About Fibromyalgia

Overview

Fibromyalgia is a chronic pain disorder that affects individuals physically, mentally, emotionally, socially and financially. For those with severe symptoms, the disorder can be extremely debilitating and interfere with basic daily activities, leading to high rates of disability.

Between 2 to 4% of the population—as many 10 million people in the United States—suffer from fibromyalgia. (American College of Rheumatology). While predominately seen in women, the disorder also occurs in men and children, and is seen in all ethnic groups.

Major Symptoms

Fibromyalgia (FM) is characterized by widespread pain, fatigue, sleep disturbances and cognitive difficulties as well as a number of overlapping conditions (American College of Rheumatology).

Pain: The primary symptom of fibromyalgia is chronic, widespread pain. This widespread pain can come in many forms: deep, sharp, dull, throbbing or aching. Most individuals with the disorder also experience painful tender points and morning stiffness. The pain, which varies in intensity, can migrate to all parts of the body. In addition, numbness, tingling and burning frequently occur, brining additional discomfort to individuals affected by the disorder (Centers for Disease Control and Prevention).

Fatigue:Defined as weariness from bodily or mental exertion, fatigue is also very common with fibromyalgia — even for individuals who are well rested. This lingering tiredness can be constant and limit one’s normal ability.

Sleep Disturbances:Most individuals with fibromyalgia have difficulty sleeping. Some researchers believe the constant pain associated with fibromyalgia causes sleep interruption. Other researchers point to an associated sleep disorder that prevents individuals from getting deep, restful, restorative sleep, an important stage of the sleep cycle that allows muscles to repair and energy to replenish.

Cognitive Difficulties:Often referred to as “fibrofog,” cognitive-related symptoms include short-term memory loss, difficulty with language, trouble concentrating and focusing, and difficulty retaining new information.

Stiffness:Individuals with fibromyalgia often experience stiffness, defined as discomfort after a period of inactivity (such as waking up in the morning or sitting for an extended period of time), decreased range of motion or a loss of range of motion.

Overlapping Conditions:Many individuals affected by fibromyalgia have one or more overlapping conditions. Below are some of the comorbitities that frequently occur with fibromyalgia (NFA).

  • Chronic Fatigue Syndrome
  • Myofascial Regional Pain Syndrome
  • Irritable Bowel Syndrome (constipation and/or diarrhea)
  • Migraine Headaches
  • Restless Legs Syndrome
  • Periodic Limb Movement Disorder
  • Depression
  • Interstitial Cystitis
  • Osteoarthritis (inflammatory condition)
  • Systemic lupus (inflammatory condition)
  • Rheumatoid arthritis (inflammatory condition)
  • Endometriosis
  • Vulvodynia
  • Temporomandibular Dysfunction
  • Carpal Tunnel Syndrome
  • Dysmenorrhea

Diagnosis

Currently, there are no laboratory, radiographic, or other diagnostic tests to diagnose fibromyalgia. Instead, healthcare professionals rely on patient histories, self-reported symptoms, a physical exam and a manual tender point examination. Based on the standardized American College of Rheumatology criteria established in 1990, widespread pain must be in all four quadrants of the body for a minimum duration of three months and tenderness or pain must occur in at least 11 of the 18 specified tender points when pressure is applied.

Potential Causes

The cause(s) of fibromyalgia are unclear. However, the Centers for Disease Control and Prevention cite several factors that have been associated with the onset of FM:

  • Chronic Stress or post traumatic stress disorder (PTSD)
  • Injuries  (e.g. car accidents, head and/or neck trauma)
  • Repetitive injuries
  • Infections (e.g, candida, yeast infection)
  • Certain diseases (i.e., lupus, rheumatoid arthritis, chronic fatigue syndrome)
  • Neuroendocrine disorders
  • Genetic predisposition

In addition, most researchers believe that fibromyalgia results from a combination of many physical and emotional stressors rather than a single event.

Treatment

A comprehensive, integrative approach to treatment is needed to reduce the symptoms associated with fibromyalgia. This may include conventional medical interventions as well as lifestyle changes and alternative therapies.

Alternative Therapies: Complementary therapies can help to reduce symptoms. Acupuncture , warm water therapy,  physical therapy, therapeutic massage, yoga, breathing techniques, cognitive therapy, biofeedback, herbs, nutritional supplements, and osteopathic or chiropractic manipulation represent some of methods used to relieve symptoms and improve functionality.

Lifestyle Changes: The alteration of everyday routines has been shown to result in recognizable improvement in function and quality of life for individuals suffering from fibromyalgia. These include eating healthier (avoid sugars and alcohol, and reduce red meats and refined food), drinking more water, becoming more physically active and finding ways to manage stress.

Physical activity, for example, has been associated with several benefits. In addition to reducing fibromyalgia symptoms, exercise has been shown to:

  • increase and balance levels of essential hormones and neurotransmitters;
  • reduce body fat tissue;
  • increase work capacity and minimize fatigue;
  • improve brain and cognitive function;
  • improve self-esteem and self-efficacy;
  • reduce the likelihood for disease and other chronic medical disorders.

Medication: Three medications are currently approved by the Food and Drug Administration (FDA) to treat fibromyalgia.

  • Lyrica (pregabalin)
  • Cymbalta (duloxetine)
  • Savella (milnacipran)

Healthcare professionals may also recommend non-narcotic pain relievers (e.g.ibuprofen, aspirin) or low doses of antidepressants (e.g. tricyclic antidepressants, serotonin selective reuptake inhibitors) or benzodiazepines (e.g. alprazolam, diazepam) to treat fibromyalgia symptoms.

Prognosis

 While there is currently no cure for fibromyalgia, clinical studies have demonstrated that symptoms can be significantly reduced through a comprehensive, integrated treatment approach. In addition to working in conjunction with knowledgeable healthcare professionals and making necessary lifestyle changes, education, motivation and a support system are key components to the successful management of the disorder.

Article References:

Clauw, D. J. (1989-2003). The taxonomy of chronic pain: moving toward more mechanistic classification. 9-16.

Mcbeth, J. (1989-2003). The epidemiology of chronic widespread pain and fibromyalgia. 17-28.

Wallace, D.J. (1999) The history of fibromyalgia. 1-8.