Fibromyalgia

Description

Fibromyalgia is a chronic pain condition that results in diffuse pain and tenderness. Additional symptoms vary from person to person. It typically involves the whole body. The pain and tenderness are marked by episodic flares during which the condition feels worse. Aside from physical manifestations, fibromyalgia can also have mental and social repercussions. Present in all age groups, it affects two to four percent of the American population. The prevalence in women is four times higher than in men.

Causes

Fibromyalgia results from a hyperactive and hypersensitive central nervous system. Proposed causes include: genetics, multiple surgical procedures, stress and trauma. However, these are not substantiated.

Symptoms

Primary symptoms:

  • Chronic pain in muscles, joints and bones

  • Fatigue

  • Sleep disturbance

  • Diffuse tenderness to light touch throughout the body

Additional symptoms found in some patients with fibromyalgia:

  • Depression and anxiety

  • Lack of concentration, memory impairment and other cognitive findings

  • Abdominal pain

  • Dry eyes

  • Chest wall pain

  • Dry mouth

  • Bladder issues

  • Pelvic pain

  • Palpitations

  • Tingling or numbness

  • Multiple allergies

  • Chemical sensitivities

  • Weight gain

Diagnosis

Establishing the diagnosis of fibromyalgia involves ruling out conditions such as chronic fatigue syndrome, rheumatoid arthritis and multiple sclerosis. The physician then evaluates the patient for the nature, severity and duration of pain.

Severe pain must be present in three to six distinct areas of the body or mild pain must be present in seven or more distinct areas.

Symptoms must be present to a similar degree for at least three months.

Other diagnoses must be excluded.

Physical exam can include applying gentle pressure to tender points.

Management

Fibromyalgia has no cure. Symptomatic treatment is most effective through a multispecialty approach along with medication. Regular aerobic exercise is very effective. Although patients with fibromyalgia can experience significant pain, low impact exercise such as yoga and Tai Chi can relieve symptoms.

Cognitive behavioral therapy, which is focused on understanding how thoughts and behavior affect pain, has demonstrated improvement in symptoms. Mindfulness, a form of meditation that cultivates present moment awareness, has demonstrated to be beneficial as well.

Consideration can be given to complimentary therapies such as acupuncture, chiropractic care and massage therapy. These have benefited many patients with fibromyalgia.

Sleep disturbances, anxiety and depression should be addressed by the appropriate specialist.

Drugs used to manage fibromyalgia include duloxetine/Cymbalta, milnacipran/Savella, amitriptyline/Elavil, cyclobenzaprine/Flexeril and pregabalin/Lyrica. Opioids are avoided in the management of fibromyalgia as research shows they can increase sensitivity to pain or result in pain being more persistent. If a short-term opioid is absolutely necessary, tramadol/Ultram can be prescribed. Over-the-counter pain medications such as NSAIDs are not effective for the pain associated with fibromyalgia, however, they can be used to manage conditions such as arthritis which can trigger fibromyalgia pain.