Fibromyalgia

Learn About Fibromyalgia

Fibromyalgia is a disorder characterized by widespread pain, diffuse tenderness, and a number of other symptoms. The word “fibromyalgia” comes from the terms for fibrous tissue (fibro), muscle (myo), and pain (algia). Although fibromyalgia causes pain, it does not cause inflammation of, or damage to, fibrous tissue (such a joints are made of) or muscle. Nonetheless, fibromyalgia causes significant pain in muscles and joints, as well as fatigue, and a wide variety of other symptoms such as:

  • Memory and thinking problems (sometimes referred to as “fibro fog”)
  • Insomnia
  • Stiffness and achiness upon arising each morning
  • Headaches
  • Bowel irritability with diarrhea and constipation
  • Prolonged and painful menstrual periods
  • Numbness or tingling of the hands and feet
  • Restlessness of the legs, especially in the evening and at bedtime
  • Over-sensitivity to heat or cold, or loud noise or bright light.

Fibromyalgia is not rare, affecting about 5 million Americans aged 18 or older. Of these, between 80 and 90 percent are women; however, men and children also can be affected. Most people are diagnosed during middle age, although the symptoms often become present in some form earlier in life, especially at or around puberty. The illness can run in families, especially in the female lineage.

While the causes of fibromyalgia are unknown, the problem is not in the tissues where the pain is experienced; rather, the issue is how pain is processed by the brain and spinal cord. Particularly, stimuli not normally considered painful are perceived as such. For this reason, current research is focused on medications that have their effects on targets in the central nervous system.

People with fibromyalgia typically see many doctors before receiving the diagnosis. One reason is that pain and fatigue, the main symptoms of fibromyalgia, overlap with those of many other conditions. Therefore, doctors have to investigate other potential causes of these symptoms before making a diagnosis of fibromyalgia. Further, standard laboratory tests fail to reveal a reason for the pain. However, a diagnosis can be made based on criteria established by the American College of Rheumatology (ACR): a history of widespread pain lasting more than 3 months, and other general physical symptoms including fatigue, waking unrefreshed, and memory or thought problems.

Pain is considered widespread when it affects all four quadrants of the body, meaning it must be felt on both the left and right sides of the body as well as above and below the waist. The ACR has also designated 18 sites on the body as tender points; tenderness upon pressure applied to these points is part of the diagnostic process. Typically, at least eleven of the 18 points must be tender for the diagnosis to be given.

Fibromyalgia can be difficult to treat. Only three medications, duloxetine (Cymbalta), milnacipran (Savella), and pregabalin (Lyrica) are approved by the U.S. Food and Drug Administration (FDA) for the treatment of fibromyalgia. Over-the-counter medications used include acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDS). Some potentially useful non-medication therapies include massage, movement therapies (such as Pilates), chiropractic treatments, acupuncture, and various herbs and dietary supplements. Although some of these supplements are being studied for fibromyalgia, there is little, if any, scientific proof yet that they help.

Sleep and fibromyalgia symptom severity are linked, to the extent that improving sleep improves fibromyalgia. Treating sleep disorders that co-occur with fibromyalgia in a given patient is a prudent first step. Medications that improve sleep continuity may be particularly helpful. One medication that modifies sleep in a specific way, sodium oxybate (Xyrem), has been studied for fibromyalgia, however it is not FDA approved for that purpose. Researchers are studying whether non-medication (behavioral) therapy for insomnia might improve fibromyalgia symptoms.



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