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Fibromyalgia

Fibromyalgia is a chronic condition described as widespread pain in your muscles, ligaments and tendons, as well as fatigue and multiple tender points — places on your body where slight pressure causes pain. This condition is more common in women than in men. Fibromyalgia may also be known by other names such as fibrositis, chronic muscle pain syndrome, psychogenic rheumatism and tension myalgias.

While the intensity of your symptoms may vary, it is unlikely the pain will disappear completely. Fortunately, fibromyalgia isn't progressive or life-threatening. Treatments and certain self-care steps can improve symptoms caused by fibromyalgia and your general health.
Factors such as weather, stress, physical activity or even the time of day may affect the signs and symptoms of fibromyalgia.

Causes

head pain The cause of fibromyalgia is unknown. A theory known as "central sensitization" states that people with fibromyalgia have a lower threshold for pain because of increased sensitivity in the brain to pain signals.

Studies show that repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain's pain receptors (neurons) — which receive signals from the neurotransmitters — seem to develop a sort of memory of the pain and become more sensitive, this can result in overreaction to pain signals. Pressure on a spot on the body that wouldn't hurt someone without fibromyalgia can be very painful to someone with the condition. It is unknown what initiates this process of central sensitization.

A number of factors may contribute to the development of fibromyalgia.

Other theories as to the cause of fibromyalgia include:

  • Sleep disturbances. Some theories point to disturbed sleep patterns as a cause rather than just a symptom of fibromyalgia.
  • Injury. An injury or trauma to the upper spinal region, may initiate the development of fibromyalgia in some people. It is possible for an injury to affect your central nervous system, which may trigger fibromyalgia.
  • Infection. A viral or bacterial infection may trigger fibromyalgia.
  • Abnormalities of the autonomic (sympathetic) nervous system. Part of your autonomic nervous system — the sympathetic, or involuntary, system — controls bodily functions that are not consciously controlled, such as heart rate, blood vessel contraction, sweating, salivary flow and intestinal movements. Sympathetic nervous system dysfunction may occur in people with fibromyalgia, in particular at night, which can lead to fatigue, stiffness, dizziness and other signs and symptoms associated with the condition.
  • Changes in muscle metabolism. Differences in metabolism and abnormalities in the hormonal substance that influences the activity of nerves may play a role.

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Symptoms

  • Widespread pain. Fibromyalgia is often characterized by pain in specific areas of your body when pressure is applied, including the back of your head, upper back and neck, upper chest, elbows, hips and knees. The pain usually persists for months at a time and accompanied by stiffness.

  • Fibromyalgia PainFatigue and sleep disturbances. While it may seem they get plenty of sleep, people with fibromyalgia often wake up tired and unrefreshed. This sleep problem may be the result of a sleep disorder called alpha wave interrupted sleep pattern, a condition in which deep sleep is frequently interrupted by bursts of brain activity similar to wakefulness. This condition causes people with fibromyalgia to miss the deep restorative stage of sleep. Other conditions, such as nighttime muscle spasms and restless legs syndrome, may also be associated with fibromyalgia.

  • Irritable bowel syndrome (IBS). Sufferers of fibromyalgia may also experience the constipation, diarrhea, abdominal pain and bloating associated with IBS.

  • Headaches and facial pain. Headaches and facial pain related to tenderness or stiffness in the neck and shoulders may be experienced by fibromyalgia sufferers.

  • Temporomandibular joint (TMJ) dysfunction. Also common in people with fibromyalgia, this affects the jaw joints and surrounding muscles.

  • Heightened sensitivity. People with fibromyalgia often report being sensitive to odors, noises, bright lights and touch.

  • Other common signs and symptoms include:

    • Depression
    • Numbness or tingling sensations in the hands and feet (paresthesia)
    • Difficulty concentrating
    • Mood changes
    • Chest pain
    • Dry eyes, skin and mouth
    • Painful menstrual periods
    • Dizziness
    • Anxiety

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Diagnosis

It is often difficult to diagnose fibromyalgia due to the fact that, oftentimes, lab testing appears normal and many of the symptoms are similar to those of other disorders. A definitive diagnosis of fibromyalgia syndrome is usually only be made when no other medical disease can explain the symptoms. Fibromyalgia is often a diagnosis of exclusion.

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Treatment

Treatment for fibromyalgia includes both medication and home therapy. The goal is to minimize symptoms and improve general health.

Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:

  • Analgesics. Acetaminophen (Tylenol, others) may help relieve the pain and stiffness caused by fibromyalgia. However, its effectiveness varies. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) — such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen sodium (Anaprox, Aleve) — when combined with other medications. NSAIDs have not shown to be effective in managing the pain in fibromyalgia when taken by themselves.
  • Antidepressants. Your doctor may prescribe antidepressant medications such as to help promote sleep. Some studies show that a newer class of antidepressants known as serotonin and norepinephrine reuptake inhibitors may help to regulate two brain chemicals that may transmit pain signals.
  • Muscle relaxants. Taking certain muscle relaxants at bedtime may help treat muscle pain and spasms. In most cases, muscle relaxants should be limited to short-term use.

Cognitive behavior therapy

This behavior therapy attempts to strengthen your belief in your abilities and teaches you methods for dealing with stressful situations. Therapy may take place through individual counseling, classes, or through tapes, CDs or DVDs. This behavior therapy may help improve the symptoms associated with fibromyalgia.

Treatment programs

In some cases, it may be necessary to implement a multidisciplinary program to help relieve symptoms and pain associated with fibromyalgia. This involves combining a variety of treatments including relaxation techniques, biofeedback and receiving education about chronic pain. Your doctor will help suggest a treatment program based on what works best for you.

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