Fibromyalgia

Alternative names
Fibromyositis; Fibrositis; Myofascial pain syndrome

Definition

Fibromyalgia is a common condition characterized by widespread pain in joints, muscles, tendons, and other soft tissues. Some other problems commonly linked to fibromyalgia include fatigue, morning stiffness, sleep problems, headaches, numbness in hands and feet, depression, and anxiety. Fibromyalgia can develop on its own, or secondary to other musculoskeletal conditions, such as rheumatoid arthritis, or systemic lupus.

Diagnosis of fibromyalgia requires a history of a least three months of widespread pain, and pain and tenderness in at least 11 of 18 tender-point sites. These tender-point sites include fibrous tissue or muscles of the:

     
  • Neck  
  • Shoulders  
  • Chest  
  • Rib cage  
  • Lower back  
  • Thighs  
  • Knees  
  • Arms (elbows)  
  • Buttocks

The overwhelming characteristic of fibromyalgia is long-standing, body-wide pain with defined tender points. Tender points are distinct from trigger points seen in other pain syndromes. Unlike tender points, trigger points can occur in isolation and represent a source of radiating pain, even in the absence of direct pressure.

Fibromyalgia pain can mimic the pain that occurs with various types of arthritis. However, the significant swelling, destruction, and deformity of joints seen in diseases such as rheumatoid arthritis does not occur with fibromyalgia syndrome alone.

The soft-tissue pain of fibromyalgia is described as deep-aching, radiating, gnawing, shooting or burning, and ranges from mild to severe. Fibromyalgia sufferers tend to wake up with body aches and stiffness.

For some patients, pain improves during the day and increases again during the evening, though many patients with fibromyalgia have day-long, unrelenting pain. Pain can increase with activity, cold or damp weather, anxiety, and stress.

Causes, incidence, and risk factors

The cause of this disorder is unknown. Physical or emotional trauma may play a role in development of the syndrome. Some evidence suggests that fibromyalgia patients have abnormal pain transmission responses.

It has been suggested that sleep disturbances, which are common in fibromyalgia patients, may actually cause the condition. Another theory suggests that the disorder may be associated with changes in skeletal muscle metabolism, possibly caused by decreased blood flow, which could cause chronic fatigue and weakness.

Others have suggested that an infectious microbe, such as a virus, triggers the illness. At this point, no such virus or microbe has been identified.

Pilot studies have shown a possible inherited tendency toward the disease, though evidence is very preliminary.

The disorder has an increased frequency among women 20 to 50 years old. The prevalence of the disease has been estimated between 0.7% and 13% for women, and between 0.2% and 3.9% for men.

Symptoms

     
  • Multiple tender areas (muscle and joint pain) on the back of the neck, shoulders, sternum, lower back, hips, shins, elbows, knees.  
  • Fatigue  
  • Sleep disturbances  
  • Body aches  
  • Reduced exercise tolerance  
  • Chronic facial muscle pain or aching

Signs and tests

A number of tests may be done to rule out other disorders. An examination reveals multiple tender areas on the back of the neck, shoulders, sternum, lower back, hips, shins, elbows, or knees.

Sometimes, laboratory and x-ray tests are done to help confirm the diagnosis. The tests will also rule out other conditions that may have similar symptoms.

Other underlying ailments, such as chronic fatigue syndrome, irritable bowel syndrome, and rheumatoid arthritis, can also be present. New patients should be checked for these underlying conditions as well as fibromyalgia.

Treatment

In mild cases, symptoms may go away when stress is decreased or lifestyle changes are implemented. A combination of treatments including medications, patient education, physical therapy, and counseling are usually recommended. Many fibromyalgia sufferers have found support groups helpful.

Certain classes of antidepressant medications are sometimes prescribed for the disorder. Studies show that antidepressants in low doses can decrease depression, relax craniofacial and skeletal muscles, improve sleep quality, and release pain-killing endorphins. Other medications that are used include anti-inflammatory pain medications and medications that work on pain transmission pathways, such as Gabapentin.

Eating a well-balanced diet, and avoiding caffeine may help with problems sleeping, and may help reduce the severity of the symptoms. Lifestyle measures to improve the quality of sleep can be effective for fibromyalgia.

Some reports indicate that fish oil, magnesium/malic acid combinations, or vitamins may be effective. Reducing stress and improving coping skills may also help reduce painful symptoms.

Improved fitness through exercise is recommended. Studies have shown that fibromyalgia symptoms can be relieved by aerobic exercise. The best way to begin a fitness program is to start with low impact exercises, like walking and swimming.

Starting slowly helps stretch and mobilize tight, sore muscles. High-impact aerobics and weight lifting could cause increased discomfort. Symptoms may be relieved by gentle stretching and light massage, as well as acupressure, acupuncture, and relaxation techniques.

Severe cases of fibromyalgia may require a referral to a pain clinic.

Expectations (prognosis)

Fibromyalgia is a common and chronic problem. The symptoms sometimes improve. At other times, the symptoms may worsen and continue for months or years. The key is seeking professional help which includes a multi-faceted approach to the management and treatment of the disease. There is no proof that fibromyalgia syndrome results in an increased death rate.

Complications

Conditions reported as associated with fibromyalgia or that mimic its symptoms include: rheumatoid arthritis, hypothyroidism, cervical and low-back degenerative disease, Lyme disease, chronic fatigue syndrome, sleep disorders, depression, cancer, and HIV infection.

Calling your health care provider

Call your health-care provider if symptoms of fibromyalgia develop.

Prevention

There is no proven prevention for this disorder. However, over the years, the treatment and management of the disease has improved.

Johns Hopkins patient information

Last revised: December 5, 2012
by Potos A. Aagen, M.D.

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