Fibromyalgia
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Fibromyalgia


Signs and Symptoms
What Causes It?
What to Expect at Your Provider's Office
Treatment Options
Following Up
Supporting Research
  

Fibromyalgia is a chronic condition characterized by pain in the muscles, ligaments, and tendons; fatigue; and multiple tender points on the body. While no one knows what causes fibromyalgia, there is evidence that people with the condition may be more sensitive to pain because something is wrong with the body's usual pain perception processes. More women than men have fibromyalgia. Fibromyalgia, while different for everyone who has it, tends to come and go throughout life. It also tends to coexist with sleep disorders, anxiety, depression, and irritable bowel syndrome. Although fibromyalgia can be debilitating for some people, it is not degenerative or life threatening, and you can manage your symptoms and improve your quality of life with professional and self care.

Signs and Symptoms

  • Widespread pain and stiffness
  • Fatigue or trouble sleeping
  • Paresthesia (tingling)
  • Irritable bowel syndrome
  • Skin sensitivity
  • Heightened sensitivity to noises, bright lights, smells
  • Depression
  • Headaches
  • Pain after exertion
  • Memory lapses or difficulty concentrating
  • Restless legs syndrome
  • Dizziness
  • Anxiety
  • Hemorrhoids

It is not uncommon for people with fibromyalgia to have other conditions, including temporomandibular joint disorder and bladder problems.

What Causes It?

No one knows what causes fibromyalgia, although there are several theories, and multiple factors may bring on the condition, including:

  • Changes in brain chemicals -- Some people with fibromyalgia have abnormal levels of brain chemicals called neurotransmitters. Specifically, they have low levels of serotonin, which affects mood, promotes sleep, and helps reduce the perception of pain. They often have high levels of substance P, which transmits the "pain message" to the brain.
  • Disregulation of the autonomic nervous system -- The autonomic nervous system releases hormones that affect how you react to stress. Some doctors think people with fibromyalgia release these hormones differently when they experience stress, and the hormones affect the perception of pain.
  • Sleep problems -- The majority of people with fibromyalgia report sleep problems, and especially have trouble with stage 4 sleep, the most restful stage in which the body repairs itself. Some doctors believe that the lack of restful sleep means that the muscles of people with fibromyalgia are not able to repair the tiny tears and trauma that occur everyday, leading to muscle pain and fatigue. Other doctors believe that sleep problems are a result, not a cause, of fibromyalgia.
  • Injury and infection -- Fibromyalgia can be triggered by an injury, especially to the upper spine or neck, or an infection caused by a virus or bacteria.
  • Genetics -- The tendency to get fibromyalgia may sometimes be inherited.
  • Having another rheumatic disease -- You may be more likely to get fibromyalgia if you have a disease such as rheumatoid arthritis or lupus.

What to Expect at Your Provider's Office

There is no laboratory test for fibromyalgia, but your doctor may order several tests, including blood tests and x-rays, to rule out other diseases. Your doctor may also press firmly on specific "tender points" on your head and body to see which ones are abnormally sensitive under pressure. Be sure to tell your health care provider about all of your symptoms. You may be referred to a rheumatologist, who specializes in treating rheumatic conditions like fibromyalgia and arthritis.

Treatment Options

The goal is to help you function as well as possible on a daily basis. While it is probably not possible to completely relieve all of your symptoms, medication and certain complementary and alternative therapies may help reduce symptoms.

Drug Therapies

Your health care provider may prescribe the following drugs:

  • Sleep disturbances are often treated successfully with low doses of tricyclic antidepressants, such as amitriptyline (Elavil), doxepin (Sinequan), and nortriptyline (Pamelor, Aventyl). Sometimes doctors may prescribe sleeping pills for short term use.
  • Analgesics treat pain. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen sodium (Aleve), ibuprofen (Advil, Motrin), or prescription NSAIDs. Sometimes these drugs may lessen pain, but they are not effective for everyone. Your doctor may also prescribe tramadol (Ultram), which is often used to treat fibromyalgia pain.
  • Muscle relaxants, such as cyclobenazaprine (Flexeril), can help treat muscle spasms.
  • A technique called "spray and stretch" is sometimes used. A prescription spray coolant is applied to a painful muscle while the muscle is stretched.
  • Pain in specific spots in muscles can be treated with lidocaine or procaine (injected into points where pain is greatest), or with capsaicin (used topically).
  • Depression can be treated with antidepressants, such as fluoxetine (Prozac) and sertraline (Zoloft).
  • Armour Thyroid, a natural thyroid hormone medication, may be helpful if tests show abnormal thyroid function. People with fibromyalgia may want to have their tests examined by both conventional and holistically oriented doctors because levels of thyroid hormone in the blood are often interpreted differently. Specifically, people with fibromyalgia may want to ask for an assessment of T3 levels, a lab test that is rarely ordered by conventional doctors.

