Fibromyalgia

Fibromyalgia is a condition with diffuse musculoskeletal pain and other frequently associated symptoms of many types, including fatigue, problems thinking clearly, and psychiatric symptoms.  
 
The cause of fibromyalgia remains unclear and is controversial. The most common understanding is that fibromyalgia reflects a problem with regulation of pain, and it is thought of as a problem in the way a person’s central nervous system processes sensory information. The term used for this is “central sensitization.”

Symptoms and Overlapping Conditions

The main symptom of fibromyalgia is chronic, widespread pain throughout the body – especially in the muscles and joints, and sometimes in the skin. This pain may come and go, flaring up from time to time to a heightened intensity. In addition to this widespread pain, patients also experience hypersensitivity in particular areas of the body, called tender points. In these points, even slight pressure from touching or poking can cause extreme pain. Patients may experience many additional symptoms and/or overlapping disorders, including:

  • Fatigue (frequent, unexplained exhaustion)
  • Insomnia
  • Cognitive (memory or thought) problems
  • Vision problems, ringing in the ears or sensitivity to light or sound
  • Impaired coordination (unexplained clumsiness or loss of full control of body movement)
  • Temporomandibular joint disorders (TMD, but often incorrectly called “TMJ,” which is really just short for the temporomandibular joint)
  • Peripheral neuropathies and other neurological symptoms
  • Irritable bowel syndrome (IBS)
  • Bladder or urinary problems
  • Restless leg syndrome
  • Headaches or migraines
  • Anxiety or depression
  • Dry eyes or dry mouth

Fibromyalgia affects women more severely and much more often than men. Most patients first experience symptoms between their late twenties and mid-thirties, but it can take hold at a later age.

Diagnosis

Because many symptoms of fibromyalgia can be associated with other disorders (such as lupus, multiple sclerosis, or Lyme disease), and because many fibromyalgia patients have overlapping conditions, the syndrome can go unrecognized for years. The diagnosis of fibromyalgia may thus be delayed. This, combined with the many possible symptoms of fibromyalgia, makes it a very frustrating condition for patients and a challenging one for healthcare practitioners. The diagnosis of fibromyalgia is especially suspected in people who “hurt all over” or always feel as if they “have the flu.” A diagnosis for fibromyalgia is ultimately made by examining the patient for specific tender points on the body, and noting whether the patient has fatigue, non-restorative sleep, difficulty concentrating, and the presence of some of the coexisting and overlapping symptoms or disorders listed above. A close evaluation for other causes of fibromyalgia-type symptoms, such as thyroid abnormality, is needed before a diagnosis can be made.

Treatment

Many treatments can help fibromyalgia. Most studies have found that fibromyalgia patients who can get into a regular aerobic exercise routine do best, although this is often difficult in light of their pain and fatigue. The most successful combination of therapies is different from person to person. Patients should work with their doctors to determine which treatments work best for them. Fibromyalgia patients can benefit from physical therapy, acupuncture, massage therapy, cognitive-behavioral therapy, and certain prescription medications.

Prescription medications approved by the FDA for fibromyalgia are duloxetine (Cymbalta®), pregabalin (Lyrica®) and milnacipran (Savella®). Although not specifically approved by the FDA, amitryptilline (Elavil®) in low doses has been used for fibromyalgia for many years. It is generally advised to try to avoid narcotic pain medication use for fibromyalgia. For many patients with fibromyalgia, a combination of medication, exercise program and physical therapy or other modalities as outlined above are needed.

When to See a Specialist

If you think you may have fibromyalgia, it is usually best to first meet with your primary care physician (PCP), since he or she knows your medical history. If the PCP has difficulty or uncertainty in establishing a diagnosis, you should seek a referral to a specialist. Depending on the type of symptoms you have, different types of specialists may be helpful. If you have difficulty concentrating and/or feel tingling in your extremities, a neurologist can help determine whether your symptoms are caused by a neurological condition separate from fibromyalgia. If joint and muscle pain are the prominent issues, a rheumatologist can help rule out the diagnosis of lupus, rheumatoid arthritis, or other rheumatic disease. Often a team approach is needed, including your primary care physician, a physical therapist, and, as dictated by your symptoms, a neurologist, rheumatologist, psychologist or pain management specialist.

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