Dear Fibromyalgia

Category: Fibromyalgia Symptoms

A detailed guide to understanding Fibromyalgia symptoms, early warning signs, and how they are diagnosed.

  • Brain fog tips and tricks

    Brain fog is a symptom of many chronic illnesses and chronic pain. Just seems that when we get ill and our bodies get fatigued or are fighting pain, or both, add in some lack of sleep… you get brain fog.

    Symptoms include:

    I listed some of them there but really there can be more. For example, transposing numbers is also transposing letters so we can spell words wrong frequently. As well as of course forgetting words and then using the wrong word. And massive concentration issues. I used to be a disorganized person. One might say I am by nature and inclination.

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    However, brain fog has made me become, to the best of my ability, an organized one. I have to be because I at times forget things I Know, so I need to have little notes of things I need to access on a daily basis for those blank-out times. It is a constant frustration to think through this fuzzy, muddled head. Not to mention the damn typo brain causing tiny errors you have to hunt down.

    There are a few tips we can keep in mind that can help out with brain fog during the day:

    Exercise

    You knew I was going to say that right? It is always on the list. But indeed it helps boost our mental clarity. Even just a 20 min walk. In fact, if you are working and you find your concentration is shot try getting up and taking a short walk around, sometimes the act of changing activities to motion and then getting back at it can stimulate the brain.

    Eat regularly and snack

    Do not skip meals. In fact, have regular snacks between meals. Snacks really help maintain your energy and you will find it helps with mental fatigue.

    Change activities or tasks

    Sometimes the act of changing what you are doing, shifting the brain from one activity to another can help clear your mind. Then go back to your task and you may find your mind more focused.

    Get sleep

    This may be difficult if you have insomnia or pain or both, but good quality sleep also helps with combating mental fatigue.

    Supplements

    I personally use B12 and Rhodiola for mental clarity and fatigue.

    Reduce stress

    Stress also can be a cause of increasing our brain fog so reducing it is beneficial. One way to help reduce it is with such things as deep breathing exercises and meditation. Even if it is just some short deep breathing exercises during the day to calm yourself down.

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    Routine is our friend

    Established routines help reduce our stress by taking away any stress associated with being flustered or in a rush. It helps maintain balance in the body. It is also beneficial to make lists and reminders to help us remember things, as again this takes stress off of us when we might have issues remembering non-routine events and appointments.

    Avoid multitasking

    It has been established in studies that the brain actually works better when we focus on one thing… I suspect a lot better for those of us with chronic illness and issues with brain fog. To avoid this inclination to multitask.

    Remember pacing

    Take breaks as needed as we can overextend ourselves and small breaks can be greatly beneficial

    Do a medication check

    There are medications that can cause mental fatigue and if it is an issue that is of concern see if it is a side effect you are dealing with and ask your doctor about it.

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  • Paresthesia and Fibromyalgia

    Paresthesia is one of the nerve symptoms of Fibromyalgia that causes the ‘pins and needles sensations, an itch, tingling, prickling, and numbness. In general, Fibromyalgia is a chronic condition, as once it starts it isn’t going away but this isn’t always the case. There can be ways to manage and reduce it at times. At least I had some luck with this but that isn’t saying much, I know, FM being the fickle beast that it is. I will explain what I went through though.

    Sensations:

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    Treatments:
    • NSAIDs or aspirin are recommended if symptoms are mild.
    • If it is more complex antidepressants have been used at low doses because they affect the perception of pain.
    • If the pain is more severe things such as codeine have been used to manage it.
    • B complex, in particular, B12. But be careful because too much B6 can actually be a Cause.
    • Acupuncture and massage have been used to reduce symptoms.
    • Ointments with capsaicin can provide relief. This actually, has been studied for FM pain beneficially.
    • Wearing loose-fitting clothing.

