Fibromyalgia

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Fibromyalgia Resources

The Basics

What is fibromyalgia?

Fibromyalgia is a chronic pain disorder that causes pain to the muscles and tissues. It is a chronic disorder. The word fibromyalgia comes form the the Latin word fibro, which means fibrous tissues, and the Greek words myo (muscle) and algia (pain). Thus the word is a description of the syndrome: pain in the tissues and muscles.

It is commonly mistaken that fibromyalgia is an arthritis-related condition, but this is not accurate. Arthritis is a disease of the joints, while fibromyalgia pertains to muscles and tissue.

Symptoms and common disturbances

• Pain
• Fatigue
• Sleep disturbances
• Morning stiffness
• Headaches
• Irritable bowel syndrome
• Painful menstrual periods
• Restless legs syndrome
• Temperature sensitivity
• Heightened sensitivity
• Cognitive and memory problems
• Depression
• Mood changes
• Anxiety
• Dizziness

Fibromyalgia is characterized by certain symptoms that generally arise together, but there is no identifiable common cause. Fibromyalgia is not life-threatening.

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What causes fibromyalgia?

It is unclear as to what exactly causes fibromyalgia. However, some theories are discussed below.

• Central sensitization: It is generally accepted that fibromyalgia occurs in people who are genetically predisposed to the disorder, which is brought on by various stressors that can trigger hypersensitivity. This theory states that people with fibromyalgia have a lower tolerance to pain because of a heightened sensitivity to pain signals. While this central sensitization theory explains how fibromyalgia occurs, it doesn't tell us why people develop this heightened sensitivity.
  
• Sleep disturbances: Some researchers believe that consistent disruptions in sleep patterns may actually cause fibromyalgia, instead of just being a symptom of the syndrome.
• Injury: Injury may cause the development of fibromyalgia in some people. Some injuries that cause damage to the central nervous system can trigger fibromyalgia.
• Infection: Some researchers theorize that viral or bacterial infections can trigger fibromyalgia.
• Abnormalities in the sympathetic nervous system: People with dysfunction of the sympathetic nervous system may experience symptoms of fibromyalgia like fatigue, stiffness, and dizziness.
• Changes in muscle metabolism: Decreased blood flow to the muscles can cause decreased strength and muscle fatigue. Deterioration of muscles is thought to potentially lead to fybromyalgia.
• Psychological stress and hormonal changes are also possible causes of fibromyalgia.

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Fybromyalgia and women: the statistics

• FM affects as many as 1 in 50 Americans.
• Most people (about 80-90% of cases) with FM are women.
• Men and children also can have the disorder. Most people are diagnosed during middle age. FM can occur by itself, but people with certain other diseases, such as rheumatoid arthritis and other types of arthritis, may be more likely to have FM.
• Individuals who have a close relative with FM are more at risk for developing FM.

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How does fibromyalgia affect women differently?

Menstruation
During menstruation, women with fibromyalgia may experience their symptoms more acutely. There is often an increase in headaches, body pain, memory problems and sleep disruptions in the time leading up to one's period, and for the first part of the menses. Fibromyalgia symptoms that may increase during this time include:

• Painful cramps
• Fatigue
• Sleep disorders
• Memory loss and difficulty learning
• Widespread pain

Pregnancy
Research concerning pregnancy and fibromyalgia is still in progress. A recent study at Temple University concluded that the fibromyalgia sufferers had more pain symptoms during pregnancy than those who did not suffer from this condition. Also, their own symptoms seemed to be exacerbated during pregnancy, especially in the third trimester.

There are currently no fibromyalgia medications that are completely safe to use during pregnancy. Therefore, sufferers are usually weaned off of painkillers and antidepressants before they become pregnant. The safest treatments for pregnant women are massage, exercise, meditation, and rest.

Menopause
Hormonal fluctuations often contribute to flare-ups in fibromyalgia. Therefore, with the changes in hormone production that the body undergoes during menopause, women are likely to experience even more intense symptoms of fibromyalgia.

