Fibromyalgia is a syndrome rather than a disease, and as such has a variety of features. Any part of the body can be involved, especially when fibromyalgia is induced or aggravated by multiple factors. This chapter will review some of the generalized complaints expressed by fibromyalgia patients and place them in perspective. One of the major problems fibromyalgia sufferers encounter is difficulty communicating how they really feel. Complaints can be subjective and hard to verify or quantify. They consist of symptoms, or expressions of what is bothersome, and signs. Physical signs are observed during a physical examination, such as a rash or an irregular heartbeat, and are easier to validate. Constitutional symptoms or signs are generalized and do not belong to any specific organ system or region of the body. Jane was an anthropology graduate student. In addition to carrying a full load of classes, she moonlighted as a waitress 20 hours a week. This pace was maintained until Jane caught what seemed to be a bad case of flu with a sore throat, runny nose, cough, fever, aching, fatigue, and swollen glands. Although most of her flu symptoms disappeared after several weeks, Jane never felt the same. The fatigue and aching became more pronounced, and Jane had to quit her waitressing job. She forced herself to go to class and was so exhausted that she spent most weekends in bed. Despite all of the bed rest, Jane never slept well and began noticing stiffness and spasm in her upper back and neck areas. The Student Health Service referred her to an internist, who ordered tests, all of which were normal. Jane now paces herself with rest periods alternating with active ones, avoids daytime sleeping, takes cyclobenzaprine (Flexeril) two hours before retiring at night, and engages in a general conditioning program. Even though Jane is still unable to work, at least she did not have to drop out of school. Fatigue is still a major problem, but its level of intensity seems to be slowly diminishing. As with Jane, generalized fatigue is a prominent feature of fibromyalgia.
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