    I have had a bad experience with this symptom. First, I developed peripheral neuropathy in my hand. Rather spontaneously one day, I woke up with half my hand with a thick numbness which over the course of a week spread over the entire hand. It caused damage to two of the fingers mobility-wise as well. Initially, it was thought to be due to a status migraine I was in the middle of but there was a substantial debate about that so I consider it to be idiopathic since they didn’t, in fact, do any actual evidence-based tests to determine that. So I endure the glove-like numbness. The sharp prickling pain. The sharper, deeper never pain. I began to take B12 because I heard it was good for nerve pain and it reduced the prickly pain sensations that were rather problematic for me.

    Second, because I had this ‘incident’ where I developed severe Paresthesia below the waist which spread slowly and gained in intensity and eventually with a significant area of numbness. It greatly disturbed my doctor who thought it might be spinal stenosis or other related back diseases. It led to three back MRIs. And it wasn’t. it wasn’t anything definable with evidence to be seen with an MRI. It was Fibromyalgia related. Just severe. Progressively so it seemed. Until it was running down my legs. Entirely waist down. And the method of treatment for it, which no doctor recommended or thought of, but coincidentally worked for me was a lot of B12. I had been taking it with some benefit for my peripheral neuropathy and by coincidence, it helped, slowly, with this bizarre intense Paresthesia. Now granted, it very well might have been the cause of my idiopathic peripheral neuropathy and the Paresthesia for all I know and that is why the B12 worked for me. All I know is that it was freaky and I am glad it was greatly reduced. I barely have the symptom there now and the severity of it is greatly reduced, so makes me wonder if for me it was a deficiency issue. Nevertheless, not a pleasant fibromyalgia symptom to endure.

    However, I still do have symptoms of this and expect I always will. Mostly now it is the crawling itchy sensation. Generally, at night I get the same sensation I had before from the waist down but less intense. I just reduced that specific area dramatically.

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  • A Flare is one of the worst fibromyalgia experiences.

    The Flare-up (see here for my article on it) is one of the worst fibromyalgia experiences. I fell into it sometime last night and woke up with the most unpleasant pains. In the hips, shoulders, and back, not to mention all over aches. I was very fatigued yesterday and perhaps that was some prediction of impending doom.

    Here is the thing we can pace and moderate but we cannot avoid all flares. Sometimes they just occur. Sometimes they are just radically unpredictable. And we just do not know where the hell they came from. This one I have no clue what triggered it. It certainly was not something obvious like overdoing it. Things like poor sleep are a constant factor but that could certainly have done it. It wasn’t the weather.

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    And, well, I can blame stress. Because I can always blame stress. But specifically, I do not know. There is nothing that stands out. I know, usually, when it is stress-induced because it is a significant stressor. But I can say I don’t always know when it is a lack of sleep because that does fluctuate from bad to horrific.

    Nevertheless, we simply can’t avoid it. And it is Painful. I was walking around like Frankenstein’s monster. And slow, so slow.

    Medications can only do so much I suppose. Mine doesn’t do that much. They take the edge off regular FM pain which is true, but not the hyped-up Flare pain. I can’t rest when I have to work. Can’t avoid stress… when I have to work. So… I am waiting it out. And moving slowly. Tomorrow I am off and I will have a day of rest. And it will be a mellow day of relaxation and a lot of menthol creams I suspect.

    It never ceases to amaze me how FM can flare up so spontaneously from like a 4-5 level pain to a 7-8 level pain. Fast, little cause, just BAM. Overdoing it is the most prevalent cause we experience. We just cross that limit a little too far… just a smidgen. And maybe we don’t even realize it right away. Or maybe we do a little bit. With muscle fatigue and aches. Then suddenly the pain just smacks into us out of nowhere. It is sometimes hard to Know where that Line is. So it is pretty easy to cross. Especially on good pain days. Not to mention we are literally told all the freaking time to not let our pain stop us from doing things. So of course, if we do things we are going to accidentally cross those invisible lines. Hell, I cross them just doing the exercise I am supposed to do. Because exercise is painful all the time, it is hard to know when I have pushed that pain limit too far. And then when I do it is extremely painful and I can’t exercise for days after.

    So to recap… pace, moderate… but don’t stop doing activities… but don’t exceed your limits and overdo it or you will cause a flare-up. So simple, right?

