Fibromyalgia is a disorder characterized by chronic muscle and joint pain, extreme fatigue, and tenderness in certain areas of the body. Other symptoms include headaches; concentration problems; increased sensitivity to touch, noise, and light; and sleep difficulties. The condition is difficult to diagnose and treat because it has no known cause and no specific tests for it exist.
People with fibromyalgia often suffer for years without an accurate diagnosis. Because the symptoms are nonspecific, they are often attributed to other common conditions. The disorder cannot be distinguished by laboratory or x-ray findings. Patients' pain and fatigue are frequently dismissed as psychological because no physical cause can be found.
Fibromyalgia is considered to be a form of arthritis because it causes chronic pain in the joints. It does not resemble other types of arthritis, however, in that it causes no inflammation or other physical changes in the joints and surrounding tissue.
Treatment includes medications for pain, muscle relaxation, and sleep, along with exercises to stretch aching muscles and increase strength. Currently, two drugs are approved for treatment of the symptoms of fibromyalgia. One is pregabalin (Lyrica), a seizure medication that also relieves pain caused by damaged nerve endings in diabetes and shingles; the other is duloxetine (Cymbalta), an antidepressant and antianxiety medication that also is used to relieve diabetic nerve pain. Many patients with fibromyalgia experience an improvement in symptoms with one of these medications, although they do not work in everyone.
Symptoms Are So General That the Condition Is Often Misdiagnosed
Fibromyalgia probably affects from 2% to 4% of the U.S. population, primarily women in their 30s through 50s. Men, children, and the elderly also develop the disorder, although far less commonly. People with autoimmune diseases such as lupus or rheumatoid arthritis are more likely to develop symptoms of fibromyalgia.
Possible Causes: It is largely unknown why fibromyalgia develops or what causes its symptoms. Symptoms often can be traced to an injury or trauma, an infection, or an emotionally stressful incident, any of which may have triggered the increased sensitivity to pain that is characteristic of fibromyalgia. Individuals who develop fibromyalgia may have a genetic condition that predisposes them to problems with sensation.
An excess of substance P, a chemical in the spinal fluid, may cause an abnormal response to pain in some people with fibromyalgia. Levels of serotonin, a brain chemical that helps control pain signals, is too low in some patients. Growth-hormone concentrations also may be lower, which may account for the muscle pain.
Symptoms: The pain of fibromyalgia is described as burning, throbbing, aching, or tenderness upon pressure. Common sites of pain are the shoulders, back, neck, and jaw, as well as the hip joints, arms, and legs. Many people experience overwhelming fatigue. Other common symptoms are morning stiffness, difficulty sleeping, restless legs syndrome, headaches, poor concentration, numbness or tingling in the extremities, irritable bowel syndrome, pelvic pain, painful menstrual periods, and depression.
Because fibromyalgia does not have unique symptoms, the condition is often misdiagnosed. The fatigue and muscle aches can mimic low thyroid levels or arthritis. Specific criteria have been identified that must be met for fibromyalgia to be diagnosed, including muscle and joint pain above and below the waist, on both sides of the body, for at least 3 months and pain at 11 of 18 "tender points." However, many physicians make the diagnosis of fibromyalgia through the patient's history, physical examination, and normal laboratory testing rather than these specific criteria.
Treatment: Fibromyalgia treatment is aimed at relieving symptoms. Treatment of pain includes exercise--which helps aching muscles become stronger and more flexible--and medications such as acetaminophen, nonsteroidal anti-inflammatory drugs, tramadol, and muscle relaxants. Sleep medications are not used for extended periods since they become less effective over time. Some antidepressants can help patients relieve both sleep problems and depression.
Two medications are specifically approved for the treatment of fibromyalgia symptoms: pregabalin, a seizure medication, and duloxetine, an antidepressant and antianxiety drug; both of these also relieve pain. Since both medications have the potential to cause serious side effects, they should be prescribed only when necessary and continued only if they provide relief.
Some people with fibromyalgia find that modalities such as massage therapy, chiropractic manipulations, and acupuncture relieve their pain and fatigue. Stress relief through such methods as biofeedback therapy or cognitive behavior therapy also can be an effective part of the overall treatment program for fibromyalgia.
Fibromyalgia does not get worse over time or cause serious complications or death, but it is a chronic and debilitating disorder. An accurate diagnosis and treatment consisting of medication, exercise, rest, and reduction of stress can mean a much more normal life for people with this condition.