Fibromyalgia

Fibromyalgia is a disorder characterized by widespread, generalized pain of the muscles, tendons, and other soft tissues. The pain occurs on both sides of the body as well as above and below the waist. It appears to increase the brain’s susceptibility to pain, over activating certain pain receptors in the brain.

The pain associated with fibromyalgia is achy and ranges from dull to almost unbearable. Fibromyalgia sufferers also complain of muscle stiffness, fatigue that can interfere with the activities of daily life, and difficulty sleeping.

Fibromyalgia is more common in women than men, and is more frequent in young or middle-aged women than in older women. However, it can occur in children, adolescents, and men, and it is more likely to be overlooked or misdiagnosed in these groups.

Causes, Incidence and Risk Factors

No one knows what causes fibromyalgia. It can occur after a viral or systemic infection, such as Lyme disease, or trauma. Other contributing factors include disruption of the delta, or deep, stage of sleep; and emotional stress. It sometimes occurs in patients with systemic rheumatic disorders, such as rheumatoid arthritis and systemic lupus erythematosus.

Genetics may also play a role. Because fibromyalgia tends to run in families, there may be certain genetic mutations that increase a person’s susceptibility to developing the disorder. However, in many patients, there is no apparent cause.

Although fibromyalgia can occur in anyone, it is most commonly seen in women aged 20 to 50.

Symptoms

Aching pain is the main symptom of fibromyalgia, but it may also feel like a shooting or burning pain. It may be mild to severe. Fibromyalgia does not usually involve the joints, although the pain may feel like it is coming from the joints.

People with fibromyalgia usually wake up with body aches and muscle stiffness, which can improve during the day and get worse at night. Other people experience pain all day long.

Cold or damp weather, anxiety, and stress can also increase the level of pain.

Fatigue, depressed mood, and sleep problems are seen in almost all patients with fibromyalgia. Many say that they can’t get to sleep or stay asleep, and most feel tired when they wake up.

Fibromyalgia patients tend to be stressed, tense, anxious, ambitious, and sometimes depressed. Some fibromyalgia sufferers describe themselves as perfectionists. They may also suffer from symptoms of irritable bowel syndrome or migraine or tension headaches. Physicians who dismiss their patient’s complaints as being “all in the head” can also make symptoms worse.

Why Does it Hurt?

It is thought that people with fibromyalgia have a lower threshold for pain because their brains are more sensitized to pain signals than are the brains of people who do not have fibromyalgia.

Researchers believe that repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain’s pain receptors seem to develop a memory of the pain and become more sensitive, meaning they can overreact to pain signals.

Pain is a complicated process, and many different pathways and areas in the brain are involved.  After a while, the pain can change brain activity and the nervous system.  Some of the same areas of the brain that are involved in processing emotions, stress, memory, and executive functioning, are also involved in processing pain. This lends support to the notion that it is important to control those negative emotions as it can have a positive impact on pain. In the brain, signals that are interpreted as pain are amplified by our emotions, beliefs, and memories.  Chronic pain can also lead to early aging of the brain; the “fibro fog” that many patients complain of may be due to physical changes within the brain.

How is Fibromyalgia Diagnosed? 

There is no specific test to diagnose for fibromyalgia. The diagnosis is made on the basis of a careful history and physical examination. The pain must occur on both sides of the body and above and below the waist.

The traditional way of diagnosing Fibromyalgia is by performing a tender point exam.  The doctor will determine if there are specific areas that experience increased pain when firm pressure is applied. These areas, called tender points, are typically found in the following locations:

  • Back of the head
  • Between shoulder blades
  • Top of shoulders
  • Front sides of neck
  • Upper chest
  • Outer elbows
  • Upper hips
  • Sides of hips
  • Inner knees

Recent work has led to newer diagnostic criteria that includes more information on the severity of symptoms you might experience.  In addition to indicating where on your body you feel pain, your doctor will ask you to rate the following symptoms:

0 = no problem

1 = slight or mild problems, generally mild or intermittent

2 = moderate, considerable problems, often present and/or at a moderate level

3 = severe: pervasive, continuous, life-disturbing problems

 

0

1

2

3

Fatigue        
Waking unrefreshed        
Cognitive symptoms        

 

You will also be asked to indicate what additional symptoms you experience:

Muscle pain Irritable bowel syndrome Fatigue / tiredness Thinking or remembering problem Muscle weakness Headache
Pain / cramps in the abdomen Numbness / tingling Dizziness Insomnia Depression Constipation
Pain in the upper abdomen

Nausea

Nervousness Chest pain Blurred vision Fever
Diarrhea Dry mouth Itching Wheezing Raynaud’s phenomenon Hives / welts
Ringing in ears Vomiting Heartburn Oral ulcers Loss of / change in   taste Seizures
Dry eyes Shortness of breath Loss of appetite Rash Sun sensitivity Hearing   difficulties
Easy bruising Hair loss Frequent urination Painful urination Bladder spasms  

Treatment

The goal of treatment is to help relieve the pain, fatigue, anxiety, and other symptoms associated with fibromyalgia.

Initial treatment may include physical therapy and an exercise program. Light massage and relaxation techniques may be taught to help sufferers cope with stress and anxiety. Acupressure and acupuncture can also help reduce pain.

Medications such as antidepressants and muscle relaxants may also be prescribed to improve sleep and increase pain tolerance. Several antidepressants have been specifically approved for the treatment of fibromyalgia. These include duloxetine (Cymbalta), pregabalin (Lyrica), and milnacipran (Savella).

Other drugs are also used to treat fibromyalgia, including anti-seizure drugs, muscle relaxants, over-the-counter and prescription pain medications.

Cognitive-behavioral therapy is an important part of treatment. It helps patients deal with negative thoughts that can accompany fibromyalgia, and can help to identify the foods, activities, and habits that make symptoms worse.

In the meantime, it is important for people with fibromyalgia to eat a well-balanced diet, avoid caffeine, and follow a consistent sleep routine to improve the quantity and quality of sleep.

What research studies are you conducting about Fibromyalgia?

We have conducted two previous studies on Fibromyalgia and Low Dose Naltrexone, and have included more information about our results on this page.  We also have more general research opportunities, which you can learn about on our Current Research Studies page.