The former head of the National Institute of Health’s Chronic Fatigue Syndrome (CFS) research center in New Jersey, Dr. Natelson, has been looking into the issue of how CFS and fibromyalgia (FMS) affect the ability of the afflicted to exercise. Dr. Natelson’s latest work involves the use of a measure called peak oxygen consumption (VO2 max). VO2 max gives an accurate indication of an individual’s fitness. This measure is the volume of oxygen used when an individual exercises according to his maximum ability. VO2 gives the maximum milliliters of oxygen used during one minute per kilogram of body weight. Those who are in good physical shape will have higher values of VO2 and can work out with greater intensity than those in poor physical condition.

Two Issues

The rate at which one can release energy through aerobic exercise is dependent on two issues:

• The chemical makeup of the muscles’ cell tissue system which affects the ability to employ oxygen as a means  of burning body fuel.
• The twinned abilities of the lungs and the heart to bring oxygen to the muscles’ tissue system.

Natelson has found that a patient can be expected to function at a comfortable level at around 50-60% of their VO2 max. To illustrate the implications of this formula as it relates to fibromyalgia patients, a person who has a VO2 max of 35 ml/min/kg, is unable to do much more than sedentary desk work. VO2 values are helpful in suggesting an assessment of a patient’s overall function. If values are monitored with regularity, a patient can be assessed in terms of how his function has improved or declined with the passing of time. This monitoring process can be important for a patient who is trying to obtain disability payments, for instance, but the main function of such a monitoring process is to give a patient’s physician some idea of how the patient’s case is progressing.

Simple Pedometer

There are different methods of obtaining VO2 max values. One study employed the used of treadmill tests. But a simple pedometer can give an accurate sense of VO2 max. Pedometers can be found for under $5.00 in stores such as Wal-Mart, but of course, fancy versions exist, some costing as much as $30.00. The high-end versions of the device allow for some patient input, such as stride length. This type of input aids the device in calculating how many miles have been covered or how many calories have been burned. This is useful in monitoring a slow increase in the level of a patient’s functioning.

In the drug trials for Ampligen, researchers found that patients’ VO2 levels dropped before patient questionnaires showed any sign of a decline in function. Physicians who are sold on VO2 max as a means of monitoring patient function feel that this is a very sensitive indicator of how the patient is responding to treatment.

The problems with diagnosing Fibromyalgia

Fibromyalgia is a condition that affects how your body processes pain, with sufferers experiencing significantly heightened sensations to pain. The condition is estimated to affect 2% to 4% of the population, with women far more prone to develop symptoms. Also, individuals with a rheumatic disease such as osteoarthritis or lupus tend to be at higher risk.

Those diagnosed with the condition suffer from a wide range of symptoms including musculoskeletal pain, fatigue, memory problems and anxiety.

However, there are considerable issues surrounding the diagnosis procedure of Fibromyalgia, with research indicating that 2/3 of patients diagnosed with the condition actually do not suffer from it at all. That means that in most cases, the symptoms that the patients are suffering from are actually caused by another condition or issue. Clearly, this can cause serious problems as the symptoms will not be correctly treated and patient suffering can be prolonged.

The criteria used to diagnose the condition was initially introduced in 1990 with 18 points identified across the body that can be indicative of Fibromyalgia if the patient experiences pain when these points are pressed. For years, patients were required to feel pain in 11 of these 18 areas to be diagnosed as suffering from Fibromyalgia.

But the issue with this procedure was that the pain the patients experienced, as well as other complaints, can be symptoms of other conditions as well. In fact, many of the symptoms displayed by patients are incredibly common such as long-term fatigue, muscle aches, gastrointestinal complaints, mild depression or anxiety and insomnia. It can be easy to jump to conclusions when diagnosing Fibromyalgia and many patients who suffered from some of these symptoms were told they had developed the condition when this may not have been the case.

In an effort to improve the quality of diagnosis of Fibromyalgia, the previous method used by specialists has since been updated to include additional symptoms that patients must also be experiencing. This includes severe levels of fatigue and cognitive problems as well as issues with sleep patterns such as repeatedly awaking and not feeling refreshed. Before Fibromyalgia is diagnosed, patients must have experienced these symptoms for the last three months without any improvement and there are no other conditions that may explain the symptoms displayed.

