Fibromyalgia Syndrome: Your Questions Answered

Fibromyalgia Syndrome: Your Questions Answered

Fibromyalgia Syndrome: Your Questions Answered

Fibromyalgia  syndrome is a common and chronic disorder characterized by widespread pain, diffuse tenderness and many other symptoms. So what do sufferers really need to know? Find out now…

Although fibromyalgia is often considered an arthritis-related condition, it’s not truly a form of arthritis (a disease of the joints) because it doesn’t cause inflammation or damage to the joints, muscles or other tissues.

But like arthritis, fibromyalgia can cause significant pain and fatigue that can interfere with a person’s daily activities. Also like arthritis, fibromyalgia is considered rheumatic, a medical condition that impairs the joints and/or soft tissues and causes chronic pain.

People with fibromyalgia may experience a variety of other symptoms, including:

  • Cognitive and memory problems (sometimes referred to as “fibro fog”)
  • Sleep disturbances
  • Morning stiffness
  • Headaches
  • Irritable bowel syndrome
  • Painful menstrual periods
  • Numbness or tingling of the extremities
  • Restless legs syndrome
  • Temperature sensitivity
  • Sensitivity to loud noises or bright lights

Fibromyalgia isn’t a disease, but a syndrome: a collection of signs, symptoms and medical problems that tend to occur together but are not related to a specific, identifiable cause. A disease, on the other hand, has a specific cause or causes and recognizable signs and symptoms.

Who Gets Fibromyalgia?
Scientists estimate that fibromyalgia affects 5 million Americans age 18 or older. For unknown reasons, between 80% and 90% are women; however, men and children also can be affected. Most people are diagnosed during middle age, although the symptoms often become present earlier in life.

People with certain rheumatic diseases – such as rheumatoid arthritis, systemic lupus erythematosus (commonly called lupus) or ankylosing spondylitis (spinal arthritis) – may be more likely to have fibromyalgia too.

Several studies indicate that women with a family member with fibromyalgia are more likely to have the condition themselves, but the reason for this – whether it be heredity, shared environmental factors or both – is unknown.What Causes Fibromyalgia?
The causes of fibromyalgia are unknown, but there are probably several factors involved. Many people associate the development of fibromyalgia with a physically or emotionally stressful or traumatic event, such as an automobile accident. Some connect it to repetitive injuries. Others link it to an illness. For others, fibromyalgia seems to occur spontaneously.

Many researchers are examining other causes, including problems with how the central nervous system (the brain and spinal cord) processes pain.

Some scientists speculate that a person’s genes may regulate the way his or her body processes painful stimuli. According to this theory, people with fibromyalgia may have a gene or genes that cause them to react strongly to stimuli that most people would not perceive as painful. There have already been several genes identified that occur more commonly in fibromyalgia patients, and NIAMS-supported researchers are currently looking at other possibilities.

How Is Fibromyalgia Diagnosed?
Research shows that people with fibromyalgia typically see many doctors before receiving the diagnosis. One reason for this may be that pain and fatigue, the main symptoms of fibromyalgia, overlap with those of many other conditions. Therefore, doctors often have to rule out other potential causes of these symptoms before making a fibromyalgia diagnosis.

Also, there are currently no diagnostic laboratory tests for fibromyalgia; standard laboratory tests fail to reveal a physiologic reason for pain. Because there is no generally accepted, objective test for fibromyalgia, some doctors unfortunately may conclude a patient’s pain is not real, or they may say there’s little they can do.

A doctor familiar with fibromyalgia, however, can make a diagnosis based on criteria established by the American College of Rheumatology (ACR): a history of widespread pain lasting more than 3 months, and other general physical symptoms including fatigue, waking unrefreshed, and cognitive (memory or thought) problems.Pain is considered to be widespread when it affects all four quadrants of the body, meaning it must be felt on both the left and right sides as well as above and below the waist. ACR also has designated 18 sites on the body as possible tender points. To meet the strict criteria for a fibromyalgia diagnosis, a person must have 11 or more tender points, but often patients with fibromyalgia will not always be this tender, especially men. People who have fibromyalgia certainly may feel pain at other sites too, but those 18 standard possible sites on the body are the criteria used for classification.

