Treating Fibromyalgia Pain

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Understanding Fibromyalgia - the Basics

What Is Fibromyalgia?

Fibromyalgia is a non-life-threatening, chronic disorder of the muscles and surrounding soft tissue, including ligaments and tendons. Its main symptoms are muscle pain, fatigue, sleep disturbances, and tender points at certain parts of the body. Many people describe fibromyalgia as feeling like a persistent flu.

Some health care providers may use these terms to refer to fibromyalgia: fibromyositis, fibrositis, periarticular fibrositis, muscular rheumatism, chronic muscle pain syndrome, musculoskeletal pain syndrome, or tension myalgia. However, "fibromyalgia," which means "pain of the muscles and other fibrous tissue," is the accepted term and has replaced some of the others. Terms ending in "-itis," which means "inflammation," are now considered incorrect because inflammation does not play a significant role in fibromyalgia.

Key Characteristics of Fibromyalgia

Muscle pain, either throughout the body or only at certain points, is the primary symptom of fibromyalgia. It may range from mild discomfort to pain severe enough to limit work, social activities, and everyday tasks. Pain commonly occurs in the neck, upper back, shoulders, chest, rib cage, lower back, and thighs and may feel like a burning, gnawing, throbbing, stabbing, or aching sensation and may develop gradually. It usually seems worse when a person is trying to relax and is less noticeable during activity.

A related, key aspect of fibromyalgia is the presence of "tender points," muscles and tendons that are tender when pressed. Typically, tender points are located in the neck, back, knee, shoulder, elbow, and hip.

People with fibromyalgia also feel moderately to severely fatigued and have sleep problems, including insomnia. Sleep disturbances may result from restless legs and arms, which may disrupt their sleep, or they may suffer from sleep apnea or grind their teeth while they sleep.

Tender Points and Fibromyalgia

According to the American Academy of Rheumatology, for a diagnosis of fibromyalgia, you must have unusual tenderness at a minimum of 11 of 18 specific "tender points" associated with the condition. Some health care providers diagnose fibromyalgia in patients who have fewer tender points but who otherwise have severe, widespread (meaning upper and lower body occurring on both right and left sides) pain symptoms that are present for at least three months.

The standard tender points are located in the muscles or other soft tissue on both sides and the front and back of the body. Those who have fibromyalgia may have unusual tenderness at any of several other points on the body as well.

Who Is Affected by Fibromyalgia?

Experts estimate that 3 million to 6 million Americans have fibromyalgia. Of these, 80% are women. One of the main risk factors is being a woman between the age of 20 and 50. Another risk factor is having a rheumatic disease, such as rheumatoid arthritis, lupus, or Sjogren's syndrome. Fibromyalgia also seems to run in families, so a gene may be at least partly responsible for the condition. Most people with fibromyalgia begin to notice symptoms between the ages of 20 and 40, but children and older adults may also develop the condition. Women with fibromyalgia typically feel pain throughout their body, while men are more likely to have facial pain or pain and stiffness in a certain part of the body as a result of a work- or recreation-related muscle strain.

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WebMD Medical Reference

Do You Have Fibromyalgia Pain?

Cymbalta is approved for the management of fibromyalgia.

Important Safety Information About Cymbalta

Antidepressants can increase suicidal thoughts and behaviors in children, teens, and young adults. Suicide is a known risk of depression and some other psychiatric disorders. Call your doctor right away if you have new or worsening depression symptoms, unusual changes in behavior, or thoughts of suicide. Be especially observant within the first few months of treatment or after a change in dose. Approved only for adults 18 and over.

What should I talk about with my healthcare provider?

Patients on antidepressants and their families or caregivers should watch for new or worsening depression symptoms, unusual changes in behavior, thoughts of suicide, anxiety, agitation, panic attacks, difficulty sleeping, irritability, hostility, aggressiveness, impulsivity, restlessness, or extreme hyperactivity. Call your healthcare provider right away if you have thoughts of suicide or if any of these symptoms are severe or occur suddenly. Be especially observant within the first few months of antidepressant treatment or whenever there is a change in dose.

Who should NOT take Cymbalta?

You should not take Cymbalta if:

You have recently taken a type of antidepressant called a monoamine oxidase inhibitor (MAOI)
You have uncontrolled narrow-angle glaucoma (increased eye pressure)
You are taking Mellaril® (thioridazine)

What other important information should I discuss with my healthcare provider?

Before starting Cymbalta, talk with your healthcare provider:

about all of your medical conditions, including kidney or liver problems, glaucoma, diabetes, seizures, or if you have bipolar disorder. Cymbalta may worsen a type of glaucoma or the control of blood sugar in some patients with diabetes
about your alcohol use
if you are taking nonprescription or prescription medicines, including those for migraine, to address a possible life-threatening condition
if you are taking NSAID pain relievers, aspirin, or blood thinners. Use with Cymbalta may increase bleeding risk
if you are pregnant, plan to become pregnant during therapy, or are breastfeeding an infant

While taking Cymbalta, talk with your healthcare provider:

if you have itching, right upper belly pain, dark urine, yellow skin/eyes, or unexplained flu-like symptoms, which may be signs of liver problems. Severe liver problems, sometimes fatal, have been reported
if you have high fever, confusion, and stiff muscles to address a possible life-threatening condition
before stopping Cymbalta or changing your dose
if you experience dizziness or fainting upon standing, especially when first starting Cymbalta or when increasing the dose.
about your blood pressure. Cymbalta can increase your blood pressure. Your healthcare provider should check your blood pressure prior to and while taking Cymbalta
if you experience headache, weakness, confusion, problems concentrating, memory problems, or feel unsteady while taking Cymbalta which may be signs of low sodium levels
if you develop problems with urine flow

If you have any questions, talk to your healthcare provider before taking Cymbalta.

What are the possible side effects of Cymbalta?

In clinical studies of depression, the most common side effect of Cymbalta was nausea. Other common side effects included dry mouth, constipation, decreased appetite, fatigue, sleepiness, and increased sweating. This is not a complete list of side effects.