Fibromyalgia Facts (cont.)
Catherine Burt Driver, MD
Catherine Burt Driver, MD
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
How do physicians diagnose fibromyalgia?
Physicians diagnose fibromyalgia based on the patient's symptoms, primarily widespread pain. Chronic widespread pain in the muscles and joints, in combination with fatigue and poor sleep, lead to the consideration of fibromyalgia. A physician will perform a thorough history and physical exam to exclude other illnesses presenting with similar symptoms.
There is no widely accepted blood test or X-ray test for fibromyalgia at this time. Any testing is done to exclude another condition. Tests for inflammation are generally normal in isolated fibromyalgia.
Usually multiple soft-tissue areas ("fibromyalgia tender points") are tender to palpation. However, not all patients are tender at the tender points. In general, females are more likely to be tender at the classic fibromyalgia tender points than males.
The American College of Rheumatology developed new guidelines to help diagnose patients with fibromyalgia. The new guidelines no longer require a certain number of tender points to be present to be confident that a patient has fibromyalgia. The new guidelines use pain and other symptoms of fibromyalgia to aid diagnosis. Patient questionnaires to assist in the diagnosis of fibromyalgia can be found online.
What is the treatment for fibromyalgia?
There are both medication and non-medication treatments for fibromyalgia. Medication treatments frequently help manage the pain and sleeplessness from which fibromyalgia patients suffer. However, the non-medication treatments are really the basis of treatment for fibromyalgia. The non-medication treatments for fibromyalgia include education, exercise, and stress reduction. Sleep disorders may require both medication and non-medication treatments.
Education about fibromyalgia is very important. Often patients have suffered with symptoms for years, and simply knowing why they have pain can be a relief, as many patients become anxious not knowing what is causing their symptoms. Patients should also be educated about treatment approaches, good sleep hygiene, and the importance of treating conditions that may contribute to their symptoms. For example, when a patient with rheumatoid arthritis has fibromyalgia as well, poor control of their rheumatoid arthritis may lead to worsening of fibromyalgia pain and sleeplessness.
An exercise program is crucial in the treatment of fibromyalgia and should include stretching, strengthening, and aerobic exercise. Many patients with fibromyalgia find it difficult to institute a regular exercise program because they feel they are too tired to exercise and they may perceive that their pain and fatigue worsen when they begin to exercise. However, numerous scientific studies have shown that exercise for fibromyalgia, especially aerobic exercise, can improve pain, physical function, and a sense of well-being. Starting slow and sticking with the exercise program is very important. Low-impact aerobic activities such as swimming, water aerobics, walking, and biking are activities that patients with fibromyalgia find helpful. Many patients find it helpful to exercise in the morning. Some patients find yoga helpful for strengthening and stretching. This should also be accompanied by an aerobic exercise program.
Stress reduction is important in managing the symptoms of fibromyalgia. Many patients feel that their symptoms are triggered by stress. Stress reduction can be challenging. There are many stressors in life; some can be changed and others cannot. Stress reduction involves a combination of changing stressors that can be changed and learning to lessen the body's stress reaction to the stressors that cannot be changed.
Cognitive behavioral therapy is a form of psychological therapy whereby a therapist and patient work together, to establish healthy patterns of behavior by replacing negative thoughts with more productive thoughts and actions. This has been proven to work in fibromyalgia. This form of therapy can be done one on one in an office setting, or even over the Internet.
The non-medication therapies are the cornerstone of treatment for fibromyalgia. With them, many patients improve and may not require medications. Moreover, without focusing on sleep hygiene, stress reduction and exercise , it is difficult to improve, even with medication.
When used with non-medication therapies, medication treatments can help improve sleep, pain, and function in fibromyalgia. Medications are most effective for pain relief when combined with ongoing non-medication treatments as discussed above. Medications often used in the treatment of fibromyalgia include medications in the antidepressant class (medications originally developed to treat anxiety and depression) and anticonvulsants (medications originally developed to treat seizures).
A few notes on other treatments for fibromyalgia: Acupuncture can be helpful for some patients with fibromyalgia but is not usually recommended as one of the first-line treatments for fibromyalgia because the scientific studies on acupuncture for fibromyalgia patients have not shown definite benefit. Likewise, trigger point injections can be helpful for some patients. Alternative medicines have not been proven to be helpful in fibromyalgia; in particular, scientific studies on guaifenesin (Mucinex) show that it does not work. Of note, patients with vitamin D deficiency can have widespread arthralgia and myalgia, like fibromyalgia, which improves with vitamin D supplementation. While having a sufficient level of vitamin D is important to maintain bone health, a healthy immune system, and perhaps prevent certain types of cancer, vitamin D supplementation does not improve fibromyalgia symptoms in patients who have sufficient levels of vitamin D. Narcotic pain medications should be avoided in fibromyalgia because they may worsen the underlying problem.
Medically Reviewed by a Doctor on 3/10/2015
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