Complementary and Alternative Therapies

Nutritional support, exercise, herbs, and mind-body techniques may help reduce symptoms.

Nutrition and Supplements

These nutritional tips may help reduce symptoms:

  • Eliminate potential food allergens, including dairy, wheat (gluten), corn, soy, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
  • Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as kale, spinach, and bell peppers).
  • Avoid refined foods, such as white breads, pastas, and sugar.
  • Eat fewer red meats and more lean meats, cold water fish, tofu (soy, if no allergy) or beans for protein.
  • Use healthy cooking oils, such as olive oil or coconut oil.
  • Reduce or eliminate trans fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
  • Avoid alcohol, tobacco, and caffeine, and limit foods that are high in sugar, salt, and fat. Avoid foods with additives such as monosodium glutamate (MSG).
  • Drink 6 - 8 glasses of filtered water daily.

You can address nutritional deficiencies with the following supplements:

  • Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 2 tablespoons of oil daily, to help decrease inflammation and improve immunity. Talk to your health care provider before taking omega-3 supplements if you are taking blood-thinning medications, such as aspirin or warfarin (Coumadin).
  • A multivitamin daily, containing the antioxidant vitamins A, C, D, E, the B-vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
  • Vitamin C, 500 - 1,000 mg daily, as an antioxidant and for immune support.
  • Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support. Alpha-lipoic acid may decrease thiamine levels. It may also act with certain medications, particularly some medicines used in chemotherapy and in the treatment of thyroid conditions; speak with your doctor.
  • L-carnitine, 500 - 2,000 mg daily, for muscular support. L-carnitine may make symptoms of hypothyroidism worse, and can potentially increase the likelihood of seizure in people with a history of seizures.
  • Magnesium, for symptoms of fibromyalgia. If you have kidney disease, talk to your doctor before taking magnesium. Magnesium can potentially interact with certain medications, including high blood pressure medicines and some antibiotics.
  • S-adenosylmethionine or SAMe, 800 mg daily, for mental and immune support. People who have manic or bipolar disorder should not take SAMe. SAMe may potentially have negative side effects in people with Parkinson's disease. If you are taking any psychoactive medication, speak with your doctor before taking SAMe.
  • Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, when needed for maintenance of gastrointestinal and immune health. Some acidophilus products may need refrigeration -- check labels carefully.
  • Calcium/vitamin D supplement, for support of muscle and skeletal weakness.
  • Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and muscular support. Coenzyme Q10 can interfere with the actions of some blood-thining medications, such as warfarin (Coumadin) and others. Talk with your doctor.
  • Chlorella (Chlorella pyrenoidosa), a blue-green algae, may help lessen symptoms. Participants in a clinical study took a specific dose of 10 g of Sun chlorella tablets and 100 ml of the liquid chlorella extract Wasaka Gold and showed significant improvement in symptoms. More studies are needed. Chlorella contains large amounts of vitamin K, a nutrient that helps the body's clotting function and may interfere with blood-clotting effects of certain medications, such as warfarin (Coumadin) and others.
  • NADH (nicotinamide adenine dinucleotide), 5 - 20 mg daily, for energy. People who have anxiety should start NADH at a lower dose and work up slowly.
  • Melatonin, 0.5 - 3 mg, once daily before bed, for sleep and immune support. Talk to your doctor first if you are using any anti-depressants or other neurological or psychiatric medications.

Exercise

It may seem odd to suggest exercising when your muscles are sore and you are in pain, but a number of studies show that regular, low intensity exercise is one of the most effective treatments for fibromyalgia. Although you may experience a slight increase in pain and soreness when you start, as you continue you will help lessen muscle tension and stiffness, improve sleep quality, and raise serotonin and endorphin levels, helping to reduce pain. Exercise programs should include multiple dimensions, including strength, endurances, flexibility, and balance. Many people with fibromyalgia find warm water aquatic exercises to be helpful. Talk to your doctor or physical therapist to design an exercise program that is best for you.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. of herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Herbal therapies aim to reduce the symptoms of fibromyalgia, or those of common conditions associated with fibromyalgia.

