Fibromyalgia – Its Many Possible Symptoms, Diagnosis via Palpation
of the Musculoskeletal Tissues (Mapping), and the Guaifenesin
Protocol
by R. Paul St. Amand, MD and Claudia Craig Marek, MA
12-01-2007 Fibromyalgia is a symptomatically progressive illness
that affects millions of people. It is manifested by many complaints
that early in the disease come and go, but later are unrelenting.
Recurrent flares eventually involve multiple body areas and systems
until patients simply cycle from bad to worse.
They are typically referred from doctor to doctor based on
individual complaints. The specialist may fail to grasp the extent
of the problem and divide the disease into categories that lead to
medical dead ends or incomplete treatments. Some of these symptom
clusters are:
Chronic fatigue,
Systemic candidiasis,
Myofascial pain,
Irritable bowel, or
Vulvar pain syndrome.
There are no diagnostic x-ray or laboratory tests to diagnose
Fibromyalgia.
The American College of Rheumatology recommends eliciting pain from
at least 11 out of 18 predetermined "tender points" to confirm the
diagnosis after a medical history is taken. Unfortunately,
individual pain perception and tenderness vary greatly. Chronic
fatigue patients have high pain thresholds and are not particularly
sensitive to finger-poking. They may feel stiff, but complain mainly
of exhaustion, muscle stiffness and cognitive impairment. The
confirmation of affected tissue is more reliably obtained by using
our method of palpation that we call mapping.
The original description of fibromyalgia as "rheumatism with hard
and tender places" has been forgotten. The tender-point exam seeks
subjective patient pain sensations and so lacks the accuracy of
objective, sequential body examinations (mapping).
We examine the musculoskeletal tissues using the pads of our fingers
to feel muscles, tendons, and ligaments.
With practice, multiple swollen places become obvious. We sketch
their location, size and degree of hardness on a caricature that
becomes our baseline for future comparisons. Hands should move as if
to iron out wrinkles in the underlying tissues. Expressions of
tenderness do not influence findings. The most important site for
confirming the diagnosis and establishing the efficacy of treatment
is the left thigh. The outside of the quadriceps muscle (Vastus
lateralis) and the front part (Rectus femoris) are involved in 100%
of adults; they clear within the first month of proper treatment.
Fibromyalgia has no set symptoms.
Various combinations from the following list can be anticipated.
(But importantly: Do not assume fibromyalgia is the cause of all
symptoms. When in doubt or confronted with new problems, please
consult your personal physician or appropriate specialist.)
Central Nervous System: Fatigue, irritability, nervousness,
depression, apathy, listlessness, impaired memory and concentration,
anxieties and even suicidal thoughts. Insomnia and frequent
awakening due to pain result in non restorative sleep.
Musculoskeletal: Swollen structures press on nerves to produce all
types of pains including stiffness. Any muscle, tendon, ligament or
fascia in the face, neck, shoulders, back, hips, knees, ankles,
feet, arms, legs and chest may be involved. Calf/foot cramps,
numbness and tingling of the face or extremities is common. Old
injured or operative sites are commonly affected. Fibromyalgia is
erroneously considered non-arthritic even though joint pain,
swelling, heat and redness occur in a large percentage of patients.
Irritable Bowel: Symptoms include nausea (usually transient,
repetitive waves), indigestion, gas, bloating, deep pain, cramps,
alternating constipation and diarrhea sometimes with mucous stools.
Genitourinary: Mostly affecting women are pungent urine, frequent
urination, bladder spasms, burning urination (dysuria) with or
without repeated bladder infections and interstitial cystitis.
Vulvodynia (vulvar pain syndrome) includes vaginal spasm, irritation
of the labia (vulvitis) or deeper (vestibulitis) that induce painful
intercourse (dyspareunia) all without the typical cottage-cheese
discharge that accompanies yeast infections. Fibromyalgia is worse
premenstrually.
Dermatological: Various rashes may appear with or without itching:
Hives, red blotches, itchy bumps or blisters, eczema, seborrheic or
neurodermatitis, and rosacea. Skin is dry and nails are brittle or
easily peel; hair is of poor quality and often falls out
prematurely. Strange sensations (paresthesias) are common such as
cold, burning (especially palms, soles and thighs), crawling,
electric vibrations, prickling, super-sensitivity to touch, and
flushing often with sweating.
Head, Eye, Ear, Nose, and Throat: Headaches (migraines), dizziness,
vertigo (spinning) or imbalance; itchy, burning and dry eyes or lids
sometimes produce morning sticky or sandy discharges; blurred
vision; hay fever or nasal congestion and post-nasal drip; painful,
burning or cut-tongue sensation, scalded mouth and abnormal tastes
(bad, metallic); intermittent low-pitched sounds or transient
ringing in the ears (tinnitus); ear and eyeball pain; sensitivity to
light, sounds and odors (perfumes or chemicals).
Miscellaneous Symptoms: Weight gain; mild fever; reduced immunity to
infection; fluid retention with morning eyelid and hand swelling
that gravitates to the legs by evening, stretches tiny tissue nerves
to produce restless leg syndrome; adult-onset asthma.
Hypoglycemia Syndrome: This is a separate entity that may affect
thirty percent of female and fifteen percent of male fibromyalgics.
Sugar craving, tremors, clamminess, anxiety, panic attacks, heart
pounding, headaches and faintness induced by hunger or by eating
sugar and starches (carbohydrates) are solid clues for diagnosis.
R. Paul St. Amand, MD
Associate Clinical Professor Medicine
Endocrinology - Harbor-UCLA
