About Fibromyalgia

 

What is Fibromyalgia?

Fibromyalgia (or "FM" for short) is a complex, chronic condition which causes widespread pain and fatigue as well as other symptoms. Unlike arthritis, FM does not affect the joints directly or cause swelling there. Rather, it produces tenderness throughout the body along with pain and stiffness in muscles and soft tissue (including those which surround joints). The pain of FM usually consists of aching or burning described as "head-to-toe" and muscle spasm. Pain can vary in severity from day to day. Sometimes, it can be so intense that it interferes with the performance of even simple tasks, while other times it may cause only moderate discomfort. Likewise, the fatigue of FM also varies, ranging from a mild, tired feeling to the exhaustion of a severe, flu-like illness.

The exact prevalence of FM in the U.S. population has not been thoroughly studied, but conservative estimates place the total between 4 and 6 million. Other experts believe the true number is closer to 10 million. Fibromyalgia disproportionately affects women, many of them working age, so FM has obvious consequences in terms of employment and family stress. FM also occurs in all other age groups as well as in men, and it exists in all races worldwide.



FM-Related Symptoms & Syndromes

 

Other Symptoms

In addition to pain and fatigue, a number of symptoms may be experienced with FM. Like pain/fatigue, their severity may wax and wane over time, and individuals may differ in the extent to which they are troubled by them. Possible symptoms include:

Stiffness: Body stiffness is usually most apparent upon awakening, after prolonged periods of sitting or standing, or with changes in barometric pressure.

Sleep Disturbances: Despite sufficient amounts of sleep, FM patients may awaken feeling unrefreshed, as if they have barely slept. Alternatively, they may have trouble falling asleep or staying asleep.

Cognitive Difficulties: These include difficulty concentrating, "spaciness" or "fibro-fog," memory lapses, difficulty thinking of words/names, and feeling overwhelmed when multi-tasking.

Paresthesia: Numbness or tingling, particularly in the hands or feet, sometimes accompanies FM. The sensation, usually called "paresthesia," can also be described as prickling or burning.

Postural Problems: Individuals with FM who engage in activities which involve continuous, forward body posture (i.e., typing, desk work, assembly line work) often have special problems with chest and upper body (thoracic) pain and dysfunction which can, in turn, cause shallow breathing and worsen postural problems.

Sensory Sensitivity/Allergy-like Symptoms: Hyper-sensitivity to light, sound, touch, odors, and ambient temperature frequently occurs among those with FM. Also, it is not uncommon for them to experience reactions to certain substances accompanied by itching, rash, nasal congestion, and sinus pain (non-allergic rhinitis). Dryness of the eyes and mouth (sicca syndrome) can be a problem. They may also feel chilled or cold when others around them are comfortable, or they may feel much warmer than others in the same room.

Difficulty With Balance/Light-Headedness: FM patients may be troubled by vestibular problems for a variety of reasons. Since fibromyalgia is thought to affect the skeletal tracking muscles of the eyes, "visual confusion" and nausea may be experienced when driving a car, reading a book, or visually tracking objects. Alternatively, over-stressed muscles and/or myofascial trigger points in the neck may cause dizziness and unsteadiness. Some FM patients may experience neurally mediated hypotension, a drop in blood pressure and heart rate upon standing, which causes light-headedness, nausea, and "brain fog."

Raynaud's Symptoms: Some FM patients suffer from constriction of the small blood vessels in the hands and feet when they are exposed to cold weather or air conditioning or when they open a freezer. Hands or feet turn cold and white or bluish and eventually other colors like purple or red. Numbness can also occur with pain/discomfort later on as hands or feet re-warm.

Depression & Anxiety: Although FM patients are frequently misdiagnosed with depression or anxiety disorders ("it's all in your head"), research has repeatedly shown that fibromyalgia is not a form of depression or hypochondriasis. Where depression or anxiety do independently co-exist with fibromyalgia or occur as a result of severe FM, treatment is important as both can exacerbate FM and interfere with successful symptom management.

 

Other Medical Conditions Known To Co-exist Or Overlap With Fibromyalgia

Gastrointestinal Upset: Digestive disturbances, abdominal pain, and bloating are quite common with FM as are constipation and/or diarrhea (or a combination of the two). Together these symptoms are usually known as "irritable bowel syndrome" or IBS. In addition, esophageal dysmotility may be a problem.

Myofascial Pain: A significant number of people with FM have myofascial pain due to trigger points, a neuromuscular condition in which hyper-irritable spots (trigger points) form in taut bands in skeletal muscle or its surrounding fascia, often as a result of injury, prolonged poor posture, illness, or repetitive motion at a work station. These spots are very painful and can refer pain to other parts of the body in very predictable ways and cause limited range of motion, loss of strength and stamina, and a variety of non-pain symptoms. Temporomandibular joint (TMJ) dysfunction, a condition which affects the jaw joints and surrounding muscles and occurs in an estimated one-third to one-half of those with FM, often includes significant myofascial pain.

Chronic Fatigue Syndrome (CFS), also known as chronic fatigue and immune dysfunction syndrome (CFIDS): involves extremely incapacitating fatigue and poor stamina which cannot be accounted for by any other medical condition. Officially, its symptoms, in addition to fatigue, include muscle pain, joint pain, sore throat, tender lymph nodes, problems with short-term memory, difficulty concentrating, headaches, malaise after exertion, and unrestful sleep. Some of these symptoms are similar to those experienced by FM patients.