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  • Lack of continuous sleep in Fibromyalgia

    Fibromyalgia has some pretty distinctive sleep disturbances associated with it not to mention comorbid sleep issues. It is one of the key factors in the syndrome… our inability to attain refreshing sleep. I wrote a post about it here. So it interests me that they have done some recent research in this area. One of the important things about our sleep dysfunction is that since it isn’t presenting like regular insomnia the treatment likewise has to be different. Lack of sleep, as we are all aware, can cause a lot of symptoms.

    So the recent Canadian study in Ontario took a look at 132 subjects (109 insomniacs and 52 without any sleep difficulties). During the two-night analysis, their sleep was recorded by polysomnography; electrodes placed on the face and scalp of the subjects enabled the researchers to look at sleep latency, the stages of sleep, sleep cycles, and duration of sleep.

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    With fibromyalgia and insomnia subjects have issues falling asleep, compared to controls and they have fragmented sleep. They have frequent night wakings. Here is specifically what they found with the differences between Primary insomnia and FM insomnia.

    • FM subjects had decreased total sleep time
    • They had slow-wave sleep
    • They had increased latency to persistent sleep
    • And wake time after sleep onset.
    • Both FM and insomniacs had short sleep duration compared to controls

    Conclusions: Increased frequency of wake and sleep tips and wake Decreased end duration, together with LPS and Increased Decreased SWS, Suggests That Sleep in FM is characterized by year Inability to Maintain continuous sleep goal and Greater sleep drive Compared with PI. Clinical Journal of Pain

    The ideal goal then is not only to get us To sleep but to maintain continuous sleep.
    There is research to suggest that the issue lies in difficulties with deep sleep interference

    ” Alpha-delta sleep is the abnormal intrusion of alpha activity (8- to 13-Hz oscillations) into the delta activity (1- to 4-Hz oscillations) That olefins slow-wave sleep. Alpha-delta sleep is Especially prevalent in fibromyalgia patients, and there is evidence Suggesting Que la Irregularities in the sleep of These patients May because of the muscle tissue and bread That characterizes the disorder. We constructed a biophysically realistic mathematical model of alpha-delta sleep. Imaging studies in fibromyalgia patients Suggesting altered levels of activity in the thalamus has motivated thalamic model as the source of alpha activity.”

    It should be noted that previous studies have also shown we have had issues with Delta deep sleep, leading to unrefreshing sleep no matter how much we get. Causing other issues as well. Although it is interesting to note they point to the thalamus as the alpha intrusion into our deep sleep.

    Now, I hardly needed a study to tell me I have difficulty falling asleep and maintaining it. It has been a long-term issue of mine since I was quite young. Not to mention pain is a factor as well. The main thing is that by researching it there can be new targets for medication. I had heard they researched a sleeping pill for people with FM. I have not heard anything since then, so maybe nothing came of it… but it was designed to keep us asleep. Maybe that is still on the go. Either way it is interesting to know primary insomnia is not quite the same as Fibromyalgia related insomnia.

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  • Brain Fog, when it isn’t just about the pain

    I have been struggling with work lately. And by lately I mean always. Always struggling to function through the pain. Always not quite doing it.

    My psychologist said well I cannot compare apples to oranges. I cannot compare myself to people doing the same job perfectly healthy. Nor to myself when I was healthy-er. And it did occur to me that this job I am now doing wouldn’t even be a challenge to me when I was younger and in less pain than now. But the pain now has eaten away at my cognitive capacity with the FM and the chronic daily migraines. Not enough space in the brain to focus on much other than tolerating the pain.

    Here is the Thing.

    The thing is I am permanently this person that is confused, befuddled, and living in a pain haze. This is who I am. No matter the job. Good days and certainly, by far, bad days.

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    And I don’t like it. I don’t want to be this person. This person frustrates the hell out of me. I just want to do my job… hell A job effectively and efficiently as possible. Hell, I want to excel at what I put my mind to, as it was before the pain became such a living force. This person is plodding. This person’s communication skills get rather tangled up. Perhaps why I love writing so much is that I don’t feel the cognitive sting so much as I do in reality. The sharp snag to the working memory, the complete lack of short-term memory, and where the hell is that long-term memory anyway. I want to get more sleep so I can shake off this infernal mental fatigue and this damn exhaustion. But I can’t because I can’t ever sleep decently and because it is a damn permanent state of affairs. Pain inhibits cognition and chronic pain therefore chronically. So I am stuck thinking through molasses forever.

