Fibromyalgia

Fibromyalgia is a chronic condition that causes pain and tenderness throughout the body. It affects an estimated 5 million Americans, according to the National Institutes of Health (NIH). The disorder typically starts in middle age and is most common in women, but it can also strike men and people of all ages, including children. People with autoimmune conditions like lupus or rheumatoid arthritis are more prone to the disorder than the general population.

What are the symptoms of fibromyalgia?

The primary symptoms of fibromyalgia are:

Widespread pain throughout the body
A heightened, painful response to pressure at many tender points on the body
Individuals with fibromyalgia may also experience these symptoms:

Moderate to severe fatigue
Difficulty sleeping
Joint stiffness
Headaches
Tingling, numbness or a burning or prickling sensation in hands and feet
Painful menstrual periods
Irritable bowel
Problems with thinking and memory


How is fibromyalgia diagnosed?

There is no blood test, other lab or diagnostic test, or imaging study that can identify fibromyalgia. That’s why doctors must rule out other possible causes of symptoms like pain and fatigue before making a fibromyalgia diagnosis. Pain and fatigue are symptoms of many conditions, including chronic fatigue syndrome, rheumatoid arthritis and lupus.

 The National Institute of Arthritis and Musculoskeletal and Skin Diseases, which is part of NIH, notes certain guidelines doctors use to help diagnose fibromyalgia. These include:

A history of widespread pain lasting more than three months
Feelings of fatigue and waking unrefreshed
Cognitive (memory or thought) problems
Pain in a high number of areas throughout the body in the previous week
The National Fibromyalgia Association advises patients to look for a doctor who has a lot of experience with fibromyalgia: “Since people with fibromyalgia tend to look healthy and conventional tests are typically normal, a physician knowledgeable about the disorder is necessary to make a diagnosis.”

One method that had been widely used for diagnosing fibromyalgia — a tender point exam — is no longer considered the preferred diagnostic test. In this tender point exam, developed in 1990, a doctor applies pressure to 18 specific points on the body; a patient who feels pain in at least 11 of these points was believed to have fibromyalgia. As research provided more insight into the causes of fibromyalgia, in 2010 the American College of Rheumatology published new diagnostic criteria. These criteria advise physicians to replace the tender point exam with a self-report survey, in which patients are asked whether they have experienced pain in any one of 19 different body parts in the past week. Patients are also asked to rate the severity of certain symptoms, such as fatigue.

What is the difference between fibromyalgia and myofascial pain syndrome?

Myofascial pain syndrome is similar to fibromyalgia, but there are important differences in symptoms and treatment. One big difference is that myosfascial pain is confined to a specific area and is associated with trigger points. For more information, see the When Seconds Count® myofascial pain syndrome page.

A person can have both fibromyalgia and myofascial pain syndrome. That makes it especially important to consult with a medical specialist who can diagnose the difference and apply the proper treatments for each condition.

What causes fibromyalgia?

The general consensus is that fibromyalgia is the result of a hypersensitive and hyperactive central nervous system, with the brain and spinal cord having developed heightened pain activity. Various risk factors have been suggested, such as genetic predisposition, trauma, multiple surgeries or chronic stress, but these are not definitive.

What are the best treatments?

At this time, there is no cure for fibromyalgia. However, there are ways to manage the pain and other symptoms. Pain management specialists understand the full range of pain relief options, including how to use them in combination to achieve a successful outcome.

Physician anesthesiologists specialize in pain control, and some focus their practices on treating patients with chronic pain. Ask your doctor about a referral to a physician anesthesiologist who specializes in treating chronic pain.

Treatment options generally fall into three categories: medicines, lifestyle changes and complementary therapies. Most patients do best when they use components from all three options. Patients may also need to try different medications to find the one that is the most effective for them.

Medicines

Nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen and naproxen
Muscle relaxants
Steroids
Pregabalin
Duloxetine or milnacipran
IV infusions of lidocaine
Low-dose naltrexone
Tricyclic antidepressants like amitriptyline and nortriptyline
Lifestyle changes

Getting plenty of exercise, which NIH says has been shown by research to be one of the most effective treatments
Developing better sleep habits and bedtime rituals
Eating foods that reduce inflammation in the body
Identifying and avoiding foods and ingredients that seem to trigger pain
Quitting smoking
Reducing stress with meditation, mindfulness, yoga or other techniques
Adjusting work demands
Complementary therapies

Acupuncture
Chiropractic therapy
Massage
Qi gong
Tai chi
Herbal supplements
Cognitive behavioral therapy