How Is Fibromyalgia Treated?
Fibromyalgia can be difficult to treat. Not all doctors are familiar with fibromyalgia and its treatment, so it is important to find a doctor who is. Many family physicians, general internists or rheumatologists (doctors who specialize in arthritis and other conditions that affect the joints or soft tissues) can treat fibromyalgia.

Fibromyalgia treatment often requires a team approach – with your doctor, a physical therapist, possibly other health professionals and, most importantly, yourself all playing an active role.

It can be hard to assemble this team, and you may struggle to find the right professionals to treat you. When you do, however, the combined expertise of these professionals can help you improve the quality of your life.

You may find several members of the treatment team at pain and rheumatology clinics that specialize in arthritis and other rheumatic diseases, including fibromyalgia.Only three medications – duloxetine, milnacipran and pregabalin – are approved by the U.S. Food and Drug Administration (FDA) for fibromyalgia treatment.

Duloxetine was originally developed for and is still used to treat depression. Milnacipran is similar to a drug used to treat depression but is FDA-approved only for fibromyalgia. Pregabalin is a medication developed to treat neuropathic pain (chronic pain caused by damage to the nervous system).

The following are some of the most commonly used categories of drugs for fibromyalgia:

Analgesics: Analgesics are painkillers. They range from over-the-counter acetaminophen to prescription medicines, such as tramadol and even stronger narcotic preparations. For some people with fibromyalgia, narcotic medications are prescribed for severe muscle pain.

However, there is no solid evidence showing that narcotics actually work to treat the chronic pain of fibromyalgia, and most doctors hesitate to prescribe them for long-term use because of the potential of physical or psychological dependency.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): As their name implies, nonsteroidal anti-inflammatory drugs – including aspirin, ibuprofen and naproxen sodium – treat inflammation. Although inflammation is not a fibromyalgia symptom, NSAIDs also relieve pain. The drugs inhibit substances in the body called prostaglandins, which play a role in pain and inflammation. These medications, some of which are available without a prescription, may help ease the muscle aches of fibromyalgia. They may also relieve menstrual cramps and the headaches often associated with fibromyalgia.Complementary and Alternative Therapies: Many people with fibromyalgia also report varying degrees of success with complementary and alternative therapies, including massage, movement therapies (such as Pilates and the Feldenkrais method), chiropractic treatments, acupuncture, and various herbs and dietary supplements for different fibromyalgia symptoms.

Although some of these supplements are being studied for fibromyalgia, there is little, if any, scientific proof yet that they help. The FDA doesn’t regulate the sale of dietary supplements, so information about side effects, proper dosage and the amount of a preparation’s active ingredient may not be well known.

If you’re using or would like to try a complementary or alternative therapy, you should first speak with your doctor, who may know more about the therapy’s effectiveness, as well as whether it’s safe to try in combination with your medications.

What Can I Do to Try to Feel Better?
Besides taking medicine prescribed by your doctor, there are many things you can do to minimize the impact of fibromyalgia on your life. These include:

Getting better sleep. Getting enough sleep and the right kind of sleep can help ease the pain and fatigue of fibromyalgia. Even so, many people with fibromyalgia have problems such as pain, restless legs syndrome, or brainwave irregularities that interfere with restful sleep. It’s important to discuss any sleep problems with your doctor, who can prescribe or recommend treatment for them.Here are some tips for a better night’s sleep:


  • Keep regular sleep habits. Try to get to bed at the same time and get up at the same time every day – even on weekends and vacations.
  • Avoid caffeine and alcohol in the late afternoon and evening. If consumed too close to bedtime, the caffeine in coffee, soft drinks, chocolate and some medications can keep you from sleeping or sleeping soundly. Even though it can make you feel sleepy, drinking alcohol around bedtime also can disturb sleep.
  • Time your exercise. Regular daytime exercise can improve nighttime sleep. But avoid exercising within 3 hours of bedtime, which actually can be stimulating, keeping you awake.
  • Avoid daytime naps. Sleeping in the afternoon can interfere with nighttime sleep. If you feel you can’t get by without a nap, set an alarm for 1 hour. When it goes off, get up and start moving.
  • Reserve your bed for sleeping. Watching the late news, reading a suspense novel, or working on your laptop in bed can stimulate you, making it hard to sleep.
  • Keep your bedroom dark, quiet and cool.
  • Avoid liquids and spicy meals before bed. Heartburn and late-night trips to the bathroom aren’t conducive to good sleep.
  • Wind down before bed. Avoid working right up to bedtime. Do relaxing activities, such as listening to soft music or taking a warm bath, that get you ready to sleep. (A warm bath also may soothe aching muscles.)

Exercising. Although pain and fatigue may make exercise and daily activities difficult, it’s crucial to be as physically active as possible. Research has repeatedly shown that regular exercise is one of the most effective treatments for fibromyalgia. People who have too much pain or fatigue to do vigorous exercise should begin with walking or other gentle exercise, and build endurance and intensity slowly.

Making changes at work. Most people with fibromyalgia continue to work, but they may have to make big changes to do so. For example, some people cut down the number of hours they work, switch to a less demanding job, or adapt a current job. If you face obstacles at work, such as an uncomfortable desk chair that leaves your back aching or difficulty lifting heavy boxes or files, your employer may make adaptations that will enable you to keep your job. An occupational therapist can help you design a more comfortable workstation or find more efficient and less painful ways to lift.

Eating well. Although some people with fibromyalgia report feeling better when they eat or avoid certain foods, no specific diet has been proven to influence fibromyalgia. Of course, it’s important to have a healthy, balanced diet. Not only will proper nutrition give you more energy and make you generally feel better, it will also help you avoid other health problems.

From the National Institutes of Health
Published May 15, 2014
Fibromyalgia Syndrome: Mystery Pain Explained

Fibromyalgia Syndrome: Mystery Pain Explained

Fibromyalgia Syndrome: Mystery Pain Explained

Painful and puzzling, fibromyalgia syndrome primarily strikes women. Why? Researchers don’t know. And with details scarce about its cause and treatment, dealing with the condition can be maddening. We have answers to 10 common questions about fibromyalgia in women…

1. What causes fibromyalgia syndrome?
Genetics may play a role in developing fibromyalgia. But no one really knows what causes the syndrome and there are no known risk factors.

The most prevalent theory is that fibromyalgia results from a disturbance in the central nervous system called central sensitization, which may intensify pain signals.

Linked to that theory is the notion that patients have higher amounts of a compound called substance P in their spinal fluid, which increases their sensitivity to pain.

Another theory: There may be two types of fibromyalgia: “primary” fibromyalgia, which occurs spontaneously, and “secondary” fibromyalgia, which may be triggered by trauma – such as a car accident – or by certain infections, such as Lyme disease and hepatitis C.Some researchers think that the primary type is caused by a sleep disturbance, but it’s also possible that the sleep disturbance is a symptom of fibromyalgia.

2. I often hear fibromyalgia, chronic fatigue syndrome and lupus mentioned together. Are they similar?
Although the three are separate conditions, symptoms of fibromyalgia and chronic fatigue syndrome overlap. And fibromyalgia and lupus both involve the muscle and bone network in our bodies, which can cause confusion between the two illnesses.

Fibromyalgia is characterized by many symptoms including muscle pain, fatigue, sleep disturbances, irritable bowel syndrome and, in some people, depression.

Despite its consistent general characteristics, it can be tough to diagnose because symptoms vary from patient to patient.The main symptoms of chronic fatigue syndrome (CFS) include:

  • Overwhelming fatigue
  • Memory loss
  • Muscle soreness
  • Sore throat
  • Swollen glands

Symptoms can coincide or come and go in individual cycles. Doctors usually diagnose CFS through a process of elimination: They rule out other potential causes of long-term fatigue.

Lupus is an autoimmune disease in which the body attacks itself. It may start with joint pains, which patients can confuse with the muscle pains of fibromyalgia.

Diagnosed by blood tests that show a high level of certain antibodies, lupus can be progressive and cause serious illness throughout the body.

People with lupus appear more prone to develop fibromyalgia and chronic fatigue, although researchers don’t know why.
3. Why do more women than men get fibromyalgia syndrome?
The majority of people with fibromyalgia (80%-90%) are women, as is the case with lupus and CFS.

No one knows why women are affected more often than men.

4. Is it age-related?
Fibromyalgia occurs most commonly in people between 20 and 55 years old, although it may arrive at any age, including childhood.

5. Is it an autoimmune disease or a form of arthritis?
Neither. In fact, unlike inflammatory arthritis and autoimmune disease, which cause joint destruction and inflammation, fibromyalgia causes neither, despite symptoms of joint and muscle pain.

6. What are warning signs or symptoms of fibromyalgia?
Alas, the symptoms of fibromyalgia arrive without warning. They can, as mentioned earlier, include muscle and joint soreness, fatigue, sleep problems, irritable bowel symptoms, morning stiffness, depression and brain fog.

7. How is it diagnosed?
Unfortunately, it’s not uncommon to be misdiagnosed or have to see several doctors before a diagnosis is made.

Your best bet is to see a rheumatologist, a doctor who specializes in conditions affecting muscles and joints.

He or she will look for symptoms and physical findings that meet a specific definition of fibromyalgia established by the American College of Rheumatology.For example, a patient must have 11 out of 18 specific tender points on her body (neck, shoulders, back, hips, and upper and lower extremities), and she must have had widespread pain in her muscles and joints lasting for three months or more without explanation.

The doctor will also work to rule out other diseases that have similar symptoms, such as lupus and polymyalgia rheumatica (another autoimmune disease).

8. What lifestyle changes can I make to help alleviate the symptoms?
Get plenty of gentle aerobic exercise (like swimming or walking briskly), working up to at least 30 minutes most days of the week.

Weight gain commonly accompanies fibromyalgia (thanks to the fatigue, muscle pain and poor sleep).

Regular exercise will give you more energy, boost your mood, lower your weight and help you sleep better.

Eating a healthy diet with lots of vegetables, fruits, whole grains, lean meats and dairyalso will energize you, lower your weight and improve your overall health as you battle fibromyalgia.You can also try eliminating the following foods, which appear to bother some people with fibromyalgia:

  • Food additives like MSG and nitrates (the preservative in hot dogs and bacon)
  • Aspartame (NutraSweet)
  • Sugar
  • Caffeine drinks

But remember, what works for one person may not work for another.

9. What are the latest fibromyalgia treatments?
Pregabalin (Lyrica) was the first to be approved by the Food and Drug Administration (FDA) for fibromyalgia [in 2007]. Studies suggest that it prevents pain and improves sleep by slowing the release of chemicals associated with pain. [Duloxetine (Cymbalta) was approved in 2008 and Milnacipran (Savella) in 2009.]

Older standbys can help too. Anti-inflammatories such as ibuprofen and muscle relaxers can relieve pain. Antidepressants – especially tricyclics (amitriptyline or Elavil) – boost mood as well as lessen pain and improve sleep.Supplements such as 5-HTP and SAM-e (S-adenosylmethionine) may also be useful. An amino acid, 5-HTP, converts to serotonin, a feel-good neurotransmitter that helps boost mood and sleep. SAM-e is an enzyme already present in the body that affects mood and lessens pain.

D-Ribose, a simple sugar in powder form, may lessen pain and fatigue when dissolved in water and taken 2-3 times daily.

Cognitive behavioral therapy, acupuncture, hypnotherapy and biofeedback may also be worth trying.

10. What is the long-term outlook for a woman with fibromyalgia?
The good news is that fibromyalgia does not cause damage to muscles and joints that can lead to debilitation, immobility or joint replacement.

The bad news is that the symptoms typically don’t resolve. Many women simply must learn to live with fibromyalgia.
The key is finding individual or combination therapies that help. Not all treatments help all patients with fibromyalgia; discovering which help you is a matter of trial and error. But scientists continue to work on finding the cause of fibromyalgia and, ultimately, a cure or effective treatment.

How Much Do You Know About Fibromyalgia?
Described by Hippocrates in ancient Greece, fibromyalgia is one of the world’s oldest medical mysteries. The disease – a complex illness marked by chronic muscle, tendon and ligament pain, fatigue and multiple tender points on the body – affects about 2% percent of Americans, most of them women.

By Robin H. Miller, M.D. and Janet Horn, M.D., Lifescript Women’s Health Experts
Published April 16, 2015