    So yes, I understand completely not to compare myself to people without chronic illnesses and pain.  Or even to myself in my lesser state of pain. Never a good idea. However, I do rather trash myself because I cannot function the way I want to function. I am constantly limited and inhibited in my capacity. I am not content with the way I am functioning. I am aware of my capacity and very aware of this thick mental lag, fatigue, and sludge in the way of it. Just like I am aware of the profound difference between the ability to function on a good pain day and a bad pain day. Well a good day, still not a great day. I think we are all aware of that wall of fatigue and pain in the way of our thinking. All the little errors, glitches, and failures to communicate happen every single day.

    That is my frustration at this point. The fact that with chronic pain, migraines specifically, I seem so cognitively impaired all the time. Migraines can vary neurologically as well. Sometimes it is straight-up aphasia that impairs my capacity to communicate. Sometimes the sensory distortions make it difficult to focus on reality. Sometimes the confusional states make it difficult to comprehend things. Mostly though it is straight-up trying to just function through pain when pain is taking up all that brain capacity.

    I’m not saying there aren’t things we can do for things like brain fog and fibrofog. I wrote something up about fibrofog Here. What I am saying is it never seems like I get a break in this area no matter what I do. Likely because the pain hasn’t given me a break. I have been reading a book on cognitive abilities and it recommends things like mindful meditation, exercise, and brain games. None of which get rid of the pain that is triggering the issue in this case, but never hurts to keep the brain going strong when clearly it is having issues. For example, I already do mindful meditation for pain, and if it can give me a cognitive boost that would indeed be a bonus, wouldn’t it?

    I really miss the clarity of thought that comes with not having a migraine. It has been years since that was the case. But I do remember the last day it occurred. I remember how clear my thinking was. How crisp. How quick. How accurate. Then the cloud sank back down.

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    References:

    Fibromyalgia Contact Us Directly

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    Official Fibromyalgia Blogs

    Click here to Get the latest Chronic illness Updates

    Fibromyalgia Stores

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  • Fibromyalgia: costochondritis

    Fibromyalgia: costochondritis

    I have been having severe fibromyalgia–related chest pains.

    The way I can tell it is fibromyalgia is that a) they are enduring and b) my sternum is extremely tender to the touch and so it is quite inflamed. I am going to the doctor to discuss it. At the moment using anti-inflammatory creams and a heating pad

    What is costochondritis anyway?

    It is swelling in the cartilage between the ribs and the sternum and the pain can radiate through the chest often feeling like a heart attack. It varies from mind to severe. It can be stabbing, aching, burning and it can be in one location specifically or just all over. It can come and go. At the beginning of this bout, I had just short bouts at night. But then, now, it is all day.

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    The reproducible tenderness you feel when you press on the rib joints (costochondral junctions) is a constant feature of costochondritis. Without this tenderness, a diagnosis of costochondritis is unlikely.

    This is a good test for costochondritis… pressing right on those rib joints and if they hurt like hell it is costochondritis. Or if you breathe in deeply and it hurts more, also a good sign. Just things I do to help assure me that is in fact what it is.

    It can get worse with:

    • Exercising and reparative motions (as I learned as a baker by ignoring it and continuing work until it was quite severe)
    • If you take a deep breath due to the chest wall expanding, you will feel it get worse. So that is why it is better to have shallow even breathing.
    • And yeah, don’t cough ( I have learned with this cold) or sneeze.
    • It can begin in one place, like the sternum, and radiate outward so it can just get worse on its own. In general it is seen to be worse on the left side of the breast bone. But may radiate to your back or even your abdomen.
    • Bending, twisting that sort of deal. I find laying on my side can make it so much worse.

    Now it is a condition in its own right. And it actually can be comorbid with other conditions. And it can occur by itself.

