What is fibromyalgia?

Fibromyalgia (formerly fibrositis) is a syndrome characterized by chronic pain, stiffness, and tenderness of muscles, tendons, and joints without detectable inflammation. It is also characterized by restless sleep, awakening tired, fatigue, anxiety, depression, and disturbances in bowel function. The condition is non-life-threatening and does not cause body damage or deformity. It affects an estimated 3-6 million Americans.

What does the name fibromyalgia mean?

The word fibromyalgia comes from the Latin term for fibrous tissue (fibro) and the Greek terms for muscle (myo) and pain (algia).

Is fibromyalgia a form of arthritis?

Fibromyalgia is considered a muscle condition. It is not a form of arthritis (a disease of the joints) because it does not cause inflammation in the joints. But fibromyalgia can (like arthritis) cause significant pain and fatigue, and it can similarly interfere with a person's ability to carry on daily activities.

Who is affected by fibromyalgia?

Fibromyalgia predominantly affects women (more than 80%) between the ages of 35 and 55. Less commonly, fibromyalgia affects men, children, and the elderly. It can occur independently or can be associated with another rheumatic disease, such as systemic lupus or rheumatoid arthritis.

What causes fibromyalgia?

While there is no known cause for fibromyalgia, recent research has revealed new facts about the disease. Fibromyalgia patients have elevated levels of the nerve chemical signal substance P and nerve growth factor in their spinal fluid. They tend to have low levels of the brain nerve chemical serotonin and impaired non-rapid eye movement (non-REM) sleep phase (which likely explains the common feature of awakening fatigued and unrefreshed).

What are symptoms of fibromyalgia?

Fibromyalgia is not always easy to diagnose because symptoms vary from person to person. Many of the symptoms mimic those of other disorders and there are no visible signs of the disorder. There is also no definitive laboratory test for fibromyalgia. The next several slides review some of the more common symptoms of the disorder.

The universal symptom of fibromyalgia is pain.

As mentioned earlier, the pain in fibromyalgia is not caused by tissue inflammation. Instead, patients seem to have an increased sensitivity to many different sensory stimuli. The result is an unusually low pain threshold. The pain is generally widespread, involving both sides of the body and commonly affecting the neck, buttocks, shoulders, arms, the upper back, and the chest.

Additional factors can increase fibromyalgia pain.

The pain of fibromyalgia can sometimes be further aggravated by sensory stressors such as noise, weather change, bright lights, and emotional stress.

Fatigue occurs in approximately 90% of fibromyalgia patients.

Normally, there are several levels of sleep depth. Getting enough of the deeper levels of sleep can be more important in refreshing a person than the total number of hours of sleep. Patients with fibromyalgia lack the deep, restorative level of sleep, called 'non-rapid eye movement' (non-REM) sleep. Consequently, patients often awaken in the morning without feeling fully rested. Some patients awaken with muscle aches or a sensation of muscle fatigue as if they had been 'working out' all night!

More than half of fibromyalgia patients experience mental and/or emotional disturbances.

These include poor concentration, forgetfulness, mood changes, irritability, depression, and anxiety. Because a firm diagnosis of fibromyalgia is difficult and no confirmatory laboratory tests are available, patients with fibromyalgia are often misdiagnosed as having depression as their primary problem.

What are additional symptoms of fibromyalgia?

Other symptoms include migraine and tension headaches, numbness or tingling of different body parts, abdominal pain related to irritable bowel syndrome (IBS), and irritable bladder, causing painful and frequent urination.

How is fibromyalgia diagnosed?

There is no specific test to determine whether someone has fibromyalgia. Therefore, the diagnosis of fibromyalgia is made on clinical grounds based on the doctor's history and physical examination. When it comes to pain, diagnosis can be made by identifying sensitive pain 'tender points' or 'trigger points' on the body. Pain is often present for longer than three months, and there are frequently 'tender points' as shown here.

Additional exams and tests.

Many medical conditions can cause pain in different areas of the body, mimicking fibromyalgia. Therefore, doctors may perform blood tests and X-rays to rule out other diseases and conditions.

What is the treatment for fibromyalgia?

Although there is no cure for fibromyalgia, treatment can relieve the symptoms. Because symptoms vary among patients, treatment programs must be individualized for each patient. Treatment programs are most effective when they combine patient education, stress reduction, regular exercise, and medications. Ultimately, the physician, the physical therapist, and the patient may all play an active role in the management of fibromyalgia.

Patient education.

Patient education is an important first step in understanding and coping with the diverse symptoms of fibromyalgia. Community hospital support groups and the local chapters of the Arthritis Foundation have become important educational resources for patients.

Stress reduction.

The effects of stress vary from person to person. Therefore, stress reduction in the treatment of fibromyalgia must be individualized. This might include simple stress modification at home or work, biofeedback, relaxation tapes, psychological counseling, and/or support among family members, friends, and doctors. Sometimes, changes in environmental factors (such as noise, temperature, and weather exposure) can be helpful.

Exercise.

For muscle pain, it can be helpful to regularly perform low-impact exercise. Keeping muscles conditioned and healthy by exercising three times a week decreases the amount of discomfort. It is important to try low-stress exercises such as walking, swimming, water aerobics, and biking. Besides helping with tenderness, regular exercises can also boost energy levels and help with sleep.

Medications.

Today, Lyrica (pregabalin), Cymbalta (duloxetine), and Savella (milnacipran hydrochloride) are the only three drugs approved by the U.S. FDA for the treatment of fibromyalgia. Lyrica is an antiseizure medication, while Cymbalta and Savella are antidepressants. All three have been shown to reduce the pain of fibromyalgia.

Traditionally, the treatment of fibromyalgia have been the tricyclic antidepressants such as amitriptyline (Elavil) and doxepin (Sinequan). Typically used in treating depression, they appear to reduce fatigue, relieve muscle pain, and promote deep, restorative sleep. Studies also show that adding fluoxetine (Prozac) further reduces pain, anxiety, and depression. Over-the-counter pain medications such as acetaminophen (Tylenol), aspirin, ibuprofen (Advil), and naproxen (Aleve) can also be helpful.

Other medications.

Local injections of analgesics and/or cortisone medication into the trigger-point areas can also be helpful in relieving painful soft tissues, while breaking cycles of pain and muscle spasm. Narcotic pain relievers are typically avoided in fibromyalgia patients because they have not been shown to be beneficial and have potential adverse side effects, including dependency, when used long term.

Alternative treatments

Other treatments and therapies used in helping patients cope with fibromyalgia include massage, acupuncture, acupressure, chiropractic care, diet and nutritional supplements, herbal remedies, and mind-body therapies (meditation, guided imagery, hypnosis).

More Reading on Fibromyalgia

• Fibromyalgia Feature Article
• Chronic Fatigue Syndrome (CFS)
• Chronic Pain
• Fibromyalgia Pain
• Pain Management Feature Article
• Fibromyalgia Friendly Exercises Slideshow