Fibromyalgia

What is Fibromyalgia?

Fibromyalgia is a condition associated with widespread chronic pain, fatigue, memory problems and mood changes. Fibromyalgia is not a single disease, but a constellation of symptoms that can be managed. It is not life threatening and does not lead to muscle or joint damage.

Researchers suspect that different factors, alone or in combination, may contribute to the development of the disease. An infectious illness, physical trauma, emotional trauma or hormonal changes may trigger the development of generalized pain, fatigue and sleep disturbances that characterize the condition.

Who’s Affected?

Fibromyalgia affects more than 3.7 million Americans, the majority of whom are women between the ages of 40 and 75, but it also affects men, young women and children. People with other rheumatic diseases, such as rheumatoid arthritis or lupus, are at greater risk for fibromyalgia. For example, about 20 to 30 percent of people with rheumatoid arthritis also develop fibromyalgia, although no one knows why. Women who are overweight or inactive have an increased risk of developing fibromyalgia.

Fibromyalgia sometimes occurs in more than one member of the same family, but doctors have not verified a hereditary link or common genetic type. Several studies have, however, found a possible link between genetic markers called human leukocyte antigens, or HLAs, and fibromyalgia. This suggests that a gene that predisposes a person to develop fibromyalgia may exist.

Although fibromyalgia is more common in adults, children (especially adolescent females) may be diagnosed with fibromyalgia.

Fibromyalgia Symptoms

Fibromyalgia has been described as a constellation of symptoms affecting various body parts and functions. From muscle pain to sleep disturbances and anxiety, here are a few of the most prevalent symptoms.

Pain

Widespread musculoskeletal pain is the most common symptom of fibromyalgia. It generally occurs at multiple sites throughout the body, although it may start in one region, such as the neck and shoulders, and later occur at other locations over a period of time.

Fibromyalgia pain has been described in a variety of ways, such as burning, aching, stiffness or soreness. It often varies according to the time of day, activity level, weather, sleep patterns and stress. Many people with fibromyalgia say that some degree of pain is always present, although the pain can come and go. For some people the pain may be quite severe.

The tender areas or points associated with fibromyalgia are similar in location to the tender areas present in other common types of muscle and bone pain, such as tennis elbow (lateral epicondylitis). Other muscles and soft tissue areas can be painful as well. People often are not aware of the presence of many of these tender points until a doctor performs a tender point evaluation.

Fatigue and Sleep Disturbances

Most people with fibromyalgia have fatigue, decreased endurance or the kind of exhaustion felt with the flu or lack of sleep. Sometimes the fatigue is severe and it can be a much greater problem than the pain.

The problems with sleep vary from person to person. Some people have difficulty falling asleep; others sleep lightly and wake up frequently during the night. Most people with fibromyalgia wake up feeling tired, even after sleeping through the night. The tiredness can range from listlessness to exhaustion, and can vary from one day to the next. Research has shown that a disruption of a phase of sleep called “deep” sleep alters many crucial body functions, such as the production of hormones needed to restore muscle tissue, as well the levels of substances that control how a person perceives pain.

Restless leg syndrome is about 10 times more common in people with fibromyalgia than those without, which might be one reason people with fibromyalgia often report difficulty sleeping.

The fatigue and other symptoms people with fibromyalgia experience may be similar to another condition called chronic fatigue syndrome (CFS). Because of this, many individuals with fibromyalgia also meet criteria for this illness. Other overlapping “labels” for people with this same collection of symptoms include somatoform disorders and multiple chemical sensitivity.

Mood and Concentration Problems

Feeling sad or being down is common, and some people with fibromyalgia have depression. People with fibromyalgia also may feel anxious. Some researchers think there is a link between fibromyalgia and certain forms of depression and chronic anxiety. However, any person with a chronic illness – not just fibromyalgia – may feel depressed at times while struggling with their pain and fatigue.

People with fibromyalgia may have difficulty concentrating or performing simple mental tasks. These problems tend to come and go, and are often most prominent at times of extreme fatigue or anxiety.

