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Fibromyalgia

Definition

Fibromyalgia is a common syndrome in which people experience long-term, body-wide pain and tender points in joints, muscles, tendons, and other soft tissues.

Fibromyalgia has also been linked to fatigue, sleep problems, headaches, depression, anxiety, and other symptoms.

Alternative Names

Fibromyositis; Fibrositis

Causes, incidence, and risk factors

The cause of this disorder is unknown. Although none have been well proven, possible causes or triggers of fibromyalgia include:

• Physical or emotional trauma
• An abnormal pain response. Areas in the brain that are responsible for pain may react differently in fibromyalgia patients.
• Sleep disturbances, which are common in fibromyalgia patients.
• An infectious microbe, such as a virus. At this point, no such virus or microbe has been identified.

Men and women of all ages get fibromyalgia, but the disorder is most common among women aged 20 to 50.

The following conditions may be seen with fibromyalgia or mimic its symptoms:

• Chronic neck or back pain
• Chronic fatigue syndrome
• Depression
• Hypothyroidism
• Lyme disease
• Sleep disorders

Symptoms

The primary symptom of fibromyalgia is pain.

• The exact locations of the pain are called tender points. Tender points are found in the soft tissue on the back of the neck, shoulders, sternum, lower back, hips, shins, elbows, and knees. The pain then spreads out from these areas.
• The pain is described as deep-aching, radiating, gnawing, shooting or burning, and ranges from mild to severe.
• The joints are not affected, although the pain may feel like it is coming from the joints.
• People with fibromyalgia tend to wake up with body aches and stiffness. For some patients, pain improves during the day and increases again during the evening, though many patients have day-long, non-stop pain.
• Pain can increase with activity, cold or damp weather, anxiety, and stress.

Fatigue and problems with sleep are seen in almost all patients with fibromyalgia. Many complain that they can't get to sleep or stay asleep, and they feel tired when they wake up.

Other symptoms may include:

• Irritable bowel syndrome with gas, and alternating diarrhea and constipation
• Memory difficulties and problems thinking clearly
• Numbness and tingling in hands and feet
• Palpitations
• Reduced exercise tolerance
• Sad or depressed mood
• Tension or migraine headaches

Signs and tests

Diagnosis of fibromyalgia requires a history of a least 3 months of widespread pain, and pain and tenderness in at least 11 of 18 tender-point sites. These tender-point sites include fibrous tissue or muscles of the:

• Arms (elbows)
• Buttocks
• Chest
• Knees
• Lower back
• Neck
• Rib cage
• Shoulders
• Thighs

Sometimes, laboratory and x-ray tests are done to help confirm the diagnosis by ruling out other conditions that may have similar symptoms.

Treatment

Treatment should focus on not only relieving symptoms, but also on helping patients learn how to cope with their symptoms.

Treatments usually involve trial and error:

• Patients may start with physical therapy, exercise, and methods for reducing stress.
• If these methods fail to improve symptoms, an antidepressant or muscle relaxant may be added to the treatment.
• Patient education programs called cognitive-behavioral therapy, which help with coping skills, are an important part of the treatment plan.
• Many fibromyalgia sufferers have found support groups helpful.

Eating a well-balanced diet and avoiding caffeine may help with problems sleeping, and may help reduce the severity of the symptoms. Lifestyle measures to improve the quality of sleep can be effective for fibromyalgia. See: Sleeping difficulty

Reducing stress and improving coping skills may also help reduce painful symptoms.

Improved fitness through exercise is recommended.

• The best way to begin a fitness program is to start with short sessions of just a few minutes of gentle, low-impact exercises such as walking and swimming.
• Increase the length of each session slowly, as tolerated. Starting out slowly and gently can help ease you into an effective program you can stick with.

Starting slowly helps stretch and mobilize tight, sore muscles, which may be relieved by gentle stretching and light massage, as well as acupressure, acupuncture, and relaxation techniques.

Cognitive therapy usually lasts for 6 to 20 1-hour sessions. During this therapy, people with fibromyalgia learn to:

• Deal with negative thoughts
• Keep a diary of their pain and symptoms
• Recognize what makes their symptoms worse
• Seek out enjoyable activities
• Set limits

The goal of using medication is to improve sleep and pain tolerance. Patients should receive drug treatments along with exercise, patient education, and behavioral therapies.

Duloxetine (Cymbalta), pregabalin (Lyrica), and milnacipran (Savella) are medications that are approved specifically for treating fibromyalgia.

However, many other drugs are also used to treat the condition, including:

• Anti-seizure drugs
• Other antidepressants
• Muscle relaxants
• Pain relievers
• Sleeping aids

Severe cases of fibromyalgia may require a referral to a pain clinic.

Support Groups

Expectations (prognosis)

Fibromyalgia is a common and chronic problem. The symptoms sometimes improve. At other times, the symptoms may worsen and continue for months or years. The key is seeking professional help which includes a multi-faceted approach to the management and treatment of the disease. There is no proof that fibromyalgia syndrome results in an increased death rate.

Calling your health care provider

Call your health-care provider if you have symptoms of fibromyalgia.

Prevention

There is no proven prevention for this disorder. However, over the years, the treatment and management of the disease have improved.

References

Abeles M, Solitar BM, Pillinger MH, Abeles AM. Update on fibromyalgia therapy. Am J Med. 2008;121:555-561.

Häuser W, Bernardy K, Üceyler N, Sommer C. Treatment of fibromyalgia syndrome with antidepressants. JAMA. 2009;301:198-209.

Wolfe F, Rasker JJ. Fibromyalgia. In: Firestein GS, Budd RC, Harris ED Jr., et al., eds. Kelley's Textbook of Rheumatology. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 38.