Fibromyalgia is a chronic painful condition - there is widespread muscular pain and stiffness, and a number of separate tender points can be found in the muscles around the neck and shoulders, the lower back, and sometimes the elbows and knees. There are often general symptoms like fatigue and insomnia. Sufferers may have other health problems - irritable bowel syndrome, Raynaud syndrome (cold white fingers), headache, nerve tingling and numbness, etc.

Although sometimes dismissed by unsympathetic health professionals as just another psychosomatic syndrome, the condition is real and distressing. According to strict diagnostic criteria established by the American College of Rheumatology, over 3.5 million people in the USA are afflicted. Women aged between 35 and 60 account for ¾ of the patients.

The cause of the fibromyalgia is unknown, although various physical or laboratory changes have been found in patients: changes in the sleep electroencephalogram (EEG), microscopic changes in muscle fibers, some altered hormone functioning, and decreased blood flow in some parts of the brain. The variety of these findings makes it difficult to prescribe a rational treatment.

Fewer than 50% of patients will experience adequate relief - early benefits of treatment are often followed by a relapse in spite of continued therapy. Treatment can be pharmaceutical (medication) or non-pharmaceutical.

Drug treatment of fibromyalgia includes the use of antidepressants, minor tranquilizers (e.g. valium), analgesics (e.g. tramodol), and lidocaine injections into the tender points. All can produce some degree of relief, at least in the short term. Anti-inflammatory drugs (steroids and non-steroids) and morphine derivatives should be avoided - the first because the condition is not really inflammatory, the second because morphine derivatives are very addictive and have serious side effects. (As a synthetic codeine derivative, tramadol is quite effective and reasonably safe).

Recently a molecule found in the body in small amounts, S-adenosyl-L-methionine (SAMe), has been used with some success in treating fibromyalgia, either given by mouth or injection. However, it is not without side effects, and it occasionally produces severe side effects.

The relative lack of effective medicinal treatments has led, not surprisingly, to the use of non-medicinal methods. These include: aerobic exercise, biofeedback (using electrical muscle activity), hypnosis, and acupuncture. All have been tried with varying degrees of success.

More recently, combinations of relaxation training, meditation, aerobic exercise and stretching, and patient/family education, together with prescribed drug treatment, have produced improvement in most symptoms of fibromyalgia over a 24-week period. However, similar benefits were seen in patients given a less-intensive regimen concentrating on relaxation, and in those treated in group therapy. This suggests that behavioral therapy coupled with medication has the most chance of success in patients with recent-onset fibromyalgia.

It seems likely that using a combination of medicinal and non-medicinal treatments in a trial-and-error fashion offers the main hope for patients with fibromyalgia, until a major breakthrough occurs in our understanding of this condition.