There are a wide range of alternative conditions that patients may be suffering from when they experience some of the symptoms linked to Fibromyalgia. For example, the origin of the discomfort and other symptoms that are displayed can often be down to a thyroid problem, such as hypothyroidism (underactive thyroid gland), which can cause many of the same symptoms but may be difficult to diagnose so is often missed by specialists.

Patients who have been prescribed long-term courses of antibiotics can often experience issues with cell functions. There may be a difficulty producing energy in the form of adenosine triphosphate (ATP) in the mitochondria cells which can leave the body energy deficient and cause some of the symptoms of Fibromyalgia to develop.

Thirdly, the discomfort and pain experienced may be a result of muscle problems. Although one of the most common symptoms among Fibromyalgia sufferers is muscle pain, the issue is actually how the brain and central nervous system interprets information and pain, rather than a severe pain in the muscles themselves.

Before finalizing a diagnosis of Fibromyalgia, specialists must ensure that they have completed tests and examinations to rule out all other potential conditions which may lie behind the symptoms. Although a physical may be able to detect tenderness, unfortunately, there are no methods such as blood tests or x-rays which are able to assist with the diagnosis.

As there are no tests that can confirm that the patient is suffering from Fibromyalgia, specialists can have a great deal of difficulty in accurately diagnosing the symptoms. One of the main methods used in the process is discussing the level of pain experienced by the patient. Of course, this is very subjective as pain thresholds vary greatly from person to person, therefore, diagnosing Fibromyalgia can be problematic.

The traditional test used to diagnosis Fibromyalgia is also easy to misinterpret, with the symptoms common in a vast variety of other conditions and complaints. There are many conditions that can easily be mistakenly diagnosed as Fibromyalgia, such as rheumatoid arthritis which can result in neck pain that may lead to an incorrect diagnosis.

The misdiagnosis of any condition only prolongs the symptoms and ensures that the real issues are not effectively treated. The difficulties with an accurate diagnosis are perhaps best demonstrated during examinations of the lower back. Pain in this region is incredibly common, with over 25% of U.S. adults experiencing lower back pain, so there are countless possible causes of these symptoms and a high chance for misdiagnosis.

Quality Of Life For Children With FM

Fibromyalgia is only just beginning to be seen as a real and debilitating medical condition. Now, it seems, we still have a need to convince the world at large, physicians not excluded, that kids can get it, too. The thing is that kids don’t get FM the same way as adults. They may have the same symptoms, but onset is a gradual process.

Measuring Impact

As the pediatric form of FM receives more recognition, researchers are struggling to create a system that can serve to evaluate the impact of fibromyalgia on children and adolescents with the condition. The medical community is also striving to determine whether or not the current treatments for pediatric FM are effective. Researchers hope to develop a standard whereby pain, quality of life, level of fatigue, quality of sleep, and physical function can be measured, but until now, only adult standards for the condition have been explored.

Since there is no standard method for evaluating fibromyalgia impact on kids and teens, scientists have substituted a variety of general measures, such as the PedsQL 4.0 (Pediatric Quality of Life Inventory), Generic Core Scales, PedsQL Multidimensional Fatigue Scale, and PedsQL Rheumatology Module Pain and Hurt Scale as patient-reported outcome (PRO) measures for kids with FM. Researchers administered the PedsQL Scales to 59 families with kids in the pediatric rheumatology clinic in a children’s hospital. The researchers then evaluated the responses and found very few answers had been skipped over and it appeared that these scales were dependable as a method for measuring the impact of the condition on children. Two tests, the PedsQL Generic Core Scales and Multidimensional Fatigue Scale, seemed to highlight major distinctions between kids with FM and healthy kids.

Greater Fatigue

Among the findings of this study, pediatric FM patients reported much lower levels of physical and psychosocial function than pediatric cancer patients undergoing treatment or even those children with other rheumatological diseases. The FM kids also reported greater fatigue than the kids undergoing cancer treatments.

These results suggest that the PedsQL Scales can work well to measure how fibromyalgia is impacting on younger patients. These standard tests also prove that the impairment of pediatric FM patients is more severe than is recognized by the medical community at large. By monitoring FM kids at regular intervals with these standard measures, physicians should be able to assess for those children and adolescents at risk for severe impairment of health-related quality of life. The PedsQL Scales can also serve as a basis for further research and the development of various treatments for the condition.

