eMedicine

Although children and adults with fibromyalgia syndrome experience similar symptoms, children seem to experience more sleep disturbances and fewer tender points than adults. Other associated symptoms include chronic headaches, soft tissue swelling, tension, and anxiety.

Some investigators believe that a successful rehabilitation program involves a multidisciplinary team of professionals and various modalities individualized for each patient. The team includes the physician, a medical psychologist, physical and massage therapists, and an exercise physiologist. These professionals should have expertise in the treatment of soft tissue disorders.

At a clinical level, fibromyalgia is much more than widespread pain. Substantial overlap exists in major depressive disorder, various anxiety disorders, and chronic fatigue syndrome and in multiple regional pain syndromes, such as headache, atypical chest pain (chest pain with normal cardiac evaluation findings), irritable bowel syndrome, chronic pelvic pain, temporomandibular joint pain (jaw pain with no underlying pathologic condition), and others. Indeed, the diagnostic label attached to a patient may be determined largely by the first specialist that he or she sees. For example, a rheumatologist might diagnosis fibromyalgia, whereas a gastroenterologist would diagnose irritable bowel syndrome.

Fibromyalgia, in many cases, presents as a form of allodynia, in which usually painless stimuli are perceived as painful, and hyperalgesia, in which normally painful stimuli is amplified. Cerebrospinal fluid levels of substance P are elevated, and additional abnormalities in the serotonin system and in the regulation of cortisol exist. Fibromyalgia can also coexist with various autoimmune diseases and often presents after a severe flulike syndrome, a defined infection (eg, Lyme disease), or trauma. Sleep is often disturbed, and nonrestorative sleep is associated with increased pain. The increased prevalence in females may point to a hormonal influence. Few abnormalities occur in the peripheral musculature. Studies that show abnormalities of cerebral blood flow in the thalamus and caudate nucleus help support the likelihood that pain processing in the central nervous system behaves abnormally.