    The causes are:

    1. Viral infection
    2. Fungal: Fungal infections are rare causes of costochondritis.
    3. Bacterial: Costochondritis may occur after surgery 
    4. Repetitive overuse or trauma (my first horrible bout was when I was a baker and lifting bags of flour all the time as well as repetitive stirring) This also includes injury due to actually lifting something too heavy for you.
    5. Chest trauma– I mean like a car accident where you can that seatbelt to the chest… can trigger this condition. Anything like that.

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    So why it is so common with fibromyalgia is a bit of a mystery. But common it is. (60-70 percent of us)

    *** WARNING: If you are experiencing chest pains for the first time or there is anything different about them from your fibromyalgia ones or you have any doubt whatsoever… go to the ER. Better safe than sorry. And I am saying this not because it may be a heart attack, but it may, but other things like severe acid reflux. We cannot know sometimes. And reviewing the pain intensity and duration with your doctor is a very good idea.***

    No one is exactly sure whether it is true costochondritis or why it occurs with FMS. One hypothesis is that FMS involves inflammation of the fascia, which is a thin layer of connective tissue that runs all through your body. If that’s true, it may explain why costochondritis is so common in this condition.

    The fibromyalgia tender points just beneath the collar bone may play a role as well. (Tender points are 18 spots on the body that are used to diagnose fibromyalgia.) Myofascial pain syndrome, which is common in people with FMS, also could be a cause.

    Treatment

    Okay, so the most common treatment for inflammation like this is NSAIDs. Since I cannot have them I am in a bit of a spot. I do try ice and menthol topical creams. Others recommend a heating pad. But ice or hot you want to go for about 20-minute treatments. My doctor recommends ice since it is inflammation and she said that is best for that sort of pain. ( Recommend an ice hot reusable pack that way you get either one you want. And I also prefer a multi-pack that offers a few sizes. The back size… works great for the chest by the way.)

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  • A new principle was discovered for how muscle pain is signaled

    Chronic muscular pain may be linked to a previously unknown principle for how pain signals are transmitted in the human body.

    This is shown by Umeå University researchers Tuija Athanassiadis and Karl-Gunnar Westberg, in collaboration with Canadian associates, in the scientific journal PLoS ONE.

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    Muscles have sensory organs called muscle spindles. Their task is to inform the brain of changes in muscle length. Muscle spindles, therefore, contain a special type of large diameter nerve filaments that signal stretch of the muscle.

    The Umeå scientists’ studies show that muscle spindles also contain fine nerve filaments with pain receptors. When a muscle is damaged as a result of overloading, these pain receptors are activated by the release of a signal substance from the neighboring stretch-sensitive nerve filaments in the muscle spindle.

    It was previously believed that the pain receptors in muscles were exclusively found in the membranes that surround the muscles or in connection with the blood vessels in the muscle. With these new findings, the Umeå researchers are drawing attention to a hitherto unknown and interesting mechanism. Damage to the stretch-sensitive nerve filaments of the muscle spindle may contribute to and sustain chronic pain in jaw muscles as well as in other muscles.

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  • Fibromyalgia Increases Pain And Fatigue For Pregnant Women

    Pregnant women with fibromyalgia (FM) experience significant pain, fatigue, and psychological stress, symptoms that are often misdiagnosed or undertreated as a normal part of pregnancy, according to a pilot study by Karen M. Schaefer, D.N.Sc., R.N., assistant professor of nursing at Temple University’s College of Health Professions. Her research, the first to look at the impact of pregnancy on women with FM, was recently presented at the 2006 Association of Women’s Health, Obstetrics and Neonatal Nurses’ convention in Baltimore.

    Fibromyalgia is a chronic condition commonly found in women that causes pain in the muscles and soft tissues of the body. Many sufferers feel weak from fatigue, and the condition, at its worst, can lead to disability.

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    “Until now, there was only anecdotal evidence suggesting that women with FM had a rougher time during pregnancy,” said Schaefer. “This data is the first step toward gathering hard evidence of FM effects on this group and will hopefully help us identify ways to reduce the impact of fibromyalgia during pregnancy.”

