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What is Fibromyalgia?
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You hurt all over, and you frequently feel exhausted. Even after numerous tests, your doctor can't seem to find anything specifically wrong with you. If this sounds familiar, you may have fibromyalgia, a condition that affects an estimated 3 million to 6 million people in the United States. Approximately 80 percent to 90 percent of affected people are women.
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Fibromyalgia is a chronic condition characterized by fatigue, widespread pain in your muscles, ligaments and tendons, and multiple tender points — places on your body where slight pressure causes pain. Previously, the condition was known by other names such as fibrositis, chronic muscle pain syndrome, psychogenic rheumatism and tension myalgias.
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Although the intensity of your symptoms may vary, they'll probably never disappear completely. It may be reassuring to know, however, that fibromyalgia isn't progressive, crippling or life-threatening. Treatments and self-care steps can improve symptoms and your general health.
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Signs and symptoms
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Signs and symptoms of fibromyalgia can vary, depending on the weather, stress, physical activity or even just the time of day. Different people experience different signs and symptoms, but common signs and symptoms include:
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• Widespread pain. Fibromyalgia is characterized by pain in specific areas of your body when pressure is applied. These areas include the back of your head, upper back and neck, upper chest, elbows, hips and knees. The pain generally persists for months at a time and is often accompanied by stiffness.
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• Fatigue and sleep disturbances. People with fibromyalgia often wake up tired and unrefreshed even though they seem to get plenty of sleep. Some studies suggest that this sleep problem is the result of a sleep disorder called alpha wave interrupted sleep pattern, a condition in which deep sleep is frequently interrupted by bursts of brain activity similar to wakefulness. So people with fibromyalgia miss the deep restorative stage of sleep (stage 4). Nighttime muscle spasms in your legs (periodic limb movement disorder or nocturnal myoclonus) and restless legs syndrome also may be associated with fibromyalgia.
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• Irritable bowel syndrome (IBS). The constipation, diarrhea, abdominal pain and bloating associated with IBS are common in people with fibromyalgia.
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• Headaches and facial pain. Many people who have fibromyalgia also have headaches and facial pain that may be related to tenderness or stiffness in their neck and shoulders. Temporomandibular joint (TMJ) dysfunction, which affects the jaw joints and surrounding muscles, is also common in people with fibromyalgia.
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• Heightened sensitivity. It's common for people with fibromyalgia to report being sensitive to odors, noises, bright lights and touch.
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Other common signs and symptoms include:
• Depression
• Numbness or tingling sensations in the hands and feet (paresthesia)
• Difficulty concentrating
• Mood changes
• Chest pain
• Irritable bladder
• Dry eyes, skin and mouth
• Painful menstrual periods
• Dizziness
• Anxiety
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Causes
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The specific cause of fibromyalgia is unknown. However, doctors believe a number of factors may contribute. These factors may include:
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• Chemical changes in the brain. Some people with fibromyalgia appear to have alterations in the regulation of certain brain chemicals called neurotransmitters. This may be particularly true of serotonin — which is linked to depression, migraines and gastrointestinal distress — and substance P, a brain chemical associated with pain, stress and anxiety, as well as depression.
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• Sleep disturbances. Some researchers theorize that disturbed sleep patterns may be a cause rather than just a symptom of fibromyalgia.
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• Injury. An injury or trauma, particularly in the upper spinal region, may trigger the development of fibromyalgia in some people. An injury may affect your central nervous system, which may trigger fibromyalgia.
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• Infection. Some researchers believe that a viral or bacterial infection may trigger fibromyalgia.
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• Abnormalities of the autonomic (sympathetic) nervous system. Your autonomic nervous system is divided into the sympathetic and parasympathetic systems. Your sympathetic nervous system releases norepinephrine and influences the release of epinephrine from the adrenal gland. The sympathetic nervous system also controls bodily functions that you don't consciously control, such as heart rate, blood vessel contraction, sweating, salivary flow and intestinal movements.
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• Changes in muscle metabolism. For example, deconditioning and decreased blood flow may contribute to decreased strength and fatigue. Differences in metabolism and abnormalities in the hormonal substance that influences the activity of nerves (neuroendocrine) may play a role.
Psychological stress and hormonal changes also may be possible causes of fibromyalgia.
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When to seek medical advice
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See your doctor if you experience general aching or widespread pain that lasts several months and is accompanied by fatigue. Many of the symptoms of fibromyalgia mimic those of other diseases, such as low thyroid hormone production (hypothyroidism), polymyalgia rheumatica, neuropathies, lupus, multiple sclerosis and rheumatoid arthritis. Your doctor can help determine if one of these other conditions may be causing your symptoms.
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Treatment
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In general, treatment for fibromyalgia is with a combination of medication and self-care. The emphasis is on minimizing symptoms and improving general health.
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Medications
Medications can help reduce the pain of fibromyalgia and improve sleep. The ones most commonly recommended by doctors include:
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• Analgesics. Over-the-counter acetaminophen (Tylenol, others) may ease the pain and stiffness caused by fibromyalgia. However, its effectiveness varies with individuals. Tramadol (Ultram) is a prescription pain reliever that may be taken with or without acetaminophen. Your doctor may have you take nonsteroidal anti-inflammatory drugs (NSAIDs) — such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen sodium (Anaprox, Aleve) — in conjunction with other medications, but NSAIDs haven't proven to be effective in managing the pain in fibromyalgia when taken by themselves.
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• Antidepressants. Your doctor may prescribe antidepressant medications, such as amitriptyline, nortriptyline (Aventyl, Pamelor) or doxepin (Sinequan) to help promote sleep. Fluoxetine (Prozac) in combination with amitriptyline has also been found effective. Sertraline (Zoloft) and paroxetine (Paxil) also are effective if you're suffering from depression. These medications may be beneficial by affecting serotonin levels in the brain.
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• Muscle relaxants. Taking the medication cyclobenzaprine (Flexeril) at bedtime may help treat muscle pain and spasms.
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• Benzodiazepines. These drugs may help relax muscles and promote sleep. Usually, doctors avoid benzodiazepines in treating fibromyalgia because they haven't been shown to have long-term benefit and have the potential for drug dependence.
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Prescription sleeping pills, such as zolpidem (Ambien), may provide short-term benefits for some people with fibromyalgia, but doctors usually advise against long-term use of these drugs. These medications tend to work for only a short time, after which your body becomes resistant to their effects. Ultimately, using sleeping pills tends to create even more sleeping problems in many people.
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Doctors don't usually recommend narcotics for treating fibromyalgia because of the potential for dependence and addiction. Corticosteroids, such as prednisone, haven't been shown to be effective in treating fibromyalgia.
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Cognitive-behavioral therapy
Cognitive-behavioral therapy seeks to increase your belief in your own abilities and teaches you methods for dealing with stressful situations. Therapy can be provided via individual counseling, audiotapes or classes, and may help you manage your fibromyalgia.
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Treatment programs
Interdisciplinary treatment programs may be effective in improving your symptoms, including relieving pain. These programs can combine a variety of treatments, such as relaxation techniques, biofeedback and receiving information about chronic pain. There isn't one combination that works best for everybody. Your doctor can create a program based on what works best for you.
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