Fibromyalgia is a chronic condition that affects about 5 million Americans. Doctors diagnose fibromyalgia based on a patient's symptoms and physical exam. Patients experience pain and stiffness in the muscles, but there are no measurable findings on X-rays or most lab tests. While fibromyalgia does not damage the joints or organs, the constant aches and fatigue can have a significant impact on daily life.
The hallmark of fibromyalgia is muscle pain throughout the body, typically accompanied by:
Anxiety or depression
Specific tender points
Fibromyalgia Tender Points
One of the unique aspects of fibromyalgia is the presence of tender points in specific locations on the body. When these points are pressed, people with fibromyalgia feel pain, while people without the condition only feel pressure. This illustration shows 18 possible tender points.
Fibromyalgia: The Pain Is Real
The pain of fibromyalgia can be intense. Because traditionally no lab tests or X-rays could confirm a diagnosis of fibromyalgia, some patients were once led to believe this pain was "all in their heads." But the medical community now accepts that the pain of fibromyalgia is real. Research suggests it's caused by a glitch in the way the body perceives pain.
Fibromyalgia: Who's at Risk?
Women between the ages of 25 and 60 have the highest risk of developing fibromyalgia. Doctors aren't sure why, but women are 10 times more likely to have the condition than men. Some researchers believe genetics may play a role, but no specific genes have been identified.
Fibromyalgia and Fatigue
After pain, the most common and debilitating symptom of fibromyalgia is fatigue. This is not the normal tiredness that follows a busy day, but a lingering feeling of exhaustion. People with fibromyalgia may feel tired first thing in the morning, even after hours spent in bed. The fatigue may be worse on some days than others and can interfere with work, physical activity, and household chores.
Causes of Fibromyalgia
There are many theories about the causes of fibromyalgia, but research has yet to pinpoint a clear culprit. Some doctors believe hormonal or chemical imbalances disrupt the way nerves signal pain. Others suggest a traumatic event or chronic stress may increase a person's susceptibility. Most experts agree that fibromyalgia probably results from a combination of factors, rather than a single cause.
Fibromyalgia: Impact on Daily Life
Constantly fighting pain and fatigue can make people irritable, anxious, and depressed. You may have trouble staying on task at work, taking care of children, or keeping up with household chores. Exercise or hobbies such as gardening may seem daunting. Exhaustion and irritability can also lead to missing out on visits with friends. Fortunately, there are effective treatments that help many patients get back to the activities they enjoy.
Your doctor may diagnose fibromyalgia after hearing your symptoms and doing a physical exam. A fibromyalgia blood test may help too.And, your doctor may do other testing to rule out other conditions. Be sure to describe your pain in detail, including where and how often it occurs. Also bring up any other symptoms, such as fatigue, sleep problems, or anxiety.
Fibromyalgia: Getting Treatment
Fibromyalgia was once the exclusive domain of rheumatologists. Today, the condition has captured the attention of a wide range of health care providers. Many people receive treatment through their primary care providers. Check with local support groups and hospitals for a list of fibromyalgia experts in your area.
An important first step is identifying what makes your symptoms worse. Common triggers include:
Cold or humid weather
Too much or too little physical activity
Fibromyalgia and Sleep
Many people with fibromyalgia have sleep problems, including trouble falling asleep or frequent awakenings during the night. Studies suggest some patients remain in a shallow state of sleep and never experience restful, deep sleep. This deprives the body of a chance to repair and replenish itself, creating a vicious cycle. Poor sleep may make pain seem worse, and pain can lead to poor sleep.
Fibromyalgia and Depression
Nearly a third of people with fibromyalgia also have major depression when they are diagnosed. The relationship between the two is unclear. Some researchers believe depression may be a result of the chronic pain and fatigue. Others suggest that abnormalities in brain chemistry may lead to both depression and an unusual sensitivity to pain. Symptoms of depression may include difficulty concentrating, hopelessness, and loss of interest in favorite activities.
Managing Fibromyalgia: Medication
The goal of fibromyalgia treatment is to minimize pain, sleep disturbances, and mood disorders. Doctors may recommend medications that help ease your symptoms -- ranging from familiar over-the-counter pain relievers to prescription drugs like amitriptyline. There are also prescription drugs specifically approved for the treatment of fibromyalgia, which include Cymbalta (duloxetine), Lyrica (pregabalin), and Savella (milnacipran).
Managing Fibromyalgia: Exercise
Exercise can relieve several fibromyalgia symptoms. Physical activity can reduce pain and improve fitness. Exercising just three times a week has also been shown to relieve fatigue and depression. But it's important not to overdo it. Walking, stretching, and water aerobics are good forms of exercise to start with for people with fibromyalgia.
Managing Fibromyalgia: Diet
Some experts say diet may play a role in fibromyalgia -- just not the same role in all patients. Certain foods, including aspartame, MSG, caffeine, and tomatoes, seem to worsen symptoms in some people. But avoiding these foods won't help everyone. To find out what works for you, try eliminating foods one at a time and recording whether your symptoms improve.
Managing Fibromyalgia: Massage
Some research suggests massage may help relieve fibromyalgia pain, though its value is not fully proven. Practitioners say that applying moderate pressure is key, while the technique is less important. Rubbing, kneading, or stroking all seem to help. A significant other can learn to provide regular massages -- and a 20-minute session may be long enough to get results.
Managing Fibromyalgia: Acupuncture
Formal studies have produced mixed results on the use of acupuncture for fibromyalgia, but some patients say it eases their symptoms. This traditional Chinese practice involves inserting thin needles at key points on the body. Acupressure stimulates the same pressure points and may be a good alternative for people who want to avoid needles.
Managing Fibromyalgia: Fibro Fog
Many people with fibromyalgia have trouble concentrating, a phenomenon known as fibro fog. While getting treatment for pain and insomnia may help, there are other steps you can take to improve your focus. Write notes about things you need to remember, keep your mind active by reading or doing puzzles, and break tasks up into small, manageable steps.
Managing Fibromyalgia: Stress
Stress appears to be one of the most common triggers of fibromyalgia flare-ups. While it's impossible to eliminate all stress from your life, you can try to reduce unnecessary stress. Determine which situations make you anxious -- at home and at work -- and find ways to make those situations less stressful. Experiment with yoga, meditation, or other relaxation techniques. And allow yourself to skip nonessential activities that cause stress.
Does Fibromyalgia Get Better?
Many people with fibromyalgia find that their symptoms and quality of life improve substantially as they identify the most effective treatments and make lifestyle changes. While fibromyalgia is a chronic condition, it does not damage the joints, muscles, or internal organs.
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American College of Rheumatology.
American Fibromyalgia Syndrome Association.
McIlwain, H. and Bruce, D. The Fibromyalgia Handbook, Holt, 2007.
National Fibromyalgia Association.
National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Wolfe, F. Arthritis Care & Research,May 2010.
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