Fibromyalgia syndrome is a complex and poorly understood arthritis-related disorder characterized by chronic generalized pain and muscle tender points. Fibromyalgia is estimated to affect 3.7 million Americans, the majority of whom are women ages 35-55.
Causes of Fibromyalgia
Although the exact cause is unknown, it appears that the central nervous system’s response to pain is altered in patients with the Fibromyalgia syndrome. Patients experience a low pain threshold and allodynia, which means that stimuli that normally are not painful, like mild pressure over a muscle, are perceived as painful by the affected individual. Several theories are proposed as to what might trigger the syndrome to begin, such as physical or emotional trauma, a febrile illness, genetic predisposition leading to altered enzymes or receptors in the nervous system, depression and sleep disorders. No single cause has been found to link all the patients with the syndrome, so research is ongoing.
- At least 3 months of widespread body pain (pain affects both sides of the body, above and below the waist)
- Pain in 11 of 14 body tender points on a doctor’s physical examination
- Normal neurological and rheumatological exams, including laboratory studies
- Associated symptoms of sleep disturbance, extreme fatigue, depression and anxiety, headaches, cognitive difficulties (“fibro fog”), bladder irritability and irritable bowel syndrome
Examination and Tests
Your doctor will take a thorough history to establish the length of time during which you have noted symptoms and where you are experiencing pain. You may be asked about the associated symptoms that can go along with the Fibromyalgia syndrome and any past treatment or testing you have undergone.
The physical examination will be directed at ruling out other disorders that can have a similar presentation to the Fibromyalgia syndrome. Particular attention will be directed at joints, muscles, reflex and sensory nerve function.
The doctor may then order blood tests, an EMG (electromyogram) or scans, like MRIs, if needed, to rule out other disorders that can present with symptoms like the Fibromyalgia syndrome.
Treatment for Fibromyalgia
The categories of treatment for the Fibromyalgia syndrome are diverse, as no single therapeutic intervention has been found to be successful in all patients. Patients are generally helped by:
- Exercise – physical therapy directed, warm pool therapy and walking are ways many patients start exercising.
- Cognitive Behavioral Therapy – tries to improve dysfunctional thinking and teach methods to deal with stressful situations.
- Sleep Management – works to increase deep restorative sleep.
- Education – addresses diet, stress management and depression/anxiety issues.
- Daily Medications – central acting medications are often used to address the abnormal central pain processing. These medicines are either anti-depressants or anti-convulsants (seizure medications). FDA-approved examples are Cymbalta, from the anti-depressant class, and Lyrica, from the anti-convulsant class. Several older generic medications are frequently used as well, but they do not have FDA approval for their use in the Fibromyalgia syndrome, as formal studies have not been done. These medications include Amitripyline, Nortriptyline and Effexor, from the anti-depressant class, and Gabapentin, from the anti-convulsant class. This is certainly not a complete list of the medicines used to treat the Fibromyalgia syndrome.
- Medications that may be prescribed to be used as needed – these medications transiently decrease pain severity, but don’t alter the overall syndrome. Examples are muscle relaxants, Cyclobenzaprine, Methocarbamol and Tizanidine; anti-inflammatories, Motrin, Aleve, Celebrex and Nambutone; and pain medications such as Tramadol.
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