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Fibromyalgia

Fibromyalgia is a chronic pain disorder characterized by diffuse musculoskeletal pain, with frequently associated additional symptoms such as fatigue and mental health issues.

How does a person get fibromyalgia?

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.”

What are the signs and symptoms of fibromyalgia?

The main and usually first noticeable 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.

Signs, symptoms and overlapping disorders can vary significantly from patient to patient, and they include:

  • Chronic, widespread body pain in the muscles, joints and, in some cases, skin
  • Tender points (which, when even lightly touched, are very painful) on the body
  • Fatigue (frequent, unexplained exhaustion)
  • Insomnia
  • Cognitive problems ("foggy" thinking, impaired memory)
  • 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 (TMJ) pain or disorders
  • Peripheral neuropathies (tingling, numbess or feelings of vibration in the limbs)
  • Other neurological symptoms
  • Irritable bowel syndrome (IBS)
  • Bladder or urinary problems
  • Restless leg syndrome
  • Headaches or migraines
  • Anxiety, depression or other psychiatric problems
  • 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.

How is fibromyalgia diagnosed?

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.

Does fibromyalgia ever go away?

There is no cure for fibromyalgia, there are many treatments that can help alleviate pain and other symptoms. 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. If you have been diagnosed with fibromyalgia, you should work with your doctors to determine which treatments work best for you. You may benefit from physical therapy, acupuncture, massage therapy, cognitive-behavioral therapy, and/or 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.

How serious is fibromyalgia?

The condition itself is not fatal, but the intensity of pain and other symptoms can take a major toll on your quality of life. While fibromyalgia itself won't kill you, it can be associated with depression and decreased physical activity, which can impact on your physical and emotional health in ways that may shorten your life.

When to see a specialist

If you think you may have fibromyalgia, it is usually best to first meet with your primary care physician (family doctor or general practitioner), since he or she knows your medical history. If your primary doctor 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:

  • A rheumatologist can help rule out the diagnosis of lupus, rheumatoid arthritis or other rheumatic disease, in which joint and muscle pain are key problems.
  • A neurologist can help rule out a neurological condition separate from fibromyalgia, if you have difficulty concentrating or if you feel tingling sensations in your arms, hands, legs or feet.
  • Often, consulting multiple clinicians is the best approach. This may include your primary care physician, a physical therapist and, depending on which symptoms you experience, a rheumatologist, neurologist, psychologist and/or pain management specialist.

Get more detailed information on fibromyalgia from the articles and other content below, or select Treating Physicians to find a doctor who treats fibromyalgia.

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