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Diagnosis and Treatment

Diagnosis

Because the symptoms of fibromyalgia may seem subjective and may also symptoms of other conditions, it is difficult to diagnose. When testing for the presence of fibromyalgia, the doctor will take a complete medical history. Then, he/she will press firmly on specific points on your head, upper body and certain joints so that you can confirm which cause pain. The American College of Rheumatology has set guidelines.

• You must have experienced widespread aching pain for at least three months.
• The 18 identified points that experience tenderness with fibromyalgia are shown below. To be diagnosed with this condition, you must experience tenderness in at least 11 of these points.

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Treatment

Once your doctor has confirmed that you have fibromyalgia, you will likely undergo a combination of treatments that balance medical interventions and self-care. The primary purposes of medications are to reduce pain and to improve sleep.

Prevention: While there is no proven method of preventing fibromyalgia, there are ways to help reduce your symptoms. These are included below.

Common and accedted treatment:

• Analgesics: Acetaminophens like Tylenol may help with the pain caused by fibromyalgia. If it helps with your symptoms, its an excellent option. However, people often need something slightly stronger. Tramadol (Ultram) is a prescription pain reliever that may be taken with or without acetaminophen. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen sodium (Anaprox, Aleve) to be used alongside other medications. NSAIDs have not been effective in treating the pain in fibromyalgia when taken alone.
• Antidepressants: If you are having trouble sleeping, your doctor may prescribe antidepressants such as amitriptyline, nortriptyline (Pamelor) or doxepin (Sinequan) to help improve sleep patterns. Fluoxetine (Prozac) in combination with amitriptyline has also been found effective. Sertraline (Zoloft) and paroxetine (Paxil) may help if you're experiencing depression.
  
  A newer class of antidepressants, called serotonin and norepinephrine reuptake inhibitors or dual uptake inhibitors, help stabilize two brain chemicals that may transmit pain signals. Studies have found that duloxetine (Cymbalta) helps control pain in people with fibromyalgia. Small trials of venlafaxine (Effexor) suggest the same.
• Muscle relaxants: The muscle relaxant cyclobenzaprine (Flexeril) can be taken at bedtime to help treat muscle pain and spasms. Muscle relaxants are usually recommenended for short-time use only, as they can be habit-forming.
• Anticonvulsants: Drugs used to treat epilepsy have proven to be effective in people with chronic pain. Pregabalin (Lyrica) decreased pain and fatigue and improved sleep in people with fibromyalgia in trials.
• Prescription sleeping pills, such as zolpidem (Ambien), may provide short-term benefits for some people with fibromyalgia, but doctors usually advise against long-term use of these drugs. These medications are usually effective for a short period of time, but after a while, your body begins to resist their effects. Ultimately, using sleeping pills can be counterproductive, as it can create even more sleeping problems in many people.
• Benzodiazepines may help relax muscles and promote sleep, but doctors often avoid these drugs in treating fibromyalgia. Benzodiazepines can become habit-forming, and they haven't been shown to provide long-term benefits.

Alternative Medicine

• Acupuncture: This Chinese medical system is based on restoring balance by inserting very thin needles at certain pressure point on the skin. Each needle goes to a specific depth. According to Western theories of acupuncture, the needles cause changes in blood flow and levels of neurotransmitters in the brain and spinal cord. In a 2006 Mayo Clinic study, acupuncture significantly improved symptoms of fibromyalgia in some patients.
• Chiropractic care: This treatment is based on the theory that when movement in the spine is restricted, people may experience pain and reduced function. Spinal manipulation is one form of therapy chiropractors use to treat restricted spinal mobility. The goal is to encourage the spine to move and thereby improve function and decrease pain. Chiropractors manipulate the spine from different positions using varying degrees of force. Manipulation doesn't need to be forceful to be effective. Chiropractors may also use massage and stretching to relax muscles that are shortened or in spasm. It is important to only go to properly trained and licensed practitioners, because spinal manipulation does have risks.
• Massage therapy: Massage is one of the oldest methods of health care still in practice. By moving the muscles and tissues of the body in various therapeutic ways, massage can improve blood circulation in the muscles. This helps move waste products through the system and helps the nutrients to flow. Massage has many benefits, including reducing your heart rate, relaxing your muscles, and improving range of motion in your joints. It can help alleviate stress and anxiety.
• Osteopathy: Doctors of osteopathy are licensed to perform many of the same therapies and procedures as conventional doctors. One way that doctors of Osteopathy help with fibromyalgia is by practicing the same spinal manipulation techniques that chiropractors perform.

