Fibromyalgia and overlapping symptoms A-Z
Allergy
Ankylosing Spondylitis
Anxiety Disorders
Arthritic Conditions
Back Pain
Carpal Tunnel Syndrome
Cervical (neck) Disk Disease
Cervical (neck) Myofascial Pain
Cervical (neck) Sprain and Strain
Chronic Fatigue Syndrome
Chronic Swollen/Tender Lymph Nodes
Cognitive Dysfunction
Complex Regional Pain Syndrome (RSDS)
Depression
Dysmenorrhea
Endocrine Disorders
Endometriosis
Enthesopathies
Esophageal Dysmotility
Female Urethral Syndrome
Functional Bowel Disorder Syndromes
Hypermobility Syndrome
Hyperthyroidism
Hyperventilation
Infections
Interstitial Cystitis
Irritable Bowel Syndrome
Lumbar (low back) Degen. Disk Disease
Lumbar (low back) Facet Arthropathy
Lupus/Autoimmune Diseases
Lyme Disease
Mechanical Low Back Pain
Meralgia Paresthetica
Migraine Headaches
Mitral Valve Prolapse
Multiple Chemical Sensitivity (MCS)
Myofascial Pain Syndrome
Nondermatomal Paresthesia
Osteoarthritis
PLMS (Periodical Limb Movement)
Postpolio Syndrome
Premenstrual Syndrome (PMS)
Pulmonary Symptoms
Raynaud Phenomenon
Restless Leg Syndrome
Sleep Disorders
Sjögren’s Syndrome
Temporomandibular Joint Syndrome
Thyroid Dysfunction
Vestibular Disorders
Vulvar Vestibulitis (Vulvodynia)
Ankylosing Spondylitis is a distinct disease entity characterized by stiffening of a joint, while spondylos means vertebra. Spondylitis
refers to inflammation of one or more vertebrae. Ankylosing spondylitis usually is classified as a chronic and progressive form of
seronegative arthritis.
Formation of bony bridges between adjacent vertebrae (syndesmophytes) and progressive ossification of extraspinal joint capsules
and ligaments are characteristic of the disease.
Spondylitis Association of America – http://www.spondylitis.org/main.aspx
Anxiety Disorders are a unique group of illnesses marked by persistent, irrational, uncontrollable anxiety. These include generalized
anxiety disorder, obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder, social phobia and specific
phobias.
Researchers have found that anxiety disorders and chronic pain often occur together. In some patients, the stress associated with
living with chronic pain may exacerbate conditions such as anxiety disorders and depression. Feelings of helplessness, loss of
control and interference with daily activities from chronic pain can trigger mental health disorders in some pain patients. In some
cases, the symptoms of an anxiety disorder may be similar to those of chronic pain and go undiagnosed. It is important to get a
correct diagnosis since anxiety disorders are treatable.
The Most Common Anxiety Disorders:
Generalized Anxiety Disorder (GAD) involves excessive and uncontrollable worry about everyday things, such as health, money or
work. It is accompanied by physical symptoms such as restlessness, irritability, muscle tension, fatigue and difficulty sleeping or
concentrating.
Obsessive-Compulsive Disorder (OCD) entails persistent, recurring thoughts (obsessions) that reflect exaggerated anxiety or fears.
Someone with OCD often will practice repetitive behaviors or rituals (compulsions). For instance, obsessing about germs may lead
someone with OCD to compulsively washing hands—perhaps 50 times or more per day.
Panic Disorder includes severe attacks of terror or sudden rushes of intense anxiety and discomfort. Symptoms can mimic those
found in heart disease, respiratory problems or thyroid problems, and individuals often fear they are dying, having a heart attack or
about to faint. The symptoms experienced during a panic attack are real and overwhelming, but not life threatening.
Posttraumatic Stress Disorder (PTSD) can follow exposure to a traumatic event, such as a car accident, rape, a terrorist attack or
other violence. Symptoms include reliving the traumatic event, avoidance, detachment or difficulty sleeping and concentrating.
Though it is commonly associated with veterans, any traumatic event can trigger PTSD.
Social Anxiety Disorder (SAD) is characterized by extreme anxiety about being judged by others or behaving in a way that might
cause embarrassment or ridicule. People who have SAD have what feels like exaggerated stage fright all the time. SAD is also
called social phobia.
Specific phobias are intense fear reactions that lead a person to avoid specific objects, places or situations, such as flying, heights
or highway driving. The level of fear is excessive and unreasonable. Although the person with a phobia recognizes the fear as being
irrational, even simply thinking about it can cause extreme anxiety.
Visit http://www.adaa.org for more information or contact ADAA at 240-485-1001
Arthritic Conditions
Arthritis Foundation – http://www.arthritis.org/index.php
Back Pain Causes of mechanical back pain (BP) generally are attributed to an acute traumatic event, but they may also include
cumulative trauma. The severity of an acute traumatic event varies widely, from twisting one's back to being involved in a motor
vehicle collision. Mechanical BP due to cumulative trauma tends to occur more commonly in the workplace.
The pathophysiology of mechanical BP remains complex and multifaceted. Multiple anatomic structures and elements of the spine
(eg, bones, ligaments, tendons, disks, muscle) are all suspected to have a role. Many of these components of the spine have
sensory innervation that can generate nociceptive (a sensory receptor that responds to pain) signals representing responses to
tissue-damaging stimuli. Other causes could be neuropathic (dysfunction of the nervous system--e.g, sciatica). Most chronic BP
cases most likely involve mixed nociceptive and neuropathic etiologies.
The National Pain Foundation – http://www.nationalpainfoundation.org/cat/862/back-and-neck
Carpal Tunnel Syndrome is a common disorder of the wrist and hand characterized by pain, tingling, and muscular weakness,
caused by pressure on the median nerve in the wrist area and often associated with trauma, rheumatoid arthritis, or edema of
pregnancy.
National Institutes of Health's Medline Plus – http://www.nlm.nih.gov/medlineplus/carpaltunnelsyndrome.html
Cervical Disc Disease encountered in physiatric practice include herniated nucleus pulposus (HNP), degenerative disc disease
(DDD), and internal disc disruption (IDD). HNP implies extension of disc material beyond the posterior margin of the vertebral body.
Most of the herniation is made up of the annulus fibrosus. DDD involves degenerative annular tears, loss of disc height, and nuclear
degradation. IDD describes annular fissuring of the disc without external disc deformation. Cervical radiculopathy (disease of the
spinal nerve roots) can result from nerve root injury in the presence of disc herniation or stenosis (narrowing of the spinal canal),
most commonly foraminal (openings in the vertebrae for the nerve bundles to enter) stenosis, leading to sensory, motor, or reflex
abnormalities in the affected nerve root distribution.
Understanding cervical disc disease requires basic knowledge of anatomy and biomechanics. The intervertebral disc absorbs
shock, accommodates movement, provides support, and separates vertebral bodies to lend height to intervertebral foramina. No
disc exists between C1 and C2, and only ligaments and joint capsules resist excessive motion. Disc degeneration and/or herniation
can injure the spinal cord or nerve roots and result in stenosis and/or myofascial pain.
Spine-health – http://www.spine-health.com/conditions/degenerative-disc-disease/cervical-degenerative-disc-disease
Cervical Myofascial Pain originates from the vertebral spine in the neck correlating to muscle and its surrounding fascia (sheath of
connective tissue supporting or binding together internal organs or parts of the body.). The diagnosis of this syndrome in clinical,
with no confirmatory laboratory tests available. Thus, myofascial pain in any location is characterized on examination by the
presence of trigger points located in skeletal muscle. In the cervical spine, the muscles most often implicated in myofascial pain are
the trapezius, levator scapulae, rhomboids, supraspinatus, and infraspinatus. A trigger point is defined as a hyperirritable area
located in a palpable taut band of muscle fibers. According to Hong and Simon's recent review on the pathophysiology and
electrophysiologic mechanisms of trigger points, the following observations help to define them further:
Trigger points are known to elicit local pain and/or referred pain in a specific recognizable distribution.
Palpation in a rapid fashion (ie, snapping palpation) may elicit a local twitch response (LTR), a brisk contraction of the muscle fibers
in or around the taut band. The LTR also can be elicited by rapid insertion of a needle into the trigger point.