Other Problems

Headaches, especially tension headaches and migraines, are common in people with fibromyalgia. Fibromyalgia may also be associated with pain of the jaw muscles and face (called temporomandibular joint disorder or TMJ syndrome) or myofascial (skeletal muscle) pain in just one region of the body. These are sometimes considered forms of regional, localized or incomplete fibromyalgia.

Abdominal pain, bloating and alternating constipation and diarrhea (called irritable bowel syndrome or spastic colon) also are common. Bladder spasms and irritability may cause frequent urination or the urge to urinate. Chronic pelvic pain can also be experienced. Additional problems that may be associated with fibromyalgia include dizziness, restless legs, endometriosis and numbness or tingling of the hands and feet.

If you think you have fibromyalgia, talk to your doctor.

Fibromyalgia Causes

The cause of fibromyalgia is unknown.

Studies suggest that an injury, trauma or infection may affect the central nervous system’s response to pain. Some researchers believe that trauma leads to biochemical changes in the muscles, and later, the central nervous system, leading to chronic pain. Others believe that an injury to the central nervous system interferes with brain wave patterns related to pain. Still others believe hormonal changes or infections, such as a flu virus, may trigger fibromyalgia.

Some studies have suggested that people with fibromyalgia have abnormal levels of different chemicals in their blood or the fluid in the brain and spine that help transmit and intensify pain signals to and from the brain. There also is evidence that the central nervous system’s ability to inhibit pain is impaired in these people.

In addition to patient reports, brain-imaging studies have confirmed that when fibromyalgia patients are given a small amount of pressure or heat, they experience much higher amounts of pain, as if the “volume control” is set too high on pain processing. Whether these abnormalities are a cause or a result of fibromyalgia is unknown.

There are some scientists who suspect that lack of exercise and changes in muscle metabolism may play a role in fibromyalgia or that the opposite, muscle overuse, may be the key.

Sleep disturbance, a symptom of fibromyalgia, may also be a cause. Sleep disturbance lowers the production of a growth hormone crucial to the repair of muscles.

An established link exists between fibromyalgia and depression, but no one knows if depression is a cause or effect of fibromyalgia.

What does seem to be true is that all of these conditions may contribute to fibromyalgia for different reasons.

Fibromyalgia Diagnosis

To diagnose fibromyalgia, your doctor will ask you about your health history and give you a physical examination. A physical exam can rule out other conditions that may cause chronic pain and fatigue.

There are no diagnostic tests for fibromyalgia, although some tests can help diagnose other medical problems with symptoms similar to fibromyalgia. For example, an under-active thyroid (hypothyroidism) causes many of the same symptoms as fibromyalgia. A doctor can order a simple blood test, however, to determine if someone has a thyroid problem.

A diagnosis is largely based on your input on the following criteria:

• Widespread pain index (WPI) score: The WPI lists 19 areas of the body where it’s common for people with fibromyalgia to have pain. You get a point for each area selected.
• Symptom Severity (SS) score, in which you rank the following symptoms on a scale of 0-3:
  • Fatigue
  • Waking unrefreshed
  • Cognitive symptoms
  • Physical symptoms such as headache, weakness, bowel problems, dizziness, numbness/tingling, hair loss
• Symptoms present for at least three months
• No other health problems that would explain the pain and other symptoms

Fibromyalgia Treatment

While there is no cure for fibromyalgia, the key to finding relief from the pain, fatigue and other symptoms is usually a combination of medications and natural therapies. The best doctor to treat fibromyalgia is a rheumatologist, a physician who specializes in the treatment of arthritis and related conditions. It may take some trial and error to find an effective combination of treatments. Here are some options worth trying:

Medications

Currently, there are three FDA-approved drugs for use as fibromyalgia treatments – pregabalin, duloxetine and milnacipran.

Pregabalin was originally developed as an anti-seizure medication, but has since shown benefits in relieving anxiety, some sleep problems and pain in people with fibromyalgia. Another anti-seizure medication, gabapentin is sometimes used off-label as a fibromyalgia treatment. Off-label means it is used by doctors because of demonstrated benefits is but not FDA-approved for a condition).

