Fibromyalgia is a syndrome characterized by muscle pain, sleep disturbance, and fatigue. The pain consists of generalyzed, widespread pain associated with pain experienced in certain precise locations called tender points. It is categorized as primary or secondary. Primary fibromyalgia is more common, easier to treat, and its cause is not known. Secondary fibromyalgia may follow physical injury, surgery, lyme disease and hepatitis C. Prevalence of fibromyalgia is around 3.4 percent for women and 0.5 percent for men.

The widespread pain is continuous and exhausting. It is often more intense after stress and disturbed sleep. It is associated with extreme, chronic fatigue, which some patients report as more debilitating than the pain.

Tender points reveal areas of severe tenderness on palpation but without the classic inflammatory signs of redness, swelling and heat in the joints and soft tissue. Tender points occur specifically in areas where the muscles attach to bone or ligament. There are 18 sites that are characteristic for fibromyalgia. (See picture).To be classified with a definitive diagnosis of fibromyalgia, the patient must have tenderness on palpation at 11 of the 18 sites. The number and location of tender points may change over time.

Patients with fibromyalgia often have one or more co-morbid conditions: Migraine headache, irritable bowel syndrome, depression, menstrual cramps, restless legs syndrome, paresthesias of hands and feet, temporomandibular joint syndrome, and myofascial pain syndrome. Along with myofascial pain syndrome, the most common of these are migraine headache, irritable bowel syndrome and a history of depression.

Myofascial pain syndrome may be confused with fibromyalgia. To complicate the situation, myofascial pain syndrome may occur in patients with fibromyalgia. Myofascial pain syndrome is defferentiated by the presence of trigger points and absence of widespread pain and fatigue. Unfortunately, location alone does not differentiate between trigger points and tender points because they often occur in similar locations. Distinguishing between trigger points and tender points depends on characteristic findings associated with trigger points that are found on physical examination. Trigger points are located within taut bands of muscle. Palpation of trigger points often can elicit a jump and a twitch in the muscle. Lastly, trigger points often have a lump described as similar to a pencil eraser, whereas tender points have no palpatory characteristics distinguishing them from surrounding tissue.

Treatment of fibromyalgia is largely empiric. Some frequently used approaches include: antidepressants (Tricyclic and SSRI's), aerobic and strength training exercise, physical therapy and biofeedback, cognitive- behavioral therapy, and acupuncture