About fibromyalgia

What is fibromyalgia?

Fibromyalgia facts

  • Fibromyalgia is a pain syndrome characterized by chronic pain, fatigue, and tenderness to touch.
  • Fibromyalgia is the most common cause of chronic, widespread pain in the United States.
  • Fibromyalgia affects 2%-4% of the population, mostly women.
  • Defining fibromyalgia symptoms and signs include
    • chronic pain,
    • fatigue,
    • unrefreshing sleep,
    • cognitive difficulties (fibro fog).
  • Those with fibromyalgia may also experience
    • depression and/or anxiety,
    • abdominal pain,
    • dry eyes,
    • chest wall pain,
    • dry mouth,
    • bladder symptoms,
    • pelvic pain,
    • heart palpitations,
    • numbness and tingling,
    • chemical sensitivities and multiple allergies,
    • weight gain.
  • Exercise and getting enough sleep are very important in the management of fibromyalgia. Taking medications can help relieve the pain.
  • There is no test to detect fibromyalgia. When a physician suspects fibromyalgia, sometimes tests are necessary to exclude other medical conditions.

What is fibromyalgia?

Fibromyalgia is a chronic pain condition that affects 4% of the population of the United States. Fibromyalgia commonly affects the muscles and ligaments and usually has been present for years when a physician diagnoses the condition. Fibromyalgia was formerly known as fibrositis.



What are the symptoms for fibromyalgia?

Symptoms of fibromyalgia include:

  • Widespread pain. The Pain associated with fibromyalgia often is described as a constant dull ache that has lasted for at least three months. To be considered widespread, the Pain must occur on both sides of your body and above and below your waist.
  • Fatigue. People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is often disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea.
  • Cognitive difficulties. A symptom commonly referred to as "fibro fog" impairs the ability to focus, pay attention and concentrate on mental tasks.

Fibromyalgia often co-exists with other painful conditions, such as:

  • Irritable bowel syndrome
  • Migraine and other types of headaches
  • Interstitial cystitis or painful bladder syndrome
  • Temporomandibular joint disorders



What are the causes for fibromyalgia?

Doctors don't know what causes fibromyalgia, but it most likely involves a variety of factors working together. These may include:

  • Genetics. Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder.
  • Infections. Some illnesses appear to trigger or aggravate fibromyalgia.
  • Physical or emotional trauma. Fibromyalgia can sometimes be triggered by a physical trauma, such as a car accident. Psychological stress may also trigger the condition.

Why does it hurt?

Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain's pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals.



What are the treatments for fibromyalgia?

There are both medication and non-medication treatments for fibromyalgia. Medication treatments frequently help manage the pain and sleeplessness from which fibromyalgia patients suffer. However, the non-medication treatments are really the basis of treatment for fibromyalgia. The non-medication treatments for fibromyalgia include education, exercise, and stress reduction. Sleep disorders may require both medication and non-medication treatments.

Education about fibromyalgia is very important. Often patients have suffered with symptoms for years, and simply knowing why they have pain can be a relief, as many patients become anxious not knowing what is causing their symptoms. Patients should also be educated about treatment approaches, good sleep hygiene, and the importance of treating conditions that may contribute to their symptoms. For example, when a patient with rheumatoid arthritis has fibromyalgia as well, poor control of their rheumatoid arthritis may lead to worsening of fibromyalgia pain and sleeplessness.

An exercise program is crucial in the treatment of fibromyalgia and should include stretching, strengthening, and aerobic exercise. Many patients with fibromyalgia find it difficult to institute a regular exercise program because they feel they are too tired to exercise and they may perceive that their pain and fatigue worsen when they begin to exercise. However, numerous scientific studies have shown that exercise for fibromyalgia, especially aerobic exercise, can improve pain, physical function, and a sense of well-being. Starting slow and sticking with the exercise program is very important. Low-impact aerobic activities such as swimming, water aerobics, walking, and biking are activities that patients with fibromyalgia find helpful. Many patients find it helpful to exercise in the morning. Some patients find yoga helpful for strengthening and stretching. This should also be accompanied by an aerobic exercise program.

