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 Health Collections: Fibromyalgia 
Micaela Sullivan-Fowler ©

Fibromyalgia or Fibromyalgia Syndrome (FMS) is a condition that elicits different responses from various groups. As with many chronic conditions it has a heritage of diagnostic misunderstanding, debates over its etiology, and confusion over its treatment. And as with many other such conditions, it can take over people's lives, whether in finding an empathetic practitioner, coaxing family members and friends to understand the debilitation, or coping with the chronic aching and stiffness. Information on Fibromyalgia on the Internet abounds, but it is not all well-organized or definitive. Below are some alternative and conventional Web sites that are helpful, discussion groups that are useful, and some carefully selected (again, there are hundreds) Medline citations on treatment and other social issues when dealing with either the condition or the patient. There's some repetition in what the first few sites offer, i.e., information on support groups, etc., but as with many chronic conditions the support from others is one of the most important factors in dealing with the condition. Any questions? E-mail the Cybrarian.

1) If you essentially want it all (though you can get lost in the hyperlinks), start with It's the Fibromyalgia Information Page, maintained by Sheri Graber. It's first paragraph includes the listserv information for Fibrom-L, a Fibromyalgia support group. Includes humor too!

2) A less imposing(but rather busy-looking) place is FIBROMYALGIA Information at: The basics on description are covered nicely, the links are appropriate. It is one place (there are many) to find information by Dr. Devin Starlanyl (Starlanyl is also on Sheri's site). There is a pain management page, useful papers by Dr. David Nye, the newsgroup,, the USA Fibrositis Association, and the USA National Fibromyalgia Research Association. Currently includes a piece on the experimental therapy, Guaifenesin.

3) An even tidier list of hyperlinks is at Emory University's MedWeb at: Click on Fibromyalgia up in their Table of Contents.

4) There's a visually pleasing, easy to decipher site called Fibromyalgia Support Groups, at: It includes Emotional Support Guides and hyperlinks to Chat groups.

5) Need succinct description of FMS to share with loved ones or patients? (originally from the Arthritis Foundation). Go to:

6) For publications suggested by The Arthritis Foundation: try: This annotated list of brochures, video tapes, newsletters, and pamphlets, includes prices and ordering information.

7) Fibromyalgia Educational Systems, Inc. at offers for sale a 170-page handbook, Taking Charge of Fibromyalgia, for patients, their families, and health professionals. An educational program is also offered for health professionals and support groups. These educational resources provide the most up-to-date information available for understanding, managing, and coping with fibromyalgia. Authored by Julie Kelly, M.S., R.N., and Rosalie Devonshire, B.S. Phone (419) 843-3153 · Fax (419) 843-3155

8) Good basic information, including Patient and Physician FAQ's can be found at from, MARRTC Missouri Arthritis Rehabilitation Research and Training Center.

9) The Fibromyalgia Association UK at is a British group that understands the need for "holding the hands" of fibromyalgia sufferers. Includes a succinct description of FMS, its etiology, treatment, notes the Fibromyalgia Support Newsgroup has an interesting Community Care Front Page, and a nicely done Internet Health Resources page.

10) This one is of particular interest to patients, it's visually appealing and cleverly presented. It's the Fibromyalgia Patient Support Center at They have a Discussion Wall and a A Graffiti Wall, the purpose being to provide an on-line resource for the patient exchange of information about Fibromyalgia. Their links to other Web sites are expansive, and they are equitable in their sharing of information. Includes a "mini-FAQ" by David A. Nye MD ( on the differences between Fibromyalgia and Chronic Fatigue Syndromes.

11) Though the Cybrarian Service does not recommend individual clinics, a very succinct description of Fibromyalgia can be found at: The Pain Institute in Chicago appears to be taking innovative approaches to the syndrome, that might be of use to patient and practitioners.

12) There's an FMS Chat room at The Cybrarian Service was unable to access it, but it could be helpful for keeping up-to-date with fellow sufferers and/or clinicians.

13) Click Here for an naturopathic/osteopathic approach to Fibromyalgia. What Treatment Seems Most Effective in Treatment of Fibromyalgia by Leon Chaitow N.D., D.O. that includes the need for Aerobic Exercise, acupuncture, cognitive training, herbal remedies, dietary supplements, and the like.

14) Still need some sites or ideas? Try: Best Links to Other Sites at: It's not annotated but it covers the spectrum of issues related to Fibromyalgia.

15) Sapient Health Network at is an interactive service for people with chronic and serious illnesses, their families, and their friends. Their mission is to provide you with timely and accurate information and support so you can successfully manage your illness and be your own best advocate in the healthcare system. All their services are free. Their especially helpful Library offers journals, a medical dictionary, a drug database, and Medline. In Newsstand, you can read the latest news from around the world, specific to your condition. And finally, "Community," includes interactive message boards, live chats with other survivors, and online workshops with experts and health care professionals.

The Clinical Stuff
The following search on the etiology, screening, treatment, and psychological aspects of fibromyalgia was performed in Medline. Included are 10 carefully selected bibliographic citations and abstracts from 1994-1997. The "Source" is the journal abbreviation. For the document delivery referred to on the Cybrarian Service: 1) take these citations and go to a local library for copies of the articles, or 2) go or HealthGate ( with the NLM Cit. ID (see below) and order copies of the articles. Any questions about what you've received? Don't hesitate to E-Mail Cybrarian.