Restricted range of motion (ROM) and increased sensitivity to stretch of muscle fibers in a taut band are noted frequently.
The muscle with a trigger point may be weak because of pain. Usually, no atrophic change is observed.
Patients with trigger points may have associated localized autonomic phenomena (eg, vasoconstriction, pilomotor response, ptosis,
hypersecretion).
An active myofascial trigger point is a site marked by generation of spontaneous pain or pain in response to movement. This
phenomenon is in contrast to the case of latent trigger points, which may not produce pain until they are compressed.
eMedicine – http://emedicine.medscape.com/article/305937-overview
Cervical Sprain and Strain is one of the most common musculoskeletal problems encountered by generalists and
neuromusculoskeletal specialists in the clinic.
One cause of cervical strain is termed cervical acceleration-deceleration injury; this is frequently called whiplash injury. Whiplash,
one of the most common events of nonfatal car injuries, is one of the most poorly understood disorders of the spine, and the severity
of the trauma is often not correlated with the seriousness of the clinical problems. A history of neck injury is a significant risk factor
for chronic neck pain. Pretorque of the head and neck increases facet capsular strains, supporting its role in the whiplash
mechanism.
The Quebec Taskforce on Whiplash-Associated Disorders has suggested the following system for classifying the severity of cervical
sprains:
- No neck pain complaints, no physical signs
- Neck pain complaints, only stiffness or tenderness, no other physical signs
- Neck complaints and musculoskeletal signs (decreased range of motion [ROM] and point tenderness)
- Neck complaints and neurologic signs (weakness, sensory and reflex changes)
- Neck complaints with fracture and/or dislocation
http://emedicine.medscape.com/article/306176-overview
Chronic Fatigue Syndrome (CFS) also known as chronic fatigue and immune dysfunction syndrome (CFIDS), is a debilitating illness
that has long been misunderstood by the public and by health care professionals. The illness has proven to be both complex and
mysterious, and there is still no known cause or cure.
Researchers have uncovered biologic abnormalities in CFS patients, producing a “critical mass” of scientific evidence that CFS is a
real biologic illness, not a psychiatric condition. Abnormalities have been found in the immune system, the brain, the hypothalamicpituitary-adrenal (HPA) axis, the cardiovascular system, the autonomic nervous system, and the endocrine system of CFS patients.
Although the cause of CFS isn’t yet understood, there is a growing body of research showing that physiologic, environmental and
behavioral events experienced over the lifespan—combined with a genetic predisposition—may lead to CFS.
What Are the Symptoms of CFS?
As the name chronic fatigue syndrome suggests, this illness is accompanied by fatigue. However, it’s not the kind of fatigue we
experience after a particularly busy day or week, a sleepless night, or stressful events. It’s a severe, incapacitating fatigue that isn’t
improved by bed rest and that may be worsened by physical or mental activity.
Although its name trivializes the illness as little more than tiredness, CFS brings with it a constellation of debilitating symptoms. The
fatigue of CFS is accompanied by characteristic symptoms lasting at least six months. These symptoms include sleep difficulties,
problems with concentration and short-term memory, flu-like symptoms, pain in the joints and muscles, tender lymph nodes, sore
throat, and headache. A hallmark of the illness is postexertional malaise, a worsening of symptoms following physical or mental
exertion that can require an extended recovery time.
The severity of CFS varies greatly from patient to patient, with some people able to maintain fairly active lives. For others, CFS has
a profound impact on work, school and family life. About 25 percent of CFS patients are disabled by the illness. There’s often a
pattern of relapse and remission, and patients may cycle between different levels of function. Most symptoms are invisible to others,
which makes it difficult for friends, family members, and the public to understand the challenges a person with CFS faces.
What are Common Comorbid Conditions?
In addition to the “diagnostic symptoms” of CFS listed above, it’s not uncommon for CFS patients to have symptoms of other
illnesses. These may include visual disturbances (blurring, sensitivity to light, eye pain); psychological problems (irritability, mood
swings, anxiety, panic attacks); chills and night sweats; irritable bowel (abdominal pain, diarrhea, constipation, intestinal gas);
allergies and sensitivities to foods, odors, chemicals, medications; brain fog and cognitive impairment; difficulty retaining upright
posture, dizziness, balance problems, and fainting; gynecological problems including PMS and endometriosis; and many other
health problems.
Because these symptoms are shared with many other illnesses—and because many of these conditions lack a diagnostic test or
biomarker—unraveling which illnesses are present can be difficult. Some patients actually receive diagnoses for multiple conditions.
Common comorbid conditions include fibromyalgia, irritable bowel syndrome, interstitial cystitis, temporomandibular joint disorder,
chronic pelvic pain ,and multiple chemical sensitivity.
Because CFS can resemble other comorbid conditions—as well as medical disorders like mononucleosis, multiple sclerosis, chronic
Lyme disease, and lupus—it’s frequently misdiagnosed. For more information, call the Association’s resource line at 704-365-2343.
CFIDS Association of America – http://www.cfids.org/
Chronic Swollen/Tender Lymph Nodes
Lymph nodes are an important component of the body's immune system and help in fighting infections.
They are small, soft, round or oval structures that are found throughout the body and are connected to each other in chain-like
(lymphatic chains) fashion by channels similar to blood vessels. Each individual lymph node is covered by a capsule made up of
connective tissue.
Within the capsule, lymph nodes contain certain kinds of immune cells. These cells are mainly lymphocytes, which produce proteins
that capture and fight viruses and other microbes, and macrophages, which destroy and remove the captured material.
Where are the lymph nodes located in the body?
Lymph nodes are located throughout the body. Some are directly under the skin while others are deep inside the body. Even the
most superficial (close to the skin) lymph nodes are usually not visible or palpable (felt by touching), unless they are swollen or
enlarged for some reason.
They are connected to each other by loosely bound lymphatic vessels. Lymph nodes generally coalesce in different regions in the
body where they are responsible for filtering the blood and performing their immunologic function for that particular area of the body.
Fluid from the lymphatic vessels eventually feeds into the venous system (veins) in the body.
Symptoms of swollen lymph nodes vary widely. A person could be completely free of symptoms (asymptomatic) and only found
when they are noted by a doctor during a general physical examination. Sometimes referred to as "swollen glands"
(lymphadenopathy or lymphadenitis). In general, lymph nodes become swollen when they are active either due to an infection,
inflammation, or cancer.
Sometimes, swollen lymph nodes can be extremely tender, painful, and disfiguring.
More importantly, other symptoms related to an underlying disease that accompany the lymph node swelling may be more
significant and clinically relevant than the lymph node swelling alone. For instance, symptoms such as fever, night sweats, weight
loss, or evidence of local infections (toothache, sore throat) may provide valuable clues in determining the cause of lymph node
swelling.
Infections: Infections are the most common causes of swollen lymph nodes. Common infectious causes of swollen lymph nodes are
viral, bacterial, parasites, and fungal. Viruses: infectious mononucleosis (mono), chickenpox, measles, HIV, herpes, common cold
viruses, adenovirus, and many other viruses. Bacteria: streptococcus, staphylococcus, cat scratch disease, syphilis, tuberculosis,
chlamydia, and other sexually transmitted diseases. Parasites: toxoplasmosis, leishmaniasis. Fungal: coccidiomycosis,
histoplasmosis
Inflammation: Inflammatory and immunologic causes of swollen lymph nodes include diseases such as rheumatoid arthritis and
lupus as well as sensitivity to some medications.
Cancer
Many cancers can also cause swelling of lymph nodes. These may be cancers that originate from the lymph nodes or blood cells
such as lymphomas and leukemias. They may also be cancers that spread from another organ in the body (metastatic cancers). For
example, breast cancer may spread to the nearest lymph nodes in the axilla (underarm), or lung cancer may spread to the lymph
nodes around the collar bone.
Other causes of swollen lymph nodes
There are many other less common causes of swollen nodes, such as genetic lipid storage diseases, transplant graft rejections,
sarcoidosis, and many other conditions.
It is also important to mention that swollen lymph nodes are not always a sign of an underlying disease. Sometimes they can be
normal. For example, small (less than 1 centimeter), flat lymph nodes under the jaw (submandibular lymph nodes) in healthy
children and young adults or small (up to 2 centimeters), groin lymph nodes (inguinal lymph nodes) in young individuals may be
normal.
