Fibromyalgia: A Disorder Not Well Understood

Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple tender points. "Tender points" refers to tenderness that occurs in certain localized areas of the muscles and soft tissues, particularly in the neck, spine, shoulders, and hips. Fibromyalgia is also known by other terms such as fibrositis, fibromyositis, fibromyalgia syndrome, and chronic muscle pain syndrome.

Who gets fibromyalgia?

According to the American College of Rheumatology, fibromyalgia affects three to six million Americans. It primarily occurs in women age 20 to 50, but children, older adults, and men can also be affected.

People who have a rheumatic disease such as arthritis, systemic lupus erythematous (SLE), or Sjögrens syndrome, or who have another family member with fibromyalgia appear to be at increased risk for developing the disorder.

What causes it?

The cause of fibromyalgia is unknown, however researchers have several theories about possible triggers. Sleep disturbances, injury or trauma to the central nervous system, viral or bacterial infection, changes in muscle metabolism, psychological stress, and, immune or endocrine system abnormalities have all been implicated as possible causes or triggers.

What are the symptoms?

The primary symptom of fibromyalgia is muscle pain that occurs throughout the body or at various tender points. The pain may range from mild discomfort to severe and disabling in nature. Fatigue and sleep-related problems such as insomnia are two other common symptoms.

A person with fibromyalgia may also experience morning stiffness, headaches, depression, anxiety, difficulty in concentrating or remembering, abdominal problems such as bloating or irritable bowel syndrome, urinary problems, menstrual problems, or other symptoms.

Symptoms tend to worsen during certain times of day, with the morning, late afternoon, and evening being the worse. They may also be affected by fatigue, changes in the weather, overexertion, hormonal fluctuations, and stress or other emotional factors.

How is it diagnosed?

Because many of the symptoms are similar to those of other diseases, such as chronic fatigue syndrome, hypothryoidism, and Lyme disease, fibromyalgia is difficult to diagnosis initially. Diagnosis is commonly made after other disorders have been ruled-out (eliminated).

Most doctors diagnosis fibromyalgia based on criteria developed in 1990 by the American College of Rheumatology:

There is no cure for fibromylagia, therefore treatment focuses on managing a chronic condition and reducing its symptoms. Management commonly includes a combination of exercise, medications, physical therapy, and relaxation techniques.

Frequent, low-impact aerobic exercise, such as walking, biking, and swimming, helps reduce muscle pain and tenderness and improves muscle fitness. Be sure to talk with your doctor before starting any exercise program, and start slowly. Exercise will also help you sleep better, which may also help reduce symptoms.

Non steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, naproxen, and ketoprofen, or other pain medications as prescribed by your doctor may help relieve muscle pain. For painful tender points, an injection of a local anesthetic or corticosteroid may help provide relief.

Medications may also be prescribed for specific symptoms, for example hypnotic drugs to help you sleep, anxiolytic or antidepressant drugs, such as tricyclic antidepressants to help anxiety or depression, or muscle relaxants.

Applying heat or cold packs or massaging painful areas, as well as performing stretching and range-of-motion exercises are physical therapy techniques that may help relieve symptoms.

Strategies to reduce stress, such as using relaxation techniques and pacing yourself with work or daily chores may help to reduce symptoms. Psychological counseling and attending support groups are two other components that may help you deal with this chronic disorder.

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