Fibromyalgia

What is fibromyalgia?

Fibromyalgia is a condition marked by aching and pain in muscles, tendons, and joints all over the body, especially along the spine.

Some people who have fibromyalgia have definite changes in function and body chemistry. These changes may be responsible for certain symptoms. However, fibromyalgia is not associated with muscle, nerve, or joint injury; inadequate muscle repair; or any serious bodily damage or disease. Also, people who have fibromyalgia are not at greater risk for any other musculoskeletal disease.

Fig. 1

When stress continues without relief, your body doesn't have time to relax or prepare for the next challenge. This is called distress. As you can see in Figure 1, distress can trigger a number of physical reactions and lead to the symptoms of fibromyalgia.

Who is affected by fibromyalgia?

In the United States, 2 to 4% of women and men have fibromyalgia. Women tend to have fibromyalgia more often than men.

What causes fibromyalgia?

The exact cause of fibromyalgia is unknown. There are, however, many theories about why people get fibromyalgia, including stress (see Figure 1).

When fibromyalgia begins, there are many stresses in a person's life. Stress often causes disturbed sleep patterns and a lack of restful sleep. When you don't get enough sleep, your body does not produce the chemicals necessary to control or regulate pain. This causes tenderness in the upper back and forearms and leads to the symptoms of fibromyalgia.

Physical and emotional factors may also play a role in fibromyalgia. For example, a physical illness (such as an infection) could cause changes in your body chemistry that lead to pain and sleeplessness.

When you are sick, you may worry about your health and become anxious, depressed, or inactive. These emotional factors could make your symptoms worse and aggravate fibromyalgia.

What are the symptoms of fibromyalgia?

The main symptom of fibromyalgia is pain. Other symptoms are often related to the pain, including:

• Sleep disturbance.
• Depression.
• Tiredness during the daytime.
• Headaches.
• Alternating diarrhea and constipation.
• Numbness and tingling in the hands and feet.
• Feelings of weakness.
• Having difficulty remembering.
• Dizziness.
• Increased sensitivity to light, odors, and sounds.

How is fibromyalgia diagnosed?

Your doctor will diagnose fibromyalgia at the time of your visit, based on a combination of factors, including:

• A complete medical history and physical exam (to rule out other illnesses that may have similar symptoms, such as rheumatoid arthritis, muscle inflammation, bursitis, or tendinitis).
• The presence of widespread pain together with some of the other symptoms of fibromyalgia.
• Presence of very tender areas ("tender points") at specific locations (see Figure 2). People who have fibromyalgia have abnormal sensitivity when light pressure is applied to many of the locations illustrated. Only about 80% of patients have tender points. The absence of tender points does not rule out the diagnosis of fibromyalgia.

Fig. 2: Common areas of pain and tenderness (called "tender points") in people who have fibromyalgia.

How is fibromyalgia treated?

People with fibromyalgia receive individual treatment based on several factors, including their overall health, medical history, number of tender points, severity of pain, and any other symptoms.

Treatment for fibromyalgia includes:

• Education about fibromyalgia and goal setting.
• Lifestyle changes, including stress reduction.
• Lifelong exercise.
• Relaxation techniques to relieve muscle tension.
• Medications that reduce pain and improve sleep.

No currently existing medications completely relieve fibromyalgia pain. However, acetaminophen (Tylenol®) is both helpful and safer than other analgesics (pain-relieving medications).

Medications help only to a certain extent. Drugs in the category of antidepressants and gabapentinoids are used to treat fibromyalgia. They help reduce pain and improve mood and the quality of sleep.

Nonsteroidal anti-inflammatory drugs, including aspirin and ibuprofen, may help reduce pain, but should be used sparingly. These drugs have many side effects, including stomach upset and fluid retention. They may also have unfavorable interactions with other drugs, such as high blood pressure medications. (These drugs are not currently recommended for the treatment of fibromyalgia.)

Glucocorticosteroids such as prednisone and cortisone are contraindicated (should not be used). There is no benefit for immunosuppressive medications, since fibromyalgia is not an inflammatory condition. There is a strong agreement among specialists that opioid medications are not indicated and should not be prescribed for fibromyalgia pain.

Exercise

Fibromyalgia is an exercise deprivation syndrome (the lack of exercise makes symptoms worse). It is recommended that patients start a graded exercise program and continue exercising regularly throughout their entire lives. Feeling more tired and achy after exercise is usual and is not a contraindication for exercise.

Brisk walking, biking, swimming, and water aerobics are good activities to choose when starting your exercise program. Your doctor can help you choose an exercise program that's right for you.

Taking part in aerobic exercise for half an hour, 3 times a week, is an important step toward improving fibromyalgia symptoms. Exercise increases heart and lung function and stretches tight, sore muscles.

Coping with stress

Certain stress factors in life (such as financial burdens, or difficulties with a boss, coworkers, or your spouse) may not be easily eliminated. Evaluating the causes of stress and learning new ways to cope may improve fibromyalgia symptoms. Anxiety and depression are major contributors to stress and must be treated to allow fibromyalgia to improve.

Relaxation techniques can help relieve muscle tension and reduce stress. Professionals trained in stress management can teach you these techniques.

Can fibromyalgia be prevented?

There is no known way to prevent fibromyalgia. It is in your best interest, however, to remain as healthy as possible. Maintaining a good diet, doing safe exercise, and getting enough rest are good rules to follow if you hope to prevent any medical condition, including fibromyalgia.

What is the long-term outlook for people with fibromyalgia?

Often, if the situations that cause stress are resolved, fibromyalgia may spontaneously improve and medications may not be necessary.

Many people with fibromyalgia will continue to have symptoms despite treatment, especially when life is stressful. However, medications that may alter the balance of pain-producing chemicals (such as antidepressant drugs) should improve symptoms by 30%.

When other forms of therapy such as acetaminophen and aerobic exercise are combined to treat fibromyalgia, even more improvement can be expected. Those who are able to continue working and fulfilling their social obligations – despite their pain – do best.