Fibromyalgia

woman rubbing neck

What Is Fibromyalgia?

The fibromyalgia syndrome (FM) is a disorder characterized by widespread, deep, and debilitating musculoskeletal pain; diffused tenderness; chronic fatigue; feelings of weakness; cognitive issues (fibro fog); and sleep disturbances (waking unrefreshed). FM affects between 2 and 4 percent of the population, mostly women, although men and children may be affected as well.

The term fibromyalgia (pronounced fī-ˌbrō-ˌmī-ˈal-j(ē)ə) means pain in the muscles, ligaments, and tendons — the fibrous tissues of the body. While its cause remains unknown, possible triggers identified include genetic predisposition, injury, physical or emotional stress, infection, repetitive injury, and certain diseases.

Researchers are examining how the central nervous system processes pain and why an FM patient seems to have an increased sensitivity to pain. According to the American College of Rheumatology (ACR), people with FM may have abnormal levels of “Substance P” in their spinal fluid. This chemical helps transmit and amplify pain signals to and from the brain. For a person with fibromyalgia, it is as though the “volume control” is turned up too high in the brain’s pain processing centers.

Symptoms

In addition to pain and fatigue, people with fibromyalgia may have some of the following symptoms:

  • trouble sleeping or unrefreshed sleep
  • headaches
  • cognitive issues with memory and difficulty concentrating, known as fibro fog
  • morning stiffness
  • muscle spasm and twitching
  • a numbness and tingling sensation
  • pain in tender points (see diagram below)

Other conditions commonly observed in fibromyalgia patients include:

  • irritable bladder
  • anxiety
  • easy bruising
  • irritable bowel
  • feeling of swollen extremities
  • dry eyes and mouth
  • jaw pain
  • skin sensitivities
  • visual disturbances
  • Raynaud’s Phenomenon
  • Restless Leg Syndrome
  • Chronic Fatigue Syndrome

A person with fibromyalgia may experience flare-ups — periods when symptoms may increase or decrease in severity. FM is not a degenerative disease, nor does it cause damage to the joints, muscles, or organs.

Aggravating Factors

Changes in weather, cold or drafty environments, hormonal changes, anxiety, stress, depression, and physical overexertion can contribute to symptom flare-ups.

How Is Fibromyalgia Diagnosed?

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, research shows that people with fibromyalgia typically see numerous doctors before receiving a fibromyalgia diagnosis because FM shares many symptoms with other health problems.

The medical community’s understanding of FM has grown significantly since the ACR first officially recognized the syndrome and established guidelines to diagnose it in 1990. These guidelines or criteria are still used today, as there are no existing lab tests or scans to help diagnose FM. However, your doctor may run tests to rule out other health problems that may be confused with FM.

A doctor familiar with FM may then make a diagnosis based on the following criteria: a history of widespread pain affecting all four quadrants of the body lasting more than three months and other general physical symptoms including fatigue, waking unrefreshed, and cognitive (memory or thought) problems.

The ACR designated 18 sites on the body as tender points, at least 11 of which need to be reactive or painful when pressed when fibromyalgia is suspected. The tender points are near joints, but not at the joints themselves. Other symptoms, as outlined above, are also important to mention to your doctor.

Fibromyalgia tender points

Treating Fibromyalgia Symptoms
According to the U.S. Food and Drug Administration, FM is typically treated with pain medicines, antidepressants, muscle relaxants, and sleep medicines. Other drugs used include anticonvulsants, seizure drugs, and local anesthetics.

Prior to June 2007, the FDA had not approved any drugs to specifically treat fibromyalgia. Drugs used before then were prescribed off-label. Since June 2007, the FDA has approved three drugs for FM: Lyrica (pregabalin), Cymbalta (duloxetine hydrochloride), and Savella (milnacipran HCI). These three drugs reduce pain and improve function by reducing the level of pain experienced in some patients with FM, although the mechanism by which they work is unknown. However, many of the older off-label drugs are in the same drug families. They work as well or better to minimize FM symptoms and may be available in a less expensive generic formulation.

Keep in mind that every FM patient is different and drugs work differently with each person. Trial and error, good communication, and patience between you and your provider are sometimes needed to find the right drug or combination of drugs to help your symptoms.

Non-drug-based therapies also recommended for FM sufferers include:

  • exercise such as walking
  • gentle body-based therapies such as yoga and tai chi
  • cognitive behavioral therapy
  • complementary and alternative therapies such as massage and acupuncture

Helpful Hints (As always, consult with your physician before making any lifestyle changes.)

  • Your pain is real. By trying to deal with it in a positive way, you begin to take control. When you are in control, you are not a victim.
  • Don’t sleep directly under a fan or an air conditioning vent. Drafts may cause muscles to tense, resulting in pain.
  • Avoid caffeine. It increases pain perception.
  • Eat a light, carbohydrate snack before bedtime, e.g. crackers and milk. It will make you sleepy.
  • Minimize or reduce stress in your life. Stress may contribute to pain in fibromyalgia.
  • Pace yourself to avoid fatigue. You will be able to do more on some days than others.
  • Accept this and feel good about yourself and what you can accomplish.
  • Exercise moderately at least three times a week. Start slowly (3-5 minutes) and increase the time weekly. Water exercises are good.
  • Ask your physician to recommend a multivitamin.
  • Add fresh fruit, vegetables, and complex carbohydrates to your diet.
  • Drink six to eight glasses of water daily.
  • If you smoke, stop. Smoking constricts blood vessels. Muscles need as much oxygen as the blood can carry.
  • Notify your physician if medications cause stomach discomfort. He or she can help you.
  • Take a warm bath or treat yourself to a massage. It may help you to feel better.
  • If you need help, don’t feel guilty asking for it.
  • Focus on positive thoughts and enjoy life. Take up a hobby. It’s hard to dwell on pain when you’re having fun.

To learn more about fibromyalgia, visit our Resource Links page for many helpful websites.