In many instances, a definitive cause for swollen lymph nodes may not be determined even after performing through examination
and testing.
http://www.medicinenet.com/swollen_lymph_nodes/article.htm
Cognitive Dysfunction or “fibrofog” has been linked to central nervous system imbalances. This condition may cause some patients
the most disability. According to some investigators, such symptoms include confusion and forgetfulness, inability to concentrate
and recall simple words and numbers, and transposing words and numbers. Often, their cognitive functions are so impaired that
they are unable to perform their usual activities of daily living (ADL), and the patient may get lost in familiar places or not be able to
communicate effectively. Those patients who work face the fear of losing their jobs. Some school-aged patients drop out because of
their inability to complete schoolwork.
Advances in noninvasive technology have made it possible to visualize the brain. New methods such as single photon emission
computed tomography (SPECT) scanning have helped define some of the abnormalities linked to the cognitive dysfunction. Studies
involving SPECT scanning show decreased blood flow in the area of the right and left caudate nuclei and thalami in fibromyalgia
patients. Cognitive dysfunction may be caused by abnormal levels of neurotransmitters such as substance P, serotonin, dopamine,
norepinephrine, and epinephrine. Some investigators claim that neuroendocrine imbalance of the HPA axis also may play a role in
fibrofog. Others studies have implicated yeast overload, water retention, and glial cell abnormalities as causes of cognitive
dysfunction in fibromyalgia.
For further information, please see http://fmscommunity.org/fibrom.htm
Complex Regional Pain Syndrome (CRPS) or Reflex Sympathetic Dystrophy Syndrome (RSDS) is a chronic neurological syndrome
characterized by: severe burning pain, pathological changes in bone and skin, excessive sweating, tissue swelling, and extreme
sensitivity to touch. In the National Fibromyalgia Association's 2005 Internet survey of 1362 people with CRPS, the average pain
score (10 being the worst pain imaginable) was 7.9 and 35% described their pain when CRPS developed as a 10, the worst pain
imaginable.
Sympathetic Dystrophy Syndrome Association website, www.rsds.org.
Depression
The National Institute of Mental Health (NIMH) – http://www.nimh.nih.gov/health/topics/depression/index.shtml
Dysmenorrhea refers to the syndrome of painful menstruation. Primary dysmenorrhea occurs in the absence of pelvic pathology,
whereas secondary dysmenorrhea results from identifiable organic diseases, most typically endometriosis, uterine fibroids, uterine
adenomyosis, or chronic pelvic inflammatory disease. The prevalence of dysmenorrhea is estimated to be between 45 and 95%
among reproductive-aged women. Although not life threatening, dysmenorrhea can be debilitating and psychologically taxing for
many women and is one of the leading causes of absenteeism from work and school.
American Congress of Obstetricians and Gynecologists – http://www.acog.org/publications/patient_education/bp046.cfm
Endocrine Disorders
Common Endocrine Disorders
Type 1 Diabetes, Type 2 Diabetes, Osteoporosis, Thyroid Cancer, Addison's Disease, Cushing's Syndrome, Gestational Diabetes,
Graves' Disease
Hashimoto's Thyroiditis, Hyperglycemia, Hyperparathyroidism, Hyperthyroidism, Hypoglycemia, Hypoparathyroidism,
Hypothyroidism, Menopause, Obesity, Pre-diabetes, Thyroid Nodules.
http://www.endocrineweb.com/
Endometriosis A condition in which tissue lining the uterus (endometrium) begins to grow in other regions of the body. This growth
causes pain, irregular bleeding, and possible infertility. This tissue growth usually occurs in the pelvic area, outside the uterus, on
the ovaries, bowel, rectum, bladder, and the lining of the pelvis. Though, these growths can also occur in other areas of the body.
This continual process can eventually cause scars (adhesions) on the tubes, ovaries, and surrounding structures in the pelvis.
Buildup of scars causes high pain.
The Endometriosis Association - http://www.endometriosisassn.org/
Enthesopathies In medicine, an enthesopathy refers to a disorder of entheses (bone attachments). If the condition is known to be
inflammatory, it can more precisely be called a enthesitis. Enthesopathies are disorders of peripheral ligamentous or muscular
attachments.
Examples include spondoarthropathy such as ankylosing spondylitis, plantar fascitis, and Achilles tendinitis
Adhesive capsulitis of shoulder, Rotator cuff syndrome of shoulder and allied disorders, Periarthritis of shoulder, Scapulohumeral
fibrositis, Enthesopathy of elbow region, Enthesopathy of wrist and carpus, Bursitis of hand or wrist, Periarthritis of wrist,
Enthesopathy of hip region, Bursitis of hip, Gluteal tendinitis, Iliac crest spur, Psoas tendinitis, Trochanteric tendinitis, Enthesopathy
of knee, Enthesopathy of ankle, tarsus and calcaneous
http://www.wrongdiagnosis.com/e/enthesopathy/intro.htm
Esophageal Motility disorders are not uncommon in gastroenterology. The spectrum of these disorders ranges from the well-defined
primary esophageal motility disorders (PEMDs) to very nonspecific disorders that may play a more indirect role in reflux disease and
otherwise be asymptomatic. Esophageal motility disorders may occur as manifestations of systemic diseases, referred to as
secondary motility disorders.
Esophageal motility disorders are less common than mechanical and inflammatory diseases affecting the esophagus, such as reflux
esophagitis, peptic strictures, and mucosal rings. The clinical presentation of a motility disorder is varied, but, classically, dysphagia
and chest pain are reported. In 80% of patients, the cause of a patient's dysphagia can be suggested from the history, including
dysmotility of the esophagus. Before entertaining a diagnosis of a motility disorder, first and foremost, the physician must evaluate
for a mechanical obstructing lesion.
eMedicine – http://emedicine.medscape.com/article/174783-overview
Female Urethral Syndrome Urethral syndrome is present in one quarter of patients presenting with lower urinary tract symptoms.
Urethral syndrome, or frequency-dysuria syndrome, is characterized by frequency, dysuria and suprapubic discomfort without any
objective finding of urological abnormalities or infection. Dysuria or constant suprapubic discomfort is partially relieved by voiding.
Patients also may report of difficulty in starting urination, slow stream, and a feeling of incomplete emptying of the bladder. Most
patients are women aged 30-50 years. Vaginal discharge and vaginal lesions must be excluded. History is important, and diagnosis
is by exclusion.
In urethral syndrome, the etiology is unknown. Historically, urethral stenosis (narrowing) was thought to be the cause of urethral
syndrome. Currently theorized etiologies include hormonal imbalances, inflammation of the "female prostate" (Skene glands and the
paraurethral glands), a reaction to certain foods, environmental chemicals (eg, douches, bubble bath, soaps, contraceptive gels,
condoms), hypersensitivity following urinary tract infection, and traumatic sexual intercourse. Regardless of the initial pain-causing
event, the patient has both involuntary spasms and voluntary tightening of the pelvic musculature during the painful episode, which,
in addition to any residual irritant or reinjury, starts a vicious circle of worsening dysfunction of the pelvic floor musculature. Often,
the original cause of the pain has healed, but the pelvic floor dysfunction persists and is worsened by patient anxiety and frustration
with the condition.
DSHI Systems, Inc. (Free MD) – http://www.freemd.com/urethral-syndrome/overview.htm
Functional Bowel Disorders These disorders include functional diarrhea, functional constipation, functional abdominal bloating,
functional abdominal pain syndrome and irritable bowel syndrome.
functional diarrhea, there is frequent or urgent passage of loose or watery stool (bowel movements), but no cause can be found.
The diarrhea is usually chronic, meaning it can happen on a fairly regular basis over months to years.
functional constipation have persistent symptoms of difficult, infrequent bowel movements, sometimes with a sensation of
incomplete emptying after having a bowel movement. Transit time, which is the time that it takes feces to move through the bowels
and be eliminated as stool, may be longer than normal in these people.
The frequency or consistency of stools are abnormal in people with functional constipation. Making this diagnosis therefore depends
on what’s normal for the individual person. It’s important to know that there’s a big range of “normal.” Not everybody has a bowel
movement every day. “Normal” frequency ranges from three bowel movements per day to three per week, consisting of firm (not
hard or lumpy) stools passed with no urgency or straining.
