linePlus Medical Encyclopedia

Fibromyalgia
URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/000427.htm
Fibromyalgia has also been linked to fatigue, sleep problems, headaches, depress
ion, anxiety, and other symptoms.
Causes
The cause of this disorder is unknown. Although none have been well proven, poss
ible causes or triggers of fibromyalgia include:

Symptoms

Physical or emotional trauma An abnormal pain response. Areas in the brain that
are responsible for pain may react differently in fibromyalgia patients. Sleep d
isturbances, which are common in fibromyalgia patients. An infectious microbe, s
uch as a virus. At this point, no such virus or microbe has been identified.
Men and women of all ages get fibromyalgia, but the disorder is most common amon
g women aged 20 to 50.
The following conditions may be seen with fibromyalgia or mimic its symptoms:
Chronic neck or back pain Chronic fatigue syndrome Depression Hypothyroidism Lym
e disease Sleep disorders
The primary symptom of fibromyalgia is pain.
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Fibromyalgia is a common syndrome in which people experience long-term, body-wid
e pain and tender points in joints, muscles, tendons, and other soft tissues.
The exact locations of the pain are called tender points. Tender points are foun
d in the soft tissue on the back of the neck, shoulders, sternum, lower back, hi
ps, shins, elbows, and knees. The pain then spreads out from these areas. The pa
in is described as deep-aching, radiating, gnawing, shooting or burning, and ran
ges from mild to severe. The joints are not affected, although the pain may feel
like it is coming from the joints. People with fibromyalgia tend to wake up wit
h body aches and stiffness. For some patients, pain improves during the day and
increases again during the evening, though many patients have day-long, non-stop
pain. Pain can increase with activity, cold or damp weather, anxiety, and stres
s.
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Fibromyalgia: MedlinePlus Medical Encyclopedia

Other symptoms may include:
Exams and Tests
Treatment

Irritable bowel syndrome with gas, and alternating diarrhea and constipation Mem
ory difficulties and problems thinking clearly Numbness and tingling in hands an
d feet Palpitations Reduced exercise tolerance Sad or depressed mood Tension or
migraine headaches
Arms (elbows) Buttocks Chest Knees Lower back Neck Rib cage Shoulders Thighs
Treatments usually involve trial and error:
Patients may start with physical therapy, exercise, and methods for reducing str
ess. If these methods fail to improve symptoms, an antidepressant or muscle rela
xant may be added to the treatment. Patient education programs called cognitive-
behavioral therapy, which help with coping skills, are an important part of the
treatment plan. Many fibromyalgia sufferers have found support groups helpful.
Eating a well-balanced diet and avoiding caffeine may help with problems sleepin
g, and may help reduce the severity of the symptoms. Lifestyle measures to impro
ve the quality of sleep can be effective for fibromyalgia. See: Sleeping difficu
lty
Reducing stress and improving coping skills may also help reduce painful symptom
s.
Improved fitness through exercise is recommended.
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Fatigue and problems with sleep are seen in almost all patients with fibromyalgi
a. Many complain that they can't get to sleep or stay asleep, and they feel tire
d when they wake up.
Diagnosis of fibromyalgia requires a history of a least 3 months of widespread p
ain, and pain and tenderness in at least 11 of 18 tender-point sites. These tend
er-point sites include fibrous tissue or muscles of the:
Sometimes, laboratory and x-ray tests are done to help confirm the diagnosis by
ruling out other conditions that may have similar symptoms.
Treatment should focus on not only relieving symptoms, but also on helping patie
nts learn how to cope with their symptoms.
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Outlook (Prognosis)
Prevention
Alternative Names
Fibromyositis; Fibrositis
Deal with negative thoughts Keep a diary of their pain and symptoms Recognize wh
at makes their symptoms worse Seek out enjoyable activities Set limits
The goal of using medication is to improve sleep and pain tolerance. Patients sh
ould receive drug treatments along with exercise, patient education, and behavio
ral therapies.
Duloxetine (Cymbalta), pregabalin (Lyrica), and milnacipran (Savella) are medica
tions that are approved specifically for treating fibromyalgia.
However, many other drugs are also used to treat the condition, including:
Anti-seizure drugs Other antidepressants Muscle relaxants Pain relievers Sleepin
g aids
Severe cases of fibromyalgia may require a referral to a pain clinic.
When to Contact a Medical Professional
Call your health-care provider if you have symptoms of fibromyalgia.
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The best way to begin a fitness program is to start with short sessions of just
a few minutes of gentle, low-impact exercises such as walking and swimming. Incr
ease the length of each session slowly, as tolerated. Starting out slowly and ge
ntly can help ease you into an effective program you can stick with.
Starting slowly helps stretch and mobilize tight, sore muscles, which may be rel
ieved by gentle stretching and light massage, as well as acupressure, acupunctur
e, and relaxation techniques.
Cognitive therapy usually lasts for 6 to 20 1-hour sessions. During this therapy
, people with fibromyalgia learn to:
Fibromyalgia is a common and chronic problem. The symptoms sometimes improve. At
other times, the symptoms may worsen and continue for months or years. The key
is seeking professional help which includes a multi-faceted approach to the mana
gement and treatment of the disease. There is no proof that fibromyalgia syndrom
e results in an increased death rate.
There is no proven prevention for this disorder. However, over the years, the tr
eatment and management of the disease have improved.
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References
Wolfe F, Rasker JJ. Fibromyalgia. In: Firestein GS, Budd RC, Harris ED Jr., et a
l., eds. Kelley's Textbook of Rheumatology. 8th ed. Philadelphia, Pa: Saunders E
lsevier; 2008:chap 38.
Update Date: 2/7/2010

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Abeles M, Solitar BM, Pillinger MH, Abeles AM. Update on fibromyalgia therapy. A
m J Med. 2008;121:555-561.
Häuser W, Bernardy K, Üceyler N, Sommer C. Treatment of fibromyalgia syndrome with a
ntidepressants. JAMA. 2009;301:198-209.
Updated by: Mark James Borigini, Associate Clinical Professor of Medicine, Unive
rsity of Calirofnia, Irvine, CA. Review provided by VeriMed Healthcare Network.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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