From WOMEN'S DAY MAGAZINE, February 20, 1996. Page 48

Your Health:  Ache All Over? Suspect Fibromyalgia 
       by Marie Savard, M.D.
       
	Don't feel bad if you don't know what fibromyalgia is.  This
painful muscle and joint affliction is neither new nor rare, but I
can't think of a medical problem that is more ignored and
misunderstood.  Some doctors don't even believe it exists.
	That's hard for me to believe when I see women who have suffered
for months, even years, with fatigue, sleep disturbances and stiff,
painful muscles all over their bodies.  Fibromyalgia is thought to
affect 3 to 5 million Americans, at least 80 percent of them women.
Unfortunately we don't know the cause and cannot offer any way to
prevent or cure it.  But new treatments are making things better.

DO YOU HAVE IT?
	Most women with fibromyalgia ache all over, often particularly
in the mornings.  It's also common to feel unusually tired, yet
sleep poorly.  Some sufferers also have irritable bowel syndrome,
migraine headaches or Raynaud's syndrome (loss of circulation in the
cold, causing painful white fingertips).  People who have had Lyme
disease may develop fibromyalgia, but most experts doubt the
connection.
	If you think you may have fibromyalgia, you _must_ see a doctor
who knows it well.  If she's not familiar with it, get a referral to
a rheumatologist (a doctor who treats muscle, joint and
connective-tissue problems) or a fibromyalgia specialist.
	Make an appointment for a thorough physical exam, including a
complete medical history.  Include your psychologic history, since
emotional trauma, abuse or other stress factors can trigger
fibromyalgia, and mention any episodes of depression.  Your doctor
should examine you to rule out other diseases such as arthritis.  If
Lyme disease is suspected, get a blood test before you take
antibiotics, even if you have had Lyme disease in the past.  Blood
tests can also exclude other conditions such as thyroid disorder or
connective-tissue problems.
	The most important part of your exam is having the doctor feel
for tender points in the muscles and around the joints.  If you have
fibromyalgia, you will feel widespread pain when the doctor presses
you around the neck, shoulders, upper arms, chest, lower back, hips,
knees and elbows.  You do not need X-rays to confirm a diagnosis.

FEELING BETTER
	MEDICATIONS.  Here's some encouragement.  Many doctors have
started prescribing very low doses of three antidepressants,
nortriiptyline (Pamelor, Aventyl), amitriptyline (Elavil, Amitril)
and fluoxetine (Prozac).  At these levels, far below what is used to
treat depression, the three drugs relieve the sleep disturbances,
fatigue and muscle aches of fibromyalgia.  A combination of
amitriptyline and fluoxetine may work even better.  Some women see
dramatic changes within days.  These drugs are not typically
habit-forming but may cause constipation and dry mouth.  We aren't
sure how well this new treatment will work over the long haul.
Another antidepressant, cyclobenzaprine (Flexeril), also at low
doses, works for some people as a muscle relaxant.
	Over-the-counter painkillers such as aspirin, acetaminophen
(Tylenol), ibuprofen (Advil) and naproxen (Aleve) offer temporary
relief, but they don't solve the long-term problem and you may build
up a tolerance.  Acupuncture is another option that has helped some
of my patients.  A local injected anesthetic (a trigger-point
injection) will numb a very painful area, but this should _not_
become a habit.  And I don't recommend prescription tranquilizers or
narcotic painkillers such as codeine--they are addicting and don't
work over the long term.
	EXERCISE.  Regular, mild movement can help improve circulation
to sore tissues.  Try low-impact exercises, such as walking or
swimming in a heated pool.  If the pain gets worse, stop the
activity and talk to your doctor.  Stretching exercises also can be
helpful.  Work with a physical therapist (insurance may pay for it)
to set up a safe and effective program.
	STRESS RELIEF.  You may improve if you can find ways to relax,
such as biofeedback, yoga or meditation.  Some women benefit from
talking to a psychotherapist about their stress.  _Any_ changes you
can make to reduce stress and fatigue can help, though that's not
always easy.  The biggest stress may be having a condition that many
people don't understand or don't take seriously because you don't
_look_ sick.
	Tell your primary-care doctor that you have fibromyalgia and
make sure she works closely with any specialists who treat you.  If
treatments aren't working or if new symptoms develop, tell your
doctors.  Your fibromyalgia probably won't disappear, but you can
learn to live with it.

--Dr.  Savard is director of the Center for Women's Health at
Medical College of Pennsylvania Hospital.

Additional Information (page 148 in the same magazine)
The Fibromyalgia Network (P.O.  Box 31750, Tucson, AZ 85751;
800-853-2929), a self-help organization, publishes a newsletter
covering the latest medical research and sharing advice.
Subscribers can get a list of support groups in the U.S.  and Canada
and the names of doctors in their area who treat fibromyalgia.  The
Arthritis Foundation (800-283-7800) offers a free brochure on the
condition.