Cognitive behavior therapy
Cognitive behavior therapy is a psychological treatment that attempts to strengthen your own resolve to deal with your disorder. At the heart of this therapy is teaching methods to deal with stressful situations and pain. There are a variety of forms of therapy, including:

• Individual counseling
• Classes
• Tapes
• CDs
• DVDs

Treatment programs
Sometimes there is no one solution to fibromyalgia. In this case, you may need to develop a program with your doctor that combines various treatment techniques. These interdisciplinary programs may combine relaxation techniques, biofeedback, and information sessions about chronic pain. You may also join self-help groups or read books on your condition.

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Empower Yourself

Dealing with fibromyalgia

One of the most difficult things with dealing with fibromyalgia is that it is a commonly misunderstood condition. Because the causes are so unclear and the symptoms seem subjective, people who suffer from fibromyalgia sometimes have to face others who question the condition's very existence. It is important to understand that this condition, while theorized to be brought on by reactions in the brain, is accepted by the medical community as a diagnosable condition. It is a real, painful condition and you need to surround yourself by family and friends who understand and support you.

It may also be helpful thing is to realize that you are not alone. As many as one in fifty Americans suffer from this condition, and it helps to talk to others who understand what you're going through. Organizations such as the Arthritis Foundation and the American Chronic Pain Association offer support groups and information for sufferers and their families to help you deal with this chronic syndrome.

In addition to the medications and treatments prescribed by your doctor, you can take steps to making your lifestyle healthier. this may reduce some of the symptoms of fibromyalgia.

• Stress: Try to limit emotional stress and overworking. Allow yourself time each day that is your time, just to relax and do something you love. Try not to change your routine too much, or to drop out of activities. You need to learn how to deal with the stresses in your life with balance, not to give up the things that you do. Deep-breathing exercises and meditation are excellent stress relievers.
• Sleep: Fatigue is one of the main characteristics of fibromyalgia, so developing healthy sleep patterns is vital. Try to go to bed and get up at the same time each day and limit napping during the day.
• Exercise: At first, exercise may seem to heighten your pain. But once you develop an exercise regimen, you will find your body growing stronger and feeling healthier. Exercises that don't put too much stress on the body but still challenge you, like walking, swimming, biking, yoga, pilates, and water aerobics are good options. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are beneficial.
• Pace yourself: When you are having a good day, enjoy it, but don't try to do too much. If you push yourself on your good days, you may experience more bad days. Also know that if you are having a bad day, your symptoms will probably come and go, so you need to work through the hard times.
• Diet: What you put into your body is going to reflect how you feel. Eat healthy foods and balance your diet. Try to limit your caffeine intake.

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Frequently asked questions

What is the difference between fibromyalgia and chronic fatigue syndrome?
Chronic fatigue syndrome (CFS) and FM are alike in many ways. In fact, it is not uncommon for a person to have both FM and CFS. Both CFS and FM have pain and fatigue as symptoms.

The main symptom of CFS is extreme tiredness. CFS often begins after having flu-like symptoms. But people with CFS do not have the tender points that people with FM have. To be diagnosed with CFS, a person must have:

• Extreme fatigue for at least 6 months that cannot be explained by medical tests or relieved by rest and
• Have 4 or more of the following symptoms:
  • Forgetting things or having a hard time focusing
  • Feeling tired even after sleeping
  • Muscle pain or aches
  • Pain or aches in joints without swelling or redness
  • Feeling discomfort or "out-of-sorts" for more than 24 hours after being active
  • Headaches of a new type, pattern, or strength
  • Tender lymph nodes in the neck or under the arm
  • Sore throat

Is there anything I can do to help me feel better?
Besides taking medicine prescribed by your doctor, there are many things you can do to lessen the impact of FM on your life:

• Get enough sleep. Getting enough sleep and the right kind of sleep can help ease the pain and fatigue of FM.
• Get moving. Though pain and fatigue may make exercise and daily activities hard, being active as possible is important. People who have a lot of pain or fatigue should begin with walking or other gentle exercises and slowly build up to more demanding workouts.
• Make changes at work. Most people with FM continue to work, but they may have to make big changes to do so. For example, some people cut down the number of hours, switch to a less demanding job, or adapt a current job.
• Eat right. Try to add more fruits, vegetables, and whole grains to your diet.