Stress reduction is important in managing the symptoms of fibromyalgia. Many patients feel that their symptoms are triggered by stress. Stress reduction can be challenging. There are many stressors in life; some can be changed and others cannot. Stress reduction involves a combination of changing stressors that can be changed and learning to lessen the body's stress reaction to the stressors that cannot be changed.

Cognitive behavioral therapy is a form of psychological therapy whereby a therapist and patient work together, to establish healthy patterns of behavior by replacing negative thoughts with more productive thoughts and actions. This has been proven to work in fibromyalgia. This form of therapy can be done one on one in an office setting, or even over the Internet.

The non-medication therapies are the cornerstone of treatment for fibromyalgia. With them, many patients improve and may not require medications. Moreover, without focusing on sleep hygiene, stress reduction and exercise , it is difficult to improve, even with medication.

When used with non-medication therapies, medication treatments can help improve sleep, pain, and function in fibromyalgia. Medications are most effective for pain relief when combined with ongoing non-medication treatments as discussed above. Medications often used in the treatment of fibromyalgia include medications in the antidepressant class (medications originally developed to treat anxiety and depression) and anticonvulsants (medications originally developed to treat seizures).

  • Medications called "tricyclic antidepressants" have been used to treat fibromyalgia for many years. These medications include amitriptyline (Elavil), doxepin (Sinequan, Silenor), and desipramine (Norpramin). These medications are generally started in low doses and increased until adequate response is achieved. The advantage of these medications is that they are effective for sleep and pain, widely available, and less costly for most patients than some of the newer agents. Cyclobenzaprine (Flexeril) is a medication that is both a muscle relaxant and tricyclic antidepressant that can be used to help with sleep and pain in patients with fibromyalgia.
  • Medications in the antidepressant class that affect the serotonin and the norepinephrine neurotransmitters (SNRI antidepressants) are frequently used in the treatment of fibromyalgia. These medications include duloxetine (Cymbalta), milnacipran (Savella), and venlafaxine (Effexor). Norepinephrine is a neurotransmitter in the brain, and increasing the levels of norepinephrine with these medications decreases pain levels. Fluoxetine (Prozac) is an antidepressant that affects mainly serotonin at low doses but increases norepinephrine as well at higher doses. Higher doses of fluoxetine can be used to treat fibromyalgia pain.
  • Pregabalin (Lyrica) and gabapentin (Neurontin) are anticonvulsants (medications initially developed to treat seizures). There are many scientific studies showing that these medications can be effective for fibromyalgia pain.
  • Tramadol (Ultram) is an opioid pain reliever which is helpful in some patients with fibromyalgia but should be used with caution as sometimes the use of opioids can worsen the pain cycle in fibromyalgia.

A few notes on other treatments for fibromyalgia: Acupuncture can be helpful for some patients with fibromyalgia but is not usually recommended as one of the first-line treatments for fibromyalgia because the scientific studies on acupuncture for fibromyalgia patients have not shown definite benefit. Likewise, trigger point injections can be helpful for some patients. Alternative medicines have not been proven to be helpful in fibromyalgia; in particular, scientific studies on guaifenesin (Mucinex) show that it does not work. Of note, patients with vitamin D deficiency can have widespread arthralgia and myalgia, like fibromyalgia, which improves with vitamin D supplementation. While having a sufficient level of vitamin D is important to maintain bone health, a healthy immune system, and perhaps prevent certain types of cancer, vitamin D supplementation does not improve fibromyalgia symptoms in patients who have sufficient levels of vitamin D. Narcotic pain medications should be avoided in fibromyalgia because they may worsen the underlying problem.



What are the risk factors for fibromyalgia?

Risk factors for fibromyalgia include:

  • Your sex. Fibromyalgia is diagnosed more often in women than in men.
  • Family history. You may be more likely to develop fibromyalgia if a relative also has the condition.
  • Other disorders. If you have osteoarthritis, rheumatoid arthritis or lupus, you may be more likely to develop fibromyalgia.



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