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Fibromyalgia Is Common, Painful Problem for Millions of Women

From the WebMD Archives

Dec. 6, 1999 (New York) -- Fibromyalgia is a chronic, painful condition that affects an estimated 3.7 million people in the U.S., most of whom are women. However, no single treatment has been established, leaving doctors and their patients with little choice but to mix and match a variety of drug and nondrug approaches. In an article in the December issue of the journal Archives of Internal Medicine, a Pennsylvania researcher concludes that physicians must empower patients to look to alternative treatments to achieve the best pain relief.

Doctors do not know the exact causes of fibromyalgia. However, there is a common pattern of symptoms that occur in about 75% of all fibromyalgia sufferers. These symptoms include fatigue, disrupted sleep, stiffness on waking in the morning, and the presence of multiple tender spots in the neck, lower back, arms and legs. Many patients with fibromyalgia also have other medical conditions such as irritable bowel syndrome, Lyme disease, arthritis, and tension headaches. Muscle abnormalities also have been observed, but some research has concluded that rather than being a feature of fibromyalgia, these abnormalities may be the result of not using certain muscles because of chronic pain.

"The diagnosis of fibromyalgia is based on a constellation of signs and symptoms, and there is really no one laboratory or radiographic test that tells you that someone does or does not have fibromyalgia," Lawrence J. Leventhal, MD, author of the article, tells WebMD. "It's a diagnosis of exclusion, so physicians have to rule out other conditions that can mimic fibromyalgia. As a result, it is an underdiagnosed entity." Leventhal is a rheumatologist at Graduate Hospital in Philadelphia.

Fibromyalgia is also difficult to treat, with only about 50% of patients who are treated reporting adequate relief of their symptoms. Contributing greatly to the difficulty of treatment is the lack of a specific drug or treatment that works best. Drugs that have been studied include pain killers, antidepressants, and anti-inflammatories. The most widely prescribed drug for fibromyalgia is Elavil (amitriptyline), an antidepressant taken at night that has consistently been found to relieve symptoms in 25-30% of patients. Another antidepressant, Effexor (venlafaxine), also has shown some success in improving symptoms. Less effective is the newer antidepressant Prozac (fluoxetine), which initially showed some success but was ineffective in larger studies. The anti-anxiety drug Xanax (alprazolam) is also used in some fibromyalgia patients, as is lidocaine (medication applied to the skin to kill sensation), growth hormone, and other drugs.

Nearly all of the medications used to treat fibromyalgia have side effects and none are 100% effective. "Unfortunately at this point in time there is no one drug available or on the horizon that by itself is a panacea for fibromyalgia," Leventhal says.

Not surprisingly, alternative therapies play a big role in fibromyalgia treatment, with approximately 90% of patients in one survey reporting that they use some type of alternative therapy, particularly dietary modification, chiropractic, or massage therapy. In studies, exercise has been shown to decrease overall pain in some patients. Also, biofeedback (controlling unconscious or involuntary bodily functions through thought processes) has been shown to decrease the number of tender spots as well as the intensity of the pain. Some patients also have reported success with hypnosis and acupuncture, all of which seem to have some role in helping patients deal with chronic pain.

"Relaxation, massage, biofeedback, yoga -- a lot of things tried sequentially and in combination with medicinal therapies are very helpful to people," Leventhal tells WebMD. "It also gives the patient some control over the management of their care." He encourages patients to learn all they can about fibromyalgia because the more they know, the better equipped they are to deal with the ups and downs of living with a chronic condition. However, he also stresses that despite having chronic pain, most patients with fibromyalgia do not end up disabled or in wheelchairs.