Fibromyalgia
(Myofascial Pain Syndrome; Fibrositis; Fibromyositis)

By Joseph J. Biundo , MD, Tulane Medical Center
Last full review/revision Feb 2020| Content last modified Feb 2020
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Fibromyalgia is characterized by poor sleep, fatigue, mental cloudiness, and widespread aching and stiffness in soft tissues, including muscles, tendons, and ligaments.
Poor sleep, stress, strains, injury, and possibly certain personality characteristics may increase the risk of fibromyalgia.
Pain is widespread, and certain parts of the body are tender to touch.
The diagnosis of fibromyalgia is based on established criteria and symptoms such as widespread pain and fatigue.
Improving sleep, taking pain relievers, exercising, applying heat, and getting massages may help.
Fibromyalgia used to be called fibrositis or fibromyositis syndrome. But because inflammation (indicated by the “itis” suffix) is not present, the suffix was dropped, and the name became fibromyalgia.

Fibromyalgia is common. It is about 7 times more common among women. It usually occurs in young or middle-aged women but can also occur in men, children, and adolescents.

Fibromyalgia is not dangerous or life threatening. Nonetheless, persistent symptoms can be very disruptive.

Causes
People with fibromyalgia seem to have a heightened sensitivity to pain. That is, areas in their brain that process pain interpret painful sensations as being more intense than seems to occur in people who do not have fibromyalgia. Usually, the cause of fibromyalgia is unknown. However, certain conditions may contribute to developing the disorder. They include poor sleep, repetitive strains, or an injury. Mental stress may also contribute. However, stress per se may not be the problem. Rather it may be how people react to the stress.

Some affected people may also have a connective tissue disorder, such as rheumatoid arthritis or systemic lupus erythematosus (lupus). Sometimes a viral or other infection (such as Lyme disease) or traumatic event can trigger fibromyalgia.

Symptoms
Most people feel a general achiness, stiffness, and pain. Symptoms can occur throughout the body. Any soft tissue (muscles, tendons, and ligaments) may be affected. But soft tissue of the neck, upper shoulders, chest, rib cage, lower back, thighs, arms, and areas around certain joints are especially likely to be painful. Less often, the lower legs, hands, and feet are painful and stiff. Symptoms may occur periodically (in flare-ups) or most of the time (chronically).

Pain may be intense. It usually worsens with fatigue, straining, or overuse. Specific areas of muscle are often tender when firm fingertip pressure is applied. These areas are called tender points. During flare-ups, muscles become tight, or spasms may occur.

Many affected people do not sleep well and feel anxious, and sometimes depressed or tense. Fatigue is common, as are mental problems such as difficulty concentrating and a general feeling of mental cloudiness. Many affected people are perfectionists, or have a type A personality. They may also have migraines or tension headaches, interstitial cystitis (a type of bladder inflammation that causes pain when urinating), and irritable bowel syndrome (with some combination of constipation, diarrhea, abdominal discomfort, and bloating). People may have pins-and-needles sensations, typically affecting both sides of the body.

The same conditions that may contribute to the development of fibromyalgia can make symptoms worse. They include emotional stress, poor sleep, injury, and fatigue. Fearing that symptoms represent a serious illness can also make symptoms worse. Having a doctor, family member, or friend imply that the disorder is “all in the head” can worsen symptoms as well. People may also feel frustrated because they are often told that they “look good” even though they are feeling unwell.

Diagnosis
Established criteria
A doctor’s examination and testing to rule out other disorders
Doctors suspect fibromyalgia in people who have the following:

Generalized pain and tenderness
Negative laboratory test results despite widespread symptoms
Fatigue as a main symptom
Doctors consider the diagnosis of fibromyalgia in people who have had widespread pain for at least 3 months, particularly when it is accompanied by various other physical symptoms such as fatigue. Pain is considered widespread when people have pain in the left and right side of the body, above and below the waist, and in the top of the spine, wall of the chest or middle of the spine, or low back.

In the past, doctors based the diagnosis in part on the presence of tenderness at some of 18 designated tender points. Now, however, the number of tender points is not considered as important as the presence of typical symptoms, especially widespread pain.

Doctors want to be sure that another disorder (such as hypothyroidism, polymyalgia rheumatica, or another muscle disorder) is not causing the symptoms, often by doing blood tests. But no test can confirm the diagnosis of fibromyalgia.

Fibromyalgia may not be easily recognized in people who also have rheumatoid arthritis or lupus because these disorders cause some similar symptoms, such as fatigue and pain in the muscles, joints, or both.

Prognosis
Fibromyalgia tends to be chronic but may resolve on its own if stress decreases. Even with appropriate treatment, most people continue to have symptoms to some degree.

Treatment
Stretching, heat therapy, and massage
Managing stress
Drugs to improve sleep
Drugs to relieve pain
People can feel better when treated appropriately. Usually, the most helpful approach includes the following:

Reducing stress, including recognizing that there is no underlying life-threatening disease causing the pain
Deep breathing exercises, meditation, mindfulness-based cognitive therapy (MBCT), mental health support, and counseling if necessary
Stretching the affected muscles gently (holding the stretch about 30 seconds and repeating it 5 times)
Doing exercises to improve physical conditioning (aerobic exercises) and very gradually but steadily increasing the intensity (for example, by using a treadmill, exercise bicycle, or elliptical machine or by swimming)
Applying heat to or gently massaging the affected area
Keeping warm
Getting enough sleep
Improving sleep

Improving sleep is essential. For example, people should avoid caffeine and other stimulants in the evening and sleep in a quiet, dark room with comfortable bedding. They should not eat or watch television in bed.

Doctors may prescribe low doses of tricyclic antidepressants. These drugs are taken by mouth 1 or 2 hours before bedtime and are used only to improve sleep rather than to relieve depression. They include trazodone, amitriptyline, and nortriptyline. Cyclobenzaprine, a muscle relaxant, can also help people sleep. Like tricyclic antidepressants, cyclobenzaprine is taken only at bedtime. These drugs are usually safer than sedatives, most of which can be habit-forming. However, tricyclic antidepressants and cyclobenzaprine can have side effects, such as drowsiness and dry mouth, particularly in older people. Taking these drugs at other times can cause daytime drowsiness.

Relieving pain

Pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), can help. Opioids, which can be habit-forming and become less effective over time, should be avoided when treating fibromyalgia.

Pregabalin (an antiseizure drug sometimes used to relieve pain), duloxetine, and milnacipran are sometimes used to treat fibromyalgia. These drugs may help when used as part of a treatment program that includes improving sleep, exercising, and managing stress.

Occasionally, local anesthetics (such as lidocaine) are injected directly into a particularly tender area, but these injections should not be used repetitively.