Your Health - Fibromyalgia

Fibromyalgia

(FM; Fibromyalgia Syndrome; FMS)

Pronounced: FI-bro-my-OWL-jah

Definition

Fibromyalgia is a complex, chronic, and disabling disorder. It causes widespread pain and stiffness in the muscles, tendons, and ligaments, along with poor sleep and fatigue.

Fibromyalgia Trigger Points

Causes

The exact cause is unknown.

The following conditions are commonly associated with fibromyalgia:

Depression and anxiety
Muscle pain
Chronic headache, such as tension headaches (frequently beginning with neck discomfort)
Numbness and tingling
Sensation of swollen hands and edema (swelling usually in the feet, ankles, and legs)
Nocturnal myoclonus (moving legs involuntarily during sleep)
Irritable bowel syndrome
Complex regional pain syndrome
Substance abuse
Premenstrual syndrome
Female urethral syndrome (irritable bladder)
Raynaud's disease

Risk Factors

A risk factor is something that increases your chance of getting fibromyalgia. Risk factors include:

Sex: female
Age: 20-60 years old
Physical or mental stress
Physical trauma (eg, accident, injury, or severe illness)

Symptoms

Common symptoms include:

Generalized fatigue or tiredness
Reduced physical endurance
Generalized aches and pains of muscles, tendons, and ligaments
Muscle tightening or spasms
Pain in specific areas of the body, especially:
- Neck
- Shoulders
- Chest
- Back (upper and lower)
- Hips and thighs
Insomnia or poor sleep
Sensations of numbness or swelling (although swelling is not actually present)
Chronic headaches, including migraines
Morning stiffness, worst on first arising

Factors that may trigger or worsen symptoms include:

Weather changes, especially cold, damp weather
Stress or anxiety
Overexertion
Medical illness
Surgery

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a thorough physical exam. There are no specific tests for this condition.

The doctor will look for the following signs:

Widespread pain lasting three months or longer
Tenderness (on physical exam) in at least 11 of 18 specific areas of the body

Treatment

The goal of treatment is to relieve or control the symptoms. Treatments include:

Physical and Behavioral Therapies

Physical therapy (gradual aerobic exercise and stretching regimen)
Heated pool treatments—Aquatic training in warm water (eg, strength, aerobic, and relaxation exercises) may help improve symptoms.
Application of heat to painful areas
Alternative treatments, such as massage , acupuncture , relaxation training , trigger point therapy, biofeedback
Cognitive behavioral therapy

Lifestyle Changes

Eating a healthful diet
Learning to cope with physical and mental stress
Doing regular, moderate, low-impact exercise with your doctor's approval
- Try gentle exercise that does not strain painful areas, such as:
  - Walking
  - Biking
  - Swimming, preferably in warmer water
Doing regular stretching exercises
Maintaining a regular sleep schedule

Medications

These medications may help to improve symptoms:

Weak opioids (eg, tramadol , paracetamol)
Antidepressants (eg, amitriptyline , fluoxetine , duloxetine , milnacipran, moclobemide , pirlindole)
Pain relievers (eg, tropisetron, pramipexole , pregabalin )
Sodium oxybate (eg, Xyrem), a central nervous system depressant

Prevention

Since the cause is unknown, there are no guidelines for preventing fibromyalgia.

RESOURCES:

The American Fibromyalgia Syndrome Association
http://www.afsafund.org/

National Fibromyalgia Partnership, Inc.
http://www.fmpartnership.org/

CANADIAN RESOURCES:

The Arthritis Society
http://www.arthritis.ca/

Fibromyalgia Information and Local Support
http://fibromyalgia.ncf.ca/

References:

Berkow R. The Merck Manual of Medical Information . New York, NY: Pocket; 2000.

Carville SF, Arendt-Nielsen S, Bliddal H, et al. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis . 2008;67:536-541.

Edema. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/disorders/edema/hic_edema.aspx . Updated November 2005. Accessed June 19, 2008.

Fibromyalgia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated June 2008. Accessed June 19, 2008.

Fibromyalgia. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health_Info/Fibromyalgia/fibromyalgia_ff.asp . Updated August 2007. Accessed June 19, 2008.

Fibromyalgia update. Bandolier website. Available at: http://www.jr2.ox.ac.uk/bandolier/band149/b149-7.html .

Myofascial pain syndrome. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/myofascial-pain-syndrome/DS01042 . Updated May 2007. Accessed June 19, 2008.

Paresthesias. MedHelp website. Available at: http://www.medhelp.org/HealthTopics/Paresthesias.html . Accessed June 19, 2008.

Periodic limb movement disorder (PLMD) or nocturnal myoclonus. Eastern Virginia Medical School website. Available at: http://www.evms.edu/sleep/disorders-limb.html . Updated March 2006. Accessed June 19, 2008.

¹2/17/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Russell IJ, Perkins AT, Michalek JE; Oxybate SXB-26 Fibromyalgia Syndrome Study Group. Sodium oxybate relieves pain and improves function in fibromyalgia syndrome: a randomized, double-blind, placebo-controlled, multicenter clinical trial. Arthritis Rheum. 2009;60:299-309.

²4/14/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Munguía-Izquierdo D, Legaz-Arrese A. Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial. Arch Phys Med Rehabil. 2008;89:2250-2257.

Last reviewed October 2009 by Jill D. Landis, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.