Dear Dr. Garner,

I am at my wits’ end. Ever since my husband passed away last July, I feel as though my body is being attacked.

All my muscles and joints ache. I cannot sleep at night, and I have no desire to see relatives or even my grandchild.

I have been to several doctors who tell me they can’t find anything wrong.

Someone mentioned it could be fibromyalgia. Is there a way to test to see if I have this?

Life has become very difficult. Please help me.

Depressed and In Pain in Prospect Park South

Dear Depressed,

Before I get into the description of fibromyalgia, I would like to recognize a loyal Tablet reader, Barbara Balsamello, who helps to keep people relaxed in Dr. Sconzo’s office in Marine Park. Her smile is medicine for the patients in the office.

The condition you discuss could very well be fibromyalgia.  I’m sorry for the loss of your husband and want you to know that whether it is fibromyalgia or depression, medications are available to help control your symptoms and help you enjoy life again.

People with fibromyalgia have pain throughout their body.  They have difficulty sleeping and remembering things. It is thought that the brain magnifies the painful sensations people experience, so that pain in the joints and muscles becomes unbearable.  The disease can be precipitated by a major loss, such as the loss of your husband. For some reason, women are much more likely to develop the syndrome than men.

Identifying Tender Points
To help determine if you have fibromyalgia, there are questions your physician will ask. To be considered widespread pain, it must occur on both sides of your body, and above and below your waist. There are specific spots in your body known as tender points. These are points that hurt when pressed with a finger.

There are 18 tender points, important to the diagnosis of fibromyalgia. These points are located in various parts of the body. To arrive at a diagnosis of fibromyalgia, 11 of the 18 tender point sites must cause pain when pressed. In addition, the pain must be present for at least three months to establish the diagnosis.

Tender point locations include the following:
• the back of the head
• between the shoulder blades
• the top of the shoulders
• the front side of the neck
• the upper chest
• the elbows
• the hips
• the inner knees

Accompanying the severe pain is fatigue and sleep disturbance. People with fibromyalgia often wake up tired, even though they report sleeping for long periods of time. The sleep pattern is frequently disrupted by pain, and many patients have associated conditions, such as restless leg syndrome and sleep apnea that further decreases the quality of their sleep.

As if having fibromyalgia is not enough discomfort, it should be noted that those with fibromyalgia may also have anxiety, depression, endometriosis, irritable bowel syndrome, and severe headaches.

No Clear Causes
It is not clear what causes fibromyalgia. We do know that it runs in families and there may be certain genetic mutations that make one susceptible to developing the problem. In addition, it may be triggered by severe infections as well as physical or emotional stress.

Doctors believe that it hurts so much because the brain misinterprets the pain and actually magnifies it. There are medications which lessen the symptoms, and allow people to live normal lives. These include anti-depressants, anti-seizure drugs and pain medication.

Reducing stress is important in the treatment plan. Take time out to take care of yourself.  Deep breathin exercises, such as meditation, regular exercise, getting enough sleep, acupuncture and massage therapy have been helpful in treating fibromyalgia. In addition, it is important to pace yourself so that you don’t overdo it.

I strongly suggest that you visit a physician who is familiar with fibromyalgia. Usually, rheumatologists have greater experience than other doctors in dealing with this disease. I would be happy to recommend a physician experienced in its treatment, to evaluate you and begin a course of therapy.

Support groups are very useful. You will learn more about the disease and realize you are not alone in your suffering. At the present time there is no lab test that can accurately diagnose fibromyalgia. Physicians need to rule out numerous conditions with similar symptoms before diagnosing it.

The first step in treating your problem is to verify the diagnosis, and rule out any treatable causes for your depression and pain.

The good news is that you will be able to resume you normal lifestyle and enjoy your family and life in general.
Please call me if you have any difficulty finding the right physician. I wish you well.[hr] Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on NET, Tuesdays at 8 p.m. on Ch. 97 Time Warner and Ch. 30 Cablevision.