What is Fibromyalgia?

Defining Fibromyalgia

Fibromyalgia -- which is also sometimes referred to as Fibromyalgia Syndrome, Fibromyositis, Fibrositis, or Myofascial pain syndrome -- is a chronic disorder characterized by tenderness in localized areas of the neck, spine, shoulders, and hips sometimes referred to as tender points or pressure points.

What are some of the other symptoms associated with Fibromyalgia?

In addition to the tender points, Fibromyalgia is also associated with other body disturbances, including:

• concentration problems
• fatigue
• headaches
• irritable bowel syndrome
• joint discomfort
• morning stiffness
• muscle spasms
• muscle weakness
• musculoskeletal pain
• numbness in hands and feet
• sleep disturbances
• temperature sensitivities
• tingling sensation that may travel throughout the body
• widespread pain in joints, muscles, tendons, and other soft tissues

Some Fibromyalgia victims also suffer from anxiety and depression, as a consequence of the illness rather than as a cause of the syndrome.

What are the criteria for a Fibromyalgia diagnosis?

Diagnosis is difficult. Currently there is not a medical test available to diagnosis the condition directly. At the present time, diagnosis is based on patient history and tender point sensitivity. A Fibromyalgia diagnosis requires a history of widespread pain lasting at least three months, 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 American Academy of Family Physicians illustration of and explanation about the muscles affected by Fibromyalgia tender points, Caring Medical Center illustration identifying the 18 Fibromyalgia Tender Points, and University of Pittsburg Medical Center illustration of the Fibromyalgia Tender Points are graphics that will help pinpoint the exact locations of these tender points and see which muscles are affected.

Long-standing, body-wide pain with defined tender points is the primary characteristic of fibromyalgia. These Fibromyalgia tender points are distinct from trigger points seen in other pain syndromes. However, unlike tender points, trigger points sometimes occur in isolation and are a source of radiating pain, even in the absence of direct pressure. The pain associated with a tender point increases upon palpation of that tender point.

Pain and Causes of Fibromyalgia

What type of pain is associated with Fibromyalgia?

The soft-tissue pain of Fibromyalgia is described as burning, deep-aching, gnawing, radiating, or shooting, and ranges from mild to severe. Fibromyalgia victims also often wake up with body aches and stiffness. For some, that pain and stiffness improves during the day and increases again during the evening, and some have the opposite time table for pain and pain tolerance. On the other hand, many with Fibromyalgia have day-long, unrelenting pain. Pain can also increase from anxiety, cold or damp weather, increased physical activity, and stress.

While Fibromyalgia pain can be similar to that which occurs with types of arthritis, Fibromyalgia pain is seldom accompanied by the significant swelling, destruction, and deformity of joints present in diseases like rheumatoid arthritis.

What causes Fibromyalgia?

The cause of this disorder is unknown. Fibromyalgia can develop on its own, or as a secondary affliction to other musculoskeletal conditions like rheumatoid arthritis, Chronic Fatigue Syndrome, or autoimmune illnesses like systemic lupus. Some believe physical or emotional trauma may play a role in development of Fibromyalgia. Also, some evidence points to the possibility that Fibromyalgia victims have abnormal pain transmission responses.

The possibility also exists that the sleep disturbances common in Fibromyalgia patients may actually cause the disorder. Another theory suggests that Fibromyalgia may be associated with changes in skeletal muscle metabolism (such as improper metabolism of the lactic acid excreted into the skeletal muscles during exertion and exercise), possibly caused by decreased blood flow, which could cause the “burning” sensation, chronic fatigue, and weakness.

Most illnesses are assumed to be triggered by an infectious microbe, such as a virus. With Fibromyalgia, no such virus or microbe has been identified.

While an exact cause for Fibromyalgia at present eludes medical professionals, research shows that Fibromyalgia patients appear to have an enhanced pain sensitivity and response originating from the central nervous system. Traumatic illness or injury may trigger the condition. Also, research continues to determine if other factors may lead to the development of Fibromyalgia, such as autoimmune dysfunction, connective tissue disease, environmental factors, genetics, or nutritional deficiencies.

Fibromyalgia Risk Factors and Treatment

What are some of the risk factors associated with Fibromyalgia?

Fibromyalgia does seem to run in families, which points to a possible inherited tendency toward the disease, though evidence of this is preliminary rather than conclusive.

Fibromyalgia also has an increased frequency of onset among women between the ages of 20 to 50. According to the U.S. National Library of Medicine and the National Institutes of Health, the prevalence of the disease has been estimated between 0.7% and 13% for women, and between 0.2% and 3.9% for men.

