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Fibromyalgia — Comprehensive overview covers symptoms, treatment of this chronic
condition characterized by widespread pain.
Definition
The
American College of Rheumatology guidelines for making a fibromyalgia diagnosis
require pain at 11 of the 18 tender points on the body.
 Fibromyalgia
tender points
You hurt
all over, and you frequently feel exhausted. Even after numerous tests, your
doctor can't find anything specifically wrong with you. If this sounds familiar,
you may have fibromyalgia.
Fibromyalgia is a chronic condition characterized by widespread pain in your
muscles, ligaments and tendons, as well as fatigue and multiple tender points —
places on your body where slight pressure causes pain.
Fibromyalgia occurs in about 2 percent of the population in the United States.
Women are much more likely to develop the disorder than are men, and the risk of
fibromyalgia increases with age. Fibromyalgia symptoms often begin after a
physical or emotional trauma, but in many cases there appears to be no
triggering event.
Symptoms
Signs and
symptoms of fibromyalgia can vary, depending on the weather, stress, physical
activity or even the time of day.
Widespread
pain and tender points
The pain
associated with fibromyalgia is described as a constant dull ache, typically
arising from muscles. To be considered widespread, the pain must occur on both
sides of your body and above and below your waist.
Fibromyalgia is characterized by additional pain when firm pressure is applied
to specific areas of your body, called tender points. Tender point locations
include:
-
Back
of the head
-
Between shoulder blades
-
Top of
shoulders
-
Front
sides of neck
-
Upper
chest
-
Outer
elbows
-
Upper
hips
-
Sides
of hips
-
Inner
knees
Fatigue
and sleep disturbances
People
with fibromyalgia often awaken tired, even though they seem to get plenty of
sleep. Experts believe that these people rarely reach the deep restorative stage
of sleep. Sleep disorders that have been linked to fibromyalgia include restless
legs syndrome and sleep apnea.
Co-existing conditions
Many
people who have fibromyalgia also may have:
-
Chronic fatigue syndrome
-
Depression
-
Endometriosis
-
Headaches
-
Irritable bowel syndrome (IBS)
-
Lupus
-
Osteoarthritis
-
Post-traumatic stress disorder
-
Restless legs syndrome
-
Rheumatoid arthritis
Causes
Doctors
don't know what causes fibromyalgia, but it most likely involves a variety of
factors working together. These may include:
-
Genetics.
Because fibromyalgia tends to run in families, there may be certain genetic
mutations that may make you more susceptible to developing the disorder.
-
Infections.
Some illnesses appear to trigger or aggravate fibromyalgia.
-
Physical or emotional trauma.
Post-traumatic stress disorder has been linked to fibromyalgia.
Why does
it hurt?
Current
thinking centers around a theory called central sensitization. This theory
states that people with fibromyalgia have a lower threshold for pain because of
increased sensitivity in the brain to pain signals.
Researchers believe repeated nerve stimulation causes the brains of people with
fibromyalgia to change. This change involves an abnormal increase in levels of
certain chemicals in the brain that signal pain (neurotransmitters). In
addition, the brain's pain receptors seem to develop a sort of memory of the
pain and become more sensitive, meaning they can overreact to pain signals.
Risk factors
Risk
factors for fibromyalgia include:
-
Your
sex.
Fibromyalgia occurs more often in women than in men.
-
Age.
Fibromyalgia tends to develop during early and middle adulthood. But it can
also occur in children and older adults.
-
Disturbed sleep patterns.
It's unclear whether sleeping difficulties are a cause or a result of
fibromyalgia. But people with sleep disorders — such as nighttime muscle
spasms in the legs, restless legs syndrome or sleep apnea — often have
fibromyalgia.
-
Family
history.
You may be more likely to develop fibromyalgia if a relative also has the
condition.
-
Rheumatic disease.
If you have a rheumatic disease, such as rheumatoid arthritis or lupus, you
may be more likely to develop fibromyalgia.
Complications
Fibromyalgia isn't progressive and generally doesn't lead to other conditions or
diseases. It can, however, lead to pain, depression and lack of sleep. These
problems can then interfere with your ability to function at home or on the job,
or maintain close family or personal relationships. The frustration of dealing
with an often-misunderstood condition also can be a complication of the
condition.
Preparing for your appointment
Because
many of the signs and symptoms of fibromyalgia are similar to various other
disorders, you may see several doctors before receiving a diagnosis. Your family
physician may refer you to a rheumatologist, a doctor who specializes in the
treatment of arthritis and other inflammatory conditions.
What you
can do
You may want to write a list that includes:
-
Detailed descriptions of your symptoms
-
Information about medical problems you've had in the past
-
Information about the medical problems of your parents or siblings
-
All
the medications and dietary supplements you take
-
Questions you want to ask the doctor
What to
expect from your doctor
In
addition to a physical exam, your doctor may check your neurological health by
testing your:
-
Reflexes
-
Muscle
strength
-
Muscle
tone
-
Senses
of touch and sight
-
Coordination
-
Balance
Tests and diagnosis
The
American College of Rheumatology guidelines for making a fibromyalgia diagnosis
require pain at 11 of the 18 tender points on the body.
Fibromyalgia
tender points
The
American College of Rheumatology has established two criteria for the diagnosis
of fibromyalgia:
-
Widespread pain lasting at least three months
-
At
least 11 positive tender points — out of a total possible of 18
Tender
points
During your physical exam, your doctor may check specific places on your body
for tenderness. The amount of pressure used during this exam is usually just
enough to whiten the doctor's fingernail bed. These 18 tender points are a
hallmark for fibromyalgia.
