Q. My mom has fibromyalgia. What is this, is her pain real, and is there a cure?

A. Fibromyalgia is a common disease of unknown cause affecting 3 percent to 10 percent of the population, resulting in widespread aching and morning stiffness. The stiffness sometimes remains all day. As the medical book UpToDate puts it, "It feels as if I always have the flu."

If 5 pounds of pressure is applied to your thumbnail, you'd barely feel pain, but those with fibromyalgia would complain of moderate pain — something you'd feel at 10 pounds of pressure. In the May 2002 issue of the journal Arthritis & Rheumatism, Dr. Richard Gracely and others did magnetic resonance imaging and found that 5 pounds of thumbnail pressure caused 12 pain areas in the brain of fibromyalgics to be activated, compared with only two areas in healthy people, confirming that folks with fibromyalgia really are in pain.

For some reason, still unknown, there is a physiological amplification of pain signals in the brain and spinal cord. And the fibromyalgic's brain pain centers can remain activated at rest, even with no pressure being applied anywhere.

The pain may be aggravated by fatigue, excessive work and adverse weather. Most also have symptoms such as fatigue, headaches, depression, fitful sleep, irritable bowel syndrome, numbness, or a sensation of fever or joint swelling. Fibromyalgia sometimes occurs with something else, like hypo-thyroidism, rheumatoid arthritis or hepatitis C. Most fibromyalgics are women who have gradual onset of symptoms between the ages of 20 and 45.

The American College of Rheumatology has defined fibromyalgia as chronic widespread pain and the presence of 11 of 18 tender points in various areas of the body. But recent data suggests that there's nothing magical about these 18 points, and that folks with fibromyalgia are more sensitive everywhere on their body.

Even though anti-inflammatories like ibuprofen and narcotics like Vicodin are often used, there's little evidence of benefit. But cognitive behavioral therapy and exercise both work. Regular aerobic exercise of lower rather than higher intensity is crucial in the treatment of fibromyalgia.

Tricyclic antidepressant drugs like amitriptyline or Flexeril also work. To reduce dizziness and dry mouth, I start at low doses (5 to 10 mg), give it two hours before bedtime, gradually increase the dose (for Flexeril, sometimes to 30 mg) and sometimes add fluoxetine in the morning.

The next step would be to try strength training, acupuncture, hypnotherapy, biofeedback, or balneotherapy (hot baths and spa treatment). The epilepsy drugs pregabalin and gabapentin sometimes work.

While there is no cure, fibromyalgia is a benign disease that can often be controlled with combination drug, exercise and behavioral therapy. For more information, go to www.patients.uptodate.com.

Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.