Fibromyalgia

Overview

Fibromyalgia is a rheumatic condition—a condition affecting the joints and soft tissues. It’s associated with widespread pain and fatigue. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, fibromyalgia affects about 5 million U.S. adults, most of them women. The pain of fibromyalgia is described as “tender points”—specific areas of the body that hurt when pressure is placed on them. Tender points often occur on the neck, shoulders, back, and hips.

Although the causes of fibromyalgia are not known, several factors may be involved in its development; these include traumatic events or accidents, repetitive injuries, illness, and certain diseases (such as rheumatoid arthritis, lupus, and spinal arthritis). The disorder, however, can occur spontaneously, meaning there is no direct cause or trigger. It is also thought that a gene or genes may be involved in fibromyalgia.

Symptoms and Diagnosis

There is no laboratory test to diagnose fibromyalgia, and the main symptoms—pain and fatigue—make it hard to differentiate from other conditions. As a result, it may take more than one consultation with different doctors before a diagnosis is made.

To diagnose fibromyalgia, a doctor familiar with the disorder will use criteria established by the American College of Rheumatology (ACR). These criteria include a history of widespread pain lasting for more than three months, diffuse tenderness, and tender points at 11 or more of 18 sites designated by the ACR.

Additional symptoms of fibromyalgia include:

  • Difficulty sleeping
  • Stiffness in the morning
  • Headaches
  • Painful menstrual periods
  • Tingling or numbness in hands and feet
  • Irritable bowel syndrome
  • Temperature sensitivity
  • Restless leg syndrome
  • Cognitive or memory difficulties (“fibro fog”)
  • Sensitivity to loud noises or bright lights

Medications and Treatment

Your first step in getting good treatment for fibromyalgia is to find a doctor with experience treating the disorder. Fibromyalgia can be hard to treat, making your physician’s familiarity with it important. Types of doctors who may have experience treating fibromyalgia include family physicians, general internists, or rheumatologists (doctors specializing in arthritis and conditions affecting joints and soft tissue). And because fibromyalgia can affect several aspects of your health, a team approach to treatment can be helpful—your doctor, a physical therapist, and possibly other healthcare providers may all contribute to your care.

Three medications have been approved by the U.S. Food and Drug Administration for the treatment of fibromyalgia. These are Cymbalta® (duloxetine), Savella® (milnacipran), and Lyrica® (pregabalin).

Medications approved for other conditions may be used to treat fibromyalgia and its symptoms. These include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDS) such as aspirin and ibuprofen
  • Antidepressants (types include tricyclics, selective serotonin reuptake inhibitors, and mixed reuptake inhibitors)
  • Benzodiazepines
  • Medication to treat specific symptoms (irritable bowel syndrome, for example)

Living with Fibromyalgia

An experienced medical team will help you manage fibromyalgia, but there are also important steps you can take on your own to feel your best from day to day. Effective management is important because fibromyalgia may last a long time—a lifetime for some. For example, you may feel better if you:

  • Take medications as prescribed.
  • Get enough sleep.
  • Exercise regularly.
  • Eat a balanced, nutritious diet.
  • If conditions at work make symptoms worse, make necessary changes.

Complementary and alternative therapies may also help relieve symptoms and improve overall well-being among people affected by fibromyalgia. Examples include massage, acupuncture, and movement therapies like Pilates. Discuss these options with your healthcare team.

Although fibromyalgia is a chronic condition, it’s important to remember that it’s not a progressive disorder, meaning that the symptoms will not get worse. Some people even find that the condition improves over time.

Resources

National Institute of Arthritis and Musculoskeletal and Skin Diseases

National Fibromyalgia Association

Fibromyalgia Network

Sources

Fibromyalgia. National Institute of Arthritis and Musculoskeletal and Skin Diseases Web site. Available at: http://www.niams.nih.gov/Health_Info/Fibromyalgia/default.asp. Accessed July 2010.