A comprehensive look at the possible causes of fibromyalgia and prevention. Different medications and their effectiveness are also discussed, along with Self-care practises and alternative medicine techniques that have been shown to provide some relief.
What Is Fibromyalgia?
You hurt all over and you frequently feel exhausted. Even after numerous tests, your doctor can't seem to find anything specifically wrong with you. If this sounds familiar, you may have fibromyalgia, a condition that affects an estimated 6 million to 8 million people. Approximately 80 percent of affected people are women.
Fibromyalgia is a chronic condition characterized by fatigue and widespread pain in the fibrous tissues in your muscles, ligaments and tendons. Previously, the condition was known by other names such as fibrositis, chronic muscle pain syndrome, psychogenic rheumatism and tension myalgias.
In 1990, the American College of Rheumatology identified specific criteria for fibromyalgia. For a diagnosis of fibromyalgia, at least 11 of 18 specific areas of your body must be painful under pressure. Also, you must have had widespread pain lasting at least 3 months.
Although the intensity of your symptoms may vary, they will probably never disappear completely. It may be reassuring to know, however, that fibromyalgia isn't progressive, crippling or life-threatening.
Signs and Symptoms
Symptoms of fibromyalgia can vary, depending on weather, stress, physical activity or just the time of day. Different people experience different symptoms, but common signs and symptoms include:
- Widespread pain. Fibromyalgia causes pain in specific areas of the body when pressure is applied to them. These areas may include the back of the head, the upper back and neck, the upper chest, and the elbows, hips and knees. The pain generally persists for months at a time and is often accompanied by stiffness.
- Fatigue and sleep disturbances. People with fibromyalgia often wake up tired and unrefreshed even though they seem to get plenty of sleep. Sleep studies suggest that this problem is caused by a sleep disorder called alpha wave interrupted sleep pattern, a condition in which deep sleep is frequently interrupted by bursts of brain activity similar to wakefulness. So people with fibromyalgia miss the deep restorative stage of sleep (stage 4). Sleep apnea , nighttime muscle spasms in the legs (nocturnal myoclonus) and restless legs syndrome may be associated with fibromyalgia.
- Irritable bowel syndrome (IBS). About 40 percent to 70 percent of people with fibromyalgia experience the constipation, diarrhea, abdominal pain and bloating associated with IBS.
- Chronic headaches and facial pain. Half of the people who have fibromyalgia also have recurrent migraine or tension-type headaches that may be related to tenderness in the neck and shoulders. As many as 90 percent experience jaw and facial pain.
- Heightened sensitivity. About 50 percent of people with fibromyalgia report being sensitive to odors, noises, bright lights, various foods and changes in weather.
- Numbness or tingling sensations in the hands and feet.
- Difficulty concentrating and mood changes.
- Chest pain or pelvic pain.
- Irritable bladder.
- Dry eyes and mouth.
- Sensation of swollen hands and feet.
Doctors believe that there isn't one single cause of fibromyalgia. Rather, a number of factors may contribute. These factors may include:
- Chemical changes in the brain. Studies suggest that some people with fibromyalgia have alterations in the regulation of certain brain chemicals called neurotransmitters. This may be particularly true of serotonin — which is linked to depression , migraines and gastrointestinal distress — and substance P, a brain chemical associated with pain, stress and anxiety, as well as depression.
- Sleep disturbances. Some researchers theorize that disturbed sleep patterns may be a cause rather than just a symptom of fibromyalgia. Studies have shown abnormally low levels of a hormone called somatomedin C in the blood of people with fibromyalgia. Somatomedin C is thought to be essential for the body to rebuild itself and is secreted only during stage 4 sleep.
- Injury. An injury to the upper spinal region has been shown to trigger the development of fibromyalgia in some people.
- Infection. Some researchers believe that a viral or bacterial infection may trigger fibromyalgia.
