Fibromyalgia

Fibromyalgia is a common and complex chronic pain disorder that affects people physically, mentally and socially. It is characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues. People with fibromyalgia have "tender points" on the body. Tender points are specific places on the neck, shoulders, back, hips, arms, and legs. These points hurt when pressure is put on them.

Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals. Symptoms can come and go. Severe symptoms can be debilitating and interfere with your basic daily activities.

Symptoms sometimes begin after a physical trauma, surgery, infection, or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.

Women are much more likely to develop fibromyalgia than are men. Many people who have fibromyalgia may also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety, and depression.

The exact cause of fibromyalgia is unknown. Anyone can get it, but it is most common in middle-aged women. People with rheumatoid arthritis and other autoimmune diseases are particularly likely to develop fibromyalgia. There is no cure for fibromyalgia, but a variety of medications can help control symptoms. Getting enough sleep, exercising, stress reduction, and eating well may also help.

Chronic widespread body pain is the primary symptom of fibromyalgia. Most people with fibromyalgia also experience the following symptoms:

• moderate to extreme fatigue
• sleep disturbances
• sensitivity to touch, light, and sound
• cognitive difficulties
• morning stiffness
• headaches
• painful menstrual periods
• tingling or numbness in hands and feet
• problems with thinking and memory (sometimes called "fibro fog")

Many individuals also experience a number of other symptoms and overlapping conditions, such as irritable bowel syndrome, lupus, and arthritis.

The exact cause of fibromyalgia is unclear, but it most likely involves a variety of factors working together. These may include:

• Genetics. Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder.
• Infections. Some illnesses appear to trigger or aggravate fibromyalgia.
• Physical or emotional trauma. Post-traumatic stress disorder has been linked to fibromyalgia.

Researchers believe 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 sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals.

Risk factors for fibromyalgia include:

• Your sex. Fibromyalgia is more common in women than in men.
• Family history. You may be more likely to develop fibromyalgia if a relative also has the condition.
• Rheumatic disease. If you have a rheumatic disease, such as rheumatoid arthritis or lupus, you may be more likely to develop fibromyalgia.

Fibromyalgia is diagnosed when a person has had widespread pain for more than 3 months with no underlying medical condition that could cause the pain.

There is no lab test to confirm a diagnosis of fibromyalgia, but your doctor may want to rule out other conditions that have similar symptoms. Blood tests may include:

• Complete blood count
• Erythrocyte sedimentation rate
• Thyroid function tests

Learning to live with a chronic illness is an emotional challenge. If you have fibromyalgia, develop a routine that provides emotional support and increases communication with family and friends. Consider joining a fibromyalgia support group. These groups can provide important information and allow participants to discuss subjects of interest to the fibromyalgia patient. Counseling sessions with a trained professional may help improve communication and understanding about the illness and help to build healthier relationships with your family.

Self-care is critical in the management of fibromyalgia. Take these steps to manage the condition:

• Reduce stress. Avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. Try stress management techniques, such as deep-breathing exercises or meditation.
• Get enough sleep. Fatigue is one of the main characteristics of fibromyalgia, so 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 gradually and regularly often decreases symptoms. Appropriate exercises may include walking, swimming, biking, and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture, and relaxation exercises also are 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. Moderation means not overdoing it on your good days, but likewise it means not self-limiting or doing too little on the days when symptoms flare.
• Maintain a healthy lifestyle. Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day.

The pain and lack of sleep associated with fibromyalgia can interfere with your ability to function at home or on the job. The frustration of dealing with an often-misunderstood condition also can result in depression and health-related anxiety.

Complementary therapies can be very beneficial in managing symptoms of fibromyalgia. These include: physical therapy, therapeutic massage, myofascial release therapy, water therapy, light aerobics, acupressure, application of heat or cold, acupuncture, yoga, relaxation exercises, breathing techniques, aromatherapy, cognitive therapy, biofeedback, herbs, nutritional supplements, and osteopathic or chiropractic manipulation.

Fibromyalgia treatment includes both medication and self-care. The goal of treatment is to minimize symptoms and improve general health. No single treatment works for all symptoms and no single treatment works for every individual.

Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:

• Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others), or naproxen sodium (Aleve, others) may be helpful. Prescription pain relievers include tramadol (Ultram, Conzip). Narcotics are not advised for fibromyalgia patients because they can lead to dependence and may even worsen the pain over time.
• Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline (Elavil, Vanatrip, Sentravil) or fluoxetine (Prozac) to help promote sleep.
• Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin, Gralise) is sometimes helpful in reducing fibromyalgia symptoms. Pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia.