In addition to pain and fatigue, a number of allied symptoms/syndromes are currently associated with FMS. Patients typically experience one or more of the following:
Stiffness: Body stiffness may be particularly apparent upon awakening and after prolonged periods of sitting or standing in one position or coincide with changes in temperature or relative humidity.
Increased Headaches Or Facial Pain: Fibromyalgia patients may experience frequent migraine, tension, or vascular headaches. Pain may also consist of referred pain to the temporal area (temples) or behind the eyes. Approximately one-third of patients with fibromyalgia are thought to have pain and dysfunction of the temporomandibular joint, or TMJ, (located where the jaw meets the ear) which produces not only headaches but also jaw and facial pain.
Sleep Disturbances: Despite sufficient amounts of sleep, FMS patients may awaken feeling unrefreshed, as if they have barely slept. Alternatively, they may have trouble falling asleep or staying asleep. Some also suffer from the condition, sleep apnea. The reasons for the non-restorative sleep and other sleep difficulties of fibromyalgia are unknown. However, early FMS research in sleep labs documented disruptions in the deep (delta) sleep of some fibromyalgia patients.
Gastrointestinal Complaints: Digestive disturbances, abdominal pain, and bloating are quite common in FMS as are constipation and/or diarrhea (also known as "irritable bowel syndrome" or IBS). In addition, patients may have difficulty swallowing food which research suggests is a result of objective abnormalities in smooth muscle functioning in the esophagus.
Genito-Urinary Problems: FMS patients may experience increased frequency of urination or increased urgency to urinate, typically in the absence of a bladder infection. Some may develop a more chronic, painful inflammatory condition of the bladder wall known as "interstitial cystitis" (IC). Women with FMS may have more painful menstrual periods or experience worsening of their FMS symptoms during this time. Conditions such as vulvar vestibulitis or vulvodynia, characterized by a painful vulvar region and painful sexual intercourse, may also develop in women.
Paresthesia: Numbness or tingling, particularly, in the hands or feet, sometimes accompanies FMS. Also known as "paresthesia", the sensation can be described as prickling or burning.
Temperature Sensitivity: Persons with fibromyalgia tend to be highly sensitive to ambient temperature. Some often feel abnormally cold (compared to others around them) while others feel abnormally warm. An unusual sensitivity to cold in the hands and/or feet, accompanied by color changes in the skin, sometimes occurs in persons with fibromyalgia. This condition is known as "Raynaud’s Phenomenon".
Skin Complaints: Nagging symptoms, such as itchy, dry, or blotchy skin, may accompany FMS. Dryness of the eyes and mouth is also not uncommon. Additionally, fibromyalgia patients may experience a sensation of swelling, particularly in extremities, like fingers. A common complaint is that a ring no longer fits on a finger. Such swelling, however, is not equivalent to the joint inflammation of arthritis; rather, it is a localized anomaly of FMS whose cause is currently unknown.
Chest Symptoms: Individuals with fibromyalgia who engage in activities involving continuous, forward body posture (i.e., typing, sitting at a desk, etc.) often have special problems with chest and upper body pain known as "thoracic pain and dysfunction".3 Often accompanying the pain is shallow breathing and postural problems. Patients may also develop a condition called "costochondralgia" which involves muscle pain where the ribs meet the chest bone. Such conditions may mimic heart disease and are therefore sometimes misdiagnosed. (Note: Anyone experiencing chest pain should always consult a physician immediately. Remember that persons with fibromyalgia can have other health problems!) Persons with fibromyalgia are also prone to a largely asymptomatic heart condition known as mitral valve prolapse (MVP) in which one of the valves of the heart bulges during a heartbeat causing a click or murmur. MVP usually does not cause much concern in FMS patients unless another cardiac condition is also present.
Dysequilibrium: FMS patients may be troubled by light-headedness and/or balance problems which manifest themselves in a number of ways. Since fibromyalgia is thought to affect the skeletal tracking muscles of the eyes, nausea or "visual confusion" may be experienced when driving a car, reading a book, or otherwise tracking objects. (Difficulties with smooth muscles in the eye may also cause additional problems with focus.) Weak muscles and/or trigger points in the neck or TMJ problems in the jaw may also cause dizziness or dysequilibrium. Researchers at Johns Hopkins Medical Center have also shown that some FMS patients have a condition known as "neurally mediated hypotension" which causes a drop in blood pressure and heart rate upon standing with resulting light-headedness, nausea, and difficulty thinking clearly.
Cognitive Disorders: Persons with FMS report a number of cognitive symptoms which tend to vary from day to day. These include difficulty concentrating, "spaciness," short-term memory lapses, and being overwhelmed easily. Many fibromyalgia patients refer to such symptoms as "fibro-fog".
Leg Sensations: Some FMS patients may develop a neurologic disorder known as "restless legs syndrome" (RLS) which involves an irresistible urge to move the legs particularly when at rest or when lying down. One recent study reported that 31% of the fibromyalgia patients studied had RLS.6 The syndrome may also involve periodic limb movements during sleep (PLMS) which can be very disruptive to both the patient and to his/her sleeping partner.
Environmental Sensitivity: Hypersensitivity to light, noise, odors, and weather patterns is common and is usually explained as being a result of the hypervigilance seen in the nervous systems of patients with FMS. Neurogenic inflammation, a discrete, localized inflammatory response which does not activate the immune response or show up in tests, seems to play a part in the itching and rashes seen in FMS. Allergic-like reactions to a variety of substances (i.e., medications, chemicals, food additives, pollutants, etc.) are common, and patients may also experience a form of non-allergic rhinitis consisting of nasal congestion/discharge and sinus pain, but in the absence of the immunologic reactions which the body experiences in allergic conditions. Daniel Clauw, M.D., and James Baraniuk, M.D., of Georgetown University Medical Center are in the process of studying nasal and airway symptoms, as well as pain and fatigue, in patients with fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, migraine headaches, and interstitial cystitis.
Depression And Anxiety: Although FMS patients are frequently misdiagnosed with depression or anxiety disorders ("it's all in your head"), research has repeatedly shown that fibromyalgia is not a form of depression or hypochondriasis. However, where depression or anxiety exist concomitant to fibromyalgia, their treatment is important as both can exacerbate FMS and interfere with successful symptom management.
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