Functional bloating is a feeling of abdominal fullness or distention. People often report that their abdomen is relatively flat in the
morning, but becomes distended over the day. The distention tends to reduce after lying down or overnight.
functional abdominal pain syndrome (FAPS) feel pain in the belly. The pain can be frequent or constant and may not be related to
eating or to having a bowel movement. The pain can be so strong that it becomes the main focus of their life. It can affect or get in
the way of daily activities. People with irritable bowel syndrome (IBS) may also have abdominal pain, but it is usually related to
bowel problems such as diarrhea and/or constipation.
http://www.acg.gi.org/patients/gihealth/functional.asp
Hypermobility Syndome is a condition that features joints that easily move beyond the normal range expected for a particular joint.
The joint hypermobility syndrome is considered a benign condition. It is estimated that 10%-15% of normal children have
hypermobile joints, or joints that can move beyond the normal range of motion. There is a tendency of the condition to run in families
(familial). It is felt that certain genes are inherited that predispose to the development of hypermobile joints. Genes that are
responsible for the production of collagen, an important protein that helps to glue tissues together, are suspected of playing a role.
Joint hypermobility is also a feature of a rare, but more significant medical condition called Ehlers-Danlos syndrome that is
characterized by weakness of the connective tissues of the body. This condition is inherited in specific genes passed on by parents
to their children.
Because the joints are capable of excessive motion in people with the joint hypermobility syndrome, they are susceptible to injury.
Symptoms of the joint hypermobility syndrome include pains in the knees, fingers, hips, and elbows. There is a higher incidence of
dislocation and sprains of involved joints. Scoliosis (curvature of the spine) occurs more frequently in people with hypermobile joints.
Joint hypermobility tends to decrease with aging as we become naturally less flexible.
Signs of the syndrome are the ability to place the palms of the hands on the floor with the knees fully extended, hyperextension of
the knee or elbow beyond 10 degrees, and the ability to touch the thumb to the forearm.
WebMD – http://www.webmd.com/rheumatoid-arthritis/benign-hypermobility-joint-syndrome
Hyperthyroidism (overactive thyroid) is a condition in which your thyroid gland produces too much of the hormone thyroxine.
Hyperthyroidism can significantly accelerate your body's metabolism, causing sudden weight loss, a rapid or irregular heartbeat,
sweating, and nervousness or irritability.
Several treatment options are available if you have hyperthyroidism. Doctors use anti-thyroid medications and radioactive iodine to
slow the production of thyroid hormones. Sometimes, treatment of hyperthyroidism involves surgery to remove part of your thyroid
gland. Although hyperthyroidism can be serious if you ignore it, most people respond well once hyperthyroidism is diagnosed and
treated.
Hyperthyroidism can mimic other health problems, which may make it difficult for your doctor to diagnose. It can also cause a wide
variety of signs and symptoms. Hyperthyroidism symptoms may include:
Sudden weight loss, even when your appetite and food intake remain normal or even increase
Rapid heartbeat (tachycardia) — commonly more than 100 beats a minute — irregular heartbeat (arrhythmia) or pounding of your
heart (palpitations)
Increased appetite, Nervousness, anxiety or anxiety attacks, irritability, Tremor — usually a fine trembling in your hands and fingers,
Sweating
Changes in menstrual patterns, Increased sensitivity to heat, Changes in bowel patterns, especially more frequent bowel
movements
An enlarged thyroid gland (goiter), which may appear as a swelling at the base of your neck
Fatigue, muscle weakness, Difficulty sleeping
Older adults are more likely to have either no signs or symptoms or subtle ones, such as an increased heart rate, heat intolerance
and a tendency to become tired during ordinary activities. Medications called beta blockers, which are used to treat high blood
pressure and other conditions, can mask many of the signs of hyperthyroidism.
Thyroid Dysfunction – – American Thyroid Association – http://www.thyroid.org/
Hyperventilation is rapid or deep breathing, usually caused by anxiety or panic. This overbreathing, as it is sometimes called, may
actually leave you feeling breathless.
When you breathe, you inhale oxygen and exhale carbon dioxide. Excessive breathing may lead to low levels of carbon dioxide in
your blood, which causes many of the symptoms that you may feel if you hyperventilate.
Often, panic and hyperventilation become a vicious cycle -- panic leads to rapid breathing while breathing rapidly can make you feel
panicked.
If you frequently overbreathe (sometimes referred to as hyperventilation syndrome), this may be triggered by ongoing emotions of
stress, anxiety, depression, or anger. However, hyperventilation from panic is generally related to a specific fear or phobia, such as
a fear of heights, dying, or closed-in spaces (claustrophobia).
If you have hyperventilation syndrome -- that is, if you regularly hyperventilate -- you might not be aware of it. But you will be aware
of having many of the associated symptoms, including dizziness or lightheadedness, shortness of breath, belching, bloating, dry
mouth, weakness, confusion, sleep disturbances, numbness and tingling in your arms or around your mouth, muscle spasms in
hands and feet, chest pain, and palpitations.
For further information, please see www.nlm.nih.gov/MEDLINEPLUS/ency/article/003071.htm
Interstitial Cystitis/Vulvodynia (pronounced in-tur-STI-shul sis-TY-tis), also known as painful bladder syndrome (PBS), is a chronic,
often times painful, inflammatory condition of the bladder. Its cause is unknown. Unlike cystitis or a urinary tract infection (UTI), IC is
believed not to be caused by bacteria and does not respond to conventional antibiotic therapy.
Some or all of these symptoms may be present:
PAIN: Can be in the lower abdominal, urethral, or vaginal area. Pain is also frequently associated with sexual intercourse, even for
days after. Men with IC may experience testicular, scrotal, and/or perineal pain, and painful ejaculation.
FREQUENCY: Day and/or night frequency of urination, sometimes severe.
URGENCY: The sensation of having to urinate immediately, which may also be accompanied by pain, pressure, or spasms.
PELVIC FLOOR DYSFUNCTION (PFD): Some people with IC may have pelvic floor dysfunction in addition to IC. PFD is usually
related to too much tension or “high-tone”—the opposite of the too-relaxed state or “low-tone” that contributes to incontinence—of
the muscles that support the pelvic floor.
OTHER DISORDERS: Some people with IC also report muscle and joint pain, migraines, allergic reactions, and gastrointestinal
problems, as well as symptoms of IC. Research indicates that IC has an as yet unexplained association with certain other chronic
pain syndromes such as fibromyalgia, vulvar vestibulitis, and irritable bowel syndrome. The word "vulvodynia" means "painful
vulva." Your vulva consists of the pad of fatty tissue at the base of your abdomen (mons pubis), the labia, the clitoris and the
opening of your vagina.
The main vulvodynia symptom is pain in your genital area, which can be characterized by burning, soreness, itching, stinging,
rawness, painful intercourse (dyspareunia), or throbbing. The pain you experience may be constant or intermittent and can last for
months or even years, but can vanish as suddenly or mysteriously as it started. A similar condition, vulvar vestibulitis, may cause
pain only when pressure is applied to the area surrounding the entrance to the vagina.
Vulvar tissue may look minimally inflamed or swollen. More often, your vulva appears normal. Doctors don't know what causes
vulvodynia, but contributing factors may include injury to or irritation of the nerves surrounding your vulvar region; past vaginal
infections; allergies or a localized hypersensitivity of your skin; muscle spasms; changing estrogen levels that occur with menopause
Many women with vulvodynia have a history of treatment for recurrent vaginitis or vaginal yeast infections. Some women with the
condition have a history of sexual abuse. Vulvodynia isn't sexually transmitted or a common sign of cancer.
Interstitial Cystititis/Vulvodynia – – Interstitial Cystitis Network – http://www.ic-network.com/
Irritable Bowel Syndrome (IBS) is the most common functional gastrointestinal (GI) disorder with worldwide prevalence rates ranging
from 9-23 percent and U.S. rates generally in the area of 10-15 percent. Functional disorders are conditions where there is an
absence of structural or biochemical abnormalities on diagnostic tests, which could explain symptoms.