Finding the right care and treatment is essential if you want to deal effectively with your fibromyalgia syndrome. Unfortunately, the multitude of symptoms associated with the illness often makes finding the right treatment plan frustratingly difficult. And to top it all off, many health care providers aren’t that knowledgeable or understanding when it comes to fibromyalgia. If you are having trouble dealing effectively with your fibromyalgia, you may want to consult with a rheumatologist. Rheumatologists are specially trained in dealing with joint and muscle conditions, and can offer wonderful knowledge and advice when it comes to fibromyalgia.

What is a Rheumatologist?
A rheumatologist is a medical doctor who specializes in treating rheumatic conditions and diseases. Typically an internist or pediatrician, rheumatologists analyze, diagnose, and treat the different illnesses that affect your joints, bones, and muscles. Rheumatologists often act as long-term health care providers for those facing serious or chronic rheumatic disease.

What Qualifications Do Rheumatologists Have?
Rheumatologists are highly skilled in the area of rheumatic disease. They must complete four years of pre-medical training at college or university and continue on to complete four more years of training at medical school. They must then complete three years in internal or pediatric medicine. In order to become qualified rheumatologists, they must then complete two to three years of specialized education and training in rheumatic disease and treatment. In order to practice their profession, rheumatologists must pass a rigorous exam and become certified by the American Board of Internal Medicine, or a similar governing body in their country of practice.

What Does a Rheumatologist Treat?
Rheumatologists specialize in treating rheumatic diseases – but what exactly are rheumatic diseases? Rheumatic illnesses are those that affect the rheumatic system, specifically the joints, bones, and muscles. Rheumatologists are most commonly associated with arthritis diagnosis and treatment, although they also help treat a number of other rheumatic conditions, including:

• musculoskeletal pain
• osteoporosis
• osteoarthritis
• gout
• lupus and other autoimmune diseases

How Can A Rheumatologist Help People with Fibromyalgia?
Though fibromyalgia is not actually a type of arthritis, it is considered a rheumatic disease because it affects the joints and muscles. A rheumatologist is often one of the best practitioners to consult if you think that you have fibromyalgia. Unlike other health care providers, rheumatologists are very familiar with the signs and symptoms of fibromyalgia syndrome. They are able to rule out other rheumatic diseases that may mimic fibromyalgia. They are excellent when it comes to dealing with all-over, widespread pain. Rheumatologists also have more knowledge and diagnostic tests at their disposal to help find the cause for fibromyalgia symptoms, such as morning stiffness and joint immobility. Rheumatologists often play a team leader role when it comes to managing fibromyalgia, and can direct information to your other health care providers.

What Will A Rheumatologist Examine?
If you decide to visit with a rheumatologist, she will likely examine different aspects of your bones, muscles, and joints. In particular, she will look for:

• areas of muscle pain
• tender points
• redness and swelling
• stiffness
• range of motion

Tests Performed by A Rheumatologist
In order to help form a diagnosis, rheumatologists rely on a variety of diagnostic test procedures. These procedures help them to analyze specific areas of your joints and muscles. Some commonly-performed tests include:

• x-rays
• joint ultrasound
• MRI (magnetic resonance imaging)
• electromyography
• joint aspiration and fluid analysis
• bone density tests

What To Expect When You Visit a Rheumatologist
If you choose to visit a rheumatologist, you may be a little apprehensive about the procedures he will perform. Here are a few things to expect when you get to the office:

• Your rheumatologist will ask you about your medical history and your current symptoms.
• He will likely perform a physical examination. He will examine your joints, looking for areas of swelling or deformity. He will also test your muscle stamina, strength, and range of motion.
• Your rheumatologist may suggest performing some diagnostic tests, including blood tests, joint aspiration, and imaging tests.
• Your rheumatologist will likely suggest a treatment regimen to help you deal with your symptoms. Treatment is often multi-faceted, and may include the use of pain medication along with physical therapy and exercise.

Finding a Rheumatologist
In order to see a rheumatologist, it is likely that you will require a referral from your general health practitioner or another medical doctor. She may be able to recommend a good rheumatologist who practices in your area. To find a rheumatologist in your area, you can also contact your local College of Rheumatology. These organizations maintain a list of all qualified practicing rheumatologists in your state or country.

