What is Fibromyalgia?
Fibromyalgia, previously called fibrositis, is a poorly understood chronic musculoskeletal syndrome characterized by pain, achiness, tenderness, and stiffness in the muscle tissue, ligaments, and tendons. Fibromyalgia affects 2-4% of the population and is more common in women. Fibromyalgia most frequently affects the neck, shoulders, chest, legs, and lower back. Pain is generally accompanied by sleep disorders, fatigue, gastrointestinal disorders, and depression. Many fibromyalgia symptoms are similar to symptoms of chronic fatigue syndrome, myofascial pain syndrome, and temporomandibular joint syndrome. Profound fatigue frequently accompanies the pain, and both are made worse by seemingly trivial physical activity. Diagnostic tests show no abnormalities of the joints and no muscle damage. It often accompanies other illnesses, such as lupus or rheumatoid arthritis, but does not lead to joint or
muscle damage. Treatment is aimed at the relief of symptoms.
Who Gets Fibromyalgia?
Fibromyalgia is more common in women than men and the incidence of it increases with age.
While fibromyalgia symptoms can be debilitating, they are not life threatening. Symptoms of fibromyalgia vary, depending on the person's stress level, physical activity, and other factors, such as time of day or even weather conditions. Pain is the primary symptom and is found in virtually 100% of cases. Fibromyalgia pain and tenderness occurs in certain areas of the body when pressure is applied. These areas, which are called tender points, include:
- Back of the head
- Upper back
- Upper chest
Fibromyalgia pain can be aching, burning, throbbing, and can move around the body. Many patients experience muscle tightness, soreness, and spasms. People with fibromyalgia may be unable to carry out normal daily activities, even though muscle strength is not affected. The pain is often worse in the morning, improves throughout the day, and worsens at night. Symptoms may be constant or intermittent for years or over a lifetime. Other common symptoms include:
- Gastrointestinal discomfort, such as abdominal pain, bloating, gas, cramps, alternating diarrhea and constipation.
- Numbness or tingling sensations.
- Chronic headaches, may include facial and jaw pain.
- Heightened sensitivity to odors, loud noises, bright lights, various foods, medicines, and changes in weather.
- Painful menstrual periods (dysmenorrhea) and painful sexual intercourse (dyspareunia)
- Frequent urination, strong urge to urinate, and painful urination (dysuria). Symptoms of irritable bowel syndrome or irritable bladder are sometimes present.
- Rapid or irregular heart rate, and shortness of breath.
- Sensation of swelling or edema in the hands and feet, even though swelling is not present.
Fibromyalgia has no known cause, but many factors have been implicated: stress, anxiety, depression, poor sleep, environmental changes, trauma or strain, and viral infections. In patients already diagnosed with fibromyalgia, these factors can aggravate the condition, which may become chronic or manifest in cycles of remission and flare-ups.
- Sleep disturbances or interruptions, especially of deep sleep, may provoke
a flare-up of fibromyalgia.
- Underused muscles, poor fitness, and impaired blood circulation may contribute to fibromyalgia.
- Emotional stress, anxiety and depression may worsen the illness.
- Sometimes trauma and injury or infection will precede the onset of fibromyalgia; whether these cause the disease is unclear.
What If You Do Nothing?
Fibromyalgia is not life-threatening and it doesn’t appear to progressively worsen over time. But without treatment, symptoms may become more irritating or new symptoms may develop. Moreover, it can take a tremendous toll on a person's physical and emotional health if left untreated. Once they are accurately diagnosed, most fibromyalgia sufferers have a positive response to self-care measures and proper medical intervention, though improvement can take months.
- Although there are no specific tests for fibromyalgia, the diagnosis is strengthened when your doctor applies pressure to 18 characteristically tender sites and the patient reports pain in at least 11 of them.
- A diagnosis of fibromyalgia is dependent upon the exclusion of other disorders. Therefore, further tests to rule out rheumatoid arthritis and other diseases may be done.
Treatment varies depending on the severity and frequency of the patient's pain. There are prescription medications, lifestyle recommendations, and alternative remedies that can help manage fibromyalgia symptoms. Treating fibromyalgia often entails trying a number of strategies to see which one—or which combination—offers the most help.
