An Overview of Fibromyalgia

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Fibromyalgia is a chronic disease characterized by widespread pain and accompanied by fatigue, depression, sleep disturbance, cognitive impairment, and digestive and urinary symptoms. It is a poorly understood disorder in which pain signals processed by the brain appear to be exaggerated, amplifying the sensation of pain in muscles and soft tissues.

Because there are no tests to confirm the disease, fibromyalgia must be diagnosed by excluding other possible causes. Treatment may involve over-the-counter pain relievers, antidepressants, physical therapy, self-care, and newer medications such as Lyrica (pregabalin) specifically approved to treat fibromyalgia.

Symptoms

Fibromyalgia is about more than just muscle aches and joint pain. It is persistent, widespread pain that can move through the body in waves, causing sensations described throbbing, diffuse, intense, or stabbing. Even mild changes in temperature or pressure (including touch) may trigger discomfort.

While some people maintain fairly consistent levels of symptoms, others will go through periods of remission alternating with periods of disease activities (flares). Beyond pain, fibromyalgia is associated with an almost dizzying array of symptoms affecting multiple organ systems.

They include:

  • Fatigue, usually chronic, affecting four of every five sufferers
  • Muscle and joint symptoms such as muscle spasms, muscle weakness, and jaw pain
  • Cognitive symptoms such as the loss of concentration, disorientation, and "brain fogs"
  • Sleep disorders such as broken sleep, sleep starts, and insomnia
  • Neurosensory symptoms such as vertigo, migraine, or sensitivity to light, sound, or smells
  • Gastrointestinal symptoms such as diarrhea, constipation, bloating, or cramping
  • Urinary symptoms including bladder pain, pain during urination, or the frequent urge to urinate
  • Psychological symptoms such as depression, mood swings, or panic attacks
  • Reproductive symptoms such as painful periods, pelvic pain, or premature menopause

Temporary hair loss, heart palpitations, and the benign overgrowth of tissue (lipomas) may also occur.

Causes

No one really knows what causes fibromyalgia. It is clustered alongside similar disorders, such as chronic fatigue syndrome (CFS) and irritable bowel syndrome (IBS), which are believed to be caused by an excessive response of the central nervous system to otherwise normal stimuli. 

While fibromyalgia is today recognized as a syndrome by the medical community, there remains debate as to whether it is a purely somatic (physical) disease or one that is influenced by external stresses—such as depression, anxiety, and sleep problems—that can either enhance the perception of pain or directly affect neurological function.

At this stage, we simply don't know. What we do know is that certain risk factors may increase the odds of getting fibromyalgia.

Among them:

  • Women are nine times more like to have fibromyalgia than men. It has been suggested that decreases in estrogen during menstruation (particularly or at the onset of menopause may trigger symptoms in some women. 
  • Age is also a factor. Despite being considered a disease affecting post-menopausal women, fibromyalgia is most often diagnosed between the ages of 20 and 50 (although symptoms usually develop several years prior).
  • Stress appears to precipitate fibromyalgia symptoms. When accompanied by sleep problems, the perception of pain is further heightened as is the risk of fatigue and depression.
  • Genetics is also believed to be a factor. Current research suggests that having a parent or sibling with fibromyalgia increases your risk by as much as 28 percent, while having a second-degree relative raises it by 19 percent.

Diagnosis

With no lab or imaging test able to diagnose the disease, fibromyalgia can only be confirmed by excluding all other possible causes of your symptoms. It is a painstaking process that should be overseen by a rheumatologist or, alternately, a neurologist or general practitioner experienced with fibromyalgia or other connective tissue diseases.

In 2010, the American College of Rheumatology (ACR) updated their diagnostic criteria for fibromyalgia, taking into consideration the distribution of the pain, the duration of the pain, and the patient's perception of the pain and other symptoms.