What research is being done on fibromyalgia?
The National Institute of Arthritis and Musculoskeletal and Skin Diseases sponsors research to help understand FM and find better ways to diagnose, treat, and prevent it. Researchers are studying:

• Why people with FM are highly sensitive to pain
• The role of stress hormones in the body
• Medicines and behavioral treatments
• Whether there is a gene or genes that make a person more likely to have FM

Will Fibromyalgia Get Better With Time?
Fibromyalgia is a chronic condition, meaning it lasts a long time - possibly a lifetime. However, it may comfort you to know that fibromyalgia is not a progressive disease. It is never fatal, and it won't cause damage to your joints, muscles, or internal organs. In many people, the condition does improve over time.

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Glossary of fibromyalgia terms

Acupuncture: The practice of inserting needles into the body to reduce pain or induce anesthesia. More broadly, acupuncture is a family of procedures involving the stimulation of anatomical locations on or in the skin by a variety of techniques. There are a number of different approaches to diagnosis and treatment in American acupuncture that incorporate medical traditions from China, Japan, Korea, and other countries. The most thoroughly studied mechanism of stimulation of acupuncture points employs penetration of the skin by thin, solid, metallic needles, which are manipulated manually or by electrical stimulation.

Amitriptyline: An antidepressants medication.

Antibody: An immunoglobulin, a specialized immune protein, produced because of the introduction of an antigen into the body, and which possesses the remarkable ability to combine with the very antigen that triggered its production.

Anxiety: A feeling of apprehension and fear characterized by physical symptoms such as palpitations, sweating, and feelings of stress.

Arthritis: Inflammation of a joint. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of arthritis.

Chronic: This important term in medicine comes from the Greek chronos, time and means lasting a long time.

Depression: An illness that involves the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.

Exacerbate: To make worse. For example, smoking may exacerbate systemic lupus erythematosus.

Fatigue: A condition characterized by a lessened capacity for work and reduced efficiency of accomplishment, usually accompanied by a feeling of weariness and tiredness. Fatigue can be acute and come on suddenly or chronic and persist.

Fibromyalgia: A syndrome characterized by chronic pain, stiffness, and tenderness of muscles, tendons, and joints without detectable inflammation. Fibromyalgia does not cause body damage or deformity. However, undue fatigue plagues the large majority of patients with fibromyalgia and sleep disorders are common in fibromyalgia.

Hormone: A chemical substance produced in the body that controls and regulates the activity of certain cells or organs.

Inflammation: A basic way in which the body reacts to infection, irritation or other injury, the key feature being redness, warmth, swelling and pain. Inflammation is now recognized as a type of nonspecific immune response.

Nerve: A bundle of fibers that uses chemical and electrical signals to transmit sensory and motor information from one body part to another.

Rheumatoid arthritis: An autoimmune disease which causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Autoimmune diseases occur when the body tissues are mistakenly attacked by its own immune system. The immune system is a complex organization of cells and antibodies designed normally to "seek and destroy" invaders of the body, particularly infections. Patients with these diseases have antibodies in their blood which target their own body tissues, where they can be associated with inflammation. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease. While rheumatoid arthritis is a chronic illness (meaning it can last for years) patients may experience long periods without symptoms.

Serotonin: A hormone' also called 5-hydroxytryptamine' in the pineal gland' blood platelets, the digestive tract, and the brain. Serotonin acts both as a chemical messenger that transmits nerve signals between nerve cells and that causes blood vessels to narrow.

Stress: Forces from the outside world impinging on the individual. Stress is a normal part of life that can help us learn and grow. Conversely, stress can cause us significant problems.

