To illustrate, abnormal transmission, production, and use of chemicals in the brain (called neurotransmitters) such as serotonin contribute to depression and occur in many FM patients. Patients also tend to have lower levels of human growth hormone, which leads to diminished production of insulin-like growth factor-1(IGF-1), contributing to muscle weakness. Another finding is that the hypothalamic-pituitary-adrenal (HPA) axis in FM patients tends to malfunction, altering cortisol levels so that the immune system doesn't work up to par. Each of these factors also alters pain perception, which may be made worse by excessive Substance P and too little endorphin secretion—Substance P enhances pain, and endorphins suppress it.

FM is often confused with three other chronic and poorly understood syndromes: myofascial pain syndrome, chronic fatigue syndrome (CFS), and environmental illness (multiple chemical sensitivity, or MCS). Some experts have said that as many as 75 percent of patients with FM meet the diagnostic criteria for CFS as well, as do 30 percent of MCS patients.

Many FM patients also have irritable bowel syndrome (IBS), and some have mitral valve prolapsed, a condition in which abnormal flaps outside one of the valves that the heart uses to push blood through close prematurely, with a click that can be heard through a stethoscope. Sometimes this causes small amounts of blood to flow backward. To compensate, the heart may have to work harder so that the necessary volume of blood is circulated, and this may lead to a general feeling of fatigue.

Lastly, depression and sleep disorders often occur in FM patients. It's unclear whether depression contributes to fibromylagia or vice-versa. The sleep disorder causes many FM sufferers to bypass a phase of sleep called delta sleep, so that they never experience restorative REM sleep, and sleep deprivation becomes an escalating problem.

Because it is so poorly understood, FM is very difficult to treat. While FM is not considered a degenerative condition (it doesn't tend to worsen with age or lead to death), the syndrome comes and goes throughout life, and is extremely discouraging. It's painful and it chips away self-esteem. It also tends to trigger anxiety and tax interpersonal and professional relationships. According to studies, patients often suffer symptoms for 15 years after initial diagnoses. Grimly enough, several years ago, one Massachusetts woman with FM sought the help of Dr. Jack Kevorkian in addressing her bleak prognosis.

Conventional treatments aim to ease pain and sleep disturbance through exercise (as do complementary approaches), tricyclic antidepressants, serotonin reuptake inhibitors, muscle relaxants, and NSAIDS (non-steroidal antiinflammatory drugs) such as ibuprofen. Sometimes, local anesthetics are injected into trigger points. With the exception of exercise, however, each of these treatments tends to lose effectiveness in just a few short months.

Just thinking about exercise exhausts people with FM; one of the most daunting tasks of each day is merely getting out of bed. But if patients can stick with it, it's probably a wise prescription.

Exercise probably relieves muscle compression, increases pain tolerance, and improves sleep. Jesse Stoff, M.D., in emphasizing the importance of exercise in the treatment of FM (and chronic fatigue syndrome as well), describes inactivity as a pain-reinforcing behavior. In his book, Chronic Fatigue Syndrome: The Hidden Epidemic, Stoff says, "When muscles aren't used, their tone decreases and they become even more sensitive to pain. A cycle develops and becomes self-sustaining. Fatigue and increased pain deter one from exercise. Decreased activity increases the pain and worsens the insomnia. Lack of restorative sleep increases the sensitivity to pain and the perception of fatigue. Ultimately, many sufferers become depressed and develop headaches and a generalized flu-ish feeling, just from the inflammation." Click here for Aches and Pains Ointment

Dr. Laurence Bradley, a FM researcher at the University of Alabama, advises as much as 30 minutes of exercise, twice a day, to FM patients. According to Bradley, exercise produces natural painkillers called endorphins, which, incidentally, also improve. Exercise also stimulates serotonin and growth hormone production, two substances believed to be deficient in FM patients.

In a Scandinavian study, 45 minutes of rigorous aerobic exercise improved symptoms of FM significantly better than stress management techniques did. A patient who chooses this approach, however, needs to be advised to keep up the exercise even after improvements are felt. Four years after the initial Scandinavian study was conducted, a follow-up study revealed that patients were no longer exercising. Their symptoms had returned with abandon. It might be easier and just as effective to integrate into daily practice twenty minutes of low-impact aerobic exercise, such as walking, cycling, swimming, or pool aerobics designed for arthritis sufferers.

In addition to exercise, dietary supplements and alternative therapies have been found to help many FM patients, particularly when conventional pharmaceutical treatments fall short of relieving symptoms. One of the first steps FM patients take is adjusting the diet so that it contains fewer sources of allergens. According to some practitioners, food allergies cause many of the same symptoms that occur in FM.

A multivitamin/mineral complex containing magnesium malate, antioxidant vitamins A, C, and E, B complex, immune-enhancing zinc, and antioxidant selenium is probably a safe and healthy choice for boosting nutrient status and avoiding deficiency. Interestingly, of all these nutritional supplements, magnesium malate is the only supplement recommended to people with FM that's been supported by any kind of scientific research. FM patients often have low blood levels of magnesium along with abnormal thiamine metabolism, which, according to researchers, may lead to poor muscle metabolism. This may be turned around with magnesium and malic acid supplements (magnesium malate). Malic acid research shows that this natural enzyme, occurring in high concentrations in apples, increases adenosine triphosphate (ATP) production, a chemical messenger that increases cellular energy. Advocates suggest that increased ATP leads to an overall increase in energy.

The effects of malic acid on FM have been evaluated in preliminary trials. The first trial, which lasted for four weeks, involved giving patients 200 mg malic acid and 50 mg magnesium two times daily and resulted in no apparent benefit to FM. But in a follow-up study, when twice the dose was taken for a six-month time period, malic acid improved pain and mood in FM patients dramatically.

The amino acid 5-hydroxytryptophan ( 5-HTP) may also help. When it is produced at below normal levels in the brain, 5-HTP contributes to depression and symptoms of FM. When patients take  5-HTP, they report that pain, morning stiffness, disturbed sleep, anxiety, and fatigue decrease.