Ask the Doctor: Fibromyalgia

By Scott Fishman, MD

Question:
I feel achy all the time and my doctor just diagnosed me with fibromyalgia. I have looked this up on the internet and see a lot of confusing information, and it sounds like this may be a life sentence of pain and suffering. What is this and what can I do about it?

Answer:
Fibromyalgia is a mysterious disorder and it afflicts a lot of people. In addition, fibromyalgia is a perplexing disorder, as it does not have a clear cause or a clear type of person that it affects. It does predominantly occur in younger women, but is also seen in both men and women of all ages.

We do know that fibromyalgia is a disorder of the connective tissue, that is to say, a disorder of the fibers that connect the muscles in our body as well as the muscles themselves. Many patients with fibromyalgia have tenderness throughout their bodies. Thus, if I have a patient with fibromyalgia, and I press on their muscles, I will be able to find tender areas, if not trigger points, meaning tender areas that radiate pain away from the site that I am pushing on. Patients with true fibromyalgia have these kinds of points all over their bodies.

Other patients, who may have a disorder that is very similar to fibromyalgia, may have this type of tenderness, but with just tender points locally or in a specific region. We consider these problems under the heading of what is called "myofascial pain." Myofascial is simply another term that relates to the connective tissues and muscles. Patients also may have other problems that occur secondary to fibromyalgia, such as depression or anxiety, which we know can worsen the sensation of pain and perpetuate the cycle of aching muscles.

The treatment options for fibromyalgia patients include sometimes injecting either a local anesthetic or anti-inflammatory medicines, such as corticosteroids into the muscle. Sometimes, just needling the muscle itself, without injecting any medication (such as might be done with an acupuncture needle) can be of benefit to patients with myofascial pain or fibromyalgia. Other times, however, these injections are not of benefit and other treatment options need to be considered.

Physical therapy remains a mainstay of treatment for this disorder. Because these people typically have impaired physical disability, rigorous physical therapy conditioning programs are usually employed. Other therapies that have been known to be helpful include medications that help regulate sleep because patients with fibromyalgia often have problems sleeping, particularly a part of sleep that is called "delta sleep." For this reason, medications in the family of drugs called "tricylic antidepressants" are often used. These medicines are not used as antidepressants, as their names might suggest, but are typically used because they have pain relieving and sedating properties that help patients with pain and sleep.

Other medications include drugs that treat nerve-type pain, in order to calm down overactive nerves. These medications include Neurontin®, and other anticonvulsants. Anti-inflammatory drugs are also used with some success. Unfortunately, there is no one class of drugs that has been uniformly successful in patients with fibromyalgia.

Scott Fishman, MD, author of The War on Pain, has given permission to use this information, which originally appeared on Discovery Health.

Updated 7/19/2005