IBS is best understood as a long-term or recurrent (chronic) disorder of gastrointestinal functioning. It is characterized by multiple
symptoms involving a disturbance in the regulation of bowel function that results in unusual sensitivity and muscle activity. These
disturbances can produce symptoms of abdominal pain or discomfort, bloating or a sense of gaseousness, and altered bowel habits
(diarrhea and/or constipation).
Abdominal pain and/or discomfort is the key symptom of IBS and is often relieved with the passing of a bowel movement
(defecation). There are many causes for abdominal pain, but in IBS, the pain or discomfort is associated with a change in bowel
habits. While everyone suffers from an occasional bowel disturbance, for those with IBS the symptoms are more severe, or occur
more often either continuously or off and on. IBS affects men and women of all ages.
Symptoms can vary and sometimes seem contradictory, such as alternating diarrhea and constipation. The intensity and location of
abdominal pain in IBS are highly variable, even at different times within a single person. The symptoms of IBS are produced by
abnormal functioning of the nerves and muscles of the bowel. In IBS there is no evidence of an organic disease (where structural or
biochemical abnormalities are found), yet, something—a "dysregulation" between the brain, the gut, and the central nervous
system—causes the bowel to become "irritated," or overly sensitive to stimuli. Symptoms may occur even in response to normal
events, such as eating a meal.
Upper gastrointestinal symptoms are commonly reported by IBS patients with 25 percent to 50 percent of patients reporting
heartburn, nausea, abdominal fullness, and bloating. In addition, a significant number report intermittent upper abdominal discomfort
or pain (dyspepsia).
Many IBS patients also report non-gastrointestinal symptoms such as fatigue, muscle pain, sleep disturbances, and sexual
dysfunction. Up to 66 percent of IBS patients report non-gastrointestinal symptoms compared to less than 15 percent of healthy
individuals. These non-gastrointestinal symptoms may be due to IBS coexistence with another disease or condition such as
fibromyalgia, chronic fatigue syndrome, and interstitial cystitis. For example, the estimated prevalence of IBS in patients with
fibromyalgia (FMS) is 30 percent or more with similar findings of FMS in patients with irritable bowel syndrome.
International Foundation for Functional Gastrointestinal Disorders– http://www.aboutibs.org/
Find out more by going to www.iffgd.org/ or www.aboutibs.org/; or call toll-free at 1-888-964-2001
Lumbar Denegerative Disk Disease As humans age, they endure both macrotraumas and microtraumas and undergo changes in
posture that alter and redistribute biomechanical forces unevenly on the lumbar spine. Natural progression of degeneration of the
lumbar segment with motion proceeds with characteristic anatomic, biomechanical, radiologic, and clinical findings in lumbar
degenerative disk disease (LDDD).
Spine-health – http://www.spine-health.com/conditions/degenerative-disc-disease/lumbar-degenerative-disc-disease
Lumbar Facet Arthropathy Low back pain (LBP) remains a common musculoskeletal complaint, with a reported lifetime incidence of
60-90%. Various structures are possible sources of chronic LBP, including the posterior longitudinal ligament, dorsal root ganglia,
dura, annular fibers, muscles of the lumbar spine, and facet joints.
eMedicine – http://emedicine.medscape.com/article/310069-overview
Lupus as the prototypical autoimmune disease, lupus occurs when the immune system malfunctions. The immune system is
designed to protect the body from foreign invaders, such as bacteria and viruses. It performs this role by producing antibodies, or
proteins, to fight off infections. In people with lupus, the immune system loses its ability to distinguish between these foreign
substances, called antigens, and the body’s own cells and tissue. For reasons that are not yet fully understood, the immune system
then makes antibodies that are directed against "self." The self-antibodies create immune complexes which lodge in the body’s
tissue, causing inflammation and organ damage.
No one knows the exact cause of lupus. However, lupus is not infectious. Researchers believe people with lupus are born with a
genetic predisposition to the disease. Certain environmental factors also play a role in triggering disease activity. These factors
include infections, antibiotics, ultraviolet light, extreme stress, certain drugs, and hormones. Hormonal factors may explain why
lupus occurs more frequently in females than in males. Although lupus is known to occur in families, researchers have not identified
a specific gene or set of genes believed responsible for the disease. Likely there are many different genes involved in various
combinations that make individuals susceptible to developing lupus. The impact of lupus varies widely from person to person.
There are several forms of true lupus. Systemic lupus can affect nearly any organ or organ system of the body. Cutaneous lupus
affects the skin. Drug-induced lupus is brought on by certain medications, and resolves when the offending medication is
discontinued. Neonatal lupus affects the fetus and can range from a rash that disappears with no ill effects to an irregular heart beat
that requires the infant to have a pacemaker. The antiphospholipid syndrome comprises a combination of symptoms and is
implicated in recurrent miscarriages and blood clots. Sometimes, people with inconclusive test results for lupus may instead be
given a diagnosis of mixed connective tissue disease or undifferentiated connective tissue disease.
LFA website at http://www.lupus.org/ or call the LFA’s national toll-free information request line at 888-38-LUPUS (385-8787)
Lyme Disease is a tick-borne illness that causes signs and symptoms ranging from rash, fever, chills and body aches to joint
swelling, weakness and temporary paralysis. Lyme disease is caused by the bacterium Borrelia burgdorferi. Deer ticks, which feed
on the blood of animals and humans, can harbor the disease and spread it when feeding. In general, Lyme disease can cause rash,
flu-like symptoms, migratory joint pain, neurological problems. Less common signs and symptoms: Some people may experience
heart problems — such as an irregular heartbeat — several weeks after infection, but this rarely lasts more than a few days or
weeks. Eye inflammation, hepatitis and severe fatigue are possible
American Lyme Disease Foundation – http://www.aldf.com/programs.shtml
Mechanical Low Back Pain Causes of mechanical LBP generally are attributed to an acute traumatic event, but they may also
include cumulative trauma as an etiology. The severity of an acute traumatic event varies widely, from twisting one's back to being
involved in a motor vehicle collision. Mechanical LBP due to cumulative trauma tends to occur more commonly in the workplace.
The pathophysiology of mechanical LBP remains complex and multifaceted. Multiple anatomic structures and elements of the
lumber spine (eg, bones, ligaments, tendons, disks, muscle) are all suspected to have a role. Many of these components of the
lumber spine have sensory innervation that can generate nociceptive signals representing responses to tissue-damaging stimuli.
Other causes could be neuropathic (dysfunction of the nervous system--e.g, sciatica). Most chronic LBP cases most likely involve
mixed nociceptive (a sensory receptor that responds to pain) and neuropathic etiologies.
Repetitive, compressive loading of the disks in flexion (eg, lifting) puts the disks at risk for an annular tear and internal disk
disruption. Likewise, torsional forces on the disks can produce shear forces that may induce annular tears. The contents of the
annulus fibrosis (nucleus pulposus) may leak through these tears. Central fibers of the disk are pain free, so early tears may not be
painful. Samples of disk material taken at the time of autopsy reveal that the cross-linked profile of pentosidine, a component of the
collagen matrix, declines. This may indicate the presence of increased matrix turnover and tissue remodeling.
Research in the past 20 years suggests that chemical causes may play a role in the production of mechanical LBP. Components of
the nucleus pulposus, most notably the enzyme phospholipase A2 (PLA2), have been identified in surgically removed herniated disk
material. This PLA2 may act directly on neural tissue, or it may orchestrate a complex inflammatory response that manifests as LBP.
Glutamate, a neuroexcitatory transmitter, has been identified in degenerated disk proteoglycan and has been found to diffuse to the
dorsal root ganglion (DRG) affecting glutamate receptors. Substance P (pain) is present in afferent neurons, including the DRG, and
is released in response to noxious stimuli, such as vibration and mechanical compression of the nerve. Steady, cyclic, or vibratory
loading induces laxity and creep in the viscoelastic structures of the spinal elements. This creep does not recover fully in the in vivo
cat model, even when rest periods are equal in duration to the loading period.
