You hurt all over, and you frequently feel exhausted. Even after numerous tests, your doctor can't seem to find anything specifically wrong with you. If this sounds familiar, you may have fibromyalgia.

Fibromyalgia is a chronic condition characterized by fatigue, widespread pain in your muscles, ligaments and tendons, and multiple tender points �?places on your body where slight pressure causes pain. Fibromyalgia is more common in women than in men. Previously, the condition was known by other names such as fibrositis, chronic muscle pain syndrome, psychogenic rheumatism and tension myalgias.

Signs and symptoms

Signs and symptoms of fibromyalgia can vary, depending on the weather, stress, physical activity or even the time of day. Common signs and symptoms include:

• Widespread pain. Fibromyalgia is characterized by pain in specific areas of your body when pressure is applied, including the back of your head, upper back and neck, upper chest, elbows, hips and knees. The pain generally persists for months at a time and is often accompanied by stiffness.
• Fatigue and sleep disturbances. People with fibromyalgia often wake up tired and unrefreshed even though they seem to get plenty of sleep. Some studies suggest that this sleep problem is the result of a sleep disorder called alpha wave interrupted sleep pattern, a condition in which deep sleep is frequently interrupted by bursts of brain activity similar to wakefulness. So people with fibromyalgia miss the deep restorative stage of sleep. Nighttime muscle spasms in your legs and restless legs syndrome also may be associated with fibromyalgia.
• Irritable bowel syndrome (IBS). The constipation, diarrhea, abdominal pain and bloating associated with IBS are common in people with fibromyalgia.
• Headaches and facial pain. Many people who have fibromyalgia also have headaches and facial pain that may be related to tenderness or stiffness in their neck and shoulders. Temporomandibular joint (TMJ) dysfunction, which affects the jaw joints and surrounding muscles, is also common in people with fibromyalgia.
• Heightened sensitivity. It's common for people with fibromyalgia to report being sensitive to odors, noises, bright lights and touch.

Other common signs and symptoms include:

• Depression
• Numbness or tingling sensations in the hands and feet (paresthesia)
• Difficulty concentrating
• Mood changes
• Chest pain
• Irritable bladder
• Dry eyes, skin and mouth
• Painful menstrual periods
• Dizziness
• Anxiety

Causes

The specific cause of fibromyalgia is unknown. However, doctors believe a number of factors may contribute. These factors may include:

• Chemical changes in the brain. Some people with fibromyalgia appear to have alterations in the regulation of certain brain chemicals called neurotransmitters. This may be particularly true of serotonin �?which is linked to depression, migraines and gastrointestinal distress �?and substance P, a brain chemical associated with pain, stress and anxiety, as well as depression.
• Sleep disturbances. Some researchers theorize that disturbed sleep patterns may be a cause rather than just a symptom of fibromyalgia.
• Injury. An injury or trauma, particularly in the upper spinal region, may trigger the development of fibromyalgia in some people. An injury may affect your central nervous system, which may trigger fibromyalgia.
• Infection. Some researchers believe that a viral or bacterial infection may trigger fibromyalgia.
• Abnormalities of the autonomic (sympathetic) nervous system. Your autonomic nervous system is divided into the sympathetic and parasympathetic systems. Your sympathetic nervous system releases norepinephrine and influences the release of epinephrine from the adrenal gland. The sympathetic nervous system also controls bodily functions that you don't consciously control, such as heart rate, blood vessel contraction, sweating, salivary flow and intestinal movements.
• Changes in muscle metabolism. For example, deconditioning and decreased blood flow may contribute to decreased strength and fatigue. Differences in metabolism and abnormalities in the hormonal substance that influences the activity of nerves (neuroendocrine) may play a role.

Psychological stress and hormonal changes also may be possible causes of fibromyalgia.

Risk factors

Risk factors for fibromyalgia include:

• Sex. Fibromyalgia occurs more often in women than in men.
• Age. Fibromyalgia tends to develop during early and middle adulthood. But it can also occur in children and elderly adults.
• Disturbed sleep patterns. It's unclear whether sleeping difficulties are a cause or a result of fibromyalgia �?people with sleep disorders, such as nighttime muscle spasms in the legs, restless legs syndrome or sleep apnea, can also develop fibromyalgia.
• Family history. You may be more likely to develop fibromyalgia if a relative also has the condition.
• Rheumatic disease. If you have a rheumatic disease, such as rheumatoid arthritis, lupus or ankylosing spondylitis, you may be more likely to have fibromyalgia.

