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Fibromyalgia

Fibromyositis; Fibrositis

 

Fibromyalgia is a common syndrome in which a person has long-term pain that is spread throughout the body. The pain is most often linked to fatigue, sleep problems, headaches, depression, and anxiety.

People with fibromyalgia may also have tenderness in the joints, muscles, tendons, and other soft tissues.

Causes

 

The cause is unknown. Possible causes or triggers of fibromyalgia include:

  • Physical or emotional trauma.
  • Abnormal pain response: Areas in the brain that control pain may react differently in people with fibromyalgia.
  • Sleep disturbances.
  • Infection, such as a virus, although none has been identified.

Fibromyalgia is most common among women age 20 to 50.

The following conditions may be seen with fibromyalgia or have similar symptoms:

  • Chronic neck or back pain
  • Chronic fatigue syndrome
  • Depression
  • Hypothyroidism (underactive thyroid)
  • Lyme disease
  • Sleep disorders

 

Symptoms

 

Pain is the main symptom of fibromyalgia. It may be mild to severe.

  • Painful areas are called tender points. Tender points are found in the soft tissue on the back of the neck, shoulders, chest, lower back, hips, shins, elbows, and knees. The pain then spreads out from these areas.
  • The pain may feel like a deep ache, or a shooting, burning pain.
  • The joints are not affected, although the pain may feel like it is coming from the joints.

People with fibromyalgia tend to wake up with body aches and stiffness. For some people, pain improves during the day and gets worse at night. Some people have pain all day long.

Pain may get worse with activity, cold or damp weather, anxiety, and stress.

Fatigue, depressed mood, and sleep problems occur in almost all people with fibromyalgia. Many people say that they cannot get to sleep or stay asleep, and they feel tired when they wake up.

Other symptoms of fibromyalgia may include:

  • Irritable bowel syndrome (IBS)
  • Memory and concentration problems
  • Numbness and tingling in hands and feet
  • Reduced ability to exercise
  • Tension or migraine headaches

 

Exams and Tests

 

To be diagnosed with fibromyalgia, you must have had at least 3 months of widespread pain with one or more of the following:

  • Ongoing problems with sleep
  • Fatigue
  • Thinking or memory problems

It is no longer necessary to find tender points during the exam to make a diagnosis.

Results from blood and urine tests, and imaging tests are normal. However, these tests may be done to rule out other conditions with similar symptoms. Studies of breathing during sleeping may be done to find out if you have a condition called sleep apnea.

 

Treatment

 

The goals of treatment are to help relieve pain and other symptoms, and to help a person cope with the symptoms.

The first type of treatment may involve:

  • Physical therapy
  • Exercise and fitness program
  • Stress-relief methods, including light massage and relaxation techniques

If these treatments do not work, your health care provider may also prescribe an antidepressant or muscle relaxant.

  • The goal of these medicines is to improve your sleep and help you better tolerate pain.
  • Medicine should be used along with exercise and behavior therapy.
  • Duloxetine (Cymbalta), pregabalin (Lyrica), and milnacipran (Savella) are drugs that are approved specifically for treating fibromyalgia.

Other drugs are also used to treat the condition, such as:

  • Anti-seizure drugs, such as gabapentin.
  • Other antidepressants, such as amytriptyline.
  • Muscle relaxants, such as cyclobenzeprine.
  • Pain relievers, but avoid narcotics, since they usually do not help.
  • Sleeping aids: If you have sleep apnea, an apparatus called CPAP may be prescribed.

Cognitive-behavioral therapy is an important part of treatment. This therapy helps you learn how to:

  • Deal with negative thoughts.
  • Keep a diary of pain and symptoms.
  • Recognize what makes your symptoms worse.
  • Seek out enjoyable activities.
  • Set limits.

Support groups may also be helpful.

Things you can do to help take care of yourself include:

  • Eat a well-balanced diet.
  • Avoid caffeine.
  • Practice a good sleep routine to improve quality of sleep.
  • Exercise regularly, starting with low-level exercise.
  • Try acupressure and acupuncture treatments.

Your doctor may refer you to a pain clinic if your condition is severe.

 

Outlook (Prognosis)

 

Fibromyalgia is a long-term disorder. Sometimes, the symptoms improve. Other times, the pain may get worse and continue for months or years.

 

When to Contact a Medical Professional

 

Call your health care provider if you have symptoms of fibromyalgia.

 

Prevention

 

There is no known prevention.

 

 

References

Bennett RM. Fibromyalgia, chronic fatigue syndrome, and myofascial pain. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 274.

Marvisi M, Balzarini L, Mancini C, Ramponi S, Marvisi C. Fibromyalgia is frequent in obstructive sleep apnea and responds to CPAP therapy. Eur J Intern Med. 2015;26(9):e49-50. PMID: 26129987 www.ncbi.nlm.nih.gov/pubmed/26129987.

McBeth J, Prescott G, Scotland G, et al. Cognitive behavior therapy, exercise, or both for treating chronic widespread pain. Arch Intern Med. 2012(1);48-57. PMID: 22082706 www.ncbi.nlm.nih.gov/pubmed/22082706.

Wolfe F, Clauw DJ, Fitzcharles MA, et al. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR preliminary diagnostic criteria for fibromyalgia. J Rheumatol. 2011;38:1113. PMID: 21285161 www.ncbi.nlm.nih.gov/pubmed/21285161.

Wolfe F, Clauw DJ, Fitzcharles MA, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010;62(5):600-610. PMID: 20461783 www.ncbi.nlm.nih.gov/pubmed/20461783.