The concept of a biomechanical degenerative spiral has an appealing quality and is gaining wider acceptance. This concept
postulates the breakdown of the annular fibers allows PLA2 and glutamate, and possibly other as-yet unknown compounds, to leak
into the epidural space and diffuse to the DRG. The weakened vertebra and disk segment become more susceptible to vibration and
physical overload, resulting in compression of the DRG and stimulating release of substance P. Substance P, in turn, stimulates
histamine and leukotriene release, leading to an altering of nerve impulse transmission. The neurons become sensitized further to
mechanical stimulation, possibly causing ischemia, which attracts polymorphonuclear cells and monocytes to areas that facilitate
further disk degeneration and produce more pain.
Please see http://www.emedicine.com/PMR/topic73.htm
Meralgia paresthetica (MP) is pain or an irritating sensation felt over the anterior or anterolateral aspect of the thigh due to injury,
compression, or disease of the lateral femoral cutaneous nerve (LFCN). Diagnosis of MP is based on history and examination.
Nerve conduction studies are used to verify the presence of the neuropathy and rule out other causes for the symptoms. Treatment
for uncomplicated or benign forms of MP includes conservative measures initially, followed by surgical intervention for chronic
discomfort. Malignant pathologic processes can produce symptoms of MP and, therefore, must be ruled out before conservative
treatments are initiated.
Nerve entrapment can occur at 3 potential sites including (1) beside the spinal column, (2) within the abdominal cavity as the nerve
courses along the pelvis, and (3) as it exits the pelvis. The last site is the most common and may involve the sartorius muscle or
may be caused by simple compression superficially near the iliac crest and ASIS by tight clothing or trauma.
For more information, please see: http://www.emedicine.com/PMR/topic76.htm
Migraine Headache is clinically defined as a vascular headache. The pain and other symptoms are associated with changes in the
size of the brain’s arteries. Unfortunately, it doesn’t take much to trigger these changes. The most common causes include:
Emotional stress, and the "flight or fight" physical reactions that follow. We’re not talking about severe stress here. Everyday tension
is enough for some unlucky people. (It’s not unusual to express that tension by clenching the jaw, or grinding teeth while awake or
asleep. But scientists have some new solutions that we’ll discuss later.)
Food sensitivity, caffeine, changing weather conditions, and hormonal changes.
Finally, there are two triggers that fibromyalgia sufferers know all too well; excessive fatigue and changes in normal sleep patterns.
Although not a symptom, another clue to migraine recognition is its links with other conditions. Statistics show that these headaches
are commonly associated with asthma, chronic fatigue syndrome, hypertension, stroke and, as with fibromyalgia, sleep disorders.
Migraine headaches are divided into two categories, "classic" migraine. The classic is known for a 15-60 minute visual aura that
signals the onset.
The auras sound like something from the 60’s drug culture: bright flashing dots or lights, blind spots, distorted vision, short-term
vision loss, and jagged or wavy lines. Sometimes other senses are affected, such as: ringing in the ears, numbness, a pins and
needles sensation, and changes in smell, taste or touch.
Common migraines often begin with anxiety, depression and fatigue. As for the actual symptoms of a migraine, it’s easy to see
some more commonalities.
Most people report pounding and throbbing headaches. These often grow from dull to throbbing pain. In a survey by the NHF, 79
percent of the respondents reported sensitivity to light and sound as the most common symptom. Physical activity just makes
matters worse. Migraines don’t play favorites inside your head. The pain can start in one location and shift to the other, or feel like
it’s saturating the brain.
As for duration, it’s about four hours for the typical migraine. However severe migraines can last up to a week. At least the average
for migraine frequency isn’t staggering. The common migraine sufferer experiences two to four per month. Obviously, even two to
four migraines per month is a serious problem. Even more so in the context of fibromyalgia and pain intensity. Studies have shown
that fibromyalgia sufferers appear to feel pain more acutely than others.
Migraine Headaches – – National Headache Foundation – http://www.headaches.org/
Mitral Valve Prolapse (also known as "click murmur syndrome" and "Barlow's syndrome") is the most common heart valve
abnormality, affecting five to ten percent of the world population. A normal mitral valve consists of two thin leaflets, located between
the left atrium and the left ventricle of the heart. Mitral valve leaflets, shaped like parachutes, are attached to the inner wall of the left
ventricle by a series of strings called "chordae." When the ventricles contract, the mitral valve leaflets close snugly and prevent the
backflow of blood from the left ventricle into the left atrium. When the ventricles relax, the valves open to allow oxygenated blood
from the lungs to fill the left ventricle.
In patients with mitral valve prolapse, the mitral apparatus (valve leaflets and chordae) becomes affected by a process called
myxomatous degeneration. In myxomatous degeneration, the structural protein collagen forms abnormally and causes thickening,
enlargement, and redundancy of the leaflets and chordae. When the ventricles contract, the redundant leaflets prolapse (flop
backwards) into the left atrium, sometimes allowing leakage of blood through the valve opening (mitral regurgitation). When severe,
mitral regurgitation can lead to heart failure and abnormal heart rhythms. Most patients are totally unaware of the prolapsing of the
mitral valve. Others may experience a number of symptoms discussed in the website.
The mitral valve prolapse (MVP) syndrome has a strong hereditary tendency, although the exact cause is unknown. Affected family
members are often tall, thin, with long arms and fingers, and straight backs. It is seen most commonly in women from 20 to 40 years
old, but also occurs in men.
http://www.medicinenet.com/mitral_valve_prolapse/article.htm
Multiple Chemical Sensitivity Syndrome is a disorder that appears to be triggered by low-level exposure to multiple chemical
substances commonly found in the environment. Multiple chemical sensitivity syndrome is more common among women than men.
In addition, 40% of people with chronic fatigue syndrome and 16% of people with fibromyalgia have multiple chemical sensitivity
syndrome as well.
Six consensus criteria were identified by researchers for the diagnosis and definition of MCS in 1989 (later edited in 1999) :
1. Symptoms are reproducible with repeated (chemical) exposures.
2. The condition has persisted for a significant period of time.
3. Low levels of exposure (lower than previously or commonly tolerated) result in manifestations of the syndrome (i.e. increased
sensitivity).
4. The symptoms improve, or resolve completely, when the triggering chemicals are removed.
5. Responses often occur to multiple, chemically unrelated substances.
6. Symptoms involve multiple-organ symptoms (runny nose, itchy eyes, headache, scratchy throat, ear ache, scalp pain, mental
confusion or sleepiness, palpitations of the heart, upset stomach, nausea and/or diarrhea, abdominal cramping, aching joints).
The National Institute of Environmental Health Sciences (a division of the NIH) defines MCS as a "chronic, recurring disease caused
by a person's inability to tolerate an environmental chemical or class of foreign chemicals". MCS has also been described as a
group of "sensitivities to extraordinarily low levels of environmental chemicals" appearing "to develop de novo in some individuals
following acute or chronic exposure to a wide variety of environmental agents including various pesticides, solvents, drugs, and air
contaminants" including those found in sick buildings.
Environmental Medicine Specialists claim that MCS causes negative health effects in multiple organ systems, and that respiratory
distress, seizures, cognitive dysfunction, heart arrhythmia, nausea, headache, and fatigue can result from exposure to levels of
common chemicals that are normally deemed as safe.
Multiple Chemical Sensitivity Syndrome – – Multiple Chemical Sensitivity Organization – http://www.multiplechemicalsensitivity.org/
Myofascial Pain Syndrome and fibromyalgia may coexist, presenting a complex clinical picture; however, fibromyalgia and
myofascial pain syndrome are not one and the same condition. Fibromyalgia is a generalized amplification of pain or hypersensitivity
condition and is associated with tender points in the muscles. Tender points are focal areas of muscle tissue that are exquisitely
tender to compression. The tender points of fibromyalgia are painful locally at the site where the pressure is applied, without referred
pain to distant areas.
By contrast, myofascial pain syndrome is considered in the narrow definition to be a disorder of trigger points. Similar to tender
points, trigger points also are discreet areas in muscle tissue and/or its associated fascia that are exquisitely tender to compression;
however, unlike tender points, when pressure is applied to the trigger point, pain occurs not only at the site of the applied pressure,
but also at a distant site (zone of pain referral). Trigger points are found in taut bands (firm elongated bands) within the muscle fibers
and are associated with the local twitch response. This local twitch response is an involuntary transient contraction of the taut band
muscle fibers and can be elicited by snapping or pinching the taut band. Some authors assert that both disorders (fibromyalgia and
myofascial pain syndrome) can magnify and perpetuate the symptoms of the other.