- Abnormalities of the autonomic (sympathetic) nervous system. Your autonomic nervous system is divided into the sympathetic and parasympathetic systems. Your sympathetic nervous system releases norepinephrine and influences the release of epinephrine from the adrenal gland. The sympathetic nervous system controls bodily functions that are not consciously controlled, such as heart rate, blood vessel contraction, sweating, salivary flow and intestinal movements. Several studies have looked at the responses of the sympathetic nervous system in people with fibromyalgia. There are reports of reduced epinephrine responses to low blood sugar levels and exercise. Other reported abnormalities include decreased responses to cold and altered heart rate and blood pressure responses during tilt-table testing — a noninvasive procedure normally used to help diagnose a common form of fainting (syncope). During the test, you lie on a bed that moves from a horizontal to a vertical position while your blood pressure and heart rate are monitored.
Approximately 2 percent of Canadians have fibromyalgia. Risk factors for fibromyalgia include:
- Sex. It's estimated that fibromyalgia occurs between 70 percent and 90 percent more often in women than in men.
- Age. Fibromyalgia tends to develop in people between the ages of 20 and 60. But it can occur in children.
- Disturbed sleep patterns. It's unclear whether sleeping difficulties are a cause or a result of fibromyalgia, but people with sleep disorders such as sleep apnea or restless legs syndrome can also develop fibromyalgia.
- Family history. You may be more likely to develop fibromyalgia if a relative also has the condition.
When To Seek Medical Advice
See your doctor if you experience general aching or widespread pain that lasts several months and is accompanied with fatigue. Many of the symptoms of fibromyalgia mimic those of other diseases, including low thyroid hormone production ( hypothyroidism ), polymyalgia rheumatica, neuropathies , systemic lupus erythematosus , multiple sclerosis and rheumatoid arthritis . Your doctor can help determine if one of these other conditions may be causing your symptoms.
Screening And Diagnosis
Diagnosing fibromyalgia is difficult because there isn't a specific laboratory test for it. In fact, before receiving a diagnosis of fibromyalgia, you may go through several medical tests, such as blood tests and X-rays, only to have the results come back normal. Although these tests may rule out other conditions, they can't confirm fibromyalgia.
The American College of Rheumatology has established some general classification guidelines for fibromyalgia to help in the assessment and study of the condition. These guidelines require that you have widespread aching for at least 3 months and have a minimum of 11 locations on your body that are abnormally tender under relatively mild pressure. In addition to taking your medical history, a doctor checking for fibromyalgia will press firmly on specific tender points on your head, upper body and certain joints so that you can confirm which cause pain.
However, not all doctors agree with the guidelines. Some believe that the criteria are too rigid and that you can have fibromyalgia even if you don't meet the required number of tender points. Others question how reliable and valid tender points are as a diagnostic tool.
Fibromyalgia is not progressive and generally doesn't lead to other conditions or diseases. It can, however, cause pain, depression and lack of sleep. These problems can then interfere with your ability to work at home or on the job, or maintain close family or personal relationships. The frustration of dealing with an often-misunderstood condition also can be a complication of the condition.
In general, fibromyalgia is treated with a combination of medication and self-care. The emphasis is on minimizing symptoms and improving general health. Recent studies also show that a brief, multidisciplinary treatment program at a special care center may reduce some symptoms of fibromyalgia, especially in people whose symptoms are more severe.
Medications can help reduce the pain of fibromyalgia and improve sleep. The ones most commonly recommended by doctors include:
- Aspirin, ibuprofen (Advil, Motrin) or acetaminophen (Tylenol, generics). These over-the-counter pain relievers may be used to treat the pain and stiffness caused by fibromyalgia. However, their effectiveness varies with different individuals, and in studies they haven't been shown to be effective. In addition, frequent or long-term use of aspirin and ibuprofen can cause serious side effects, including stomach pain, bleeding or ulcers. Overuse of acetaminophen may lead to kidney or liver damage.
- Antidepressants. Your doctor may prescribe antidepressant medications, such as amitriptyline (Elavil), nortriptyline (Pamelor), trazodone (Desyrel) or doxepin (Sinequan) to help promote sleep. Fluoxetine (Prozac) in combination with amitriptyline has been found effective. These medications may be beneficial by affecting serotonin levels in the brain. Side effects of antidepressants include dry eyes and mouth, constipation and increased appetite.
- Muscle relaxants. Cyclobenzaprine (Flexeril) given at bedtime has been shown to be helpful.
Prescription sleeping pills may provide short-term benefits for some people with fibromyalgia, but long-term use of these drugs is usually not advised. These medications tend to work for only a short time, after which the body becomes resistant to their effects. Ultimately, the use of sleeping pills tends to create even more sleeping problems in people with fibromyalgia.
