Fibromyalgia

What is fibromyalgia?
Fibromyalgia is a condition characterized by aching and pain in muscles, tendons, and joints all over the body, especially along the spine.

There are measurable changes in body chemistry and function in some people with fibromyalgia. These changes may be responsible for certain symptoms. However, fibromyalgia is not associated with muscle, nerve, or joint injury; inadequate muscle repair; or any serious bodily damage or disease. Also, people who have fibromyalgia are not at greater risk for any other musculoskeletal disease.

What are the symptoms of fibromyalgia?
The pain in people with fibromyalgia usually seems worse when they are trying to relax and is less noticeable during busy activities or exercise. Other symptoms are often associated with the pain, including:

• Sleep disturbance
• Depression
• Daytime tiredness
• Headaches
• Alternating diarrhea and constipation
• Numbness and tingling in the hands and feet
• Feelings of weakness
• Having difficulty remembering
• Dizziness

What causes fibromyalgia?
The exact cause of fibromyalgia is unknown. There are, however, many theories about why people develop fibromyalgia. One theory suggests that stress contributes to the onset of fibromyalgia.

When stress continues without relief, your body doesn't have time to relax or prepare for the next challenge. This is called distress. Distress can trigger a number of physical reactions and lead to the symptoms of fibromyalgia.

When fibromyalgia begins, stresses in a person's life are prominent. Stress often results in disturbed sleep patterns and a lack of restful sleep. When you don't get enough sleep, your body does not produce the chemicals necessary to control or regulate pain. A lack of these pain-regulating chemicals results in tenderness in the upper back and forearms, leading to the symptoms of fibromyalgia.

Physical and emotional factors may also contribute to the onset of fibromyalgia. For example, a physical illness (such as an infection) could cause changes in your body chemistry that lead to pain and sleeplessness.

When you are sick, you may worry about your health and become anxious, depressed or inactive. These emotional factors could make your symptoms worse and aggravate fibromyalgia.

How is fibromyalgia diagnosed?
The diagnosis of fibromyalgia is based on a combination of factors, including:

• Complete medical history and physical exam (to exclude other illnesses that may have similar symptoms such as rheumatoid arthritis, muscle inflammation, bursitis, or tendinitis).
• Presence of widespread pain together with some of the other symptoms of fibromyalgia.
• Presence of very tender areas ("tender points") at specific locations.
• People who have fibromyalgia experience abnormal sensitivity when light pressure is applied to many of the locations (illustrated to the right).

How is fibromyalgia treated?
People with fibromyalgia receive individual treatment based on several factors including their overall health, medical history, number of tender points, severity of pain, and presence of other symptoms. Treatment for fibromyalgia includes:

• Medications that decrease pain and improve sleep
• Lifestyle changes including stress reduction
• Exercises to improve cardiovascular (heart and lung) health
• Relaxation techniques to relieve muscle tension

Medications
Medications that increase restful sleep, such as low doses of anti-depressant drugs taken before bedtime, may help. Other kinds of sleeping pills are not very helpful for people who have fibromyalgia.

Non-steroidal anti-inflammatory drugs including aspirin and ibuprofen (such as Motrin) may help decrease pain, but should be used sparingly. These drugs have many side effects such as stomach upset and fluid retention. They may also have unfavorable interactions with other drugs such as high blood pressure medications.

No currently existing medications completely relieve fibromyalgia pain. However, acetaminophen (such as Tylenol) is both helpful and safer than other analgesics (pain-relieving medications).

Anti-inflammatory medications (such as cortisone derivatives) used to treat other rheumatic conditions have been tested in people with fibromyalgia and do not improve symptoms.

Exercise
Brisk walking, biking, swimming, and water aerobics are good activities to choose when starting your exercise program. Your physician can help you choose an exercise program that's right for you.

Participating in aerobic exercise for 1/2 hour three times each week is an important step to improve fibromyalgia symptoms. Exercise increases heart and lung function and stretches tight, sore muscles.

Coping with stress
Certain stress factors in life (such as financial burdens, difficulties with a boss, coworkers, or your spouse) may not be easily eliminated. Evaluating the causes of stress and learning new ways to handle or cope may improve fibromyalgia.

Anxiety and depression are major contributors to stress and must be treated to enable fibromyalgia to improve.

Relaxation techniques can help relieve muscle tension and reduce stress. Professionals trained in stress management can teach you these techniques.

What is the long-term outlook for people with fibromyalgia?
Often, if the situations that caused stress are resolved, fibromyalgia may spontaneously improve and medications may not be necessary.

Many people with fibromyalgia will continue to have symptoms despite treatment, especially when life is stressful. However, medications (such as anti-depressant drugs) that may alter the balance of pain-producing chemicals can improve symptoms.

When other forms of therapy such as acetominophen (Tylenol) and aerobic exercise are combined to treat fibromyalgia, even more improvement can be expected.