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Fibromyalgia is a commonly encountered disorder characterized by
widespread musculoskeletal pain, stiffness, paresthesia, nonrestorative
sleep, and easy fatigability, along with multiple tender points that are
widely and symmetrically distributed.
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Symptoms
include generalized aching and stiffness of the trunk, hip, and
shoulder girdles. Other patients complain of generalized muscle aching
and weakness. Patients may complain of low back pain, which may
radiate into buttock and legs. Others complain of pain and tightness
in the neck and across the upper posterior shoulders. Some patients
complain of muscle pain after even mild exertion. Some degree of pain
is always present. The pain has been described as burning or gnawing,
or as soreness, stiffness or aching.
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While pain may begin in one region, such as the shoulders, neck, or
lower back, it eventually becomes widespread. Patients may complain of
joint pain and perceive that their joints are swollen; however, joint
examination yields normal findings. Stiffness is usually present upon
waking in the morning; usually it improves during the day, but in some
patients, it lasts all day. Patients may complain of numbness of the
hands and feet. Symptoms are made worse by stress, anxiety, cold, damp
weather, and overexertion. Patients often feel better during warmer
weather and vacations. Results of joint and muscle examination are
normal in fibromyalgia patients, and there are no laboratory
abnormalities.
The
characteristic feature on physical examination is the demonstration of
specific tender points, which are exclusively more tender or painful
than adjacent areas. The ACR criteria for fibromyalgia defines 18
tender points (see Figure 1). These points of tenderness are
remarkably constant in location. Remarkably,
these points of tenderness correspond exactly to traditional
acupuncture points. Practitioners have for centuries worked out
specific therapies to reduce pain in these and other areas.
Integrative
medicine, in terms of acupuncture and Chinese medicine combined with
Western medicine and other therapies, is very helpful in treating all
kinds of pain related to fibromyalgia. In addition to the treatment of
specific tender and painful areas, acupuncture has standard therapies
for treating underlying imbalances that lead to fibromyalgia. The role
of the acupuncturist is to bring the body’s homeostatic resources
back into balance as well as to provide palliative care of multiple
symptoms.
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