    For this study, Schaefer recruited pregnant women with and without FM through an Internet announcement on a fibromyalgia Web site. Study subjects were between the ages of 29 and 31, in their third trimester, with no history of stillbirth and free of chronic illnesses other than FM.

    The women were then mailed a questionnaire about fatigue, depression, pain, and ability to function. A demographic form was also used to assess the number of painful areas in the body as well as age, marital status, education, hours slept, and use of medication.

    Schaefer’s results revealed that pregnant women with fibromyalgia had a hard time functioning, felt more stiff and tired, and experienced pain in more body areas than women without FM.

    “Most women with FM have trouble getting this condition properly diagnosed, let alone knowing where to turn for help once their condition is identified. We need to start looking at how FM affects all areas of these women’s lives and come up with ways to provide as much comfort and support as possible,” she said.

    Schaefer, whose research focuses on women with chronic illness (fibromyalgia, lupus, ovarian cancer) is currently expanding her study to include a larger group of subjects.

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  • Ordinary Touches Multiply Into Severe Pain For Fibromyalgia Patients

    The millions of Americans who suffer from fibromyalgia live with a two-edged sword: excruciating pain, accompanied by the doubts of many who dismiss it as a made-up illness invented by a troubled mind.

    But researchers at the University of Florida and elsewhere are beginning to piece together clues that reveal the physical basis of the puzzling syndrome that causes severe fatigue and aches and has defied easy diagnosis.

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    UF scientists have found an abnormal central nervous system reaction in those with fibromyalgia-the body magnifies ordinary repetitive stimulation into an experience of crippling pain.

    “This is particularly important because it has been unclear if fibromyalgia was just an imagined illness or a real syndrome,” said Dr. Roland Staud, an associate professor of medicine at UF’s College of Medicine who also is affiliated with the UF Brain Institute. “We now have good evidence that shows that it’s not a psychological abnormality, but that there is a neurological abnormality present.”

    Staud, who presented his research findings at the annual meeting of the American College of Rheumatology last November, recently was awarded a National Institutes of Health grant worth nearly $800,000 to continue his studies for the next four years. Donald Price, a UFprofessor of oral and maxillofacial surgery, and Charles Vierck, a UF professor of neuroscience, are collaborating on the research. Their goal is to develop a better understanding of the condition, with an eye toward improving diagnostic tests and treatments.

    An estimated 3.7 million people in the United States – primarily women who are diagnosed during their 30s and 40s – have fibromyalgia, according to the NIH. A chronic illness with no known cure, its cause also is not known. Researchers have theorized that an injury to the central nervous system or an infectious agent might be responsible for triggering it in people who have inherited susceptibility. Symptoms include persistent and widespread musculoskeletal pain, fatigue and tenderness in the neck, spine, shoulders, and hips.

    Staud and colleagues found the central nervous system abnormality by conducting a series of repetitive stimulation tests on people with the syndrome as well as healthy research participants. The tests involved repeatedly placing warm plates on their hands and arms. The healthy participants felt the sensation but did not report it as pain.

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    For those with fibromyalgia, however, the sensation would magnify with each repetition into an experience of crippling and unbearable pain.

    “When a sensation signal reaches the spinal cord, the signal can be omitted, changed, or augmented,” Staud said. “If it is augmented, then something that is innocuous, such as pressure on the skin, can then be perceived as a painful stimulus.”

    Jessica LeMay, one of Staud’s patients, has been battling fibromyalgia since 1993. The 30-year-old Lake City resident said the pain starts in one area and usually spreads, sometimes becoming overwhelming.

    “I imagine if someone had taken a baseball bat and beaten me with it,that’s got to be what it feels like,” she said. “Depending on the day, I’ll just move out of the way if someone tries to touch me.”

    The pain of fibromyalgia often interferes with a person’s working life.

    “These are people who are diagnosed in their productive years. Many have personal or professional problems adjusting to the pain experience,” Staud said. “The illness makes some people feel dysfunctional because they can’t do the activities they once did.”