P.S. A book came out in 1994 called The Fibromyalgia Syndrome: Current Research and Future Directions in Epidemiology, Pathogenesis and Treatment, by Stanley R. Pillemer. Haworth Medical Press. Check it out!

There's also a fine review article in Patient Care, March 15, 1995 (v. 29, n 5) p 29- (10 pages), entitled "Coping Successfully with Fibromyalgia." By Robert M. Bennett and Glenn McCain

A randomized, double-blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia.
Goldenberg D; Mayskiy M; Mossey C; Ruthazer R; Schmid C
Newton-Wellesley Hospital, Massachusetts, USA.
Arthritis Rheum 1996 Nov;39(11):1852-9
To study the effect of fluoxetine (FL) and amitriptyline (AM), alone and in combination, in patients with fibromyalgia (FM). METHODS: Nineteen patients with FM completed a randomized, double-blind crossover study, which consisted of 4 6-week trials of FL (20 mg), AM (25 mg), a combination of FL and AM, or placebo. Patients were evaluated on the first and last day of each trial period. Outcome measures included a tender point score, the Fibromyalgia Impact Questionnaire (FIQ), the Beck Depression Inventory (BDI) scale, and visual analog scales (VAS) for global well-being (1 completed by the physician and 1 by the patient), pain, sleep trouble, fatigue, and feeling refreshed upon awakening. RESULTS: Both FL and AM were associated with significantly improved scores on the FIQ and on the VAS for pain, global well-being, and sleep disturbances. When combined, the 2 treatments worked better than either medication alone. Similar, but nonsignificant, improvement occurred in the BDI scale, the physician global VAS, and the VAS for fatigue and feeling refreshed upon awakening. Trends were less clear for the tender point score. CONCLUSION: Both FL and AM are effective treatments for FM, and they work better in combination than either medication alone.

1a) A related article comes in "Fluoxetine and amitriptyline in the treatment of fibromyalgia." By SP Johnson, in the Journal of Family Practice 44 (2) : 128-130, Feb. 1997

Fibromyalgia syndrome: a review.
Reiffenberger DH; Amundson LH
Brown Clinic, Watertown, South Dakota, USA.
Am Fam Physician 1996 Apr;53(5):1698-712
Fibromyalgia syndrome includes symptoms of widespread, chronic musculoskeletal aching and stiffness and soft tissue tender points. It is frequently accompanied by fatigue and sleep disturbance. Fibromyalgia is more common in women than in men, and it occurs at a mean age of 49 years. Differential diagnosis includes myofascial pain syndrome and chronic fatigue syndrome. Fibromyalgia is a multifactorial problem and no universal treatment guidelines apply to all cases. Pharmacologic therapy may include tricyclic antidepressants. In addition to commonly used pharmacologic therapies, patient education, reassurance and an exercise program can each play an important role in relieving the symptoms associated with this common musculoskeletal syndrome.

An analytical review of 24 controlled clinical trials for fibromyalgia syndrome (FMS).
White KP; Harth M
University of Western Ontario, University Hospital Rheumatic Disease Unit, London, Canada.
Pain 1996 Feb;64(2):211-9
We performed a combined manual and computer search of the FMS literature to identify controlled clinical trials in FMS from 1980 to June 1994 inclusive. Our specific objectives were: 1) to determine which outcome measures have been used in clinical trials for FMS, and the methods utilized to measure these outcomes; 2) to identify which outcome measures were most and least sensitive in distinguishing between treatment groups, and 3) to identify weakness in trial design. Our analysis of 24 clinical trials demonstrates the large diversity of outcome measures and measurement instruments that have been used to detect differences between treatment and placebo in the management of FMS. Whereas certain outcomes, such as self-reported pain and sleep quality, were frequently measured, other clinically important outcomes, such as functional and psychological status, were infrequently included in data collection. Finally, we identified several significant potential sources of bias, including potential flaws in subject selection and group allocation, inadequate randomization, incomplete blinding, errors in outcome measurement, and inappropriate analysis of data.

A guide to the understanding and use of tricyclic antidepressants in the overall management of fibromyalgia and other chronic pain syndromes.
Godfrey RG
Department of Medicine, University of Kansas School of Medicine, Kansas City, USA.
Arch Intern Med 1996 May 27;156(10):1047-52
The purpose of this review is to present relatively detailed information on the characteristics of tricyclic antidepressants, mainly amitriptyline hydrochloride and doxepin hydrochloride, for use as an integral part of the safe and effective management of fibromyalgia and, to a lesser extent, other chronic pain syndromes. Data sources include MEDLINE searches in English, relevant reference books and textbooks, my personal database and library, as well as personal clinical experience. I discuss these data with regard to the pharmacologic characteristics, mechanisms of action, adverse effects, and precautions involved with the use of tricyclic antidepressants. Additional information is given on drug selection and dosage titration. Much emphasis is placed on the fact that while tricyclic antidepressants play a major role in the management of fibromyalgia and other chronic pain syndromes, lifestyle alterations (eg. physical reconditioning and exercise), as well as behavior modification, are also vital to a successful outcome in management.
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