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Fibromyalgia

Definition

Fibromyalgia is a common syndrome in which a person has long-term pain, spread throughout the body. The pain is most often linked to fatigue, sleep problems, headaches, depression, and anxiety.

People with fibromalgia may also have tenderness in the joints, muscles, tendons, and other soft tissues.

Alternative Names

Fibromyositis; Fibrositis

Causes

The cause is unknown. Possible causes or triggers of fibromyalgia include:

  • Physical or emotional trauma
  • Abnormal pain response (Areas in the brain that control pain may react differently in people with fibromyalgia.)
  • Sleep disturbances
  • Infection, such as a virus, although none has been identified

Fibromyalgia is most common among women age 20 to 50.

The following conditions may be seen with fibromyalgia or have similar symptoms:

  • Chronic neck or back pain
  • Chronic fatigue syndrome
  • Depression
  • Hypothyroidism (underactive thyroid)
  • Lyme disease
  • Sleep disorders

Symptoms

Pain is the main symptom of fibromyalgia. It may be mild to severe.

  • Painful areas are called tender points. Tender points are found in the soft tissue on the back of the neck, shoulders, chest, lower back, hips, shins, elbows, and knees. The pain then spreads out from these areas.
  • The pain may feel like a deep ache, or a shooting, burning pain.
  • The joints are not affected, although the pain may feel like it is coming from the joints.

People with fibromyalgia tend to wake up with body aches and stiffness. For some people, pain improves during the day and gets worse at night. Some people have pain all day long.

Pain may get worse with activity, cold or damp weather, anxiety, and stress.

Fatigue, depressed mood, and sleep problems occur in almost all people with fibromyalgia. Many people say that they cannot get to sleep or stay asleep, and they feel tired when they wake up.

Other symptoms of fibromyalgia may include:

  • Irritable bowel syndrome (IBS)
  • Memory and concentration problems
  • Numbness and tingling in hands and feet
  • Reduced ability to exercise
  • Tension or migraine headaches

Exams and Tests

To be diagnosed with fibromyalgia, you must have had at least 3 months of widespread pain with one or more of the following:

  • Ongoing problems with sleep
  • Fatigue
  • Thinking or memory problems

It is no longer necessary to find tender points during the exam to make a diagnosis.

Results from blood and urine tests are normal most of the time. However, these tests may be done to rule out other conditions with similar symptoms.

Treatment

The goals of treatment are to help relieve pain and other symptoms, and to help a person cope with the symptoms.

The first type of treatment may involve:

  • Physical therapy
  • Exercise and fitness program
  • Stress-relief methods, including light massage and relaxation techniques

If these treatments do not work, your doctor may prescribe an antidepressant or muscle relaxant.

  • The goal of these medicines is to improve your sleep and help you better tolerate pain.
  • Medicine should be used along with exercise and behavior therapy.
  • Duloxetine (Cymbalta), pregabalin (Lyrica), and milnacipran (Savella) are drugs that are approved specifically for treating fibromyalgia.

Other drugs are also used to treat the condition, such as:

  • Anti-seizure drugs, such as gabapentin
  • Other antidepressants, such as amytriptyline
  • Muscle relaxants, such as cyclobenzeprine
  • Pain relievers, but avoid narcotics, since they usually do not help
  • Sleeping aids

Cognitive-behavioral therapy is an important part of treatment. This therapy helps you learn how to:

  • Deal with negative thoughts
  • Keep a diary of pain and symptoms
  • Recognize what makes your symptoms worse
  • Seek out enjoyable activities
  • Set limits

Support groups may also be helpful.

Things you can do to help take care of yourself include:

  • Eat a well-balanced diet.
  • Avoid caffeine.
  • Practice a good sleep routine to improve quality of sleep.
  • Exercise regularly, starting with low-level exercise.
  • Try acupressure and acupuncture treatments.

Your doctor may refer you to a pain clinic if your condition is severe.

Outlook (Prognosis)

Fibromyalgia is a long-term disorder. Sometimes, the symptoms improve. Other times, the pain may get worse and continue for months or years.

When to Contact a Medical Professional

Call your health care provider if you have symptoms of fibromyalgia.

Prevention

There is no known prevention.

References

Bennett RM. Fibromyalgia, chronic fatigue syndrome, and myofascial pain In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 274.

Clauw DJ, Arnold LM, McCarberg BH, FibroCollaborative. The science of fibromyalgia. Mayo Clin Proc. 2011;86(9):907-11.

Häuser W, Bernardy K, Ãœceyler N, Sommer C. Treatment of fibromyalgia syndrome with antidepressants. JAMA. 2009;301:198-209. PMID: 19141768 www.ncbi.nlm.nih.gov/pubmed/19141768.

McBeth J, Prescott G, Scotland G, Lovell K, Keeley P, Hannaford P, et al. Cognitive behavior therapy, exercise, or both for treating chronic widespread pain. Arch Intern Med. 2012(1);48-57. PMID: 22082706 www.ncbi.nlm.nih.gov/pubmed/22082706.

Wolfe F, Clauw DJ, Fitzcharles MA, et al. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol. 2011; 38:1113. PMID: 21285161 www.ncbi.nlm.nih.gov/pubmed/21285161.

Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010;62(5):600-610. PMID: 20461783 www.ncbi.nlm.nih.gov/pubmed/20461783.

Wolfe F, Rasker JJ. Fibromyalgia. In: Firestein GS, Budd RC, Gabriel SE, et al, eds. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 52.

Review Date:1/20/2015
Reviewed By:Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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