Fibromyalgia or FMS is an extremely common clinical disorder affecting as many as 20 million people, primarily women. The precise cause is unknown. It may be due to an immune system disturbance generated by stress, by trauma, by biomechanical factors such as poor posture or by viral or other infection. Thus, it probably is related to chronic fatigue and immune dysfunction syndrome (CFIDS). 

The pain is real and not "psychosomatic" or "in the patient’s mind, although the disease is often associated with depression. Fibromyalgia is characterized by widespread muscle and joint pain, inexplicable muscle stiffness and soreness, sometimes headaches, temperomandibular joint dysfunction and often bowel and bladder disturbances. Afternoon fatigue is a common complaint. Head, neck, shoulders, arms, back, buttocks, hips, and even legs are affected. These symptoms are chronic, i.e. over 3 months in duration, and are often aggravated by physical and/or emotional stress, exercise, and even most conventional forms of therapy. 

Most, but not all, patients cite either the inability to fall asleep, multiple awakenings, and/or a feeling of exhaustion and increased pain or stiffness upon arising. According to current theory, the body depends upon Delta, or types 3 & 4, non rapid eye movement (non-REM) sleep to relax and reset resting muscle function. If this sleep state is interrupted by Alpha wave intrusion, muscle strain and body tension accumulate daily. Delta sleep is dependent on the presence in the brain of sufficient concentrations of the neuro-transmitter serotonin and possibly norepinephrine. Serotonin may also be a prerequisite to normal muscle functioning and low levels may increase muscle irritability. Some sort of sleep disturbance, associated with serotonin deficiency, is characteristic in over 90% of Fibromyalgia sufferers. The diagnosis is made on the basis of the history described above associated with the finding of multiple "tender points" in the muscles and their attachments to bones in specific locations.


At Catskill Rehabilitation & Sports Medicine, a successful treatment program includes an accurate diagnosis, physical therapy, lifestyle and movement modification, musculoskeletal conditioning, aerobic exercise, stress management and/or psychological counseling. Injection of tender points with a local anaesthetic and/or dry needling are effective during periods of exacerbation. Acupuncture appears also be of value. Restoration of Delta sleep may require the use of extremely small doses of a tricyclic anti-depressant or muscle relaxant such as Elavil or Flexeril. These medications increase the concentration of brain serotonin. They are neither addicting or habit-forming, and may be discontinued during periods of remission. Some of the newer serotoninergic medications such as Effexor, Serzone, Prozac and others of that ilk may also be useful. Although there is little or no hard scientific evidence to support anecdotal claims, over-the-counter supplements or "neutraceuticals" such as coenzyme Q-10 are said to have positive value. One word of caution regarding these substances: the expense can be heavy

All of these treatment modalities are available at Catskill Rehabilitation & Sports Medicine.