Syndrome: A set of signs and symptoms that tend to occur together and which reflect the presence of a particular disease or an increased chance of developing a particular disease.

Tissue: A tissue in medicine is not like a piece of tissue paper. It is a broad term that is applied to any group of cells that perform specific functions. A tissue in medicine need not form a layer. Thus,

• The bone marrow is a tissue;
• Connective tissue consists of cells that make up fibers in the framework supporting other body tissues; and
• Lymphoid tissue is the part of the body's immune system that helps protect it from bacteria and other foreign entities.

Trigger: Something that either sets off a disease in people who are genetically predisposed to developing the disease, or that causes a certain symptom to occur in a person who has a disease. For example, sunlight can trigger rashes in people with lupus.

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Fibromyalgia resources and tools

Government Agencies

*Accepts Spanish calls

*National Women's Health Information Center, OWH, HHS
8270 Willow Oaks Corporate Drive
Fairfax, VA 22031
Phone: (800) 994-9662
TDD: (888) 220-5446
FAX: (703) 663-6942
http://www.4woman.gov/faq/endomet.htm

National Institute of Arthritis and Musculoskeletal and Skin Diseases
Information Clearinghouse
National Institutes of Health
1 AMS Circle
Bethesda, Maryland 20892-3675
Phone: (301) 495-4484
TTY: (301) 565-2966
Fax: (301) 718-6366
www.niams.nih.gov

Department of Health and Human Services
Food and Drug Administration
5600 Fishers Lane
Rockville, Maryland 20857
Phone: (888) INFO-FDA
http://www.fda.gov/fdac/reprints/ots_endo.html

Office on Women's Health, HHS
200 Independence Avenue, SW, Room 712E
Washington, DC 20201
Phone: (202) 690-7650
FAX: (202) 205-2631
http://www.womenshealth.gov/owh

* National Center for Complementary and Alternative Medicine, NIH, HHS
PO Box 7923
Gaithersburg, MD 20898
Phone: (888) 644-6226
TTY: (866) 464-3615
FAX: (866) 464-3616
http://nccam.nih.gov

Office of Research on Women's Health, NIH, HHS
Building 1, Room 201
Bethesda, MD 20892-0161
Phone: (301) 402-1770
FAX: (301) 402-1798
http://orwh.od.nih.gov/index.html

Office of Women's Health, CDC, HHS
Parklawn Building, Room 1561
5600 Fishers Lane
Rockville, MD 20857
Phone: (301) 827-0350
FAX: (301) 827-0926
http://www.fda.gov/womens/default.htm



Private Organizations

American College of Rheumatology
1800 Century Place, Suite 250
Atlanta, GA 30345-4300
Phone: 404 633 3777
Fax: 404 633 1870
www.rheumatology.org

American Chronic Pain Association
PO Box 850
Rocklin, CA 95677
Phone: (800) 533-3231  
Fax: (916) 632-3208
www.theacpa.org


Newsletters, Magazines, Reports

Healthy Women Today
The National Women's Health Information Center
www.womenshealth.gov/newsletter

Fibromyalgia Network
To stay up-to-date on what's going on in fibromyalgia research, check out this frequently updated web site.
http://www.fmnetnews.com/


Tools

Fibromyalgia Screening
Take this quick self-test to see if you may have the symptoms of fibromyalgia,
http://arthritis.about.com/od/fibromyalgia/l/blfibroquiz.htm

Stress Assessment
Take this assessment to see what your stress levels are like.
http://www.mayoclinic.com/health/stress-assessment/SR00029

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References

1. Goldenberg DL, Burckhardt CS, Crofford L. Management of fibromyalgia syndrome. JAMA. 2004;292:2388-2395./p>

2. Poyhia R, Da Costa D, Fitzcharles MA. Pain and pain relief in fibromyalgia patients followed for three years. Arthritis Rheum. 2001;45:355-361.

3. Heymann RE, Helfenstein M, Feldman D. A double-blind, randomized, controlled study of amitriptyline, nortriptyline and placebo in patients with fibromyalgia: an analysis of outcome measures. Clin Exp Rheumatol. 2001;19:697-702.

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