Definition of Fibromyalgia

Fibromyalgia is a chronic condition of pain felt in the muscles and connective tissues throughout the body, with accompanying fatigue and multiple trigger points (areas on the body where the slightest touch activates a severe pain response).

Characteristically people experience a constant level of discomfort with pressure or contact causing overt pain in the shoulders, chest, back, hips, and knees. Many people also experience stiffness in the areas of pain, similar to the stiffness of rheumatoid arthritis or osteoarthritis.

However, there is no joint inflammation or deterioration with fibromyalgia. Fibromyalgia may persist for months to years.

About 6 million Americans have fibromyalgia, the majority of whom are women. Researchers believe fibromyalgia develops through a convergence of multiple factors.

Symptoms and Diagnostic Path

The symptoms of fibromyalgia are widely variable, making diagnosis somewhat of a challenge for many people. Some people have periods of weeks to months without any symptoms, interlaced with periods of weeks to months with symptoms severe enough to prevent normal activity. Other people have a clear path of symptom onset, persistence, and improvement that spans months to years. Characteristic symptoms of fibromyalgia include

  • Muscle pain throughout the body
  • Sleep disturbances such as insomnia and restless legs syndrome
  • Fatigue
  • Gastrointestinal symptoms that suggest irritable bowel syndrome (IBS), such as frequent nausea and diarrhea
  • Depression, anxiety, and mood swings
  • Headaches
  • Hypersensitivity to sensory stimulation (sight, sound, touch, taste, smell)

The diagnostic path begins with a comprehensive medical examination including general blood and urine tests, a neurologic examination, and detailed personal health history. The doctor may conduct further tests to rule out other conditions that can cause similar symptoms, such as rheumatoid arthritis and systemic lupus erythematosus (SLE).

However, there are no tests that can confirm the diagnosis of fibromyalgia. Doctors typically follow clinical guidelines for reaching a diagnosis of fibromyalgia that include the presence of these key signs:

  • Diagnostic tests rule out other possible causes for the symptoms
  • Point tenderness (discomfort or pain with mild pressure) at a minimum of 11 places on the body
  • Widespread, persistent aching or pain in the muscles and joints for at least three months

The diagnosis also considers factors researchers believe may be precipitating, such as recent infection or injury, the existence of any autoimmune disorders, and family history of fibromyalgia. Symptoms generally begin between ages 30 and 50.

Treatment Options and Outlook

Treatment efforts focus on relieving symptoms to a degree that allows participation in regular activities and satisfactory quality of life with the presumption that symptoms will persist indefinitely.

Though the condition may eventually go away, in most people the course of fibromyalgia is unpredictable though symptoms do not worsen.

Treatment is a process of finding the combination of approaches that most effectively relieves symptoms. Common treatment options include

  • Analgesic medications such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDS) to relieve pain
  • Antidepressant medications to treat depression and to relieve pain
  • Muscle relaxant medications
  • Chiropractic, osteopathic manipulative treatment (omt), and massage therapy to relax muscles and improve range of motion and flexibility of joints
  • Acupuncture for pain relief and stress reduction
  • Yoga and tai chi to improve flexibility, strength, and balance and to relieve stress
  • Meditation for stress relief

Doctors seldom prescribe narcotic pain relievers, sleep medications, corticosteroid medications (such as prednisone), or benzodiazepine muscle relaxants (such as diazepam), because these treatments interfere with normal activities and are not proven to improve symptoms long term. As well, the side effects and potential dependency issues with these medications are greater than the shortterm benefits for most people.

Doctors also recommend daily physical exercise because it increases the release of endorphins and enkephalins, the body’s natural pain relievers. It also stretches and strengthens the muscles and connective tissues, and promotes a sense of accomplishment and well-being.

Risk Factors and Preventive Measures

About 80 percent of people who have fibromyalgia are women, though researchers do not know why this gender correlation exists. People who have autoimmune forms of arthritis, such as rheumatoid arthritis or ankylosing spondylitis, also have increased risk for fibromyalgia.

Because researchers do not know what causes fibromyalgia, there are no recommended preventive measures.

See also ACUTE PAIN; ALTERNATIVE METHODS FOR PAIN RELIEF; CHRONIC FATIGUE SYNDROME; CHRONIC PAIN; STRESS AND STRESS MANAGEMENT.

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