  • Green tea (Camelia sinensis), for antioxidant and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
  • Cat's claw (Uncaria tomentosa), for inflammation, immune, and antifungal activity. Cat's claw can interfere with a variety of medications, and may worsen certain conditions such as leukemia and some autoimmune disorders. Talk to your doctor.
  • Bromelain (Ananus comosus), for pain and inflammation. Bromelain can have a blood thinning effect and increase the effectiveness of blood thinning medications, such as aspirin and Coumadin. People with peptic ulcers should not take bromelain. Bromelain can affect the absorption of certain antibiotics, 5-fluoracil and vincristine, and medications that cause drowsiness, such as benzodiazepines lorazepam (Ativan) or diazepam (Valium), some antidepressants, and narcotics, such as codeine, and barbituates, such as phenobarbitol.
  • Turmeric (Curcuma longa), for imflammation. Turmeric can have a blood thinning effect and can increasethe effectiveness of blood thinning medications, such as aspirin and Coumadin.
  • Rhodiola (Rhodiola rosea), for antioxidant, antistress, and immune activity.
  • Capsicum or capsaicin (Zostrix), as a cream containing .025% capsaicin, applied topically (on the skin) 1 - 3 times daily.

Homeopathy

Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual. Some of the homeopathic remedies used for fibromyalgia are below.

  • Arnica, for someone who feels sore and bruised, and does not want to be touched. Laying down is difficult, and the patient is restless when trying to find a comfortable position. Soreness stays after gentle exercise.
  • Bryonia, used when the slightest movement aggravates pain. The person is usually very thirsty. Pain is worse at night and upon waking in the morning.
  • Calcarea carbonica, for people who tend to move slowly, look pasty, and are always chilly. Exertion leaves them weak and breathless. They feel better when lying down. Being warm relieves symptoms.
  • Rhus toxicodendron, for joint stiffness, worse when starting to move, then easing with more movement. Stiffness is worse in the morning and in cold or damp weather.
  • Ruta graveolens, for sore, bruised pain in the joints and tendons that feel worse when lying on the affected area.

Mind-Body Therapies

Stress makes symptoms of fibromyalgia worse, so mind-body therapies including meditation and biofeedback can be helpful in learning relaxation techniques.

Physical Medicine

Using 2 - 4 cups of Epsom salts in a warm bath can soothe aching muscles.

Acupuncture

Acupuncturists treat people with fibromyalgia based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In fibromyalgia, a qi deficiency is usually detected in the spleen or kidney meridians. Moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) is used to strengthen the entire energy system. Qualified practitioners may also advise people with fibromyalgia on lifestyle and diet, and provide recommendations on the use of herbal medicines.

Chiropractic

Because fibromyalgia generally includes low back pain or neck pain (for which spinal manipulation is beneficial), chiropractors commonly treat people who have this condition. In one small study, women with fibromyalgia reported that they experienced a 77% reduction in pain intensity, 63% improvement in sleep quality, and 75% improvement in fatigue level after receiving 30 chiropractic treatments. Symptom relief continued for 1 month after treatment ended.

Massage

Massage may reduce stress, improve circulation, and soothe sore muscles. Find a massage therapist who has experience working with fibromyalgia.

Following Up

Education and support groups may help you manage your condition.

Supporting Research

Abeles M, Solitar B, Pillinger M, Abeles A. Update on Fibromyalgia Therapy. The American Journal of Medicine. 2008;121(7).

Bartecchi CE. Fibromyalgia and complementary and alternative medicine. Mayo Clin Proc. 2005;80(6):826; author reply 826-7.

Bennett R. Clinical Manifestations and Diagnosis of Fibromyalgia. Rheumatic Diseases Clinics of North America. 2009;35(2).

Bernardy K, Füber N, Klose P, Häuser W. Efficacy of hypnosis/guided imagery in fibromyalgia syndrome--a systematic review and meta-analysis of controlled trials. [Review]. BMC Musculoskelet Disord. 2011;12:133.

Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat. 2010;18:3.

Cao H, Liu J, Lewith GT. Traditional Chinese Medicine for treatment of fibromyalgia: a systematic review of randomized controlled trials. [Review]. J Altern Complement Med. 2010;16(4):397-409. 

Casanueva-Fernández B, Llorca J, Rubió JB, Rodero-Fernández B, González-Gay MA. Efficacy of a multidisciplinary treatment program in patients with severe fibromyalgia. Rheumatol Int. 2011. [Epub ahead of print]. 

Castro-Sánchez AM, Matarán-Peñarrocha GA, Granero-Molina J, Aguilera-Manrique G, Quesada-Rubio JM, Moreno-Lorenzo C. Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. Evid Based Complement Alternat Med. 2011;2011:561753. 

Castro-Sánchez AM, Matarán-Peñarrocha GA, Arroyo-Morales M, Saavedra-Hernández M, Fernández-Sola C, Moreno-Lorenzo C. Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: a randomized controlled trial. Clin Rehabil. 2011;25(9):800-13. 