Blood
tests
While there is no lab test to confirm a diagnosis of fibromyalgia, your doctor
may want to rule out other conditions that may have similar symptoms. Blood
tests may include:
-
Complete blood count
-
Erythrocyte sedimentation rate
-
Thyroid function tests
Treatments and drugs
In
general, treatments for fibromyalgia include both medication and self-care. The
emphasis is on minimizing symptoms and improving general health.
Medications
Medications can help reduce the pain of fibromyalgia and improve sleep. Common
choices include:
-
Analgesics.
Acetaminophen (Tylenol, others) may ease the pain and stiffness caused by
fibromyalgia. However, its effectiveness varies. Tramadol (Ultram) is a
prescription pain reliever that may be taken with or without acetaminophen.
Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) —
such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen sodium
(Aleve, others) — in conjunction with other medications. NSAIDs haven't
proved to be as effective in managing the pain in fibromyalgia when taken by
themselves.
-
Antidepressants.
Your doctor may prescribe amitriptyline to help promote sleep. Fluoxetine
(Prozac) in combination with amitriptyline is effective in some people.
Duloxetine (Cymbalta) may help ease the pain and fatigue associated with
fibromyalgia. And milnacipran (Savella) was recently approved by the Food
and Drug Administration for the treatment of fibromyalgia symptoms.
-
Anti-seizure drugs.
Medications designed to treat epilepsy are often useful in reducing certain
types of pain. Gabapentin (Neurontin) is sometimes helpful in reducing
fibromyalgia symptoms, while pregabalin (Lyrica) is the first drug approved
by the Food and Drug Administration to treat fibromyalgia.
Therapy
-
Physical therapy.
Specific exercises can help restore muscle balance and may reduce pain.
Stretching techniques and the application of hot or cold also may help.
-
Counseling.
Cognitive behavioral therapy seeks to strengthen your belief in your
abilities and teaches you methods for dealing with stressful situations.
Therapy is provided through individual counseling, classes, and with tapes,
CDs or DVDs, and may help you manage your fibromyalgia.
Lifestyle and home remedies
Self-care
is critical in the management of fibromyalgia.
-
Reduce
stress.
Develop a plan to avoid or limit overexertion and emotional stress. Allow
yourself time each day to relax. That may mean learning how to say no
without guilt. But try not to change your routine completely. People who
quit work or drop all activity tend to do worse than those who remain
active. Try stress management techniques, such as deep-breathing exercises
or meditation.
-
Get
enough sleep.
Because fatigue is one of the main characteristics of fibromyalgia, getting
sufficient sleep is essential. In addition to allotting enough time for
sleep, practice good sleep habits, such as going to bed and getting up at
the same time each day and limiting daytime napping.
-
Exercise regularly.
At first, exercise may increase your pain. But doing it regularly often
decreases symptoms. Appropriate exercises may include walking, swimming,
biking and water aerobics. A physical therapist can help you develop a home
exercise program. Stretching, good posture and relaxation exercises also are
helpful.
-
Pace
yourself.
Keep your activity on an even level. If you do too much on your good days,
you may have more bad days.
-
Maintain a healthy lifestyle.
Eat healthy foods. Limit your caffeine intake. Do something that you find
enjoyable and fulfilling every day.
Alternative medicine
Complementary and alternative therapies for pain and stress management aren't
new. Some, such as meditation and yoga, have been practiced for thousands of
years. But their use has become more popular in recent years, especially with
people who have chronic illnesses, such as fibromyalgia.
Several of
these treatments do appear to safely relieve stress and reduce pain, and some
are gaining acceptance in mainstream medicine. But many practices remain
unproved because they haven't been adequately studied. Some of the more common
complementary and alternative treatments promoted for pain management include:
-
Acupuncture.
Acupuncture is a Chinese medical system based on restoring normal balance of
life forces by inserting very fine needles through the skin to various
depths. According to Western theories of acupuncture, the needles cause
changes in blood flow and levels of neurotransmitters in the brain and
spinal cord. Some studies indicate that acupuncture helps relieve
fibromyalgia symptoms, while others show no benefit.
-
Chiropractic care.
This treatment is based on the philosophy that restricted movement in the
spine may lead to pain and reduced function. Spinal adjustment
(manipulation) is one form of therapy chiropractors use to treat restricted
spinal mobility. The goal is to restore spinal movement and, as a result,
improve function and decrease pain. Chiropractors manipulate the spine from
different positions using varying degrees of force. Manipulation doesn't
need to be forceful to be effective. Chiropractors may also use massage and
stretching to relax muscles that are shortened or in spasm. Because
manipulation has risks, always go to properly trained and licensed
practitioners.
-
Massage therapy.
This is one of the oldest methods of health care still in practice. It
involves use of different manipulative techniques to move your body's
muscles and soft tissues. The therapy aims to improve blood circulation in
the muscle, increasing the flow of nutrients and eliminating waste products.
Massage can reduce your heart rate, relax your muscles, improve range of
motion in your joints and increase production of your body's natural
painkillers. It often helps relieve stress and anxiety. Although massage is
almost always safe, avoid it if you have open sores, acute inflammation or
circulatory problems.
Coping and support
Besides
dealing with the pain and fatigue of fibromyalgia, you may also have to deal
with the frustration of having a condition that's often misunderstood. In
addition to educating yourself about fibromyalgia, you may find it helpful to
provide your family, friends and co-workers with information.
It's also
helpful to know that you're not alone. Organizations such as the Arthritis
Foundation and the American Chronic Pain Association provide educational classes
and support groups. These groups can often provide a level of help and advice
that you might not find anywhere else. They can also help put you in touch with
others who have had similar experiences and can understand what you're going
through.
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