Genito-Urinary Disorders: FM patients may experience increased frequency of urination or increased urgency to urinate, typically in the absence of a bladder infection (irritable bladder syndrome). Some may develop a chronic, painful inflammatory condition of the bladder wall known as interstitial cystitis. Women with FM may have more painful menstrual periods or experience a worsening of their FM symptoms during this time. Conditions such as vulvodynia, characterized by a painful vulvar region and pain during sexual activity, may also develop.

Restless Leg Syndrome (RLS): A neurologic disorder which involves a "creepy crawly" sensation in the legs and an irresistible urge to move the legs when at rest or when lying down. The syndrome may also involve periodic limb movements during sleep (PLMS) which can be very disruptive to both the patient and the sleeping partner.

FM & Other Rheumatic Conditions: Can FM occur concurrently with other rheumatic conditions? Eminent fibromyalgia researcher, Robert Bennett, M.D., answers this way:  "Long-term followup of fibromyalgia patients has shown that it is very unusual for them to develop another rheumatic disease or neurological condition. However, it is quite common for patients with well established rheumatic disease, such as rheumatoid arthritis, systemic lupus, or Sjögren's Syndrome to also have fibromyalgia."
(Source: www.myalgia.com)

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Official Diagnostic Criteria

In 1990, official diagnostic criteria for FM were established by the American College of Rheumatology (ACR) to provide researchers with a standardized framework with which to classify patients for study. [Arthritis & Rhematism 1990;33(2)]  The 1990 criteria include the following.

(1) A History of Widespread Pain: Chronic, widespread, musculoskeletal pain lasting longer than three months in all four quadrants of the body. ("Widespread pain" is defined as pain above and below the waist and on both sides of the body.) In addition, axial skeletal pain (in the cervical spine, anterior chest, thoracic spine, or low back) must be present.

(2) Pain in 11 of 18 Tender Point Sites on Digital Palpation: There are 18 tender points in anatomically specific locations that doctors look for in making a fibromyalgia diagnosis. According to the ACR requirements, a patient must have 11 of the 18 tender points to be diagnosed with fibromyalgia. Approximately four kilograms of pressure (or about 9 lbs.) must be applied to a tender point, and the patient must indicate that the tender point locations are painful. As the ACR criteria suggest, a FM diagnosis requires the "hands-on" evaluation of a patient by a skilled medical professional. Because routine laboratory and x-ray tests are often normal in patients, a complete medical history and physical exam are crucial for a correct diagnosis. Since FM symptoms can mimic several other diseases (i.e., lupus, polymyalgia rheumatic, thyroid disease, and MS), it is necessary to rule out such conditions before a diagnosis is made.

In 2010, a new supplemental questionnaire was proposed for use in physicians' offices to help in the diagnosis of fibromyalgia. The criteria are currently being considered by the American College of Rheumatology.

What Causes Fibromyalgia?

At one time, researchers believed that there was pathology in the muscles and soft tissues of people with FM. In recent years, however, research has documented abnormalities in the levels of several neurochemicals in the brain and spinal cord as well as irregularities in the functioning of the autonomic nervous system and the body's pain processing system, making it clear that FM is a centrally-mediated condition rather than one originating in the periphery. Although genetic research in the field is still in its infancy, there is already evidence that FM runs in some families. The condition can be triggered in pre-disposed individuals by a traumatic injury to the body (i.e., an auto accident or fall), a severe illness/surgery, or acute stress. In some people FM develops for no readily apparent reason.

Summary of Fibromyalgia Management

The goal of treatment is to manage fibromyalgia symptoms to the greatest extent possible. Because symptoms vary from patient to patient, it is necessary to tailor treatment plans to fit individual needs and to find a regimen which offers useful improvement. Options typically include medication(s), physical rehabilitation /exercise, and alternative therapies - used singly or in combination.

Medications: The prescription drugs most frequently prescribed for fibromyalgia are those which address the prominent FM symptoms of pain and fatigue. Because some FM patients are sensitive to medications, a low dosage may need to be prescribed at first and then slowly increased. Low-dose, tricyclic anti-depressants (TCA's) and muscle relaxants are popular choices which have a long track record of testing and evaluation. When treating acute pain over an extended period, long-term narcotic analgesics can be used. Still being evaluated by researchers are newer FDA-approved medications for FM called selective serotonin and norepinephrine reuptake inhibitors (SSNRI's). When levels of serotonin and norepinephrine are increased, they activate mechanisms in the body which reduce pain. As with all medications, the potential adverse effects of drugs for FM need to be discussed.

Physical Rehabilitation & Exercise: A wide variety of hands-on "body work" therapies are available to individuals with FM. These include massage therapy, craniosacral therapy, muscle/joint re-education, and for those who have myofascial pain due to trigger points - trigger point therapy. Also recommended are gentle stretching and low-impact exercises (i.e., walking/treadmill, aquatic exercise in warm water, and bicycling).Working with a personal trainer can also be very beneficial. Because successful treatment can sometimes require a variety of medical professionals, a coordinated, team approach to FM management is recommended when feasible.

Complementary/Alternative Treatments: Other useful approaches include: acupuncture, postural training, tai chi/qigong, yoga, relaxation therapy, biofeedback, neurotherapy, nutritional counseling, and cognitive behavioral therapy.

See also:

NFP's 2010 Guide to Fibromyalgia Management

 

 

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National Fibromyalgia Partnership, Inc.
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The National Fibromyalgia Partnership, Inc., is a 501(c)(3) non-profit, educational organization established in 1992.