The ACR criteria include two score-based evaluations:

  • The first, called the widespread pain index (WPI), assigns one point for each of the 19 body parts in which you’ve experienced pain (for a maximum of 19 points).
  • The second, called the symptom severity (SS) scale, assigns 0 to 3 points—0 meaning no symptoms to 3 meaning serious symptoms—to each of four characteristic symptoms of the disease (for a maximum of 12 points).

To be diagnosed with fibromyalgia, you would need to satisfy the following three conditions:

  1. You must either have a WPI of 7 or more with an SS score of 5 or more or, alternatively, a WPI of 3 to 6 and an SS score of 9 or more.
  2. You must have had these symptoms for at least three months.
  3. There must be no other medical explanation for your symptoms.

Treatment

There is no single pill that can treat fibromyalgia or ensure the sustained remission of symptoms. For this, you would need to take a multi-faceted approach, which may include over-the-counter (OTC) and prescription medications, physical therapy and counseling, lifestyle interventions, and complementary therapies.

Because no two cases of fibromyalgia are alike, treatment can vary from one person to the next.

Medications and Medical Treatments

Medications are typically the backbone of therapy. The choice of drugs are largely dependent on the types and severity of your symptoms. Among them:

  • OTC pain relievers like Tylenol (acetaminophen) and nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen) may provide short-term relief of minor pain. Stomach upset and increased blood pressure are common with NSAIDs.
  • Prescription pain relievers such as Celebrex (celecoxib) or Voltaren (diclofenac) are longer lasting but may cause nausea, dizziness, abdominal pain, ulcers, and liver toxicity.
  • Antidepressants can ease pain and fatigue while elevating moods by raising serotonin levels. The antidepressants Cymbalta (duloxetine) and Savella (milnacipran) are approved to treat fibromyalgia and, while effective, may cause nausea, headache, constipation, insomnia, and dizziness.
  • Anticonvulsive drugs may also be effective in treating pain. They include Lyrica (pregabalin), which is approved for the treatment of fibromyalgia, and others like Neurotin (gabapentin) which may be prescribed off-label. Swelling, weight gain, dizziness, and drowsiness are among the possible side effects.

Sleep problems are typically treated with low-dose antidepressants like Elavil (amitriptyline) rather than sleeping pills. Muscle relaxers like Flexeril (cyclobenzaprine) can also do double duty by alleviating muscle tension while helping a person sleep.

In addition to medications, your doctor may refer to specialists to help overcome physical or emotional challenges, including physical therapists, occupational therapists, psychiatrists, or counselors.

Lifestyle and Complementary Therapies

Stress alleviation is among the primary facets of any fibromyalgia treatment plan. This not only involves relaxation techniques or mind-body therapies, it may require you to eat better, exercise, and avoid things like caffeine, alcohol, and smoking. Doing so will not only make you stronger, it can elevate your mood (especially exercise which triggers the release of serotonin, dopamine, and endorphins).

Other complementary approaches to treatment include:

A Word From Verywell

Despite increased public awareness, fibromyalgia remains a mystery to many peoples, some of whom may doubt its existence or suggest that it’s "all in your head." It is not.

Don’t let other people’s misconceptions prevent you from seeking the care you need. Find support from friends and family, opening up about not only what you feel but how you feel. Join a local support group or contact the National Fibromyalgia & Chronic Pain Association to find one near you. Building a support system can provide you the confidence and education to become an advocate in your own care.

If your doctor is unable to help or understand your concerns, find a rheumatologist in your area through the online locator offered by the American College of Rheumatology. Drug co-pay and patient assistance programs are also available to help defray the cost of treatment, if eligible.

Sources:

Bellato, E.; Marini, E.; Castoldi, F. et al. Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment. Pain Res Treat. 2012; 2012: 426130. DOI: 10.1155/2012/426130.

Wolfe, F.; Clauw, D.; Fitzcharles, M.; et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010; 62(5):600-10. DOI: 10.1002/acr.20140.

Park, D. and Lee, S. New insights into the genetics of fibromyalgia. Korean J Intern Med. 2017; 32(6):984-95. DOI: 10.3904/kjim.2016.207.