Myofascial Pain Syndrome – – International MYOPAIN Society – http://www.myopain.org/
Nondermatomal Paresthesia or aching pain in one or both arms may occur as a result of a whiplash injury to the neck. The term
“whiplash is not a medical diagnosis, but is the result of soft-tissue trauma to the neck. A whiplash injury occurs as a result of a
sudden acceleration or deceleration of the head and neck, the cervical spine. Whiplash injury could cause symptoms lasting for
several years after the initial trauma.
Nondermatomal Paresthesia – – Paresthesia.net – http://www.paresthesia.net/
Osteoarthritis (OA) is a chronic disease process affecting synovial joints, particularly large weight-bearing joints. OA is particularly
common in older patients but can occur in younger patients either through a genetic mechanism or, more commonly, because of
previous joint trauma.
Joints can be classified as synovial, fibrous, or combination joints, based on the presence or absence of a synovial membrane and
the amount of motion that occurs in the joint. Normal synovial joints allow a significant amount of motion along their extremely
smooth articular surface. These joints are comprised of a synovial membrane, articular or hyaline cartilage, subchondral bone,
synovial fluid, and a joint capsule.
Although traditional teaching prescribes that OA affects primarily the articular cartilage of synovial joints, pathophysiologic changes
also occur in the synovial fluid, as well as in the underlying (subchondral) bone and overlying joint capsule. The affected cartilage
initially develops small tears, known as fibrillations, at the articular surface, followed by larger tears; the cartilage eventually
fragments off into joints. The cartilage-forming cells (ie, chondrocytes) replicate in an attempt to keep up with the cartilage loss;
however, they eventually are unable to do so, and the underlying bone becomes exposed because of gross areas of bone denuded
of cartilage.
The osteoarthritic joint is characterized by decreased concentration of hyaluronic acid because of reduced production by
synoviocytes and increased water content because of inflammation, particularly during later stages of the disease.
Pain is usually of insidious onset, is generally described as aching or throbbing, and may result from changes that have occurred
over the last 15-20 years. Most often, the pain is worse with activity involving the affected joint and is initially relieved with rest;
eventually pain occurs even at rest. Since cartilage itself is not innervated, the pain is presumed to be from a combination of
mechanisms, including (1) osteophytic periosteal elevation, (2) vascular congestion of subchondral bone leading to increased
intraosseous pressure, (3) synovitis with activation of synovial membrane nociceptors, (4) fatigue of muscles that cross the joint, and
(5) overall joint contracture.
In addition to the underlying pathophysiologic changes described above, overall, the joint may undergo mechanical deformation with
resultant malalignment and instability. Alternatively, the joint can ankylose.
Osteoarthritis – – Mayo Clinic – http://www.mayoclinic.com/health/osteoarthritis/DS00019
Periodic limb movement (PLM) disorder is unique in that the movements occur during sleep. Most other movement disorders
manifest during wakefulness. The condition is remarkably periodic, and the movements may cause poor sleep and subsequent
daytime somnolence. Periodic limb movement disorder may occur with other sleep disorders and is related to, but not synonymous
with, restless legs syndrome (RLS), a less specific condition with sensory features that manifest during wakefulness. The majority of
patients with restless legs syndrome have periodic limb movement disorder, but the reverse is not true. Treatment involves either
dopaminergic medication in an attempt to modify activity of the subcortical motor system or, more commonly, sedative medications
to allow uninterrupted sleep. Many new agents are proving efficacious for treatment as well.
http://emedicine.medscape.com/article/1188558-overview
Postpolio Syndrome Accepted criteria for diagnosis of postpolio syndrome (PPS) are a prior history of poliomyelitis, a stable period
after recovery, a residual deficit of the initial polio, new muscle weakness, and, sometimes, new muscle atrophy. Fatigue and
muscle pain need not be present to meet the criteria for the syndrome.
One possible cause of PPS is decompensation of a chronic denervation and reinnervation process to the extent that the remaining
healthy motor neurons can no longer maintain new sprouts; thus, denervation exceeds reinnervation.
A second possible mechanism for PPS is motor neuronal loss due to reactivation of a persistent latent virus. In addition to muscle
atrophy and denervation, foci of perivascular and interstitial inflammatory cells have been found on 50% of biopsies of patients with
PPS. Activated T cells and immunoglobulin M and immunoglobulin G antibodies specific for gangliosides also have been found.
Another possibility is an infection of the polio survivor's motor neurons by an enterovirus that is different from the one responsible for
the patient's polio. Others sources hypothesize that PPS is merely the loss of strength due to the usual stresses of aging and weight
gain. In patients with PPS, these processes occur in muscles that already are weak, so the consequences are more noticeable
compared with those of patients who have not had polio.
Postpolio Syndrome – – Post-Polio Health International – http://www.post-polio.org/
Premenstrual Syndrome (PMS) is a group of symptoms that start one to two weeks before your period. Most women have at least
some symptoms of PMS, and the symptoms go away after their periods start. For some women, the symptoms are severe enough
to interfere with their lives. They have a type of PMS called premenstrual dysphoric disorder, or PMDD.
Common PMS symptoms include breast swelling and tenderness; acne; bloating and weight gain; pain - headache or joint pain;
food cravings; irritability, mood swings, crying spells, depression
For more information, please see http://www.nlm.nih.gov/medlineplus/premenstrualsyndrome.html
Premenstrual Syndrome (PMS) – – MedLine Plus – http://www.nlm.nih.gov/medlineplus/premenstrualsyndrome.html
Raynaud's phenomenon is a vasospastic disorder causing discoloration of the fingers, toes, and occasionally other extremities. This
condition can also cause nails to become brittle with longitudinal ridges. The cause of the phenomenon is believed to be the result
of vasospasms that decrease blood supply to the respective regions. Emotional stress and cold are classic triggers of the
phenomenon, and the discoloration follows a characteristic pattern in time: white, blue and red.
For more information, please see http://en.wikipedia.org/wiki/Raynaud%27s_phenomenon
Raynaud Phenomenon – – Raynaud's & Scleroderma Association – http://www.raynauds.org.uk/raynauds/raynauds
Reflex Sympathetic Dystrophy Syndrome (RSDS) or Complex Regional Pain Syndrome (CRPS) is a chronic neurological syndrome
characterized by: severe burning pain, pathological changes in bone and skin, excessive sweating, tissue swelling, and extreme
sensitivity to touch. In our recently completed 2005 Internet survey of 1362 people with CRPS, the average pain score (10 being the
worst pain imaginable) was 7.9 and 35% described their pain when CRPS developed as a 10, the worst pain imaginable.
For a complete description of RSD/CRPS symptoms, please read the Diagnosis section of the Clinical Practice Guidelines section of
our website, www.rsds.org
Restless Leg Syndrome
How many of these questions can you answer “yes” to:
When you sit or lie down, do you have a strong desire to move your legs?
Is that desire to move your legs impossible to resist?
Have you ever used the words “unpleasant,” creepy crawly,” “creeping, “itching,” “pulling,” or “tugging” to describe your symptoms to
others?
Does your desire to move often occur when you are resting or sitting still?
Does moving your legs make you feel better?
Do you complain of these symptoms more at night?
Do you keep your bed partner awake with the jerking movements of your legs?
Do you ever have involuntary leg movements while you are awake?
Are you tired or unable to concentrate during the day?
Do any of your family members have similar complaints?
Does a trip to the doctor only reveal that nothing is wrong and there is no physical cause for your discomfort?
If you answered "yes" to a majority of these questions, you may have restless legs syndrome (RLS). This topic is especially
important to individuals living with fibromyalgia. According to Dr. Helen A. Emsellem MD, the Medical Director for the Center for
Sleep & Wake Disorders in Chevy Chase, MD, “RLS is seen in approximately one-third of patients with fibromyalgia.”
Learn more by calling 877-INFO RLS or going to www.rls.org/
Restless Leg Syndrome – – National Sleep Foundation – http://www.sleepfoundation.org/article/sleep-related-problems/restlesslegs-syndrome-rls-and-sleep
Sleep Disorders Sleep is not a state of massive system shutdown, but quite the contrary. During sleep, the brain is very active,
constantly communicating with the body. Many neurohormones, antibodies, and other molecules also are synthesized during sleep;
therefore, when sleep is disrupted, biochemical abnormalities can occur, leading to multisystem disturbances.
