Fibromyalgia

Fibromyalgia is a syndrome, or collection of signs (findings on exam) and symptoms (complaints), with no known underlying disease process. It may be that fibromyalgia syndrome has more than one cause. Some researchers have suggested that it is 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 low levels of somatomedin C, a chemical related to muscle strength and muscle repair, or to high levels of substance P, a chemical involved in pain perception. Still others have cited trauma, blood-flow abnormalities in the muscles, viral infections or other infections as possible triggers of fibromyalgia. Fibromyalgia syndrome is a controversial illness, as some physicians do not believe that it is a medical illness as much as it may be a reflection of psychological distress, stress or somatization (that is, experiencing bodily symptoms as a result of psychological stress). There is currently no proof of a physical or psychological cause, and until we have a better understanding of the disorder, it is likely to remain controversial.

Fibromyalgia afflicts an estimated 3.4 percent of women and 0.5 percent of men in the United States, affecting 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 percent of women in their 70s suffer from fibromyalgia.

Many patients with fibromyalgia also suffer from psychiatric problems such as depression, anxiety or eating disorders, although the relationship between them remains unclear.

Fibromyalgia can cause pain and stiffness in the muscles and joints almost anywhere in the body, including the trunk, neck, shoulders, back and hips. The regions between the shoulder blades and at the bottom of the neck are particularly favored sites of pain. Pain may be either a general soreness or a gnawing ache, and stiffness is often worst in the morning. Typically, patients also complain of feeling abnormally tired, especially of waking up tired, although they may not recall having specific sleep disturbances. Patients with fibromyalgia also have tender points, specific body areas that are painful to touch. The American College of Rheumatology (ACR), in its list of criteria for diagnosing fibromyalgia, lists 18 typical tender points.

After asking about your symptoms, your doctor will check for swelling, redness and impaired movement in those portions of your body where you are having pain. Your doctor will also check for tenderness in the 18 specific tender points designated by the ACR. A full medical history and physical examination is important to search for an alternative explanation for the symptoms.

In order to meet the research criteria for the diagnosis of fibromyalgia, a patient must have suffered at least three months of widespread pain and must have tenderness at 11 or more of the 18 specific tender points. In actual practice, physicians often diagnose the illness without meeting these strict criteria, but only after alternative causes of diffuse pain and fatigue have been ruled out.

By definition, the widespread pain of fibromyalgia must last for at least three months, although many patients experience pain for much longer periods. The frequency of disability caused by fibromyalgia is uncertain, but most patients, although bothered by symptoms, are able to adapt to or control symptoms and remain active.

There is currently no way to prevent fibromyalgia, because its definite cause remains unknown.

To relieve the pain of fibromyalgia, your doctor will generally prescribe acetaminophen such as Tylenol; 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 a tricyclic antidepressant such as amitriptyline (Elavil). Aerobic exercise, such as a low-impact stepping, cycling or swimming several times each week, is also considered an essential part of treatment. Finally, improved sleep quality may improve symptoms, so avoiding caffeine, late evening fluid intake, and exercise late in the day may be helpful. If your symptoms do not improve, your doctor may also suggest that you try one or more of the following therapies: acupuncture, massage therapy, warm compresses, biofeedback, hypnosis, group therapy or stress management. If you have symptoms of depression or anxiety, these may improve with psychotherapy and/or antidepressant or antianxiety medication.

Note: Every fibromyalgia patient is different, so an individual patient may have a significantly different treatment plan from the usual measures outlined above.

Call your doctor whenever chronic pain or extreme tiredness interferes with your ability to work, sleep, perform normal household chores or enjoy recreational activities.

Current studies do not agree about the prognosis of people with fibromyalgia. For example, results from some specialized treatment centers show a poor prognosis, whereas community-based treatment programs show remissions in 24 percent of patients and symptom improvement in 47 percent.

Arthritis Foundation
1330 West Peachtree St.
Atlanta, GA 30309
Phone: (404) 872-7100
Toll-free: (800) 283-7800
http://www.arthritis.org/

National Institute of Arthritis and Musculoskeletal and Skin Diseases
Information Clearinghouse
1 AMS Circle
Bethesda, MD 20892-3675
Phone: (301) 495-4484
Toll-free: (877) 226-4267
Fax: (301) 718-6366
TTY: (301) 565-2966
E-Mail: niamsinfo@mail.nih.gov
http://www.nih.gov/niams

American College of Rheumatology
1800 Century Place, Suite 250
Atlanta, GA 30345
Phone: (404) 633-3777
Fax: (404) 633-1870
E-Mail: acr@rheumatology.org
http://www.rheumatology.org/