Fibromyalgia: An Overview

Fibromalygia (FM) is a complex chronic disorder characterized by widespread pain in the muscles, joints and tendons and other sensory problems. Afflicting approximately 10 million Americans FM most commonly occurs in adult women but strikes significant amounts of men and every age group.

Still poorly diagnosed, particularly among men, the general criteria for diagnosing FM were created by the American College of Rheumatology in 1990. Rates of disability are high with annual productivity costs to the U.S. economy estimated at 12-14 billion dollars.

Signs and Symptoms

   ◊ Widespread pain - particularly in the upper body often accompanied by stiffness.

   ◊ Fatigue – better described as physical and/or mental exhaustion.

   ◊ Unrefreshing Sleep – while FM patients often get sufficient amounts of sleep their sleep is often described as unrefreshing and they often wake up tired.

   ◊ Irritable bowel syndrome (IBS) - FM patients often experience constipation, diarrhea, abdominal pain and bloating.

   ◊ Headaches and facial pain - may be related to the upper body stiffness and tenderness characteristic of FM. Temporomandibular joint (TMJ) is common in FM.

   ◊ Heightened sensitivity – FM patients often experience increased sensitivities to odors, noises, bright lights and touch.

   ◊ Other symptoms include depression, concentration problems, dry eyes, chest pain and dizziness.

Risk Factors: Women of early adulthood and middle age with a family history of a chronic pain disorder are at the highest risk for FM. Many events (infection, trauma, physical/emotional stress) have been reported to trigger FM.

Diagnosis: Because a lab test for FM is not available diagnosing FM is done using symptoms and exclusionary factors. Guidelines developed by the American College of Rheumatology (ACR) are most often used to diagnose FM.

The ACR guidelines specify a FM patient must have had widespread aching pain for at least three months and register unusual tenderness under pressure at 11 of 18 points around the body. Some physicians believe these criteria are arbitrary and will diagnose FM if not all tender points are found.

Because many of FM’s symptoms mimic those of other disorders such as low thyroid activity (hypothyroidism), polymyalgia rheumatica, neuropathies, lupus, multiple sclerosis and rheumatoid arthritis, these disorders need to be excluded before a FM diagnosis is made.

Prognosis: There are no cures for FM but with proper management its symptoms can be significantly ameliorated and most FM patients improve over time.

Treatment: A wide variety of treatment options are available including pharmaceutical drugs, alternative treatments, coping strategies and exercise. Treatment requires tackling the many different aspects of FM in a comprehensive program under the guidance of a knowledgeable physician.

   ◊ Analgesics - Acetaminophen (Tylenol, etc.), ibuprofen (Advil, etc.) or prescription drugs such as Ultram may, in conjunction with other medications be helpful in a minority of FM patients.

   ◊ Antidepressants - Amitriptyline, nortriptyline (Pamelor) or doxepin (Sinequan) can help with sleep. Sertraline (Zoloft) or paroxetine (Paxil)) may help battle depression. Serotonin and norepinephrine reuptake inibitors such as duloxetine (Cymbalta, gabapentin, may be helpful in controlling pain.

   ◊ Anticonvulsants - Pregabalin (Lyrica) has decreased pain and fatigue and improved sleep in people with fibromyalgia in trials.

   ◊ Alternative Treatments - Massage, stretching, exercise, myofascial release, hydroptherapy, yoga, breathing techniques,acupuncture, etc., have been reported to improve symptoms in some FM patients.

   ◊ Behavioral therapies - relaxation techniques, bio-feedback, etc – can improve symptoms and increase quality of life.

   ◊ Coping Mechanisms/Lifestyle Changes - Reducing stress, getting sufficient sleep and exercise, pacing yourself and having a good diet all play an important role in managing FM symptoms.

Finding a Good Physician: FM is a multi-dimensional disease that requires the services of a knowledgeable physician for proper management. Unfortunately FM is still greatly misunderstood in the medical community. National or local FM support groups can help you find an appropriate doctor.

The Future: The future of FM research and treatment is bright. FM, long a controversial disease, appears to be finally getting ‘over the hump’ with regards to the research community. Significant progress understanding FM in the past ten years has lead to increased research funding, and pharmaceutical companies are for the first time vigorously pursuing drug options for FM patients. The promise of gene mutation studies recently prompted Dr. Clauw to state that:

“There probably will be 20 or so genes that end up predicting ….where someone is on this continuum of pain processing….Where I think it’s going to be incredibly useful in 5-10 years is to figure out what drugs to give people”