Wolfe F, Rasker JJ. Fibromyalgia. In: Firestein GS, Budd RC, Gabriel SE, et al, eds. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 52.

 
  • Fibromyalgia

    Fibromyalgia

    Animation

  •  

    Fibromyalgia - Animation

    Usually when you're in pain, you can quickly find the cause, like the muscle you strained while working out, or the cut you gave yourself while slicing carrots. Yet for people with fibromyalgia, the source of their pain is harder to pinpoint. Although they experience pain daily, it can take some time to find the cause, and to get the right treatment for it. Fibromyalgia is still somewhat of a mystery, because no one knows what causes it and it's often mistaken for conditions with similar symptoms, like Lyme disease or depression. Some people think fibromyalgia stems from physical or emotional trauma. Others believe it's caused by an abnormal response to pain. Whatever the cause, fibromyalgia leads to widespread areas of pain on both sides of the body, and both below and above the waist. The pain may feel like an ache, or a sharp stabbing feeling, and it doesn't go away. To be diagnosed with fibromyalgia, you need to have physical findings at at least 11 specific tender points, which can be in your arms, buttocks, chest, knees, lower back, neck, rib cage, shoulders, or thighs. Doctors may diagnose fibromyalgia without a tender point examination by using the widespread pain index (WPI), and the symptoms severity scale score (SS). If the symptoms have been present at a similar level for at least 3 months and there is no other disorder that would otherwise explain the pain. The pain may get worse when you exercise, go outside in cold weather, or are under a lot of stress. In addition to pain, you may have problems concentrating or fatigue, and waking up unrefreshed. And you may have any of a long list of other symptoms as well including in the GI tract, urinary system, nervous system, and skin. There's no cure for fibromyalgia, but there are treatments to control your symptoms. Your doctor will probably start you on an exercise regimen and have you work with a physical therapist. Some have found real help from acupuncture, learning Tai Chi, or taking yoga classes. You may also need to take medicine to help you sleep and relieve your pain. Medicines that are commonly prescribed for fibromyalgia include antidepressants, antiseizure medications, pain relievers, and sleep aids. Meanwhile, talking to a therapist can help you better manage and live with your pain, and deal with any negative thoughts you may have about your condition. Despite improvements in the way doctors diagnose and treat fibromyalgia, it's still a chronic condition. But by working with your doctor, you can manage the symptoms and learn to live with them, so that you can control your fibromyalgia, rather than the other way around.

  • Fibromyalgia

    Fibromyalgia - illustration

    Fibromyalgia is a common rheumatic syndrome indicating widespread pain in fibrous tissues, muscles, tendons, and other connective tissues, resulting in painful muscles without weakness. The cause of this disorder is unknown, although it is a chronic problem that can come and go for years. The nine paired red circles are recognized as common tender points associated with fibromyalgia

    Fibromyalgia

    illustration

  • Fibromyalgia

    Animation

  •  

    Fibromyalgia - Animation

    Usually when you're in pain, you can quickly find the cause, like the muscle you strained while working out, or the cut you gave yourself while slicing carrots. Yet for people with fibromyalgia, the source of their pain is harder to pinpoint. Although they experience pain daily, it can take some time to find the cause, and to get the right treatment for it. Fibromyalgia is still somewhat of a mystery, because no one knows what causes it and it's often mistaken for conditions with similar symptoms, like Lyme disease or depression. Some people think fibromyalgia stems from physical or emotional trauma. Others believe it's caused by an abnormal response to pain. Whatever the cause, fibromyalgia leads to widespread areas of pain on both sides of the body, and both below and above the waist. The pain may feel like an ache, or a sharp stabbing feeling, and it doesn't go away. To be diagnosed with fibromyalgia, you need to have physical findings at at least 11 specific tender points, which can be in your arms, buttocks, chest, knees, lower back, neck, rib cage, shoulders, or thighs. Doctors may diagnose fibromyalgia without a tender point examination by using the widespread pain index (WPI), and the symptoms severity scale score (SS). If the symptoms have been present at a similar level for at least 3 months and there is no other disorder that would otherwise explain the pain. The pain may get worse when you exercise, go outside in cold weather, or are under a lot of stress. In addition to pain, you may have problems concentrating or fatigue, and waking up unrefreshed. And you may have any of a long list of other symptoms as well including in the GI tract, urinary system, nervous system, and skin. There's no cure for fibromyalgia, but there are treatments to control your symptoms. Your doctor will probably start you on an exercise regimen and have you work with a physical therapist. Some have found real help from acupuncture, learning Tai Chi, or taking yoga classes. You may also need to take medicine to help you sleep and relieve your pain. Medicines that are commonly prescribed for fibromyalgia include antidepressants, antiseizure medications, pain relievers, and sleep aids. Meanwhile, talking to a therapist can help you better manage and live with your pain, and deal with any negative thoughts you may have about your condition. Despite improvements in the way doctors diagnose and treat fibromyalgia, it's still a chronic condition. But by working with your doctor, you can manage the symptoms and learn to live with them, so that you can control your fibromyalgia, rather than the other way around.

  • Fibromyalgia

    Fibromyalgia - illustration

    Fibromyalgia is a common rheumatic syndrome indicating widespread pain in fibrous tissues, muscles, tendons, and other connective tissues, resulting in painful muscles without weakness. The cause of this disorder is unknown, although it is a chronic problem that can come and go for years. The nine paired red circles are recognized as common tender points associated with fibromyalgia

    Fibromyalgia

    illustration

A Closer Look

 

 

Review Date: 1/16/2016

Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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