Fibromyalgia: Your Most Important Questions Answered

Fibromyalgia is a common and chronic disorder characterized by widespread pain, diffuse tenderness and many other symptoms. So what do sufferers really need to know? Find out now…

Although fibromyalgia is often considered an arthritis-related condition, it’s not truly a form of arthritis (a disease of the joints) because it doesn’t cause inflammation or damage to the joints, muscles or other tissues.

But like arthritis, fibromyalgia can cause significant pain and fatigue that can interfere with a person’s daily activities. Also like arthritis, fibromyalgia is considered rheumatic, a medical condition that impairs the joints and/or soft tissues and causes chronic pain.

People with fibromyalgia may experience a variety of other symptoms, including:

Cognitive and memory problems (sometimes referred to as “fibro fog”)

Sleep disturbances

Morning stiffness

Headaches

Irritable bowel syndrome

Painful menstrual periods

Numbness or tingling of the extremities

Restless legs syndrome

Temperature sensitivity

Sensitivity to loud noises or bright lights

Fibromyalgia isn’t a disease, but a syndrome: a collection of signs, symptoms and medical problems that tend to occur together but are not related to a specific, identifiable cause. A disease, on the other hand, has a specific cause or causes and recognizable signs and symptoms.
Who Gets Fibromyalgia?
Scientists estimate that fibromyalgia affects 5 million Americans age 18 or older. For unknown reasons, between 80% and 90% are women; however, men and children also can be affected. Most people are diagnosed during middle age, although the symptoms often become present earlier in life.

People with certain rheumatic diseases - such as rheumatoid arthritis, systemic lupus erythematosus (commonly called lupus) or ankylosing spondylitis (spinal arthritis) - may be more likely to have fibromyalgia too.

Several studies indicate that women with a family member with fibromyalgia are more likely to have the condition themselves, but the reason for this – whether it be heredity, shared environmental factors or both – is unknown. One current study supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is trying to determine whether variations in certain genes cause some people to be more sensitive to stimuli, which leads to pain syndromes.

What Causes Fibromyalgia?
The causes of fibromyalgia are unknown, but there are probably several factors involved. Many people associate the development of fibromyalgia with a physically or emotionally stressful or traumatic event, such as an automobile accident. Some connect it to repetitive injuries. Others link it to an illness. For others, fibromyalgia seems to occur spontaneously.

Many researchers are examining other causes, including problems with how the central nervous system (the brain and spinal cord) processes pain.

Some scientists speculate that a person’s genes may regulate the way his or her body processes painful stimuli. According to this theory, people with fibromyalgia may have a gene or genes that cause them to react strongly to stimuli that most people would not perceive as painful. There have already been several genes identified that occur more commonly in fibromyalgia patients, and NIAMS-supported researchers are currently looking at other possibilities.

How Is Fibromyalgia Diagnosed?
Research shows that people with fibromyalgia typically see many doctors before receiving the diagnosis. One reason for this may be that pain and fatigue, the main symptoms of fibromyalgia, overlap with those of many other conditions. Therefore, doctors often have to rule out other potential causes of these symptoms before making a fibromyalgia diagnosis.

Also, there are currently no diagnostic laboratory tests for fibromyalgia; standard laboratory tests fail to reveal a physiologic reason for pain. Because there is no generally accepted, objective test for fibromyalgia, some doctors unfortunately may conclude a patient’s pain is not real, or they may say there’s little they can do.
A doctor familiar with fibromyalgia, however, can make a diagnosis based on criteria established by the American College of Rheumatology (ACR): a history of widespread pain lasting more than 3 months, and the presence of diffuse tenderness.

Pain is considered to be widespread when it affects all four quadrants of the body, meaning it must be felt on both the left and right sides as well as above and below the waist. ACR also has designated 18 sites on the body as possible tender points. To meet the strict criteria for a fibromyalgia diagnosis, a person must have 11 or more tender points, but often patients with fibromyalgia will not always be this tender, especially men. People who have fibromyalgia certainly may feel pain at other sites too, but those 18 standard possible sites on the body are the criteria used for classification.

How Is Fibromyalgia Treated?
Fibromyalgia can be difficult to treat. Not all doctors are familiar with fibromyalgia and its treatment, so it is important to find a doctor who is. Many family physicians, general internists or rheumatologists (doctors who specialize in arthritis and other conditions that affect the joints or soft tissues) can treat fibromyalgia.

Fibromyalgia treatment often requires a team approach - with your doctor, a physical therapist, possibly other health professionals and, most importantly, yourself all playing an active role.

It can be hard to assemble this team, and you may struggle to find the right professionals to treat you. When you do, however, the combined expertise of these professionals can help you improve the quality of your life.

You may find several members of the treatment team at pain and rheumatology clinics that specialize in arthritis and other rheumatic diseases, including fibromyalgia.

Only three medications - duloxetine (Cymbalta), milnacipran (Savella) and pregabalin (Lyrica) - are approved by the U.S. Food and Drug Administration (FDA) for fibromyalgia treatment.

Cymbalta was originally developed for and is still used to treat depression. Savella is similar to a drug used to treat depression but is FDA-approved only for fibromyalgia. Lyrica is a medication developed to treat neuropathic pain (chronic pain caused by damage to the nervous system). These products are not endorsed by the National Institutes of Health or any other government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.
The following are some of the most commonly used categories of drugs for fibromyalgia:

Analgesics: Analgesics are painkillers. They range from over-the-counter acetaminophen (Tylenol) to prescription medicines, such as tramadol (Ultram), and even stronger narcotic preparations. For some people with fibromyalgia, narcotic medications are prescribed for severe muscle pain.

