Understanding Fibromyalgia

What Is Fibromyalgia?

Fibromyalgia is a non-life-threatening, chronic disorder of the muscles and related soft tissue, including ligaments and tendons.  Its main symptoms are muscle pain, fatigue, sleep disturbances, and tender points at certain parts of the body.  Many people describe fibromyalgia as feeling like a persistent flu.

Some health care providers may use these terms to refer to fibromyalgia:  fibromyositis, fibrositis, periarticular fibrositis, muscular rheumatism, chronic muscle pain syndrome, musculoskeletal pain syndrome, or tension myalgia.  However, "fibromyalgia," which means "pain of the muscles and other fibrous tissue," is the accepted term and has replaced some of the others.  Terms ending in "-itis," which means "inflammation," are now considered incorrect because inflammation does not play a significant role in fibromyalgia.

Key Characteristics

Muscle pain, either throughout the body or only at certain points, is the primary symptom.  It may range from mild discomfort to pain severe enough to limit work, social activities, and everyday tasks.  Pain commonly occurs in the neck, shoulders, chest, rib cage, lower back and thighs and may feel like a burning, gnawing, throbbing, stabbing, or aching sensation and may develop gradually. It usually seems worse when a person is trying to relax and is less noticeable during activity.

A related, key aspect of fibromyalgia is the presence of "tender points," muscles and tendons that are tender when pressed.  Typically, tender points are located in the neck, back, knee, shoulder, elbow, and hip.

People with fibromyalgia also feel moderately to severely fatigued and have sleep problems, including insomnia.  This may result from restless legs and arms, which may disrupt their sleep, or they may suffer from sleep apnea or grind their teeth while they sleep.

Tender Points

According to the American Academy of Rheumatology, for a diagnosis of fibromyalgia, you must have unusual tenderness at a minimum of 11 of the 18 "tender points" associated with the condition.  Some health care providers diagnose fibromyalgia in patients who have fewer tender points but who otherwise have severe, widespread (meaning upper and lower body occurring on both right and left sides) pain symptoms that are present for at least three months.

The standard tender points are located in the muscle or other soft tissue on both sides and the front and back of the body.  Those who have fibromyalgia may have unusual tenderness at any of several other points on the body as well.

Who Is Affected

Experts estimate that 3 million to 6 million Americans have fibromyalgia.  Of these, 80% are women.  One of the main risk factors is being a woman between the age of 20 and 50.  Another risk factor is having a rheumatic disease, such as rheumatoid arthritis, lupus or Sjogren's syndrome.  Fibromyalgia also seems to run in families, so a gene may be at least partly responsible for the condition.  Most people with fibromyalgia begin to notice symptoms between the ages of 20 and 40, but children and older adults may also develop the condition.  Women with fibromyalgia typically feel pain throughout their body, while men are more likely to have facial pain or pain and stiffness in a certain part of the body as a result of a work- or recreation-related muscle strain.

What Causes It?

Experts do not know what causes fibromyalgia.  There are several theories about possible causes or triggers. Inadequate sleep is a possible trigger.  Another is suffering an injury or physical or emotional trauma that affects the brain, spine, and nerves.  Some experts believe that a viral or bacterial infection plays a part.

Abnormal production of pain-related chemicals in the nervous system also contributes to the symptoms of fibromyalgia.  It's thought that any one of these factors may bring on the symptoms of fibromyalgia in someone who is already genetically predisposed to the condition.

 

What Are the Symptoms?

Symptoms of fibromyalgia include:

• Chronic muscle pain, muscle spasms or tightness, and leg cramps
• Moderate or severe fatigue and decreased energy
• Insomnia or waking up feeling just as tired as when you went to sleep
• Stiffness upon waking or after staying in one position for too long
• Difficulty remembering, concentrating, and performing simple mental tasks
• Abdominal pain, bloating, nausea, and constipation alternating with diarrhea (irritable bowel syndrome)
• Tension or migraine headaches
• Jaw and facial tenderness
• Sensitivity to one or more of the following: odors, noise, bright lights, medications, certain foods, and cold
• Feeling anxious or depressed
• Numbness or tingling in the face, arms, hands, legs, or feet
• Increase in urinary urgency or frequency (irritable bladder)
• Reduced tolerance for exercise and muscle pain after exercise
• A feeling of swelling (without actual swelling) in the hands and feet
• Painful menstrual periods
• Dizziness

Symptoms may intensify depending on the time of day -- morning, late afternoon, and evening tend to be the worst times, while 11 a.m. to 3 p.m. tends to be the best time.  They may also get worse with fatigue, tension, inactivity, changes in the weather, cold or drafty conditions, overexertion, hormonal fluctuations (such as just before your period or during menopause), stress, depression, or other emotional factors.

If the condition is not diagnosed and treated early, symptoms can go on indefinitely, or they may disappear for months and then recur.

Call Your Doctor If:

You have chronic muscle pain and overwhelming fatigue.

 

How Do I Know If I Have It?

Before fibromyalgia treatment can begin a doctor must diagnose the condition.

Some experts think that fibromyalgia is underdiagnosed.  It can be difficult to diagnose because many of its symptoms are the same as those of other conditions, such as chronic fatigue syndrome, underactive thyroid, Lyme disease, lupus, and multiple chemical sensitivity.  Fibromyalgia is usually diagnosed after other possible causes have been ruled out.

