Fibromyalgia Syndrome: Your Questions Answered
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
- 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
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 other general physical symptoms including fatigue, waking unrefreshed, and cognitive (memory or thought) problems.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, milnacipran and pregabalin – are approved by the U.S. Food and Drug Administration (FDA) for fibromyalgia treatment.
Duloxetine was originally developed for and is still used to treat depression. Milnacipran is similar to a drug used to treat depression but is FDA-approved only for fibromyalgia. Pregabalin is a medication developed to treat neuropathic pain (chronic pain caused by damage to the nervous system).
The following are some of the most commonly used categories of drugs for fibromyalgia:
Analgesics are painkillers. They range from over-the-counter acetaminophen to prescription medicines, such as tramadol 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 and naproxen sodium – 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.
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 doesn’t 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’s safe to try in combination with your medications.
What Can I Do to Try to Feel Better?
Besides taking medicine prescribed by your doctor, there are many things you can do to minimize the impact of fibromyalgia on your life. These include:
Getting better sleep.
Getting enough sleep and the right kind of sleep can help ease the pain and fatigue of fibromyalgia. Even so, many people with fibromyalgia have problems such as pain, restless legs syndrome, or brainwave irregularities that interfere with restful sleep. It’s important to discuss any sleep problems with your doctor, who can prescribe or recommend treatment for them.Here are some tips for a better night’s sleep:
- Keep regular sleep habits. Try to get to bed at the same time and get up at the same time every day – even on weekends and vacations.
- Avoid caffeine and alcohol in the late afternoon and evening. If consumed too close to bedtime, the caffeine in coffee, soft drinks, chocolate and some medications can keep you from sleeping or sleeping soundly. Even though it can make you feel sleepy, drinking alcohol around bedtime also can disturb sleep.
- Time your exercise. Regular daytime exercise can improve nighttime sleep. But avoid exercising within 3 hours of bedtime, which actually can be stimulating, keeping you awake.
- Avoid daytime naps. Sleeping in the afternoon can interfere with nighttime sleep. If you feel you can’t get by without a nap, set an alarm for 1 hour. When it goes off, get up and start moving.
- Reserve your bed for sleeping. Watching the late news, reading a suspense novel, or working on your laptop in bed can stimulate you, making it hard to sleep.
- Keep your bedroom dark, quiet and cool.
- Avoid liquids and spicy meals before bed. Heartburn and late-night trips to the bathroom aren’t conducive to good sleep.
- Wind down before bed. Avoid working right up to bedtime. Do relaxing activities, such as listening to soft music or taking a warm bath, that get you ready to sleep. (A warm bath also may soothe aching muscles.)
Although pain and fatigue may make exercise and daily activities difficult, it’s crucial to be as physically active as possible. Research has repeatedly shown that regular exercise is one of the most effective treatments for fibromyalgia. People who have too much pain or fatigue to do vigorous exercise should begin with walking or other gentle exercise, and build endurance and intensity slowly.
Making changes at work.
Most people with fibromyalgia continue to work, but they may have to make big changes to do so. For example, some people cut down the number of hours they work, switch to a less demanding job, or adapt a current job. If you face obstacles at work, such as an uncomfortable desk chair that leaves your back aching or difficulty lifting heavy boxes or files, your employer may make adaptations that will enable you to keep your job. An occupational therapist can help you design a more comfortable workstation or find more efficient and less painful ways to lift.
Although some people with fibromyalgia report feeling better when they eat or avoid certain foods, no specific diet has been proven to influence fibromyalgia. Of course, it’s important to have a healthy, balanced diet. Not only will proper nutrition give you more energy and make you generally feel better, it will also help you avoid other health problems.