A single copy of this article may be reprinted for personal, noncommercial use only.
FibromyalgiaBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/fibromyalgia/DS00079
Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals.
Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.
Women are much more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression.
While there is no cure for fibromyalgia, a variety of medications can help control symptoms. Exercise, relaxation and stress-reduction measures also may help.
CLICK TO ENLARGE
The pain associated with fibromyalgia often 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 report sleeping for long periods of time. Sleep is frequently disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea, that further worsen symptoms.
Many people who have fibromyalgia also may have:
- Irritable bowel syndrome
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 for fibromyalgia include:
- Your sex. Fibromyalgia is diagnosed more often in women than in men. Female reproductive hormones may play a part in how women experience pain.
- 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.
Fibromyalgia generally doesn't lead to other conditions or diseases. But the pain and lack of sleep associated with fibromyalgia can interfere with your ability to function at home or on the job. The frustration of dealing with an often-misunderstood condition also can result in depression and health-related anxiety.
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
Before your appointment, 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 will probably ask you if you have problems sleeping, and if you've been feeling depressed or anxious.
Tests and diagnosis
CLICK TO ENLARGE
In 1990, the American College of Rheumatology (ACR) 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
But fibromyalgia symptoms can come and go. And many doctors were uncertain about how much pressure to apply during a tender point exam. While the 1990 guidelines may still be used by researchers studying fibromyalgia, less stringent guidelines have been developed for doctors to use in general practice. These newer diagnostic criteria include:
- Widespread pain lasting at least three months
- No other underlying condition that might be causing the pain
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 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 ibuprofen (Advil, Motrin, others) or naproxen sodium (Aleve, others) — in conjunction with other medications.
- Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline or fluoxetine (Prozac) to help promote sleep.
- 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) was the first drug approved by the Food and Drug Administration to treat fibromyalgia.
Talking with a counselor can help strengthen your belief in your abilities and teach you strategies for dealing with stressful situations.
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 gradually and 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. Moderation means not "overdoing it" on your good days, but likewise it means not self-limiting or doing "too little" on the days when symptoms flare.
- Maintain a healthy lifestyle. Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day.
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.
- 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.
- 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. 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.
- Yoga and tai chi. These practices combine meditation, slow movements, deep breathing and relaxation. Both have been found to be helpful in controlling fibromyalgia symptoms.
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 National Fibromyalgia Association and the American Chronic Pain Association can help put you in touch with others who have had similar experiences and can understand what you're going through.
- Fibromyalgia. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Fibromyalgia/default.asp. Accessed Nov. 2, 2010.
- Bennett RM. Fibromyalgia and chronic fatigue syndrome. In: Goldman L, et al. Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/225054422-4/1077621679/1492/1050.html#4-u1.0-B978-1-4160-2805-5..50300-1_13277. Accessed Nov. 2, 2010.
- Clauw DJ. Fibromyalgia: An overview. American Journal of Medicine. 2009;122:S3.
- Bennett RM. Clinical manifestations of diagnosis of fibromyalgia. Rheumatic Disease Clinics of North America. 2009;35:215.
- Goldenberg DL. Clinical manifestations and diagnosis of fibromyalgia in adults. http://www.uptodate.com/home/index.html. Accessed Nov. 4, 2010.
- Muller D, et al. Fibromyalgia syndrome. In: Rakel D. Integrative Medicine. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/225324736-4/1078619948/1494/93.html#4-u1.0-B978-1-4160-2954-0..50050-8_2384. Accessed Nov. 4, 2010.
- Goldenberg DL. Treatment of fibromyalgia in adults. http://www.uptodate.com/home/index.html. Accessed Nov. 4, 2010.
- Wolfe F, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care and Research. 2010;62:600.
- Hassett AL, et al. Nonpharmacologic treatment for fibromyalgia: Patient education, cognitive-behavioral therapy, relaxation techniques and complementary and alternative medicine. Rheumatic Disease Clinics of North America. 2009;35:393.
- Fibromyalgia and CAM: At a glance. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/health/pain/fibromyalgia.htm. Accessed Nov. 4, 2010.
- Carson JW, et al. A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia. Pain. 2010;151:530.
- Wang C, et al. A randomized trial of tai chi for fibromyalgia. New England Journal of Medicine. 2010;363:743.
- Vincent A (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 16, 2010.