What medical tests are used to diagnose Fibromyalgia?

In addition to establishing the presence of 11 of the 18 tender points, laboratory, x-ray, and other tests may be done to rule out other disorders that have similar symptoms.

Other underlying ailments, such as Chronic Fatigue Syndrome, irritable bowel syndrome, and rheumatoid arthritis, are also often present. Tests are done to check for these underlying conditions as well as to confirm Fibromyalgia.

What treatments are available for Fibromyalgia?

In some mild cases, symptoms sometimes decrease or go away altogether when stress is decreased or lifestyle changes are made. A combination of treatments can include counseling, medications, patient education, and physical therapy. Many Fibromyalgia victims also find support groups helpful.

For some, antidepressant medications are sometimes prescribed. Studies show that antidepressants (in lower doses than those used to treat clinical depression, which is a separate disorder) can decrease depression, improve sleep quality, release pain-killing endorphins, and relax craniofacial and skeletal muscles. Other medications sometimes used include anti-inflammatory pain medications and medications that work on pain transmission pathways, such as the epilepsy drug Gabapentin.

Eating a well-balanced diet and avoiding caffeine may help ease sleeping problems, and may help reduce the severity of the symptoms. Lifestyle measures to improve the quality of sleep can be effective for Fibromyalgia. Reducing stress and improving coping skills may also help reduce painful symptoms.

Fish oil, magnesium and malic acid combinations, vitamins, and other supplements may be effective.

Some may find relief from fibromyalgia symptoms by increasing exercise, especially low impact exercises, like walking and swimming, and later selective aerobic exercise. Beginning an exercise program slowly helps stretch and mobilize tight, sore muscles. High-impact aerobics and weight lifting may cause increased discomfort. Symptoms can also sometimes 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.

Long-term effects and symptom comparisons

What long-term effects should somebody with Fibromyalgia expect? (In other words: What is the prognosis?)

While Fibromyalgia is a chronic problem for which there may be some fluctuation in the symptoms, there is no proof that Fibromyalgia Syndrome results in an increased death rate.

What other conditions mimic the symptoms of Fibromyalgia?

Cancer, depression, cervical and low-back degenerative disease, Chronic Fatigue Syndrome, HIV infection, hypothyroidism, Lyme disease, rheumatoid arthritis, and sleep disorders may have symptoms similar to Fibromyalgia; however, none of them are known to be caused directly by Fibromyalgia.

Treatment Problems and Solutions

Are there any other factors that make treatment difficult for Fibromyalgia?

Management of Fibromyalgia is difficult because it requires a multi-therapeutic approach. The degree, frequency, and location of pain can vary from day to day for Fibromyalgia patients. In other words, a Fibromyalgia patient's level of discomfort may range from mild muscle stiffness to extreme, radiating pain severe enough to cause complete debilitation that makes it impossible to carry out simple daily activities.

Keep in mind that most treatment primarily focuses on managing the symptoms. Because the severity of these symptoms varies from person to person and day to day, an efficient treatment plan focuses on trying to determine the underlying causes and establish an effective regimen to alleviate the symptoms sufficiently to allow the Fibromyalgia victim to meet his or her lifestyle goals. This requires an individualized plan. Determining what constitutes that plan is made more difficult when a Fibromyalgia victim’s pain and fatigue hinders the focus, determination, and dedication to take the necessary control to implement and maintain a treatment regimen.

Are there any factors that make treatment easier for the Fibromyalgia patient?

Perhaps first and foremost is the support of family and friends. It helps tremendously when the Fibromyalgia victim has the understanding of loved ones regarding the condition and the limitations it causes. Friends and family can help the patient apply the personalized Fibromyalgia management program. For example, this support can help the patient work through the lows and depression that can result during those times when pain levels are high. That support also includes gently ensuring the Fibromyalgia victim doesn’t overdo it on days when the pain is less severe.

This support of family and friends combined with a well-rounded, personalized management program created with the assistance of a knowledgeable physician who will work diligently to determine the underlying factors promises the best chance for improvement.

Are there any known ways to prevent Fibromyalgia?

There is no proven prevention for this disorder. Maintaining healthy eating and exercise habits is believed to help prevent most illness. Likewise do good sleep habits and stress coping skills. If, despite your best efforts, you develop the symptoms of Fibromyalgia, contact your health-care provider. The only way you can adequately treat any illness symptoms is by pinpointing as best is possible what is causing those symptoms. That includes ruling out other conditions that can mimic the symptoms of Fibromyalgia.

Copyright © 2004-2007 Pamela Rice Hahn
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