To diagnose fibromyalgia, your doctor will take a thorough history and do physical and neurological exams.  He or she may order laboratory tests to rule out other conditions.  They will also determine whether you have any tender points, the key distinguishing symptom of fibromyalgia.  Some doctors use the American College of Rheumatology guidelines that require a minimum of 11 out of 18 tender points for a fibromyalgia diagnosis.  Others believe that fewer than 11 tender points may indicate fibromyalgia, particularly if you also have severe fatigue and widespread pain that has lasted more than three months.

Because of the difficulty in diagnosing fibromyalgia, it is best to see a doctor who is knowledgeable about the condition, such as a rheumatologist.  Diagnosis is important because the earlier fibromyalgia is detected, the sooner you can make lifestyle changes to reduce the symptoms.

What Are the Treatments?

There is no cure for fibromyalgia, and people with the condition usually have it for life.  However, it is not likely to get worse as you age and it does not damage your muscles, tendons, or ligaments.  Many people are able to reduce their symptoms with a combination of exercise, medication, physical therapy and relaxation.

Lifestyle Choices

A vital part of treating fibromyalgia is frequent, low-impact aerobic exercise.  Examples include walking, biking, water aerobics, and swimming.  Exercise tends to reduce pain and tenderness and to improve muscle fitness and sleep.  Stretching is also important and may help reduce stiffness and pain.

At first, pain and fatigue may make it difficult for you to exercise.  Keep in mind that persisting with an exercise routine may reduce your symptoms, while becoming unfit may make symptoms worse.  If you have not exercised recently, be sure to talk with your doctor before you begin an exercise program, and start slowly.  Your doctor or a physical therapist can help you work up to 20 to 30 minutes of exercise on most days of the week.

Better-quality sleep may also help reduce fibromyalgia symptoms.  Low-dose tricyclic antidepressants help relieve sleep problems and pain in many people with fibromyalgia.  Also, try to go to bed and wake up at the same time every day; some people notice that their symptoms get worse when they stay up just an hour or two later than usual.

Avoid alcohol and caffeine.  These disrupt deep, restorative sleep and may aggravate your symptoms.

Relaxation techniques can help relieve muscle tension and reduce stress.  Evaluating the causes of stress and learning new ways to cope may also lessen symptoms.

Medication

Nonsteroidal anti-inflammatory drugs (such as ibuprofen, naproxen, ketoprofen, and aspirin) or other pain medication (such as Ultram) may help relieve muscle pain.  For a particularly tender area, your health care provider may inject a local anesthetic to provide relief that typically lasts about two to three month

At-Home Remedies

Applying heat or cold packs to painful areas may relieve symptoms temporarily. Staying warm and improving your posture may also help. Reducing stress may reduce symptoms and may even eliminate them in mild cases. Pace yourself with work, household chores, and social activities -- don't take on too much.

Take a proactive role in learning about fibromyalgia to help control it, and be vigilant about following your treatment plan.  Emotional support is very important, too.  Living with fibromyalgia may be difficult if your family, friends, or employer do not understand the condition.  Seek out supportive family, friends, clergy, support groups or a mental health counselor.

 

Medications for Fibromyalgia

Medications

The most effective medications in the treatment of fibromyalgia are the tricyclic antidepressants, medications traditionally used in treating depression. In treating fibromyalgia, tricyclic antidepressants are taken at bedtime in doses that are a fraction of those used for treating depression. Tricyclic antidepressants appear to reduce fatigue, relieve muscle pain and spasm, and promote deep restorative sleep in patients with fibromyalgia. Scientists believe that tricyclics work by interfering with a nerve transmitter chemical in the brain called "serotonin." Examples of tricyclic antidepressants commonly used in treating fibromyalgia include amitriptyline (Elavil) and doxepin (Sinequan).

A recent study suggests that adding fluoxetine (Prozac) to low dose amitriptyline (Elavil) further reduces muscle pain, anxiety, and depression in patients with fibromyalgia. The combination is also more effective in promoting restful sleep and improving an overall sense of well-being. These two medications also tend to cancel out certain side effects each can have. Tricyclic medications can cause tiredness and fatigue, while fluoxetine can make patients more cheerful and awake. Even more recently, study of patients with resistant fibromyalgia found that lorazepam (Ativan) was helpful in relieving symptoms. Fluoxetine has also been shown to be effective when used alone for some patients with fibromyalgia. Newer antidepressants including Effexor and Cymbalta and drugs such as Lyrica may reduce pain and improve functioning.

Other Treatments

Local injections of analgesics and/or cortisone medication into the trigger point areas can also be helpful in relieving painful soft tissues, while breaking cycles of pain and muscle spasm. Some studies indicate that the pain-reliever tramadol (Ultram) and tramadol/acetaminophen (Ultracet) may be helpful for the treatment of fibromyalgia pains. The muscle relaxant cyclobenzaprine (Flexeril) has been helpful for reducing pain symptoms and improving sleep.

The nonsteroidal antiinflammatory drugs (NSAIDs), while very helpful in treating other rheumatic conditions, have only a limited value in treating fibromyalgia pain. Narcotic pain relievers and cortisone medications have not been shown to be beneficial in this condition. Narcotics and cortisone medications are avoided because they have not been shown to be beneficial and they have potential adverse side effects, including dependency, when used long-term.

Both biofeedback and electroacupuncture have been used for relief of symptoms with some success. Standard acupuncture was recently reported to be effective in treating some patients with fibromyalgia.

 

WebMD Guide

Reference Link:

http://www.webmd.com/fibromyalgia/guide