    The condition can worsen from stress and inadequate sleep, Staud said. Because living with fibromyalgia often causes stress, and pain and makes sleeping difficult, a vicious cycle develops.

    LeMay said many people dismiss her condition, not understanding the “huge difference” between her severe fatigue and a healthy person’s occasional tiredness.

    “When this fatigue would come about, it’s almost like a weight being dropped on you, and you can’t function anymore,” she said.

    LeMay said she is hopeful that Staud’s research will lead to more effective treatment for fibromyalgia patients and better understanding by the general public.

    “In our society, you either get better or you die, and fibromyalgia patients don’t do that,” she said. “We don’t fit in the mold, so people don’t know what to do with us.”

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    For More Information Related to Fibromyalgia Visit below sites:

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    Official Fibromyalgia Blogs

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  • High rate of restless legs syndrome found in adults with fibromyalgia

    High rate of restless legs syndrome found in adults with fibromyalgia

    A study in the Oct. 15 issue of the Journal of Clinical Sleep Medicine found that adults with fibromyalgia had a much higher prevalence and risk of restless legs syndrome than healthy controls. The study suggests that treating RLS may improve sleep and quality of life in people with fibromyalgia.

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    Results show that the prevalence of restless legs syndrome was about 10 times higher in the fibromyalgia group (33 percent) than among controls (3.1 percent). After statistical adjustments for potential confounders such as age, gender, and ethnicity, participants with fibromyalgia were 11 times more likely than controls to have RLS (odds ratio = 11.2). As expected, considerable sleep disruption was reported by participants with fibromyalgia using the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale. In the fibromyalgia group, these sleep problems were more severe among people who also had RLS.

    “Sleep disruption is common in fibromyalgia, and often difficult to treat,” said contributing author Dr. Nathaniel F. Watson, associate professor of neurology at the University of Washington in Seattle, Wash. “It is apparent from our study that a substantial portion of sleep disruption in fibromyalgia is due to restless legs syndrome.”

    The research team led by Dr. Watson and lead author Dr. Mari Viola-Saltzman of Loyola University Medical Center in Maywood, Ill., studied 172 people with fibromyalgia who had a mean age of 50 years; 93 percent were female. They were compared with 63 healthy controls who had a mean age of 41 years.

    Fibromyalgia was identified by self-report or review of the medical records, and it was confirmed on examination according to published guidelines regarding the presence of pain that is chronic and widespread. The pain was assessed by the subjective report and by objective measurement with a dolorimeter, a spring-loaded gauge that is used to apply standardized rates of pressure to tender points on the arms and legs.

    According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, fibromyalgia can cause significant pain and fatigue. It is estimated to affect 5 million Americans age 18 or older, and between 80 and 90 percent of those diagnosed with fibromyalgia are women. The causes of fibromyalgia remain unknown.

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    Restless legs syndrome was diagnosed using a self-administered, validated questionnaire. RLS is a sleep-related movement disorder that involves an urge to move the legs that are usually accompanied or caused by uncomfortable and unpleasant sensations in the legs. This urge begins or worsens during periods of rest or inactivity, is partially or totally resolved by movement, and worsens or only occurs at night. RLS occurs 1.5 to two times more commonly in women than in men.

    Watson noted that treating restless legs syndrome may be one of the keys to reducing fatigue and improving the quality of life in people with fibromyalgia. RLS often can be successfully treated with a medication such as pramipexole or ropinirole.

    “Since restless legs syndrome is a treatable condition, diagnosing and treating RLS in fibromyalgia patients has the potential to improve their sleep,” Watson said.

    According to the authors, the cross-sectional nature of the study did not allow for an examination of causality. However, several aspects of the two syndromes suggest a logical overlap. Both disorders involve sensory abnormalities, and similar pathophysiology of the system that regulates the neurotransmitter dopamine has been proposed for both syndromes. Furthermore, restless legs syndrome may be induced by antidepressants, which are a common treatment for pain and depression in fibromyalgia. Also, exercise has been shown to improve the symptoms of both syndromes.

    The study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health and by the National Fibromyalgia Research Association.

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