Narcotics usually aren't recommended for fibromyalgia because of the potential for dependence and addiction. Corticosteroids, such as prednisone, haven't been shown to be effective in fibromyalgia because it isn't an inflammatory condition.
Self-care is critical in the management of fibromyalgia. Important aspects of self-care include taking these steps:
- Reduce stress. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But don't change your routine totally. People who quit work or drop all activity tend to do worse than those who remain active.
- Get enough sleep. Because fatigue is one of the main effects of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.
- Exercise regularly. At first, exercise may increase your pain. But doing it regularly often improves symptoms. Appropriate exercises include walking, swimming, biking and water aerobics. A physical therapist may help you develop a home exercise program. Aim for at least 20 to 30 minutes of exercise four or more times a week. Stretching, good posture and relaxation exercises are also helpful.
- Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days.
- Maintain a healthy lifestyle. Try to eat a balanced diet, limit your caffeine intake, work on smoking cessation, get adequate rest, exercise regularly and do something that you find enjoyable and fulfilling.
- Use eyedrops as needed. If you experience dry eyes, you can use over-the-counter drops for relief. These preparations resemble your own tears and contain substances that hold water in your eye. Choose one that's preservative free.
Besides dealing with the pain and fatigue of fibromyalgia, you may also have to deal with the frustration of having a condition that has no visible symptoms and is often misunderstood. In addition to educating yourself about fibromyalgia, you may find it helpful to provide your family, friends and co-workers with information.
It's also helpful to know that you're not alone. Organizations such as the Arthritis Foundation and the American Chronic Pain Association provide educational classes and support groups. These groups can often provide a level of help and advice that you might not find anywhere else. They can also help put you in touch with others who have had similar experiences and can understand what you're going through.
Complementary and Alternative Medicine
Complementary and alternative therapies in the area of pain and stress management aren't new. Some, such as meditation and yoga, have been practiced for thousands of years. But their use has become more popular in recent years, especially with people who have chronic illnesses, such as fibromyalgia.
Several of these treatments do appear to safely relieve stress and reduce pain, and some are gaining acceptance in mainstream medicine. But there are many practices that remain unproven because they haven't been adequately studied.
Below is a look at some of the more common complementary and alternative treatments promoted for pain management and the current thinking about their effectiveness and safety.
- Chiropractic medicine. This is a commonly used alternative therapy. It's based on the belief that certain conditions are caused by impairment of your nervous system due to problems in your joints. To treat these problems, chiropractors manipulate joints by slightly stretching or adjusting them. Not all doctors agree on the effectiveness of chiropractic therapies, however, and the practice is still considered controversial.
- Massage therapy. This is one of the oldest methods of health care still in practice. It involves use of different manipulative techniques to move your body's muscles and soft tissues. The therapy aims to improve circulation in the muscle, increasing the flow of nutrients and eliminating waste products. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body's natural painkillers. It often helps relieve stress and anxiety. Although massage is almost always safe, avoid it if you have open sores, acute inflammation or circulatory problems.
- Osteopathy. Doctors of osteopathy go through rigorous and lengthy training in academic and clinical settings. They're licensed to perform many of the same therapies and procedures as traditional doctors. One area where osteopathy differs from conventional medicine — but is similar to chiropractic medicine — is in the use of manipulation to address joint and spinal problems. Again, this is an area of controversy, but many studies support osteopathic techniques for many joint and muscle conditions.
- Acupressure and acupuncture. Both acupressure and acupuncture stem from the Chinese belief that 14 invisible pathways, called meridians, lie beneath your skin. In this belief, when the life force that runs through these meridians is interrupted, you become ill. Practitioners restore the flow of the energy by applying pressure with their fingers (acupressure) or by inserting very fine needles (acupuncture) into the skin. Research on the benefits of acupressure is inconclusive. But according to the National Institutes of Health, acupuncture to help control pain associated with fibromyalgia may be effective.
This material is intended for informational purposes only and is not a substitute for the medical advice of your doctor or any other health care professional. Always consult with your physician if you are in any way concerned about your health.
Revised May 30 2002
© 2002 SLPM Self care Ltd.