Fibromyalgia means that a previously healthy person develops unexplained exhaustion, fatigue and muscle aches and pains that last for more than six months, all blood tests are normal and doctors can't find a cause. One report shows that a large number of people who were diagnosed as having fibromyalgia really had polymyalgia rheumatica that does have an abnormal blood test. Another study shows that many sufferers have low spinal fluid levels of vitamin B12 and may be treated with 1000 mcg B12 pills each day.

The diagnosis of fibromyalgia should be made only after all other causes have been ruled out. Many infections can cause fatigue and muscle pain, such as parvovirus B19, which was reported to be cured with intravenous injections of immunoglobulin. The evaluation should include tests for infectious diseases; such as Lyme disease and hepatitis B or C, cytomegalovirus, toxoplasmosis or the helicobacter that causes stomach ulcers; autoimmune diseases, such as rheumatoid arthritis, lupus, Crohn's disease or ulcerative colitis; hidden cancers such as those of the breast or prostate; hormonal diseases such as low thyroid; or side effects from a medication or illicit drug.

About twenty percent of the patients are depressed, and most people miss work and complain of illness long before their diagnosis. A diagnosis of chronic fatigue means that tiredness is the major complaint. Fibromyalgia usually means that muscle and joint pains are the major symptoms. Many studies show that there is no dependable way to define chronic fatigue syndrome or fibromyalgia, and that three months of antibiotics does not cure them, but if the doctor suspects a reactive arthritis it is reasonable to give a trial with antibiotics for a longer term. Reactive arthritis patients who may be be cured with long-term antibiotics are:

* Those who have positive blood tests for arthritis which are really measures of an overactive immunity that is trying to kill a germ,

* those who suffer from a chronic infection characterized by burning on urination, urgency or having to get up many times during the night

* those who have chronic diarrhea,

* those who have belching and burning in the stomach,

* those who have a chronic cough or sinus infections,

* those who have swelling in the middle of the hand which is characteristic of Rheumatoid arthritis.

However, people who have reactive arthritis must be treated for longer than three months, often for more than a year.

An article from the University of Washington, Seattle demonstrates that fibromyalgia, chronic fatigue syndrome, temporomandibular joint syndrome, irritable bowel syndrome, interstitial cystitis and chronic headaches share the same symptoms, occur in the same people and doctors can't find a cause or treatment. I have prescribed doxycycline 100 mg twice a day for several months, and sometimes azithromycin 500 mg twice a week, and some get better. However, this treatment is controversial and is not accepted by many doctors. Please check with your doctor.

For journal references on the studies mentioned in this article, see http://www.drmirkin.com/morehealth/G115.htm

Dr. Gabe Mirkin has been a radio talk show host for 25 years and practicing physician for more than 40 years; he is board certified in four specialties, including sports medicine. Read or listen to hundreds of his fitness and health reports at http://www.DrMirkin.com

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