However, there is no solid evidence showing that narcotics actually work to treat the chronic pain of fibromyalgia, and most doctors hesitate to prescribe them for long-term use because of the potential of physical or psychological dependency.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): As their name implies, nonsteroidal anti-inflammatory drugs - including aspirin, ibuprofen (Advil, Motrin) and naproxen sodium (Anaprox, Aleve) - treat inflammation. Although inflammation is not a fibromyalgia symptom, NSAIDs also relieve pain. The drugs inhibit substances in the body called prostaglandins, which play a role in pain and inflammation. These medications, some of which are available without a prescription, may help ease the muscle aches of fibromyalgia. They may also relieve menstrual cramps and the headaches often associated with fibromyalgia.

Antidepressants: Perhaps the most useful medications for fibromyalgia are in the antidepressant class. These drugs work equally well in fibromyalgia patients with and without depression, because antidepressants elevate the levels of certain chemicals in the brain (including serotonin and norepinephrine) that are associated not only with depression but also with pain and fatigue. Increasing the levels of these chemicals can reduce pain in people with fibromyalgia. Doctors prescribe several types of antidepressants for fibromyalgia:

Tricyclic antidepressants: When taken at bedtime in dosages lower than those for depression, tricyclic antidepressants can help promote restorative sleep in people with fibromyalgia. They also can relax painful muscles and heighten the effects of the body’s natural pain-killing substances called endorphins. Tricyclic antidepressants have been around for almost half a century. Some examples of tricyclic medications used to treat fibromyalgia include amitriptyline hydrochloride (Elavil, Endep), cyclobenzaprine (Cycloflex, Flexeril, Flexiban), doxepin (Adapin, Sinequan) and nortriptyline (Aventyl, Pamelor). Both amitriptyline and cyclobenzaprine have been proven useful for the treatment of fibromyalgia.

Selective serotonin reuptake inhibitors: If a tricyclic antidepressant fails to bring relief, doctors sometimes prescribe newer antidepressants called selective serotonin reuptake inhibitors (SSRI). As with tricyclics, doctors usually prescribe these for people with fibromyalgia in lower dosages than are used for depression. By promoting the release of serotonin, these drugs may reduce fatigue and some other symptoms associated with fibromyalgia. The group of SSRIs includes fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft). Newer SSRIs such as citalopram (Celexa) or escitalopram (Lexapro) do not seem to work as well for pain as older SSRIs.

SSRIs may be prescribed along with a tricyclic antidepressant. Studies have shown that a combination therapy of the tricyclic amitriptyline and the SSRI fluoxetine resulted in greater improvements in the study participants’ fibromyalgia symptoms than either drug alone.
Mixed reuptake inhibitors: Some newer antidepressants raise levels of both serotonin and norepinephrine and are therefore called mixed reuptake inhibitors. Examples of these medications include venlafaxine (Effexor), duloxetine (Cymbalta) and (Savella). In general, these drugs work better for pain than SSRIs, probably because they also raise norepinephrine, which may play an even greater role in pain transmission than serotonin.

Benzodiazepines: Benzodiazepines can sometimes help people with fibromyalgia by relaxing tense, painful muscles and stabilizing the erratic brain waves that can interfere with deep sleep.

Benzodiazepines also can relieve symptoms of restless legs syndrome, a neurological disorder common among people with fibromyalgia. The disorder is characterized by unpleasant sensations in the legs and an uncontrollable urge to move the legs, particularly when at rest, in an effort to relieve restlessness. Doctors usually prescribe benzodiazepines only for people who haven’t responded to other therapies because of the potential for addiction. Benzodiazepines include clonazepam (Klonopin) and diazepam (Valium).

Other Medications: Doctors also may recommend or prescribe other drugs, depending on a person’s symptoms or fibromyalgia-related conditions.

For example, for people with irritable bowel syndrome (IBS), doctors may suggest fiber supplements or laxatives to relieve constipation or medications such as diphenoxylate/atropine (Lotomil) or loperamide (Imodium) for diarrhea. A prescription medication called alosetron (Lotronex) is approved for the treatment of severe IBS with diarrhea that does not respond to other treatment. Another drug, lubiprostone (Amitiza), is approved for the treatment of IBS with constipation.

Antispasmodic medications may be useful for relieving intestinal spasms and reducing abdominal pain. Other symptom-specific medications include sleep medications, muscle relaxants and headache remedies.

People with fibromyalgia also may benefit from a combination of physical and occupational therapy, from learning pain management and coping techniques, and from properly balancing rest and activity.

Complementary and Alternative Therapies: Many people with fibromyalgia also report varying degrees of success with complementary and alternative therapies, including massage, movement therapies (such as Pilates and the Feldenkrais method), chiropractic treatments, acupuncture, and various herbs and dietary supplements for different fibromyalgia symptoms.
Although some of these supplements are being studied for fibromyalgia, there is little, if any, scientific proof yet that they help. The FDA does not regulate the sale of dietary supplements, so information about side effects, proper dosage and the amount of a preparation’s active ingredient may not be well known.

If you’re using or would like to try a complementary or alternative therapy, you should first speak with your doctor, who may know more about the therapy’s effectiveness, as well as whether it is safe to try in combination with your medications.

How Much Do You Know About Fibromyalgia?
Described by Hippocrates in ancient Greece, fibromyalgia is one of the world’s oldest medical mysteries. The disease – a complex illness marked by chronic muscle, tendon and ligament pain, fatigue and multiple tender points on the body – affects about 2% percent of Americans, most of them women