Fibromyalgia is a condition most of us have heard of largely through watching TV. Those repetitive commercials for pharmaceuticals including Lyrica and Cymbalta cause many of us to play the word over and over in our heads. Although we can pronounce it, many of us don't have a clue what it is. Those of us who can identify with the symptoms pay closer attention. This is especially true in the case of fibromyalgia because it's a condition that is difficult to diagnose.

Dr. Michael Clark, Associate Professor of Psychiatry at Johns Hopkins Medical Center, said the main feature of the illness is persistent pain. Working in his subspecialty of chronic pain at John Hopkins' Bayview Medical Centre, he's seen thousands of people with the condition, mostly middle-aged women.

An all over body pain and intense pain in certain areas when pressure is applied coupled with tiredness, fatigue or complete exhaustion, are the main symptoms of the disease. Of course it isn't unusual for most of us to have some tenderness or soreness in our bodies from time to time. When pressure is applied to these sore areas, we are familiar with the pain that results. It's also fairly common for most of us to feel fatigued from time to time. For this reason diagnosing fibromyalgia has always been challenging.

Physicians typically do a battery of tests and on ruling out everything else, are able to diagnose fibromyalgia.

Dr. Clark admitted that patients with the condition were often thought to have what is called a psychogenic complaint. These are conditions that have happened through complex interactions in the brain and not something physical.

For this reason primary care physicians often referred their fibromyalgia patients to psychologists and psychiatrists without offering them any relief from their physical pain. "We'd like to think we are more sophisticated than that now," said Dr. Clark. "We try to take a more holistic approach today."

Adding to the difficulty in diagnosing the condition is that scientists have not pinpointed the cause. "Because patients had high rates of psych disorders like depression, there was a concern they were psych patients," he said. "Now there's been much study that shows they have a sensitization of their nervous system. Components of their nervous system are hyperactive or fail to inhibit the processing of pain," he added.

And just what causes a person's nervous system to become overly sensitive? According to Dr. Clark scientists still don't know but are working through some theories. He said some research points to it being genetic while other studies show a pattern in life stresses. One study shows a correlation with increased emotional risk, while others show the disease may be caused by a virus or other microbial infection.

"Some patients have a rapid onset of their symptoms after a cold or flu," said Dr. Clark. "We don't know if there's a specific virus or whether it's any infection that causes the autoimmune system to become overwhelmed and lead to this type of sensitization and fibromyalgia or chronic fatigue syndrome," he added.

(Chronic fatigue syndrome has the same symptoms as fibromyalgia. The diagnosis is usually made on the dominant complaint so that for those who complain mostly of pain – a diagnosis of fibromyalgia is given, and for those who mostly feel exhausted – a diagnosis of chronic fatigue syndrome is returned.)

At the Bayview Medical Center Dr. Clark said he works with a team of specialists to give the best treatment option for each patient. Being at one of the leading healthcare facilities in the US, the team have can call in almost any specialist you can think of, to help.

"We have access to any specialist we need whether its neurology, rheumatology or allied health workers," he said.

And while patients may have been suffering for years, he said there are effective treatments that can help them minimise or rid themselves of the pain.

"The average length of suffering is ten years for a person with fibromyalgia," he said. "These people have not failed treatment, they just were not given appropriate treatment. When we give them a multi-disciplinary approach we can get them back to work and functioning how they want to function," he added.

The multidisciplinary approach always includes exercise and psychotherapy.

"It is important for them to have psychotherapy in order to develop problem solving and coping skills," said Dr. Clark. "Physical therapy helps them rebuild their bodies, increase muscle strength and increase aerobic capacity."

Exercising is a real challenge for those with fibromyalgia as the pressure triggers or increases the existing pain. Dr. Clark said patients are able to tolerate physical treatment if the proper dose is given and he said over time they see improvement in their symptoms.

"It's not like training for a marathon," he said. "Often very small increments of gentle activity like walking, stretching and swimming help patients in building up strength. This continued over a very long time period reduces the chance their symptoms will flare up," he added.

Fibromyalgia is thought to affect about five percent of the population in the US, according to Dr. Clark. In Bermuda there are no statistics on the number of sufferers. However the Bermuda Hospitals Board has invited Dr. Clark to give a public talk on the topic. Dr. Clark will lecture on the illness next Wednesday at the Mid Atlantic Wellness Institute from 6 p.m. to 8 p.m. For more information call 239-5818.