A. Fibromyalgia syndrome is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and nonrestorative sleep. Your sister is tired because she is not getting good quality sleep. Therefore her body is not able to replenish her energy and get the rest provided by deep sleep. Her constant muscle pain, fatigue and the many other symptoms associated with FMS interfere with her ability and motivation to complete necessary chores, perform effectively at work and socialize. You are helping her by giving your compassion, support, and understanding.

Most of the treatments outlined in this column are recommended by FMS experts. However individuals with FMS are unique in how they experience their symptoms and how they react to the suggested treatment. Therefore it is wise to work closely with your medical treatment team. Also, keep trying proven methods in different dosages and degrees and stay current with the research by reading credible newsletters and web sites.

Treatment for FMS requires a comprehensive, and interdisciplinary approach to control symptoms. Each person's recipe for relief will be different, and there is no definitive answer to why some things work well for one person and not at all for another. However, if you look at medicine in general, the trial-and-error approach is used for many medical conditions. There is no one-plan-fits-all, nor is there a cure. For more information on research and treatment update attend the educational conference, Fibromyalgia Awareness Main Event, or F.A.M.E. 2000, at the Universal Sheraton Hotel, Universal City, CA. on May 19-21 and check out the Arthritis and Fibromyalgia web sites and newsletters in this column or attend the International Awareness Day For FMS May 12. The following nonpharmacologic treatments are just a few ways to manage the symptoms of FMS:

• •Educate yourself. The more you learn about FMS the more you understand and the less frightening it is. With time you will realize that it is a treatable and valid medical condition that is not life threatening. It's important to have a self-help, self-care philosophy and join a FMS support group. Support groups offer current information, physician referrals, validation, acceptance, networking, goal setting and reinforcement. You can also attend an ARTHRITIS FOUNDATION FIBROMYALGIA SELF-HELP COURSE. It's a education course designed to provide skills and support to people with FMS or sign up with the FRIENDS HEALTH CONNECTION. They help individuals cope through the power of friendship and the empowerment and mutual inspiration that friendship can offer.

• • Eat healthy. Choose supplements that meet your dietary needs. Many nutritional supplements are effective in reducing FMS symptoms. Supplements such as SAMe, Magnesium, L-carnitine and NADH are just a few. It is critical to follow a balanced diet and take a multivitamin containing at least 50 milligrams of the B-complex vitamins. Beyond these, consider adding L-carnitine a natural fatigue fighter and NADH a natural energy producer. As the cells become more energized the body becomes stronger and more vitalized. Recent studies indicate that people with FMS have low levels of magnesium. NATURAL CALM, an organic magnesium drink with superior assimilation, replenishes those levels as it relaxes the body, reduces muscle pain and promotes sleep. FMS individuals using a combination of malic acid and magnesium hydroxide report improvements with reduction of muscle fatigue, soreness, and pain, and an increase in exercise tolerance.

• •Reduce your stress. Massage can help ease some of the muscle pain, and induce relaxation so that you can sleep better. Playing soothing music and breathing deeply also will relax you. Train yourself to "pace, not push" as you move through your day. Take mini-relaxation breaks all day. Be creative in finding tools and techniques that will help you relax e.g., The NEUROBAND™, a product that enhances relaxation, aids in the release of tension and allows the body to return to its natural state of balance so you are better able to handle the challenges of your day. Realize that you can only change yourself and how you choose to react to your stressors. Your positive attitude and outlook are what will help keep stress under control. Exercises involving slow, gentle, gradual stretching, like pilates, are especially helpful in promoting deep relaxation, muscle reconditioning and improved posture. Physical therapists recommend stretching to improve sleep and manage pain. The type of stretching pilates offers also helps to elongate muscles, alleviate pain, tension, increases agility, strength, endurance and mobility. Miora Stott, a highly acclaimed and recommended leader in the pilates industry, has compiled The FITNESS CIRCLE WORKOUT and the Stott Conditioning Videos. Also, a physical therapist can help you select the best stretching program for your needs and teach you specific stretch exercises. Several controlled studies have shown that cognitive-behavioral therapy improves fibromyalgia. Cognitive therapy involves stress reduction techniques and education. Stress can also be reduced using biofeedback, yoga and meditation. In a controlled study using hypnotherapy in treating fibromyalgia, researchers concluded that hypnotherapy may be useful in relieving symptoms and reducing stress. Hypnosis is an effective adjunct to cognitive-behavioral therapy. In a hypnotherapy session, you and the therapist work together as detectives to determine what changes need to be made and what is behind your struggle to make these changes. A hypnotherapist who specializes in FMS is recommended. Lane LaRue, a clinical hypnotherapist specializing in clients with FMS has a unique program that she offers to FMS support groups. She gives FMS suffers specific assistance in deep relaxation, pain reduction and sleep enhancement. She teaches her clients self-hypnosis techniques, creates customized audio tapes and offers phone sessions as adjuncts to the first several sessions.

• •Begin an exercise program. Experts recommend that you establish a program of gentle stretching first. Then add a progressive, gradual walking program starting with five or 10 minutes twice a day, slowly building up to 30 minutes daily. Walking is the first step toward a general toning and conditioning program. Over time, muscle and vascular spasms will decrease, and muscle tissues will become more oxygenated. You can also add warm-water exercise and stationary bicycling. The Arthritis Foundation offers a videotape of a warm-water exercise program, FIBROMYALGIA INTERVAL TRAINING. It also offers local Aquatics Programs, a six-to-10-week exercise program in a heated pool. FMS individuals should avoid high impact exercises such as jogging, basketball or any activity that involves jumping up and down. The best approach to consistent exercise is to look at it as part of your daily activities and start each daily walk with gentle stretching. To stay motivated use videos, gadgets, or join a walking club. The Mio™ Watch and Heart-Rate Monitor is a perfect personal coach. It motivates you while you're walking by accurately measuring your heart rate (but without the awkward chest-strap that other monitors require) by simply pressing the watch face. By pressing another button, it will tell you your calories consumed and burned, your distance, speed, and time. What makes this watch/monitor so special is its ease of use and accuracy. Dr. Sharon R. Clark, Assistant Professor of Medicine Oregon Health Science University is a fibromyalgia fitness expert and consultant. For more exercise information or to learn more about her exercise videos, visit her web site at www.myalgia.com.

Researchers and FMS doctors continue to study FMS to determine the etiology of the illness, to validate or disapprove the many theories and to produce effective medications and therapies. Their efforts have given us much relief and hope.

This column is not intended to diagnose, treat, cure or prevent any disease. It is for entertainment and educational purposes only and not intended as medical advice.