Medication. Pharmacological approaches for treating fibromyalgia include:
- Over-the-counter pain relievers. Small doses of aspirin or acetaminophen may provide some pain relief and relieve muscle stiffness. Nonsteroidal anti-inflammatory drugs, such as ibuprofen, narcotics, and corticosteroids like prednisone have not proven to be effective.
- Duloxetine hydrochloride (Cymbalta) reduces pain and improves function in some patients. Common side effects of Cymbalta include constipation, diarrhea, dry mouth, and nausea. Cymbalta also may cause dizziness and hot flashes, and can increase the risk for depression, other psychiatric disorders, and suicidal thoughts in some patients.
- Pregabalin (Lyrica) also reduces pain and improves function in some patients. Side effects associated with Lyrica include dizziness, excessive sleepiness (somnolence), blurred vision, and weight gain. Patients should notify a physician if severe side effects occur.
- Milnacipran (Savella) was approved by the U.S. Food and Drug Administration in 2009 as a treatment for fibromyalgia. This medication should not be used in patients who are taking a monoamine oxidase inhibitor (MAOI; e.g., isocarboxazid [Marplan], phenelzine [Nardil], rasagiline [Azilect]). Side effects of Savella include excessive sleepiness, mood changes, and thoughts of suicide. Patients who are taking this drug should avoid drinking alcohol.
- Antidepressants, specifically selective serotonin-reuptake inhibitors (SSRIs), boost the level of the neurotransmitter serotonin in the brain, which modulates mood, but do not improve physical symptoms. Fluoxetine (Prozac) is a commonly prescribed SSRI. The overall benefit of these medications appears to be limited, as far as relieving pain, fatigue, and sleeplessness. Many patients are unable to tolerate antidepressant side effects, even at low doses, and stop taking them.Side effects include nausea, loss of appetite, and insomnia.
- Trigger point injectionsinvolve injecting a local anesthetic, such as lidocaine, and/or a corticosteroid into a tender point and then stretching the involved muscle. Local anesthetic increases blood flow to the muscle and corticosteroids reduce inflammation. The injections can be painful, and it may take two to four days for improvement.
Lifestyle and Non-Pharmacological Approaches. Sometimes fibromyalgia symptoms can be managed with changes that focus on diet, fitness and reducing stress.
- Exercise. Physical activity may relieve stiffness but worsen pain. Stiffness is usually worse upon awakening in the morning, but may be present all day. Routine low-impact aerobics and strength may help reduce pain, tender-point counts, depression, and sleep disturbances in patients with fibromyalgia. During aerobic exercise, hormone-like substances called endorphins are released. Endorphins help relieve pain and produce a feeling of well-being. Walking, swimming, and riding a stationary bicycle provide excellent low-impact aerobic exercise. Fibromyalgia patients should choose an exercise program they enjoy and stick with it, because exercise must be routine to be beneficial.
- Physical Therapy. Depending on individual fibromyalgia symptoms, heat, ice, massage, whirlpool, ultrasound, and electrical stimulation may be used to reduce pain. Physical therapists can also design an exercise program to improve flexibility, fitness, and posture in people with fibromyalgia.
- Behavior Modification. Behavior modification is a stress management approach involves learning coping skills, relaxation exercises, and self-hypnosis. Pain perception involves both physical and psychological components and counseling or therapy may help patients with fibromyalgia learn better methods of coping with their illness, enhance self-esteem, and reduce stress.
- Behavioral cognitive therapy involves working one-on-one with a trained mental health professional to address a person's behaviors and how those behaviors contribute to a person's physical and emotional well-being. Behavioral cognitive therapy can strengthen a person's belief in their own abilities for dealing with stress. A specific goal of cognitive therapy is to change the idea that patients are helpless in regard to their pain.
- Emotional Support and Education. Fibromyalgia patients who take an active role in their care can often improve their quality of life. Emotional support is very important when dealing with a chronic condition such as fibromyalgia. Some patients find support among family and friends, and others find support groups or group therapy to be helpful.
There is no known way to prevent fibromyalgia. Eating a healthy, well-balanced diet and getting
regular exercise may help decrease the risk.
When To Call A Doctor
Call your doctor if you experience symptoms of fibromyalgia for more than 10 to 14 days continuously. Call sooner if pain, sleeping difficulty, or depression are interfering with daily activities.
Reviewed by Diane M. Horowitz, M.D., Rheumatologist, North Shore Long Island Jewish Health System, Great Neck, NY. Review provided by VeriMed Healthcare Network.