When to seek medical advice

See your doctor if you experience general aching or widespread pain that lasts several months and is accompanied by fatigue. Many of the symptoms of fibromyalgia mimic those of other diseases, such as low thyroid hormone production (hypothyroidism), polymyalgia rheumatica, neuropathies, lupus, multiple sclerosis and rheumatoid arthritis. Your doctor can help determine if one of these other conditions may be causing your symptoms.

Screening and diagnosis

Diagnosing fibromyalgia is difficult because there isn't a single, specific diagnostic laboratory test. In fact, before receiving a diagnosis of fibromyalgia, you may go through several medical tests, such as blood tests and X-rays, only to have the results come back normal. Although these tests may rule out other conditions, such as rheumatoid arthritis, lupus and multiple sclerosis, they can't confirm fibromyalgia.

The American College of Rheumatology has established general classification guidelines for fibromyalgia, to help in the assessment and study of the condition. According to these guidelines, to be diagnosed with fibromyalgia you must have experienced widespread aching pain for at least three months and have a minimum of 11 locations on your body that are abnormally tender under relatively mild, firm pressure. In addition to taking your medical history, a doctor checking for fibromyalgia will press firmly on specific points on your head, upper body and certain joints so that you can confirm which cause pain.

Not all doctors agree with these guidelines. Some believe that the criteria are too rigid and that you can have fibromyalgia even if you don't meet the required number of tender points. Others question how reliable and valid tender points are as a diagnostic tool.

Complications

Fibromyalgia isn't progressive and generally doesn't lead to other conditions or diseases. It can, however, cause pain, depression and lack of sleep. These problems can then interfere with your ability to work at home or on the job, or maintain close family or personal relationships. The frustration of dealing with an often-misunderstood condition also can be a complication of the condition.

Treatment

In general, treatment for fibromyalgia is with a combination of medication and self-care. The emphasis is on minimizing symptoms and improving general health.

Medications
Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:

• Analgesics. Acetaminophen (Tylenol, others) may ease the pain and stiffness caused by fibromyalgia. However, its effectiveness varies. Tramadol (Ultram) is a prescription pain reliever that may be taken with or without acetaminophen. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) �?such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen sodium (Anaprox, Aleve) �?in conjunction with other medications, but NSAIDs haven't proven to be effective in managing the pain in fibromyalgia when taken by themselves.
• Antidepressants. Your doctor may prescribe antidepressant medications, such as amitriptyline (Elavil), nortriptyline (Aventyl, Pamelor) or doxepin (Sinequan) to help promote sleep. Fluoxetine (Prozac) in combination with amitriptyline has also been found effective. Sertraline (Zoloft) and paroxetine (Paxil) can help if you're experiencing depression.
• Muscle relaxants. Taking the medication cyclobenzaprine (Flexeril) at bedtime may help treat muscle pain and spasms. Muscle relaxants are generally limited to short-term use.

Prescription sleeping pills, such as zolpidem (Ambien), may provide short-term benefits for some people with fibromyalgia, but doctors usually advise against long-term use of these drugs. These medications tend to work for only a short time, after which your body becomes resistant to their effects. Ultimately, using sleeping pills tends to create even more sleeping problems in many people.

Benzodiazepines may help relax muscles and promote sleep, but doctors often avoid these drugs in treating fibromyalgia. Benzodiazepines can become habit-forming, and they haven't been shown to provide long-term benefits.

Doctors don't usually recommend narcotics for treating fibromyalgia because of the potential for dependence and addiction. Corticosteroids, such as prednisone, haven't been shown to be effective in treating fibromyalgia.

Cognitive-behavioral therapy
Cognitive-behavioral therapy seeks to increase your belief in your own abilities and teaches you methods for dealing with stressful situations. Therapy can be provided via individual counseling, audiotapes or classes, and may help you manage your fibromyalgia.

Treatment programs
Interdisciplinary treatment programs may be effective in improving your symptoms, including relieving pain. These programs can combine a variety of treatments, such as relaxation techniques, biofeedback and receiving information about chronic pain. There isn't one combination that works best for everybody. Your doctor can create a program based on what works best for you.