Duloxetine and milnacipran are anti-depressants, which raise concentrations of neurotransmitters known to inhibit feelings of pain.

Other anti-depressants found to be useful in the treatment for fibromyalgia and are used off-label include:

• Tricyclics, such as amitriptyline that relieves pain and improves sleep
• Cyclobenzaprine, which works similarly to amitriptyline
• Selective serotonin reuptake inhibitors, or SSRIs, such as fluoxetine, paroxetine and sertraline, that relieve pain and improve mood

These drugs work to treat fibromyalgia in patients with and without depression, so don’t think your doctor feels that you’re depressed just because they prescribe one of these drugs.

Other drugs that have been shown to be effective in fibromyalgia include venlafaxine, tizanidine and tramadol, cannabinoids (medications derived from the components of marijuana), gamma-hydroxybutyrate (GHB) and low-dose naltrexone.

Modest doses of nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen, may provide some pain relief. Most doctors don’t prescribe opioid pain relievers or tranquilizers except for the most severe cases of fibromyalgia, because these drugs aren’t as effective for fibromyalgia pain as other types of pain. Also, taking them long term can affect the organs.

Exercise

Physical activity has been shown to be a valuable fibromyalgia treatment, but activities must be chosen carefully and started at a low level. In some cases people with fibromyalgia are given the drug pyridostigmine prior to exercise to help reduce pain.

Biofeedback

Biofeedback teaches people how to change physiological functions, such as slowing a racing heartbeat or relax clenched or tight muscles. People who clench their jaw muscles may have temporomandibular joint (TMJ) pain, which is common in those with fibromyalgia.

Acupuncture

A few studies have shown statistically significant improvement of pain with acupuncture, but others have not. If you are curious about acupuncture, try three treatments. If you think you have benefited from the sessions, continue up to six or eight treatments. By then, you can decide whether acupuncture is cost-effective helpful enough for you to continue further.

Fibromyalgia Self Care

One of the best ways to take care of your health if you have fibromyalgia is to take a proactive role in your own treatment – a process called self-management.

Here are some ways you can manage your health when you have fibromyalgia:

Improving Sleep

Maintaining good sleep hygiene is important to improving sleep quality. That means doing things to make it easier for you to go to sleep and stay asleep. Establishing a regular bedtime, a regular time to wake up and strictly adhering to them is impor­tant. It may take up to six weeks for your body to get used to this change but it will aid in sleep. By practicing sleep hygiene techniques, such as reducing caffeine in the diet, us­ing relaxation tapes before bedtime, and keeping regular bed and wake-up times, sleep can often be dramatically improved. This, in turn, helps to reduce daytime fatigue and pain.

Being Physically Active

Exercise is an extremely impor­tant aspect of the management of fibromyalgia. Studies show that certain aerobic exercise programs give people with fibromyalgia an improved sense of well-being, increased endurance and decreased pain. It may do this by acting as a natural “drug,” raising the levels of endorphins (chemicals) in your body that can reduce pain and fatigue.

You may be reluctant to exercise if you’re already tired and in pain but there are several types of exer­cise you can choose. Forms of exercise that include stretching and relaxation, such as yoga, may be very useful for people with fibromyalgia. Strength train­ing can be performed by people with fibromyalgia, but it’s generally recommended that these types of exercise be started after a successful aerobic exercise program. Low- or non-impact aerobic exercises, such as walking, biking, Pilates, water aerobics or swimming, generally are the best ways to start your exercise therapy. However, it’s important to begin exercising at a level that you can tolerate without a substantial increase in pain. Many people with fibromyalgia find it necessary to consult with an experienced physical therapist for best results. Physi­cal therapists can help you by designing a specific exercise program to improve posture, flexibility and fitness.

Reducing Stress

Stress management techniques, such as breath­ing exercises, and learning to manage fatigue by pacing techniques, such as alternating periods of activity with periods of rest, can help you control the feelings of anger, sadness and panic that often overwhelm people living with frequent pain and fatigue. It’s very important to find ways to reduce the sources of stress as you manage your condition.