Fibromyalgia tends to be a very difficult illness to treat. Because there are so many different symptoms of fibromyalgia syndrome and because no cause has yet been identified, it is often impossible to effectively treat this illness. Your best bet is to look to a number of different health practitioners in order to find the treatment options that work best for you. A neurologist can often be very helpful in helping to diagnose your illness and in recommending appropriate treatments.

What is a Neurologist?

A neurologist is a medical doctor who specializes in diagnosing, treating, and managing nervous system disorders. Neurologists deal with medical problems that occur in the two parts of the nervous system: the central nervous system (which includes the brain and spinal cord) and the peripheral nervous system (which includes the nerves, nerve roots, and muscles). They often perform tests and special examinations on various parts of your nervous system in order to properly diagnose and treat illness.

What Qualifications Does a Neurologist Have?

Neurologists need to complete years of special education and training in order to become board licensed and certified. All certified neurologists have completed four years of pre-medical training, four years of medical school training, and a one-year internship in internal or surgical medicine. They have also completed three years of specialized education in a recognized neurological residency program. All neurologists must then be licensed after completing a lengthy test. In the United States all neurologists are licensed by the American Board of Psychiatry and Neurology or by the American Board of Medical Specialties.

What Conditions Does a Neurologist Treat?

Neurologists can help treat a variety of different conditions, ranging from minor aches and pains to serious illness. Neurologists often deal with patients suffering from:

• headaches
• facial pain
• head injury
• stroke or tumors
• Parkinson’s Disease
• epilepsy
• Multiple Sclerosis and other muscle diseases

How Can a Neurologist Help Fibromyalgia Sufferers?

Neurologists often form an integral part of the diagnosis and management of fibromyalgia. This is because many of the symptoms of fibromyalgia may actually be related to a disorder of the central nervous system. Researchers have theorized that fibromyalgia is actually the result of a pain processing disorder within the brain. Based on this information, a neurologist is one of the best medical practitioners a fibromyalgia patient could see. A neurologist can help to narrow down the cause of your pain and treat it specifically.

What Does A Neurologist Examine?

Neurologists examine specific aspects of your health and wellness in order to determine how efficiently your nervous system is working. If you visit a neurologist, she will likely assess your:

• head and neck nerves
• reflexes
• memory and cognition
• speech and language
• muscle strength and movement
• balance

What Tests Does a Neurologist Perform?

Neurologists need to be able to get a good look at all aspects of your central and peripheral nervous system. This means that your neurologist will likely perform a number of different diagnostic tests. These tests often help to produce visual images of the way your brain, muscles, and nerves are functioning. Some common tests performed by neurologists include:

• CAT scan (computed axial tomography)
• MRI (magnetic resonance imaging)
• EEG (electroencephalography)
• EMG (electromyography)

These diagnostic procedures often involve the use of high-tech, and sometimes frightening-looking equipment. However, most of these tests are completely pain free.

What To Expect When You See a Neurologist

If you decide to see a neurologist, you should expect to receive a proper evaluation, diagnosis, and treatment plan for your fibromyalgia. Typically, treatment is ongoing, so you can anticipate to return to your neurologist on a regular basis for follow-up appointments.

Your neurologist will begin diagnosis by examining your medical history as well as your symptoms. He will likely perform a variety of blood tests in order to rule out disorders that are commonly confused with fibromyalgia, like rheumatoid arthritis. You may also be given a lumbar puncture (or spinal tap) to assess the quality of your spinal fluid. You will likely undergo a variety of other diagnostic tests, such as an MRI and CAT scan.

After diagnosis, your neurologist will recommend a treatment plan in order to relieve your specific symptoms. Neurologists often recommend combination therapy, which includes physical therapy, exercise, and medical treatments. Medical treatments commonly offered by neurologists for fibromyalgia include:

• trigger point injections
• nerve blocks
• pain medications

Finding a Neurologist

The best way to find a neurologist is to ask your current health care provider for a referral. Most neurologists work out of hospitals or in a private practice. Be sure to inquire about your neurologist’s qualifications and about his experience in treating fibromyalgia. You may want to ask your local fibromyalgia organization or support group for the names of qualified neurologists in your area.