Fibromyalgia

What is Fibromyalgia?

Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple tender points. Fibromyalgia mainly affects muscles and their attachments to bones. Although it may feel like a joint disease, it is not a true form of arthritis and does not cause deformities or loss of function of the joints. Instead fibromyalgia is considered a form of soft tissue rheumatism.

As with many other rheumatic diseases, the cause of fibromyalgia is not known. Theories include sleep disturbances, psychological stress, immune or endocrine abnormalities, or biochemical abnormalities in the central nervous system. Others believe an infectious agent such as a virus in susceptible people may trigger the syndrome, but no such agent has been identified.

What are the symptoms?

Muscle pain and fatigue are the most common symptoms of fibromyalgia. The pain occurs in areas where the muscles attach to bone or ligaments and is similar to the pain of arthritis. Other symptoms vary from person to person and may include sleep disturbances, dizziness, tingling or numbness in the hands and feet, and gastrointestinal problems, including irritable bowel syndrome with gas and alternating diarrhea and constipation, and urinary frequency caused by bladder spasms. Women may have painful menstrual periods.

How is it diagnosed?

Fibromyalgia is difficult to diagnose because many of the symptoms mimic those of other disorders.
According to the American College of Rheumatology, intense pain when a finger is pressed to 11 of the following 18 pressure points may indicate a diagnosis of fibromyalgia. (Note each is bilateral making a total of 18)

1. On left or right side of the back of the neck, directly below the hairline
2. On left or right side of the front of the neck, above the collar bone (clavicle)
3. On left or right side of the chest, right below the collar bone
4. On left or right side of the upper back, near where the neck and shoulder join
5. On left or right side of the spine in the upper back between the shoulder blades (scapula)
6. On the inside of either arm, where it bends at the elbow
7. On left or right side of the lower back, right below the waist
8. On either side of the buttocks right under the hip bones
9. On either knee cap

How is it treated?

The treatment of fibromyalgia usually requires a combination of exercise, medication, and stress reduction.

Medications:
Antidepressants known as tricyclics are commonly prescribed for the treatment of fibromyalgia, primarily to reduce sleeplessness and muscle pain. Other anti-depressants may be used if there is depression accompanying the symptoms.

Muscle relaxers such as Flexeril may be used to relax muscle spasms in specific locations without affecting overall muscle function.

The corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) typically used in other types of arthritis are of little benefit for those with fibromyalgia. Acetaminophen is usually the pain reliever of choice.

Exercise:
Many studies have indicated that exercise is the one of the most effective treatments in managing fibromyalgia. A long-term exercise program should be developed and adhered to. Some people with fibromyalgia avoid exercise for fear it will exacerbate their pain. However, according to studies, any pain caused by exercising subsides within 30 minutes. Physical activity prevents muscle atrophy, increases a sense of well being, and, eventually, reduces fatigue and pain itself.

Stress reduction:
Some people with fibromyalgia seem to have a more stressful response to daily conflicts and encounters than those without the disorder. Some methods of stress reduction to consider include biofeedback, deep breathing, meditation and massage therapy.

What research is being done?

Recent studies show that abnormally low levels of the hormone cortisol may be associated with fibromyalgia. Researchers are studying regulation of the function of the adrenal gland in fibromyalgia.

Researchers are concentrating on how specific brain structures are involved in the painful symptoms of fibromyalgia. Other scientists are investigating the causes of a post-Lyme disease syndrome as a model for fibromyalgia. Some patients develop a fibromyalgia-like condition following Lyme disease, an infectious disorder associated with arthritis and other symptoms.

Some of the related information found on Arthritis Insight:

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For more information:

USA Fibromyalgia Association
Fibromyalgic Syndrome: by drdoc on-line
Fibroworld
MARRTC Fibromyalgia Syndrome (FMS) Resources