Arthritis: Fibromyalgia

Fibromyalgia is a condition characterized by aching and pain in muscles, tendons, and joints all over the body, but especially along the spine. The body also is tender to touch in specific areas, called tender or trigger points. The primary symptom is pain, and stress can make fibromyalgia symptoms worse.

Fibromyalgia is not associated with muscle, nerve or joint injury; inadequate muscle repair; or any serious bodily damage or disease. Also, people who have fibromyalgia are not at greater risk for any other musculoskeletal disease.

What Causes Fibromyalgia?

Researchers have not been able to pinpoint one identifiable cause for fibromyalgia, but there are many theories. One theory suggests that stress contributes to the onset of fibromyalgia. Other possible causes are:

• Disordered sleep patterns, which can lead to fatigue and a lower pain tolerance.
• Abnormal production of pain-related chemicals in the nervous system.
• Low levels of growth hormone in the body.

What Are the Symptoms of Fibromyalgia?

Bodily pain is the primary symptom of fibromyalgia. Although the pain of fibromyalgia can be felt all over the body, there usually are certain areas of the body that are tender even to light touch. In addition, the pain is usually worse when a person is trying to relax and is less noticeable during busy activities or exercise.

Other symptoms often are associated with the pain, including:

• Sleep disturbance
• Depression
• Daytime tiredness
• Headaches
• Alternating diarrhea and constipation
• Numbness and tingling in the hands and feet
• Feelings of weakness
• Memory difficulties
• Dizziness

Stress often makes the symptoms of fibromyalgia worse.

Who Gets Fibromyalgia?

Women are affected by fibromyalgia seven times more commonly than men. People typically first develop symptoms in their 20s or 30s. In the U.S., about 5 million people, or 2% of the population, have fibromyalgia.

How Is Fibromyalgia Diagnosed?

The diagnosis of fibromyalgia is based on the results of a combination of tests and symptoms, including:

• Complete medical history and physical exam (to exclude other illnesses that may have similar symptoms such as rheumatoid arthritis, muscle inflammation, bursitis or tendonitis).
• Presence of widespread pain together with some of the other symptoms of fibromyalgia.
• Presence of very tender areas ("tender/trigger points") at specific locations. (People who have fibromyalgia experience abnormal sensitivity when light pressure is applied to at least 11 out of 18 specific areas on the body.)

How Is Fibromyalgia Treated?

People with fibromyalgia receive individual treatment based on several factors, including their overall health, medical history, number of tender points, severity of pain and presence of other symptoms. Treatment for fibromyalgia includes:

• Medications that decrease pain and improve sleep (see below)
• Lifestyle changes, including stress reduction
• Exercise to improve heart and lung health, flexibility, and strength
• Relaxation techniques to relieve muscle tension.

What Medications Are Used to Treat Fibromyalgia?

Medications that increase restful sleep may help. These include low doses of antidepressant medication taken before bedtime. Other kinds of sleeping pills are not very helpful for people who have fibromyalgia.

Nonsteroidal anti-inflammatory drugs (NSAIDs) -- including ibuprofen and naproxen -- may help decrease pain, but should be used long-term only under the care of a doctor. These drugs have many side effects, such as stomach upset and swelling from fluid retention. They also may interact unfavorably with other drugs, such as medications for high blood pressure. Tylenol (acetaminophen) may be helpful, and it is easier on the stomach and less likely to cause drug interactions than NSAIDs. However, acetaminophen should only be taken as recommended. Too much acetaminophen can lead to liver problems.

Muscle relaxants, such as Flexeril, may provide some relief of muscle pain when taken at bedtime.

Steroids (such as prednisone) used to treat inflammation associated with other rheumatic conditions have been tested in people with fibromyalgia and did not appear to improve symptoms. However, a steroid injection directly into a muscle spasm may sometimes be used when other treatments have failed.

What Exercises Should People With Fibromyalgia Consider?

Participating in aerobic exercise for 30 minutes at least four times each week is an important step to improve fibromyalgia symptoms. Exercise increases heart and lung function and stretches tight, sore muscles. Brisk walking, biking, swimming and water aerobics are good activities to choose when starting your exercise program. Your doctor can help you choose an exercise program that is right for you.

What Are Some Techniques I Can Use to Reduce Stress and Relax?

Evaluating the causes of stress and learning new ways to handle stress should help improve fibromyalgia. Relaxation exercises can help you cope with stress.

What Is the Long-Term Outlook for People With Fibromyalgia?

Although fibromyalgia is not caused by stress, stress can make symptoms much worse. Occasionally, if the situations that caused the initial stress are resolved, the condition may spontaneously improve and medications may not be necessary.

Many people with fibromyalgia will continue to have symptoms despite treatment, especially when life is stressful. However, medications that can alter the balance of pain-producing chemicals, such as anti-depressant drugs, should improve symptoms.

When other forms of treatment, such as acetaminophen (Tylenol) and aerobic exercise, are combined to treat fibromyalgia, even more improvement can be expected.

Those who are able to continue working and fulfilling their social obligations, despite their pain, end up doing best.

Reviewed by the doctors at The Cleveland Clinic Department of Rheumatic and Immunologic Diseases.

Edited by Tracy Shuman, MD

WebMD Medical Reference provided in collaboration with the Cleveland Clinic

SOURCE: National Fibromyalgia Foundation. The Arthritis Foundation.

Edited by Marc C. Levesque, PhD, MD on February 01, 2007

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