Self-care

Self-care is critical in the management of fibromyalgia.

• Reduce stress. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But don't change your routine totally. People who quit work or drop all activity tend to do worse than those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation.
• Get enough sleep. Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.
• Exercise regularly. At first, exercise may increase your pain. But doing it regularly often decreases symptoms. Appropriate exercises often include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful.
• Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days.
• Maintain a healthy lifestyle. Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day.

Coping skills

Besides dealing with the pain and fatigue of fibromyalgia, you may also have to deal with the frustration of having a condition that's often misunderstood. In addition to educating yourself about fibromyalgia, you may find it helpful to provide your family, friends and co-workers with information.

It's also helpful to know that you're not alone. Organizations such as the Arthritis Foundation and the American Chronic Pain Association provide educational classes and support groups. These groups can often provide a level of help and advice that you might not find anywhere else. They can also help put you in touch with others who have had similar experiences and can understand what you're going through.

Complementary and alternative medicine

Complementary and alternative therapies for pain and stress management aren't new. Some, such as meditation and yoga, have been practiced for thousands of years. But their use has become more popular in recent years, especially with people who have chronic illnesses, such as fibromyalgia.

Several of these treatments do appear to safely relieve stress and reduce pain, and some are gaining acceptance in mainstream medicine. But many practices remain unproved because they haven't been adequately studied. Some of the more common complementary and alternative treatments promoted for pain management include:

• Chiropractic care. This treatment is based on the philosophy that restricted movement in the spine may lead to pain and reduced function. Spinal adjustment (manipulation) is one form of therapy chiropractors use to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease pain. Chiropractors manipulate the spine from different positions using varying degrees of force. Manipulation doesn't need to be forceful to be effective. Chiropractors may also use massage and stretching to relax muscles that are shortened or in spasm. Because manipulation has risks, always go to properly trained and licensed practitioners.
• Massage therapy. This is one of the oldest methods of health care still in practice. It involves use of different manipulative techniques to move your body's muscles and soft tissues. The therapy aims to improve circulation in the muscle, increasing the flow of nutrients and eliminating waste products. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body's natural painkillers. It often helps relieve stress and anxiety. Although massage is almost always safe, avoid it if you have open sores, acute inflammation or circulatory problems.
• Osteopathy. Doctors of osteopathy go through rigorous and lengthy training in academic and clinical settings, equivalent to medical doctors. They're licensed to perform many of the same therapies and procedures as conventional doctors. One area where osteopathy differs from conventional medicine �?but is similar to chiropractic medicine �?is in the use of manipulation to address joint and spinal problems.
• Acupuncture. Acupuncture is a Chinese medical system based on restoring normal balance of life forces by inserting very fine needles through the skin to various depths. According to Western theories of acupuncture, the needles cause changes in blood flow and levels of neurotransmitters in the brain and spinal cord. In a 2006 Mayo Clinic study, acupuncture significantly improved symptoms of fibromyalgia. Research on the benefits of acupressure �?a similar practice that uses finger pressure on the skin rather than needles �?is inconclusive.

Herbal muscle relaxants

Many herbs make wonderful remedies for stiff joints and aching muscles. Used as baths or compresses, herbs have been used for chronic rheumatism and other external aches and pains for centuries. Check with your doctor before using any herbs.

Horseradish, for example, is one. A native of Hungary or Russia, this perennial plant is now well established throughout the temperate zones of Europe and America. The root, which is dug in the fall, is considered a stimulant, diuretic, antiseptic, and laxative. Externally, horseradish has been used to treat chronic rheumatism, chest colds, and muscle aches and pains for many years.

To make a horseradish poultice, grate a large horseradish root, spread it ona clean cloth (linen or cheesecloth) and lay it on the painful area, with the cloth being directly against the skin, until you feel a burning sensation.

This burning sensation means that blood flow has been stimulated, and some relief will be forthcoming. Especially effective at night, just before bedtime. The same poultice will also bring relief from chest congestion. Hyssop, an evergreen herb that can grow up to 2 feet high, is a member of the mint family. Traditionally, hyssop has been used as an expectorant, stimulant, and diaphoretic. A compress of hyssop tea is considered a good antirheumatic treatment. Because hyssop contains volatile oils that are mildly antiseptic, it is considered very useful for aches and pains. Fresh hyssop
leaves, applied directly to an affected area, will help heal cuts and bruises.