Sleep studies have shown that patients with fibromyalgia have disordered sleep physiology. Most of these patients experience
unrefreshing sleep with morning fatigue.
To understand abnormal sleep architecture, it is essential to know the basics of normal sleep. Sleep can be divided into 2 main
parts, nonrapid eye movement (NREM) and rapid eye movement (REM) sleep, which alternate cyclically through the night, always
starting with NREM sleep. In each successive NREM and REM cycle through the night, the amount of NREM sleep decreases and
the amount of REM sleep progressively increases. Each cycle, NREM plus REM, lasts about 90 minutes. NREM is divided even
further into 4 stages: stage 1 is initial drowsiness; stage 2 is light sleep; and stages 3 and 4 are progressively deeper levels of sleep.
In stages 3 and 4 of NREM sleep, the electroencephalogram (EEG) shows a pattern called delta waves, which are high-amplitude
waves (greater than 75 mV) that move slowly (0.5-2 Hz). Much of the body's regulatory work, as well as synthesis of many
substances (eg, antibodies, growth hormone, other neurochemicals), occurs during NREM sleep.
REM sleep has a low-voltage mixed-frequency pattern on EEG and is considered dream sleep. In this stage, the body has a
complete loss of muscle tone, known as flaccid paralysis, and cannot move. During this part of sleep, consolidation of memories
may occur, but there is still disagreement over exactly what occurs with memory during REM sleep. Some investigators found that
during waking hours, the brain generates alpha waves with a frequency of 7.5-11 Hz.
Sleep dysfunction is considered an integral feature of fibromyalgia syndrome. Seventy percent of patients with fibromyalgia
recognize a connection with poor sleep and an increased pain, along with feeling unrefreshed, fatigued, and emotionally distressed.
Several studies have linked abnormal sleep with these symptoms.
Some researchers have studied fibromyalgia and sleep, confirming the disordered sleep physiology in fibromyalgia. This
abnormality has been identified as an alpha-wave intrusion sleep anomaly, which occurs during NREM stage-4 sleep. This intrusion
into deep sleep causes the patient to awaken or to be aroused into a lighter level of sleep.
Some authors describe the altered sleep physiology and somatic symptoms as a nonrestorative sleep syndrome. This sleep
dysfunction is believed to be linked to the numerous metabolic disturbances associated with fibromyalgia, including abnormal levels
of neurotransmitters (serotonin, substance P) and neuroendocrine and immune substances (growth hormone, cortisol, and
interleukin-1). These authors propose that these metabolic imbalances are responsible for the increase in symptoms associated with
this alpha-wave intrusion sleep disorder by impairing tissue repair and disturbing the immunoregulatory role of sleep. Studies show
that the greatest amount of alpha-wave intrusions occur during the first few hours of sleep, decreasing throughout the night to
normal levels by early morning. Some researchers note that this hypothesis correlates well with patients' frequent reporting that their
best sleep is obtained in the early morning hours just prior to arising.
Sleep Disorders – – National Sleep Foundation – http://www.sleepfoundation.org/primary-links/how-sleep-works
Sjögren’s Syndrome often is undiagnosed or misdiagnosed. The symptoms of Sjögren’s syndrome may mimic those of menopause,
drug side effects, or medical conditions such as lupus, rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome, and multiple
sclerosis. Because all symptoms are not always present at the same time and because Sjögren’s can involve several body systems,
physicians and dentists sometimes treat each symptom individually and do not recognize that a systemic disease is present. The
average time from the onset of symptoms to diagnosis is over six years.
Sjögren’s syndrome is a chronic autoimmune inflammatory disease in which moisture-producing glands are damaged, significantly
decreasing the quantity and quality of saliva and tears. The disease was first dentified by a Swedish physician, Henrik Sjögren, in
1933. Although the hallmark symptoms are dry eyes and dry mouth, Sjögren’s also may cause dysfunction of other organs, affecting
the kidneys, gastrointestinal system, blood vessels, lungs, liver, pancreas, and the nervous system. Patients may experience
extreme fatigue and joint pain and have a higher risk of lymphoma.
Sjogrens – – Sjögren’s Syndrome Foundation – http://www.sjogrens.org/
Temporomandibular Joint Syndrome, Temporomandibular disorder(s) (TMD) or temporomandibular joint (TMJ) syndrome is the
most common cause of facial pain after toothache. In the past, many physicians called this condition TMJ disease or TMJ
syndrome. The term temporomandibular disorder (TMD) is the preferred term according to the American Academy of Orofacial Pain
(AAOP) and most other groups who sponsor studies into its origins and treatment. Interestingly, the National Institute of Dental and
Craniofacial Research (NIDCR) puts TMJ and TMD together and refers to them as temporomandibular joint disorder (TMJD) on its
Web site. The authors preferentially use the term temporomandibular disorder (TMD) in this article.
Two widely used classification schemes exist. The AAOP classification divides TMD broadly into 2 syndromes: (1) muscle-related
TMD (myogenous TMD), sometimes this is called TMD secondary to myofacial pain and dysfunction (MPD), and (2) joint-related
(arthrogenous) TMD, that is TMD secondary to true articular disease. The 2 types can be present at the same time, making
diagnosis and treatment more challenging.
Temporomandibular Joint Syndrome – – The TMJ Association – http://www.tmj.org/site/
Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn't produce enough of certain important
hormones. This condition is also called Graves
Women, especially those older than 50, are more likely to have hypothyroidism. Hypothyroidism upsets the normal balance of
chemical reactions in your body. It seldom causes symptoms in the early stages, but over time, untreated hypothyroidism can cause
a number of health problems, such as obesity, joint pain, infertility and heart disease.
The signs and symptoms of hypothyroidism vary widely, depending on the severity of the hormone deficiency. But in general, any
problems you do have tend to develop slowly, often over a number of years. At first, you may barely notice the symptoms of
hypothyroidism, such as fatigue and sluggishness, or you may simply attribute them to getting older. But as your metabolism
continues to slow, you may develop more obvious signs and symptoms. Hypothyroidism symptom may include:
Fatigue
Sluggishness
Increased sensitivity to cold
Constipation
Pale, dry skin
A puffy face
Hoarse voice
An elevated blood cholesterol level
Unexplained weight gain
Muscle aches, tenderness and stiffness
Muscle weakness
Pain, stiffness or swelling in your joints
Brittle fingernails and hair
Heavier than normal menstrual periods
Depression
For more information, please see http://www.mayoclinic.com/health/hypothyroidism
Vestibular Disorders are related to problems with balance. Dizziness, vertigo, lightheadedness, motion sickness, etc. and can be
caused by visual, inner ear, general sensory and brain dysfunctions. Balance is a state of body equilibrium or stability.
Vestibular Disorders – – Vestibular Disorders Association – http://www.vestibular.org/
Vulvar Vestibulitis Syndrome/Vulvodynia is a medical term that means "painful vulva." The term can cover a wide variety of vulvar
pain syndromes, including various infections and skin disorders. Vulvar Vestibulitis Syndrome (VVS) is an inflammation of the
vestibule, or opening to the vagina and the tissues immediately around the vaginal opening. This condition is also sometimes called
"vestibular adenitis".The classic description of VVS involves redness of the vulvar vestibule, especially with small red spots; pain
with intercourse or tampon insertion and stinging pain when urinating.
Vulvodynia of neurologic origin is also called "essential vulvodynia," "pudendal neuralgia" or "dysthetic vulvodynia". The classic
description of pudendal neuralgia involves a more or less constant itching or tingling sensation in the vulva, ranging from mild to
excruciating pain of the entire vulva. Pudendal neuralgia is probably due to compression or degeneration of the pudendal nerve, one
of the main nerves that relays sensation to and from the genitals. This condition can also result from a spinal injury, or a tumor or
cyst in the spine. Trauma during childbirth can also cause vulvodynia. In many cases, the exact cause remains unknown.
The National Vulvodynia Association (NVA) - http://www.nva.org/
Vulvar Vestibulitis – – American Academy of Family Physicians – http://www.aafp.org/afp/990315ap/990315d.html