BS Foad, M.D  2010

What is Fibromyalgia? FMS
Is a syndrome of chronic pain and fatigue. It is chronic (lasts for years) but does not cause crippling or deformities.

What are the symptoms of FMS
1-Aching all over
2-Fatigue: “I wake up tired as I never slept”
3-Sometimes there is numbness or tingling
4-Sometimes there is a sense of swollen joints
5-The aching is worse with stress and weather changes and when sleep is disturbed

What are the signs of Fibromyalgia on Examination?
1-Tenderness in trigger points at specific locations like the shoulder blade areas, lower
    Back and hips, elbows, knees and sternum
2-Though joints may be painful, yet there is no swelling and range of motion is not
3-No skin rash or involvement of other organs in the body

Is there a diagnostic test for Fibromyalgia?
No, there is no diagnostic test. The diagnosis depends on the patient’s history and exam. Tests are done to rule out other types of Arthritis or other medical problems.
There is no X-ray diagnostic test and no diagnostic lab. test for Fibromyalgia

What is the cause of Fibromyalgia?
We do not know. There are several theories, none has been proven.
-FMS may relate to abnormalities in pain receptors related to Serotonin or
-FMS may relate to abnormal pain pathway or exaggerated pain response
-FMS may in some cases be associated with depression. In most cases depression is
  A reaction to the pain and inability to pursue activity
-FMS may be associated in some cases with Arthritis or connective tissue diseases
-FMS may relate to sleep abnormality

What to do if you have Fibromyalgia?
1-Proper diagnosis is needed by a Rheumatologist. The specialist will take a history
   And examine the patient and get appropriate tests to verify the diagnosis and to
   Rule out other possibilities or aggravating factors.
2-Then a plan of treatment will be developed that involves several aspects. There
    Is no one drug treatment that will help every patient.
   *Exercise is crucial in FMS. Range of motion exercises are necessary to stretch
    Muscles that have contracted (became short) because of pain and not being used
   *Aerobic exercise is necessary to combat the fatigue that is common with FMS
   *If sleep is disturbed then medications to relax the muscles and improve sleep
    Become useful. Such medications include Fexeril (Cyclobenzaprine) given at
  Bed time, or Tricyclic Anti-depressants like Elavil (Amitryptiline), Pamelor
  (Nortryptiline) or similar drugs
 *Anti-Inflammatory medications like Motrin (Ibuprofen), Naprosyn (Naproxen),
   Mobic (Meloxicam), Celebrex (Celecoxib), Voltaren (Diclofenac) etc. will
   Take the edge of the pain off, but cannot relieve the pain of FMS completely.
   This what disspoints many patients who wrongly assume that a medication
    Will relieve their pain.

  • Pain medications obviously help but carry with them the danger of becoming

Dependant on such medication and of drug addiction. Therefore, in FMS it is
Important to use pain medications sparingly and only for short periods of time

  • Lyrica and Savella are 2 new medications approved for FMS. They work on the

Pain receptors. They help some patients, but not all patients. The problem is
The occurrence of side effects like headache, dizziness, weight gain and
 *Another drug that may help patients with FMS who also have depression and
   Chronic pain is Pristic
*Injection of trigger points help relieve the pain in many patients with FMS. Pain
  Relief usually lasts for 6-8 weeks. Some patients experience pain after the injection
  For 1-2 days. The injection help by relieving pain referred from these trigger points
*Physical therapy is necessary for patients who have limited range of motion, and or
 Suffer from muscle weakness and fatigue.
*Taking care of any associated Arthritis or other medical problems
*Follow up is important to make sure that pain is adequately controlled and that no
  Side effects from medications did occur, and that the patient understands the goals
  Of treatment and that medications are reduced if possible and that exercise program is maintained.




Osteoporosis means you have less calcium in your bones, and your bones are structurally weak, and thus, prone to fracture. Osteoporosis is common, especially in women past menopause and in patients taking cortisone. A family history of fracture or osteoporosis in a mother or sister indicates an increased risk. It is important to make the diagnosis of Osteoporosis early, and to start treatment as soon as possible to avoid fractures. Do not wait until a fracture occurs because many complications can develop.

  • Once a vertebral fracture occurs, the risk of other fractures increases
  • Many patients become disabled after a fracture and lose their independence
  • Fractures also increase the risk of death

The best way of diagnosing osteoporosis is by using a Dexa scan (bone density scan). This test measures the calcium content in the bones of the back and hip. Common indications for having a Dexa scan include:

  • Women post menopause with risk factors
  • Persons over the age of 65
  • Patients who are on Cortisone
  • A History of fracture