A hyssop infusion can be made by using one ounce of the dried herb to 1 pint of water. Bring water to a rolling boil. Remove from the heat. Immerse 1 ounce (about 2 cups) of the dried herb in it and let it steep 15 minutes, covered. Strain and use.

Lavender, the bushy perennial with the refreshing and delightful scent, has a long history of medicinal uses. Lavender is calming and has an uplifting influence. Warm lavender tea applied as a compress can relieve a headache. In the bath water, lavender oil relaxes one, and gets rid of tension, thereby making one feel better.

A ginger bath helps to promote circulation, and has been traditionally used to treat arthritis and bursitis. Heat two pounds of fresh, grated ginger in a gallon of water until hot but do not let it boil. Let steep for 10 minutes. Strain. Pour this mixture into hot bath water and soak in it for 20 minutes or more.

To make a ginger compress to relieve pain and improve circulation use 2 quarts of water and 5 ounces of grated ginger. Make the water very hot but do not boil it. Steep for 15 minutes, strain, and apply as a compress by soaking a small towel in the tea, and then apply that to the painful are.

Another great bath for aching muscles and joints is to use a combination of 1 ounce burdock root, 1 ounce mugwort, 1 ounce comfrey leaf and 1 ounce sage.

Infuse these herbs in 1 quart of boiled water. Steep for 10 minutes. Strain. Add to bath water and soak to your hearts content.

These are just a few of the herbs one can use to alleviate common aches and pains in the least painful way.

With the advent of mosquito season, many people are feeling concern for more than just the annoying itchiness of a bite or two. Worries about West Nile Virus (and other mosquito-carried diseases) are leading many who would normally avoid excessive use of chemicals, to start spraying and slathering on insect repellents containing the chemical DEET (N,N-diethyl-m-toluamide).

But are there valid, healthier options when it comes to repelling our fine buzzing and biting friends? You bet! Some ideas for natural insect repellents fall into the category of folklore, myth and urban legends, but other natural remedies can be an effective means of protecting yourself and your loved ones from biting bugs and harsh chemicals.

Natural insect repellents tend to provide coverage for a shorter time, but their coverage is safer so you may find it worth the extra effort applying a bit more often. Most natural repellents only offer about one-tenth of the protection time found in DEET-containing products, so plan on reapplying every 30 minutes or so. Because of their shorter protection time, natural repellents are ideal for short evening outdoor activities like walking the dog, barbecuing, or watering the garden.

Don't spray or apply any insect repellents (natural or chemical) over cuts, scratches, rashes, or other open spots in the skin. Also, be sure to avoid the eye area when applying repellents.

Essential Oils as Natural Repellents

The most common (and most effective) natural insect repellents are various essential oils. Clove oil and citronella (rose geranium) are the most effective against mosquitoes, but be careful with clove oil and use it sparingly. It can be a skin irritant. Other fairly effective essential oils include lemon grass, eucalyptus, castor oil, peppermint, tea tree oil, lavender, and cedar. You can buy cedar oil in spray-on bottles at your local pet store.

It's important to remember when using essential oils that you shouldn't use them internally! They need to be used externally on your skin and garments. Be sure to test any oils on a small patch of skin before applying widely to your body to avoid allergic reactions or skin irritations.

You can make your own insect repellent sprays by combining rubbing alcohol (or witch hazel, vodka, or olive oil) with one of the listed essential oils (about 10-to-1, alcohol-to-oil ratio). Shake well before each use.

To make a lotion, use two ounces of distilled water, two ounces of olive oil, and about 120 drops essential oil. Put the water into a deep mixing bowl, and using a wire whip, begin beating quickly while slowly drizzling in the olive oil. After oil is mixed into the distilled water, stir in the essential oil of your choice (citronella is probably the most effective for insect repellent use).

You can also add a few drops of your choice of insect-repelling essential oils to your shampoo or liquid soap to help counteract the perfumes in these products.

Keep in mind that clothing rubbing on your skin, natural evaporation, your skin's natural ability to absorb anything applied to it, sweat or rain washing off the repellent, and a windy environment reduces the effectiveness of all insect repellents.

Some folks claim that garlic is an effective insect repellent, but I think it works best for repelling friends (and maybe a vampire or two).