- What is fibromyalgia syndrome?
- Are women more likely to get fibromyalgia than men?
- What are fibromyalgia symptoms?
- What tests are used to diagnose fibromyalgia?
- What is the standard treatment for fibromyalgia?
- What medications are used to treat fibromyalgia?
- Are there alternative treatments for fibromyalgia?
Fibromyalgia is the most common musculoskeletal condition after osteoarthritis. Still, it is often misdiagnosed and misunderstood. Its characteristics include widespread muscle and joint pain and fatigue as well as other symptoms. Fibromyalgia can lead to depression and social isolation.
This overview of fibromyalgia syndrome (FMS) covers symptoms, diagnosis and treatment, and the impact fibromyalgia has on lives. The impact comes from the tremendous physical and psychological strains that come with FMS. Those strains can lead to loss of work hours, reduced income, and even job loss.
What Is Fibromyalgia Syndrome?
A syndrome is a set of symptoms. When they exist together, they imply the presence of a specific disease or a greater chance of developing the disease. With fibromyalgia syndrome, the following symptoms commonly occur together:
- anxiety or depression
- decreased pain threshold or tender points
- incapacitating fatigue
- widespread pain
Are Women More Likely to Get Fibromyalgia Than Men?
More than 12 million Americans have fibromyalgia. Most of them are women ranging in age from 25 to 60. Women are 10 times more likely to get this disease than men.
What Are Fibromyalgia Symptoms?
Fibromyalgia causes you to ache all over. You may have symptoms of crippling fatigue -- even on arising. Specific tender points on the body may be painful to touch. You may experience swelling, disturbances in deep-level or restful sleep, and mood disturbances or depression.
Your muscles may feel like they have been overworked or pulled. They'll feel that way even without exercise or another cause. Sometimes, your muscles twitch, burn, or have deep stabbing pain.
Some patients with fibromyalgia have pain and achiness around the joints in the neck, shoulder, back, and hips. This makes it difficult for them to sleep or exercise. Other fibromyalgia symptoms include:
- abdominal pain
- anxiety and depression
- chronic headaches
- difficulty maintaining sleep or light sleep
- dryness in mouth, nose, and eyes
- fatigue upon arising
- hypersensitivity to cold and/or heat
- inability to concentrate (called "fibro fog")
- irritable bowel syndrome
- numbness or tingling in the fingers and feet
Fibromyalgia can cause signs and feelings similar to osteoarthritis, bursitis, and tendinitis. Some experts include it in this group of arthritis and related disorders. However, while the pain of bursitis or tendinitis is localized to a specific area, pain and stiffness with fibromyalgia are widespread.
What Tests Are Used to Diagnose Fibromyalgia?
There are no specific laboratory tests to diagnose fibromyalgia. To make an accurate diagnosis, your doctor will rely on a comprehensive physical exam and your medical history. Fibromyalgia is mostly a diagnosis of exclusion. That means the doctor will rule out other conditions that could cause similar symptoms.
To rule out more serious illnesses, your doctor may run some specific blood tests. For example, your doctor may ask for a complete blood count (CBC). The doctor may also ask for tests for chemicals, such as glucose, that can create problems similar to problems caused by fibromyalgia. A thyroid test may also be done. An underactive thyroid (hypothyroidism) can cause problems similar to fibromyalgia. That includes fatigue, muscle aches, weakness, and depression.
Other laboratory tests used to rule out serious illnesses may include Lyme titers, antinuclear antibodies (ANA), rheumatoid factor (RF), erythrocyte (red blood cell) sedimentation rate (ESR), prolactin level, calcium level, and vitamin D level.
Your doctor may see if your symptoms satisfy the diagnostic criteria for fibromyalgia syndrome outlined by the American College of Rheumatology. These criteria include widespread pain that persists for at least three months. Widespread pain refers to pain that occurs in both the right and left sides of the body, both above and below the waist, and in the chest, neck, and mid or lower back. The criteria also include the presence of tender points at various spots on the body.
The doctor will evaluate the severity of related symptoms such as fatigue, sleep disturbances, and mood disorders. This will help measure the impact FMS has on your physical and emotional function as well as on your overall health-related quality of life.
What Is the Standard Treatment for Fibromyalgia?
There is no fibromyalgia cure. And there is no treatment that will address all of the fibromyalgia symptoms. Instead, a wide array of traditional and alternative treatments has been shown to be effective in treating this difficult syndrome. A treatment program may include a combination of medications, exercises -- both strengthening and aerobic conditioning -- and behavioral techniques.
What Drugs Are Used to Treat Fibromyalgia?
According to the American College of Rheumatology, drug therapy for fibromyalgia primarily treats the symptoms. The FDA has approved three drugs to treat fibromyalgia: Lyrica, Cymbalta, and Savella. The FDA says Lyrica -- which is also used to treat nerve pain caused by shingles, diabetes, and spinal cord injuries -- can ease fibromyalgia pain for some patients. Cymbalta and Savella are in a class of drugs known as serotonin and norepinephrine reuptake inhibitors (SNRIs).
Low doses of tricyclic drugs such as Flexeril and amitriptyline have been found effective in treating the pain of FMS. In addition, positive results have been shown with the antidepressants known as dual reuptake inhibitors (Effexor). Ultram is a pain-relieving medicine that can be helpful.
Your doctor may prescribe an antidepressant such as Prozac, Paxil, or Zoloft. These drugs may help relieve feelings of depression, sleep disorders, and pain. Recently, researchers have found that the antiepileptic Neurontin is promising for fibromyalgia treatment.
The nonsteroidal anti-inflammatory drugs (NSAIDs), including Cox-2 inhibitors, have not been found to be effective for treating FMS pain. It's usually best to avoid opioid pain medications because they tend not to work well in the long-run and can lead to problems with dependency.
Are There Alternative Treatments for Fibromyalgia?
Alternative therapies, although they are not well-tested, can help manage the symptoms of fibromyalgia. For instance, therapeutic massage manipulates the muscles and soft tissues of the body and helps ease deep muscle pain. It also helps relieve pain of tender points, muscles spasms, and tense muscles. Similarly, myofascial release therapy, which works on a broader range of muscles, can gently stretch, soften, lengthen, and realign the connective tissue to ease discomfort.
The American Pain Society recommends moderately intense aerobic exercise at least two or three times a week. They also endorse clinician-assisted treatments, such as hypnosis, acupuncture, therapeutic massage, and chiropractic manipulation for pain relief.
Along with alternative therapies, it's important to allow time each day to rest and relax. Relaxation therapies -- such as deep muscle relaxation or deep breathing exercises -- may help reduce the added stress that can trigger fibromyalgia symptoms. Having a regularly scheduled bedtime is also important. Sleep is essential to let the body repair itself.
WebMD Medical Reference
Latest Chronic Pain News
American College of Rheumatology: "What Is Fibromyalgia?"
Arthritis Foundation: "Fibromyalgia: What Is It?"
American Fibromyalgia Syndrome Association: "What Is Fibromyalgia?"
National Institute of Arthritis and Musculoskeletal and Skin Diseases: "Fast Facts About Fibromyalgia."
McIlwain, H. and Bruce, D. The Fibromyalgia Handbook, Holt, 2007.
WebMD Health News: "FDA OKs Fibromyalgia Drug Savella."
Monthly Prescribing Reference: "Lyrica Approved for Neuropathic Pain Associated with Spinal Cord Injury."
Reviewed by David Zelman, MD on April 17, 2012
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