Chakrabarty S, Zoorob R. Fibromyalgia. Am Fam Physician. 2007;76(2):247-54.

De Silva V, El-Metwally A, Ernst E, Lewith G, Macfarlane GJ; Arthritis Research Campaign working group on complementary and alternative medicines. Evidence for the efficacy of complementary and alternative medicines in the management of fibromyalgia: a systematic review. [Review]. Rheumatology (Oxford).2010;49(6):1063-8. 

Ernst E. Herbal medicine in the treatment of rheumatic diseases. [Review]. Rheum Dis Clin North Am. 2011;37(1):95-102.

Firestein: Kelly's Textbook of Rheumatology, 8th ed. Philadelphia, PA: Saunders. 2008.

Gunnarsdottir TJ, Peden-McAlpine C. Effects of reflexology on fibromyalgia symptoms: a multiple case study. Complement Ther Clin Pract. 2010;16(3):167-72.

Häuser W, Klose P, Langhorst J, Moradi B, Steinbach M, Schiltenwolf M, Busch A. Efficacy of different types of aerobic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomised controlled trials. [Review]. Arthritis Res Ther. 2010;12(3):R79. 

Hsu MC, Schubiner H, Lumley MA, Stracks JS, Clauw DJ, Williams DA. Sustained pain reduction through affective self-awareness in fibromyalgia: a randomized controlled trial. J Gen Intern Med. 2010;25(10):1064-70.

Itoh K, Kitakoji H. Effects of acupuncture to treat fibromyalgia: a preliminary randomised controlled trial. Chin Med. 2010;5:11. 

Kalichman L. Massage therapy for fibromyalgia symptoms. [Review]. Rheumatol Int. 2010;30(9):1151-7.

Langhorst J, Klose P, Musial F, Irnich D, Häuser W. Efficacy of acupuncture in fibromyalgia syndrome--a systematic review with a meta-analysis of controlled clinical trials. Rheumatology (Oxford).2010;49(4):778-88. 

McBeth J, Jones K. Epidemiology of chronic musculoskeletal pain. Best Pract Res ClinRheumatol. 2007;21(3):403-25.

Müller W, Schneider EM, Stratz T. The classification of fibromyalgia syndrome. Rheumatol Int. 2007;27(11):1005-10.

Perry R, Terry R, Ernst E. A systematic review of homoeopathy for the treatment of fibromyalgia. [Review]. Clin Rheumatol. 2010;29(5):457-64

Porter NS, Jason LA, Boulton A, Bothne N, Coleman B. Alternative medical interventions used in the treatment and management of myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia. [Review]. J Altern Complement Med. 2010;16(3):235-49.

Reiter RJ, Acuna-Castroviejo D, Tan DX. Melatonin therapy in fibromyalgia. Curr Pain Headache Rep. 2007;11(5):339-42.

Schmidt S, Grossman P, Schwarzer B, Jena S, Naumann J, Walach H. Treating fibromyalgia with mindfulness-based stress reduction: results from a 3-armed randomized controlled trial. Pain. 2011;152(2):361-9. 

Staud R. Treatment of fibromyalgia and its symptoms. Expert Opin Pharmacother. 2007;8(11):1629-42.

Targino RA, Imamura M, Kaziyama HH, Souza LP, Hsing WT, Furlan AD, Imamura ST, Azevedo Neto RS. A randomized controlled trial of acupuncture added to usual treatment for fibromyalgia. J Rehabil Med. 2008;40(7):582-8.

Terhorst L, Schneider MJ, Kim KH, Goozdich LM, Stilley CS. Complementary and alternative medicine in the treatment of pain in fibromyalgia: a systematic review of randomized controlled trials. [Review]. J Manipulative Physiol Ther. 2011;34(7):483-96.

Terry R, Perry R, Ernst E. An overview of systematic reviews of complementary and alternative medicine for fibromyalgia. Clin Rheumatol. 2012;31(1):55-66.

Vas J, Modesto M, Aguilar I, Santos-Rey K, Benítez-Parejo N, Rivas-Ruiz F. Effects of acupuncture on patients with fibromyalgia: study protocol of a multicentre randomized controlled trial. Trials. 2011;12:59.

Wang C. Tai chi and rheumatic diseases. [Review]. Rheum Dis Clin North Am. 2011;37(1):19-32.

Zoppi M, Maresca M. Symptoms accompanying fibromyalgia. Reumatismo. 2008;60(3):217-20.


Review Date: 3/4/2012
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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