Fibromyalgia

Overview

Fibromyalgia is a common syndrome characterized by chronic, widespread pain and tenderness throughout the body accompanied by other symptoms, including fatigue, difficulty sleeping, and memory problems. In fibromyalgia, joint pain resembles arthritis but differs in that there is no joint disease or inflammation. This tendency to mimic other diseases makes fibromyalgia difficult to diagnose.

The syndrome occurs in 2 to 4% of the population, and approximately 80 to 90% of all cases occur in women. Fibromyalgia typically starts in adulthood but may develop in teens or the elderly as well.

So far, there is no cure for fibromyalgia; however, it is not fatal and does not damage joints or internal organs. Usually a combination of treatments is needed to control the symptoms.

Causes and Risk Factors

Brain and spinal cord, and their role in fibromyalgiaThe causes of fibromyalgia are unclear. Researchers speculate that the syndrome is caused by a malfunction in the way the brain and spinal cord process pain so that affected individuals become abnormally sensitive to stimuli that are normally not painful, and pain signals become abnormally amplified. Genetics is an important factor since people who have a relative with fibromyalgia are at increased risk for the disorder. Emotional stress, trauma, or other factors may trigger the onset of the illness.

Frequently, fibromyalgia occurs in the presence of other diseases including:

  • Osteoarthritis
  • Rheumatoid arthritis
  • Ankylosing spondylitis
  • Lupus.

Symptoms

In fibromyalgia, the predominant symptoms are widespread pain and tenderness all over the body. The pain is accompanied by other symptoms, which collectively diminish the quality of life.

Typical symptoms include:

  • Tenderness to touch involving joints and muscles, especially in the neck, shoulders, back, and hips
  • Unusual fatigue
  • Sleep disturbances (awakening tired and unrefreshed)
  • Morning stiffness
  • Memory or thinking problems
  • Headaches
  • Depression
  • Anxiety
  • Irritable bowel syndrome (symptoms of abdominal pain, gas, and a change in bowel habits)
  • Irritable bladder
  • Pelvic pain
  • Painful menstrual periods
  • Temporomandibular joint disorders.

Diagnosis and Treatment

Doctors diagnose fibromyalgia based on a patient’s symptoms and physical examination findings of tenderness in numerous tendons, joints, and muscles. Currently, there are no laboratory tests or X-rays to diagnose fibromyalgia, but tests may be performed to rule out other conditions with similar symptoms. Although often confused with other disorders, such as rheumatoid arthritis and lupus, fibromyalgia is distinguished by the presence of pain with a lack of joint and muscle inflammation.

Diagnostic Criteria for Fibromyalgia:

  1. Widespread pain, tenderness, and other symptoms such as fatigue, waking unrefreshed, and memory problems.
  2. Symptoms lasting for more than 3 months. 
  3. No underlying medical problem that explains the symptoms.

Treatment

There is no cure for fibromyalgia. The goal of treatment is to control the pain and other symptoms using a combination of medications and a number of other therapies.

Medications:

  • Duloxetine (Cymbalta) and Milnacipran (Savella) are antidepressant medications that treat fibromyalgia by altering the level of brain chemicals that modulate pain.
  • Pregabalin (Lyrica) inhibits the transmission of pain signals in the body.
  • Acetaminophen relieves pain.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, can relieve pain even though inflammation is absent.
  • Cyclobenzaprine, amitriptyline, gabapentin, and pregabalin may improve sleep problems.
  • Opioids (narcotics for pain) are generally avoided because they are not proven effective for fibromyalgia and may exacerbate symptoms.

Other Treatments Include:

  • Cognitive behavioral therapy (to improve a person’s response to pain)
  • Tai chi (a stress-reducing exercise accompanied by deep breathing)
  • Yoga
  • Acupuncture
  • Chiropractic therapy
  • Massage therapy
  • Meditation and other relaxation techniques
  • Improved sleep
  • Regular exercise
  • Healthy diet.

The symptoms of fibromyalgia are usually difficult to treat. Typically, patients need a combination of therapies and a team of various health professionals to implement the necessary regimens and improve the quality of life.

Prevention

Research has not determined ways to prevent fibromyalgia since the cause is unknown and some people have a genetic predisposition for the disorder. Doctors have no specific recommendations, but their general advice includes a set of lifestyle choices to maintain overall good health - namely, stress reduction, proper sleep, regular exercise, and a nutritious diet.

Sources

  • Wolfe F, Rasker JJ, Chapter 52. Fibromyalgia. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O’Dell Jr, eds. Kelley’s Textbook of Rheumatology, 9e. Philadelphia, PA: Elsevier Saunders; 2013.
  • Crofford LJ. Fibromyalgia. 2013. American College of Rheumatology website. http://www.rheumatology.org/Practice/Clinical/Patients/Diseases_And_Conditions/Fibromyalgia/. Accessed April 29, 2014.
  • Fibromyalgia. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. http://www.niams.nih.gov/Health_Info/Fibromyalgia/default.asp. Accessed April 29, 2014.