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Fibromyalgia

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Fibromyalgia is a chronic condition characterized by widespread pain and allodynia (a heightened and painful response to pressure).  Fibromyalgia is also often associated with other symptoms including chronic fatigue, sleep problems, headaches, depression, and anxiety

What Causes Fibromyalgia?


The cause of fibromyalgia is unknown.  However, several hypotheses have been developed including that of "central sensitization".  This theory proposes that patients with fibromyalgia have a lower threshold for pain because of increased reactivity of pain-sensitive nerve cells in the spinal cord or brain.

Other possible causes or triggers of fibromyalgia include:

Genetic predisposition:  For example, fibromyalgia tends to run in families.  Women are also 7 to 10 times more likely to get this disease than men.

Abnormal pain response: Areas in the brain that are responsible for pain may react differently in fibromyalgia patients (as mentioned above)

Stress:  Stress may be an important precipitating factor in the development of fibromyalgia.  Fibromyalgia occurs frequently with stress-related disorders such as chronic fatigue syndrome, post-traumatic stress disorder, irritable bowel syndrome and depression.

Infection, such as a virus, although none has been identified

Physical trauma: Neck trauma has been reported to increase the risk of developing fibromyalgia.

Sleep disturbances: An association between sleep problems and increased risk of fibromyalgia has been found.

 

What Are The Symptoms?


The main symptom of fibromyalgia is pain, which may range from being mild to severe.   The pain in fibromyalgia often is described as a constant dull ache, typically arising from muscles. To be considered widespread, the pain must occur on both sides of the body and above and below the waist.

Fibromyalgia is also characterized by additional pain when firm pressure is applied to specific areas of the body, called tender points.  These points are typically found in the soft tissues on the back of the neck, shoulders, chest, lower back, hips, shins, elbows and knees.  The pain then spreads out from these tender spots.  The joints are not affected, although the pain may sometimes feel like it is originating from the joints.

People with fibromyalgia tend to wake up with body aches and stiffness.  For some, the pain improves during the day and gets worse at night.   Others have pain all day long.

The pain may get worse with activity, cold or damp weather, anxiety, and stress.

Fatigue, depressed mood, and sleep problems are seen in many patients with fibromyalgia.   Many are unable to get to sleep or stay asleep, and they feel tired when they wake up.


Fibromyalgia Chronic PainOther symptoms of fibromyalgia include:

Irritable bowel syndrome

• Memory problems and difficulty concentrating

• Numbness and tingling in hands and feet

• Reduced ability to exercise

• Tension or migraine headaches 

How is Fibromyalgia Diagnosed?


Your doctor may suspect fibromyalgia based on your symptoms.  A physical exam may be helpful in detecting tender points and to exclude other causes of muscle pain.   Whilst there are no specific diagnostic tests (such as X-rays or blood tests) for fibromyalgia, several tests may still need to be done in order to rule out another health problem (such as rheumatoid arthritis, lupus, hypothyroid and polymyalgia rheumatica) that can be confused with fibromyalgia.

Blood tests may include a full blood count, erythrocyte sedimentation rate and a thyroid function test.

 
How is Fibromyalgia Treated?


In general, treatments for fibromyalgia include both medication and self-care. The goal of treatment is to help relieve pain and other symptoms, and to help a person cope with the symptoms.

The first line of therapy may involve physical therapy, and exercise and fitness program, or stress-relief methods (eg. light massage, meditation).

If these treatments do not work, your doctor may prescribe an pain-killers (such as non-steroidal anti-inflammatory drugs, muscle relaxants, tramadol) or an anti-depressant.  Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia.

Medicine should be used alongside exercise and behavior therapy.

Cognitive-behavioral therapy is also an important part of treatment,  and patients often benefit from joining support groups.

Other recommendations include eating a well-balanced diet, practicing good sleeping habits to improve the quality of sleep, and going for acupressure and acunpuncture therapy.   More severe cases of fibromyalgia may require a referral to a pain clinic.


Further Reading

 
The article above is meant to provide general information and does not replace a doctor's consultation.
Please see your doctor for professional advice.