Fibromyalgia

What is it?

People with fibromyalgia have widespread pain, aches, and stiffness in muscles and joints throughout the body, along with unusual tiredness. There is no known cause of fibromyalgia. In addition, doctors can't find any other explanation for the symptoms. Blood tests, x-rays, and other tests usually are normal in people with fibromyalgia.

Fibromyalgia is a controversial illness. Some physicians don't believe that it's a medical illness but think it may be a reflection of psychological distress or stress. However, there's no proof of a psychological cause either. Until we have a better understanding of the disorder, it's likely to remain controversial.

It may be that fibromyalgia has more than one cause. Some researchers have suggested that it's related to abnormalities in a non-dream part of the sleep cycle or to low levels of serotonin, a brain chemical that regulates sleep and pain perception. Other theories have linked fibromyalgia to alterations in the threshold at which a person experiences pain. Still others have cited physical or psychological trauma, blood-flow abnormalities in the muscles, viral infections, or other infections as possible triggers of fibromyalgia.

Fibromyalgia affects an estimated 3.4% of women and 0.5% of men in the United States, or 3 million to 6 million Americans. It most commonly affects women of childbearing age or older. In fact, some estimates suggest that more than 7% of women in their 70s have fibromyalgia. Many people with fibromyalgia also have psychiatric problems such as depression, anxiety, or eating disorders, although the relationship between fibromyalgia and mental health disorders remains unclear.

Symptoms

Fibromyalgia can cause pain and stiffness in the muscles and joints almost anywhere in the body, including the trunk, neck, shoulders, back, and hips. People often have pain between the shoulder blades and at the bottom of the neck. Pain may be either a general soreness or a gnawing ache, and stiffness is often worst in the morning.

Typically, people also complain of feeling abnormally tired, especially of waking up tired, although they have slept well. Many people with fibromyalgia also have tender points, which are specific spots on the body that are painful to touch. Some people report symptoms of irritable bowel syndrome, depression, anxiety, and headache.

For research studies, the American College of Rheumatology (ACR) has established criteria for fibromyalgia that include a combination of unexplained symptoms such as pain, fatigue, waking without feeling rested, and/or problems with thinking or memory. But doctors often make the diagnosis in people with widespread pain and no other identifiable cause, even if criteria are not met.

Diagnosis

After asking about your symptoms, your doctor will check for swelling, redness, and impaired movement in parts of your body where you're having pain. Your doctor will also check for tender points (although the presence of tender points is not required to make the diagnosis).

Your doctor will ask detailed questions about your medical history and examine you to rule out other conditions or diseases that could explain your symptoms, such as thyroid disease or vitamin D deficiency.

Expected duration

The symptoms of fibromyalgia are usually chronic. While treatment can be helpful, symptoms tend to be long-lasting (and frequently lifelong).

Prevention

There is no known way to prevent fibromyalgia.

Treatment

Standard treatment of fibromyalgia includes both nonmedication and medication approaches.

Nonmedication treatments may be much more helpful than medications. Aerobic exercise, such as low-impact stepping, cycling, or swimming several times each week, is considered an essential part of treatment. A physical therapist or trainer can be helpful in developing an individualized exercise program.

Improved sleep quality may improve symptoms, so it may help to avoid caffeine, exercise late in the day, and fluids late in the evening.

If your symptoms do not improve, your doctor also may suggest that you try one or more of the following therapies: acupuncture, massage therapy, warm compresses, biofeedback, tai chi, hypnosis, group therapy, or stress management. If you have symptoms of depression or anxiety, these may improve with psychotherapy and antidepressant or antianxiety medication.

Education about the disease and treatment of accompanying conditions (such as sleep apnea) can make a big difference.

While no medication reliably cures fibromyalgia, medications can provide at least some relief. These include acetaminophen (Tylenol and other brand names); aspirin or other nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil, and others) or naproxen (Aleve); a muscle relaxant such as cyclobenzaprine (Flexeril); or an antidepressant such as amitriptyline (Elavil) or fluoxetine (Prozac). Sometimes these medicines are prescribed in combination. For example, the combination of amitriptyline and fluoxetine (taken at different times of the day) may help more than either alone.

In recent years, the FDA has approved pregabalin (Lyrica), duloxetine (Cymbalta), and milnacipran (Savella) for the treatment of fibromyalgia. However, studies have not yet compared these with older medications for the long-term treatment of this condition. A number of other medicines, including gabapentin (Neurontin), tramadol (Ultram), and tizanidine (Zanaflex), are commonly prescribed for fibromyalgia.

Each person with fibromyalgia is different, so people may have significantly different treatment plans than the measures outlined above.

When to call a professional

Call your doctor whenever you experience chronic pain or extreme tiredness, especially if it interferes with your ability to work, sleep, do normal household chores, or enjoy recreational activities.

Prognosis

Studies do not agree about the outlook for people with fibromyalgia. For example, results from some specialized treatment centers show a poor outlook. However, community-based treatment programs show that symptoms go away in a quarter of patients and symptoms significantly improve in about half.

Additional info

Arthritis Foundation
http://www.arthritis.org/

National Institute of Arthritis and Musculoskeletal and Skin Diseases
http://www.niams.nih.gov/

American College of Rheumatology
http://www.rheumatology.org/