnoses have been greeted by doubt in the past - sometimes by health-care professionals.

"There are still some physicians that are skeptical that this disease truly exists," said Vucich, an osteopathic physician in practice with Physical Medicine Specialists of Hagerstown.


The word fibromyalgia means muscle, ligament and tendon pain. The condition is difficult to diagnose. There is no laboratory test or X-ray that identifies fibromyalgia, a condition that is estimated to affect 3.7 million Americans - more women than men - according to the Arthritis Foundation.

A diagnosis of fibromyalgia is a diagnosis of exclusion, said Wendy Radonovich-Crum, licensed occupational therapist at Total Rehab Care at Robinwood Medical Center.

Other conditions with similar symptoms - thyroid problems and Lyme disease, rheumatoid arthritis, lupus and multiple sclerosis among them - are ruled out. In 1990, the American College of Rheumatology presented criteria for diagnosing fibromyalgia. They include pain in at least 11 of 18 "tender-point sites."

People who have fibromyalgia can look healthy, but pain is the most prominent symptom. Symptoms also may include fatigue, sleep disturbances, depression, anxiety, difficulty in concentrating, headaches, abdominal pain, bloating or alternating constipation and diarrhea, tingling limbs, jaw pain and restless leg syndrome.

There is no cure for fibromyalgia. For most people, it never completely goes away; it waxes and wanes, Vucich said.

Several medications - including antidepressants, muscle relaxants and certain analgesics - are used in treating fibromyalgia, but none were developed for the condition or even have been approved by the U.S. Food and Drug Administration for treating it, according to information on the Web site of the Arthritis Foundation at

Alternative treatments such as massage and acupuncture are showing some promise for alleviating symptoms, Vucich said.

Behavior strategies - exercise, pacing activities, relaxation techniques - are key in managing fibromyalgia.

Radonovich-Crum, lead therapist for Total Rehab Care's Fibromyalgia Therapy Program, knows the importance of exercise in managing the condition.

She's lived with it for 15 years.

She was 21 when she experienced her initial symptoms - imbalance, dizziness. She understands the difficulty of diagnosis. For five years, she thought she had multiple sclerosis.

Fatigue has been more prominent than pain for Radonovich-Crum. It was so bad in 1994, she couldn't work. But she started exercising - slowly. She kept an exercise bicycle next to her bed and would get up and ride for two or three minutes. Then she'd go back to bed.

For a year, she increased her workout, adding one minute at a time.

She got strong enough to use a cross-country ski machine, initially working only her legs, later adding her arms.

She advanced to 20-minute workouts and joined a gym.

A good cardiovascular workout three to four times a week is a goal for people who have fibromyalgia, Radonovich-Crum said.

She cited the release of endorphins - pain-relieving substances in the brain - as a benefit.

Cardiovascular exercise flushes toxins from the body, Vucich said. Strengthening and stretching exercises are good. Muscles in better shape are less likely to be fatigued, she explained.

When Radonovich-Crum was "so sick" with fibromyalgia, she and her husband decided not to have children.

After she got control of it, that changed.

Their son Alan is 15 months old. Since he arrived, Radonovich-Crum is down to two workouts per week, but she still pays attention to balancing and pacing the many aspects of her busy life.

She said she has the advantage of wonderful support from a husband and family who understand fibromyalgia.

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