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Fibromyalgia is associated with a wide range of symptoms. Most studies report that these symptoms can be remarkably persistent and pervasive over the years, sometimes remaining as long as 15 years after onset. Most symptoms, however, do tend to improve over time.

Symptoms are typically worse during cold or damp weather, periods of emotional stress and at the beginning and end of the day. They may be aggravated by poor sleep, physical and mental fatigue, excessive physical activity or inactivity, anxiety or stress. Signs and symptoms include:

* Multiple tender points (trigger points). The presence of multiple tender points, usually at muscle-tendon junctions, is a major characteristic of fibromyalgia. These points are more susceptible to pain than the rest of the body.

* Chronic, widespread pain. Another major characteristic of fibromyalgia is tender skin and an overall reduction in pain threshold. The pain is most often within the muscles (myalgia). It may be confined to specific areas (e.g., neck, shoulders) early in the course of the disorder but usually spreads to other muscle groups over time (e.g., back, arms, legs, chest). This pain is often described as deep muscular aching, throbbing, twitching, stabbing and/or shooting pain. It may be accompanied by soreness, stiffness, numbness, tingling, burning and/or a crawling sensation. Though varying in intensity, some degree of muscle pain is always present. Pain behaviors such as limping, grimacing, or guarded movements and postures, may be easily noticeable and impair quality of life.

* Muscle stiffness. This is usually present upon awakening and tends to improve over time, but may remain throughout the day. Often, the joints feel swollen, although inflammation is not present.

* Fatigue. A general, all-encompassing exhaustion exists in the vast majority of fibromyalgia patients. Specific muscle fatigability and weakness is also increased. This fatigue tends to interfere with daily activities and may leave the individual with a limited ability to function, mentally and physically.

* Sleep problems. Includes disorders that prevent deep, restful, restorative sleep. An individual may have difficulties falling asleep or may be awakened repeatedly during the night. Other individuals may get a full night’s sleep, but awaken feeling unrefreshed and exhausted. Specific sleep problems, including sleep apnea (repeated episodes where an individual temporarily stops breathing) and bursts of awake-like brain activity that interrupts deep sleep may be observed.

* Headaches. More than half of all patients who have fibromyalgia report migraines and other headaches.

* Impaired cognitive function (“fibro fog”). Includes memory failure, poor working memory (ability to hold something in mind while using it for another mental process) and impairments in concentration, coordination and vocabulary retention. Research indicates that these individuals perform as poorly as healthy individuals 20 to 30 years their senior, although they retain a speed of mental processing roughly equal to healthy individuals their age.

* Hypersensitivity (increased sensitivity). Many fibromyalgia patients report heightened sensitivity to temperature, odors, sounds, lights and vibration. They also suffer from increased skin sensitivity.

* Mood disturbances. Irritability, depression and anxiety are common symptoms of fibromyalgia. Depressed individuals may not be aware of or deny their depression, which can complicate the treatment of fibromyalgia. The presence of these symptoms may be due to many factors, including:

- Prolonged pre-diagnosis period
- Disrespectful medical treatment
- Grief and loss common to any chronic illness
- Poor support
- Sleep deprivation
- Other coexisting chronic health conditions
- Severe chronic pain
- Neurotransmitter abnormalities

* Difficulty in sustaining repetitive motor tasks. Many fibromyalgia patients report trouble performing repetitive activities such as typing because of increased pain and fatigue.

* Reduced physical efficiency. Decreased physical efficiency, due to a longer time required to accomplish tasks, is common.

* Variations in alertness. Many fibromyalgia patients report a diurnal (daytime) variation in energy levels and alertness and describe a window of opportunity at which they are at their best that typically extends from about 10 a.m. to 2 p.m.

* Other symptoms, including:

- Dry eyes and mouth
- Rashes
- Excessive menstrual pain
- Ringing in the ears (tinnitus) and ear pain
- Painful intercourse
- Dizziness
- Vision problems
- Low-grade fever
- Below-normal temperature

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Typically the first choice in drug treatment of fibromyalgia has consisted of an antidepressant or a muscle relaxant. The goal has been to improve sleep and pain tolerance. Medications from other drug classes (such as sleeping aids and pain relievers) may also be prescribed. Patients receive drug treatments in combination with exercise, patient education, and behavioral therapies. In 2007 the Food and Drug Administration approved Pregabalin as the first drug for the treatment of fibromyalgia.

Targeting Pressure Points and Stretching Techniques

Trigger-Point Injections.

In some cases, “trigger-point injections” of an anesthetic such as lidocaine may be used for particularly painful tender points as an aid to stretching.

* The injection causes intense, transient pain in the trigger point. After the medication has taken effect, however, the ability to stretch the muscle is greatly enhanced.
* There is some soreness afterward, which can be severe. After an injection, spraying the whole muscle with cooling agents may inactivate less severe tender points.
* In some cases, injections may be needed two or three times over six to eight weeks.

The benefits of this treatment may not be apparent immediately.

Although antidepressants do not work for all fibromyalgia patients, a 2001 analysis of 10 studies reported that antidepressants can also help relieve pain, fatigue, and insomnia in about 25% of patients. None have been well researched for fibromyalgia, however. It should be noted that some patients report worse symptoms with antidepressants.

The two main classes of antidepressants used for fibromyalgia are the tricyclics and selective serotonin-reuptake inhibitors (SSRIs). Tricyclics are better at reducing pain and the SSRIs for relieving depression. Doses used specifically for fibromyalgia in nondepressed patients are often lower than for depression, so combinations may be an option. In fact, benefits may be strongest with combinations of the tricyclics and SSRIs.

Tricyclics not only help relieve depression but they also have properties that reduce sleeplessness and muscle pain. The tricyclic drug most commonly used for fibromyalgia is amitriptyline (Elavil), which produces modest benefits with pain, but which can lose effectiveness over time. Other tricyclics include desipramine, doxepin, imipramine, amoxapine, and nortriptyline.

Generally only small doses are necessary for relief of fibromyalgia, so, although tricyclics have a number of side effects, they may occur less frequently in fibromyalgia patients than in those taking tricyclics for depression. Side effects most often reported include dry mouth, blurred vision, sexual dysfunction, weight gain, difficulty in urinating, disturbances in heart rhythm, drowsiness, and dizziness. Like all medications, tricyclics must be taken as directed; overdose can be life threatening.

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