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Health Encyclopedia - Diseases and Conditions

Fibromyalgia

Definition of Fibromyalgia
Description of Fibromyalgia
Causes and Risk Factors of Fibromyalgia
Symptoms of Fibromyalgia
Diagnosis of Fibromyalgia
Treatment of Fibromyalgia
What Questions To Ask Your Doctor About Fibromyalgia

Definition of Fibromyalgia

Article updated and reviewed by Ariel D. Teitel, MD, MBA, Chief, Division of Rheumatology, St. Vincent’s Hospital, Manhattan on May 16, 2005.

Fibromyalgia, (also known as fibrositis, fibromyositis, and muscular rheumatism), is a chronic syndrome that causes pain and stiffness throughout the tissues that support and move the bones and joints. Muscle pain, tender points, and fatigue are the predominant symptoms associated with fibromyalgia.

Fibromyalgia may occur alone or in conjunction with rheumatic disorders such as arthritis, osteoarthritis, or lupus.

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Description of Fibromyalgia

Fibromyalgia is very common, affecting up to 5 percent of the U.S. population. Although anyone can get fibromyalgia, eight times as many women develop it relative to men.

Most cases occur among women between the ages of 20 to 65. It shares many features with the chronic fatigue syndrome.

People with fibromyalgia are found to have multiple tender points in specific muscle areas. Most individuals complain of aching and stiffness in areas around the neck, shoulders, upper back, lower back and hip areas.

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Causes and Risk Factors of Fibromyalgia

Fibromyalgia can be a complication of hypothyroidism, rheumatoid arthritis, or in men, sleep apnea.

Although the exact causes of fibromyalgia are not known, there are a number of theories as to the cause of this syndrome. The theories include:

The cerebral spinal fluid in those afflicted with fibromyalgia had more substance P (a neuropeptide that carries pain signals).
• There is a diminished blood flow to the two areas of the brain that help regulate the amount of pain signals the brain receives.
The syndrome is psychosomatically based. Psychological factors such as anxiety, depression, disappointment, or failure to achieve goals somatize (express themselves) as physical symptoms such as backache or sore muscles.
Fibromyalgia is caused by sleep disturbances. Tests of people with fibromyalgia often show a sleep disorder in which the deepest or most restful stage of sleep (stage IV) is disturbed or interrupted. This disruption in sleep may be responsible for the shortage of the growth hormone called somatomedin-C which is produced in deep sleep. This hormone is responsible for muscle repair and maintenance.
There is a deficit in the levels of tryptophan. Tryptophan is a neurotransmitter that plays an important role in inhibiting pain and inducing deep sleep.

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Symptoms of Fibromyalgia

The major symptoms of fibromyalgia are:

Widespread muscular and joint pain for over three months (such as aching, stiffness, and tenderness around joints, muscles, tendons, and ligaments). Pain may appear in one or more locations at the same time and also in many different parts of the body. The pain is bilateral in that it appears above and below the waist. The pain is located within the muscles themselves, as well as the points where ligaments attach muscles to bones.
Extreme tenderness in specific "tender points."
Poor-sleep patients report non-refreshing sleep.
Fatigue: Some people experience fatigue as a lack of muscle endurance, while others describe the fatigue as an overall sense of lack of energy. Much of the fatigue is thought to result from lack of sleep.

Tender points or trigger points are localized tender areas of the body that can bring on widespread pain and muscle spasm when touched. There are at least 18 tender points on the body to which people with fibromyalgia seem to be more susceptible. They are:

At the base of the skull at both neck muscles;
Midway between the neck and shoulder (both sides);
Muscle over upper inner shoulder blade (both sides);
Two centimeters below side bone at elbow (both sides);
Upper outer buttock (both sides);
Hip bone (both hips);
Just above knee on inside (both knees);
Lower neck in front (both sides); and
Edge of upper breast bone (both sides).

These symptoms may be aggravated by stress, anxiety, depression, hormonal changes, cold environments as well as the change in weather.

Up to 70% of patients have coexistent chronic fatigue syndrome, 50% have multiple chemical sensitivities, and 75% have a psychiatric diagnosis.

Other symptoms that may accompany fibromyalgia are Raynaud's phenomenon (poor circulation to the hands or toes), tension headaches, migraine headaches, dizziness, tingling and numbness, an irritable bowel, muscle tremors, bladder spasms, and blurred vision.

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Diagnosis of Fibromyalgia

There are no blood or x-ray tests to help doctors diagnose fibromyalgia. Therefore, the diagnosis is made purely on clinical findings and the medical history.

The doctor also will rule out the existence of other diseases that mimic the symptoms of fibromyalgia. In chronic fatigue syndrome, fatigue is the predominant symptom, as opposed to pain. Other diseases to consider are hypothyroidism, inflammatory disorders such as rheumatoid arthritis, and autoimmune diseases such as myositis or polymyalgia rheumatica.

Prognosis of Fibromyalgia

The disease may be long-lasting, but it is not progressive. There is no long-term organ damage.

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Treatment of Fibromyalgia

There is presently no cure for fibromyalgia, but the symptoms of this syndrome can be controlled by education, exercise, medication, sleep, and stress reduction.

Education. Education begins with reassurance that the pain is valid; however the condition is not crippling, does not weaken joints or muscles, is not life-threatening and need not hinder the ability to work. Professionals try to reinforce that fibromyalgia is not a disease but a constellation of symptoms that add up to "pain," for which sufferers need a large amount of support.

Exercise. The emphasis is often on muscle conditioning and programs to improve aerobic fitness (such as swimming, cycling, walking and stationary cross-country ski machines) as well as physical therapy. Patients should be told that exercise is safe and effective. After an initial training period, the exercise regimen chosen should be done daily for 30 to 40 minutes.

Medication. To reduce fatigue, relieve muscle pain and spasm, and promote sleep the doctor may prescribe medication. Medications may include tricyclic antidepressants such as amitriptyline (Elavil) or Nortriptyline (Pamelor), selective serotonin reuptake inhibitors (SSRI’s) such as fluoxetine (Prozac), or muscle relaxants such as Cyclobenzaprine (Flexeril). NSAIDS (non-steroidal anti-inflammatory drugs) are generally not useful. Newer medications which decrease pain sensitivity in the brain include Neurontin (gabapentin) or Ultram (tramadol); these may be helpful for pain control. Opioids are usually not advisable given the potential for creating dependency and addiction. Steroids are ineffective. For severe pain in the tender points, the doctor may give an injection of a local anesthetic to help with the pain.

Sleep. Patients with fibromyalgia need adequate sleep every night.

Stress reduction. Since stress and tension can contribute to the symptoms, relaxation techniques such as muscle relaxation, yoga and meditation can be very helpful. Acupuncture may be beneficial. Stress reduction might also include biofeedback, stress modification exercises, relaxation tapes, and psychological counseling.

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