What Is It?
People with fibromyalgia have widespread pain, aches and stiffness in muscles and joints throughout the body along with unusual tiredness. There is no known cause of fibromyalgia. In addition, doctors can't find a physical reason for the symptoms. Blood tests, X-rays and other tests usually are normal in people with fibromyalgia.
Fibromyalgia is a controversial illness. Some physicians don't believe that it's a medical illness but may be a reflection of psychological distress or stress. However, there's no proof of a psychological cause either. Until we have a better understanding of the disorder, it's likely to remain controversial.
It may be that fibromyalgia has more than one cause. Some researchers have suggested that it's related to abnormalities in a non-dream part of the sleep cycle or to low levels of serotonin, a brain chemical that regulates sleep and pain perception. Other theories have linked fibromyalgia to low levels of somatomedin C, a chemical related to muscle strength and muscle repair, or to high levels of substance P, a chemical that affects the threshold at which a person experiences pain. Still others have cited trauma, blood-flow abnormalities in the muscles, viral infections or other infections as possible triggers of fibromyalgia.
Fibromyalgia affects an estimated 3.4% of women and 0.5% of men in the United States, or 3 million to 6 million Americans. It most commonly affects women of childbearing age or older. In fact, some estimates suggest that more than 7% of women in their 70s have fibromyalgia. Many people with fibromyalgia also have psychiatric problems such as depression, anxiety or eating disorders, although the relationship between them remains unclear.
Fibromyalgia can cause pain and stiffness in the muscles and joints almost anywhere in the body, including the trunk, neck, shoulders, back and hips. People often have pain between the shoulder blades and at the bottom of the neck. Pain may be either a general soreness or a gnawing ache, and stiffness is often worst in the morning. Typically, people also complain of feeling abnormally tired, especially of waking up tired, although they have slept well. People with fibromyalgia also have tender points, which are specific spots on the body that are painful to touch. Some people report symptoms of irritable bowel syndrome, depression, anxiety and headache. For research studies, the American College of Rheumatology (ACR) has established criteria for fibromyalgia. To meet these criteria, one must have at least 3 months of unexplained, body-wide pain and at least 11 of 18 tender points in specific locations.
After asking about your symptoms, your doctor will check for swelling, redness and impaired movement in parts of your body where you're having pain. Your doctor will check for tenderness and pain in the ACR-designated tender points. Your doctor will ask detailed questions about your medical history and examine you to rule out other conditions or diseases that could explain your symptoms.
Because the ACR criteria were developed for research studies, physicians who are not participating in research often diagnose the illness without meeting these strict criteria, but only after they have been unable to find alternative causes of the pain and fatigue.
Many people experience pain for much longer than the minimum three months required to be diagnosed with fibromyalgia. How often fibromyalgia causes disability is uncertain, but most people are able to adapt to or control symptoms and remain active.
There is no known way to prevent fibromyalgia.
To relieve the pain of fibromyalgia, your doctor may prescribe acetaminophen (Tylenol and other brand names); aspirin or other nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil and others) or naproxen (Aleve); a muscle relaxant such as cyclobenzaprine (Flexeril); or an antidepressant such as amitriptyline (Elavil) or fluoxetine (Prozac). Sometimes these medicines are prescribed in combination. For example, amitriptyline and fluoxetine given together may help more than either alone.
In recent years, the FDA has approved pregabalin (Lyrica), duloxetine (Cymbalta) and milnacipran (Savella) for the treatment of fibromyalgia. However, studies have not yet compared these with older medications for the long-term treatment of this condition. A number of other medicines, including gabapentin (Neurontin), tramadol (Ultram) and tizanidine (Zanaflex), are being investigated for the treatment of fibromyalgia. However, medications often don't work well and non-medication treatments (see below) may be much more helpful.
Aerobic exercise, such as low-impact stepping, cycling or swimming several times each week, also is considered an essential part of treatment. Finally, improved sleep quality may improve symptoms, so it may help to avoid caffeine, exercise late in the day and fluids late in the evening. If your symptoms do not improve, your doctor also may suggest that you try one or more of the following therapies: acupuncture, massage therapy, warm compresses, biofeedback, hypnosis, group therapy or stress management. If you have symptoms of depression or anxiety, these may improve with psychotherapy and antidepressant or antianxiety medication.
Every person with fibromyalgia is different, so people may have significantly different treatment plans than the usual measures outlined above.
When to Call a Professional
Call your doctor whenever chronic pain or extreme tiredness interferes with your ability to work, sleep, do normal household chores or enjoy recreational activities.
Studies do not agree about the outlook for people with fibromyalgia. For example, results from some specialized treatment centers show a poor outlook. However, community-based treatment programs show that symptoms go away in a quarter of patients and symptoms significantly improve in about half.
P.O. Box 7669
Atlanta, GA 30357-0669
National Institute of Arthritis and Musculoskeletal and Skin Diseases
National Insitutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
American College of Rheumatology
2200 Lake Boulevard NE
Atlanta, GA 30319