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Definition of Fibromyalgia

Article updated and reviewed by Ariel D. Teitel, MD, MBA, Chief, Division of

Rheumatology, St. Vincents Hospital, Manhattan on May 16, 2005.

Fibromyalgia, (also known as fibrositis, fibromyositis, and muscular rheumatism), is achronic syndrome that causes pain and stiffness throughout the tissues that support and

move the bones and joints. Muscle pain, tender points, and fatigue are the predominant

symptoms associated with fibromyalgia.

Fibromyalgia may occur alone or in conjunction with rheumatic disorders such as

arthritis, osteoarthritis, orlupus.

Description of Fibromyalgia

Fibromyalgia is very common, affecting up to 5 percent of the U.S. population. Although

anyone can get fibromyalgia, eight times as many women develop it relative to men.

Most cases occur among women between the ages of 20 to 65. It shares many features

with the chronic fatigue syndrome.

People with fibromyalgia are found to have multiple tender points in specific muscle

areas. Most individuals complain of aching and stiffness in areas around the neck,shoulders, upper back, lower back and hip areas.

Causes and Risk Factors of Fibromyalgia

Fibromyalgia can be a complication of hypothyroidism, rheumatoid arthritis, or in men,

sleep apnea.

Although the exact causes of fibromyalgia are not known, there are a number of theories

as to the cause of this syndrome. The theories include:

The cerebral spinal fluid in those afflicted with fibromyalgia had more substance

P (a neuropeptide that carries pain signals).

There is a diminished blood flow to the two areas of the brain that help regulate

the amount of pain signals the brain receives.

The syndrome is psychosomatically based. Psychological factors such asanxiety,

depression, disappointment, or failure to achieve goals somatize (express

themselves) as physical symptoms such as backache or sore muscles. Fibromyalgia is caused by sleep disturbances. Tests of people with fibromyalgia

often show a sleep disorder in which the deepest or most restful stage of sleep

(stage IV) is disturbed or interrupted. This disruption in sleep may be responsiblefor the shortage of the growth hormone called somatomedin-C which is produced

in deep sleep. This hormone is responsible for muscle repair and maintenance.

There is a deficit in the levels of tryptophan. Tryptophan is a neurotransmitter that

plays an important role in inhibiting pain and inducing deep sleep.

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Symptoms of Fibromyalgia

The major symptoms of fibromyalgia are:

Widespread muscular and joint pain for over three months (such as aching,

stiffness, and tenderness around joints, muscles, tendons, and ligaments). Painmay appear in one or more locations at the same time and also in many different

parts of the body. The pain is bilateral in that it appears above and below the

waist. The pain is located within the muscles themselves, as well as the pointswhere ligaments attach muscles to bones.

Extreme tenderness in specific "tender points."

Poor-sleep patients report non-refreshing sleep.

Fatigue: Some people experience fatigue as a lack of muscle endurance, while

others describe the fatigue as an overall sense of lack of energy. Much of the

fatigue is thought to result from lack of sleep.

Tender points or trigger points are localized tender areas of the body that can bring onwidespread pain and muscle spasm when touched. There are at least 18 tender points onthe body to which people with fibromyalgia seem to be more susceptible. They are:

At the base of the skull at both neck muscles;

Midway between the neck and shoulder (both sides);

Muscle over upper inner shoulder blade (both sides);

Two centimeters below side bone at elbow (both sides);

Upper outer buttock (both sides);

Hip bone (both hips);

Just above knee on inside (both knees);

Lower neck in front (both sides); and Edge of upper breast bone (both sides).

These symptoms may be aggravated bystress,anxiety,depression, hormonal changes,

cold environments as well as the change in weather.

Up to 70% of patients have coexistent chronic fatigue syndrome, 50% have multiple

chemical sensitivities, and 75% have a psychiatric diagnosis.

Other symptoms that may accompany fibromyalgia areRaynaud's phenomenon (poorcirculation to the hands or toes), tension headaches,migraineheadaches, dizziness,

tingling and numbness, an irritable bowel, muscle tremors, bladder spasms, and blurredvision.

Diagnosis of Fibromyalgia

There are no blood or x-ray tests to help doctors diagnose fibromyalgia. Therefore, the

diagnosis is made purely on clinical findings and the medical history.

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The doctor also will rule out the existence of other diseases that mimic the symptoms of

fibromyalgia. In chronic fatigue syndrome, fatigue is the predominant symptom, as

opposed to pain. Other diseases to consider are hypothyroidism, inflammatory disorderssuch as rheumatoid arthritis, and autoimmune diseases such as myositis or polymyalgia

rheumatica.

Prognosis of Fibromyalgia

The disease may be long-lasting, but it is not progressive. There is no long-term organdamage.

Treatment of Fibromyalgia

There is presently no cure for fibromyalgia, but the symptoms of this syndrome can be

controlled by education, exercise, medication, sleep, and stress reduction.

Education. Education begins with reassurance that the pain is valid; however thecondition is not crippling, does not weaken joints or muscles, is not life-threatening and

need not hinder the ability to work. Professionals try to reinforce that fibromyalgia is not

a disease but a constellation of symptoms that add up to "pain," for which sufferers needa large amount of support.

Exercise. The emphasis is often on muscle conditioning and programs to improve aerobic

fitness (such as swimming, cycling, walking and stationary cross-country ski machines)

as well as physical therapy. Patients should be told that exercise is safe and effective.After an initial training period, the exercise regimen chosen should be done daily for 30

to 40 minutes.

Medication. To reduce fatigue, relieve muscle pain and spasm, and promote sleep the

doctor may prescribe medication. Medications may include tricyclic antidepressants suchas amitriptyline (Elavil) or Nortriptyline (Pamelor), selective serotonin reuptake

inhibitors (SSRIs) such as fluoxetine (Prozac), or muscle relaxants such as

Cyclobenzaprine (Flexeril). NSAIDS (non-steroidal anti-inflammatory drugs) aregenerally not useful. Newer medications which decrease pain sensitivity in the brain

include Neurontin (gabapentin) or Ultram (tramadol); these may be helpful for pain

control. Opioids are usually not advisable given the potential for creating dependency andaddiction. Steroids are ineffective. For severe pain in the tender points, the doctor may

give an injection of a local anesthetic to help with the pain.

Sleep. Patients with fibromyalgia need adequate sleep every night.

Stress reduction. Since stress and tension can contribute to the symptoms, relaxation

techniques such as muscle relaxation, yoga and meditation can be very helpful.Acupuncture may be beneficial. Stress reduction might also include biofeedback, stress

modification exercises, relaxation tapes, and psychological counseling.

Questions To Ask Your Doctor About Fibromyalgia

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Do any tests need to be done to diagnose fibromyalgia or to rule out any other disease?

What type of treatment do you recommend?

Will you be prescribing any medications?

What are the side effects?

What can be expected in the future from this disease?

What daily activities, including rest and sleep, will help

decrease the symptoms?