Fibromyalgia
(FM; Fibromyalgia Syndrome; FMS)
Pronounced: FI-bro-my-OWL-jah
by Rick Alan
Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention
Definition
Fibromyalgia is a complex, chronic, and disabling disorder. It causes widespread pain and stiffness in the muscles, tendons, and ligaments, along with poor sleep and fatigue.
Fibromyalgia Trigger Points
© 2009 Nucleus Medical Media, Inc.
Causes
The exact cause is unknown.
The following conditions are commonly associated with fibromyalgia:
- Depression and anxiety
- Muscle pain
- Chronic headache, such as tension headaches (frequently beginning with neck discomfort)
- Numbness and tingling
- Sensation of swollen hands and edema (swelling usually in the feet, ankles, and legs)
- Nocturnal myoclonus (moving legs involuntarily during sleep)
- Irritable bowel syndrome
- Complex regional pain syndrome
- Substance abuse
- Premenstrual syndrome
- Female urethral syndrome (irritable bladder)
- Raynaud's disease
Risk Factors
A risk factor is something that increases your chance of getting fibromyalgia. Risk factors include:
- Sex: female
- Age: 20-60 years old
- Physical or mental stress
- Physical trauma (eg, accident, injury, or severe illness)
Symptoms
Common symptoms include:
- Generalized fatigue or tiredness
- Reduced physical endurance
- Generalized aches and pains of muscles, tendons, and ligaments
- Muscle tightening or spasms
-
Pain in specific areas of the body, especially:
- Neck
- Shoulders
- Chest
- Back (upper and lower)
- Hips and thighs
- Insomnia or poor sleep
- Sensations of numbness or swelling (although swelling is not actually present)
- Chronic headaches, including migraines
- Morning stiffness, worst on first arising
Factors that may trigger or worsen symptoms include:
- Weather changes, especially cold, damp weather
- Stress or anxiety
- Overexertion
- Medical illness
- Surgery
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a thorough physical exam. There are no specific tests for this condition.
The doctor will look for the following signs:
- Widespread pain lasting three months or longer
- Tenderness (on physical exam) in at least 11 of 18 specific areas of the body
Treatment
The goal of treatment is to relieve or control the symptoms. Treatments include:
Physical and Behavioral Therapies
- Physical therapy (gradual aerobic exercise and stretching regimen)
- Heated pool treatments—Aquatic training in warm water (eg, strength, aerobic, and relaxation exercises) may help improve symptoms.
- Application of heat to painful areas
- Alternative treatments, such as massage, acupuncture, relaxation training, trigger point therapy, biofeedback
- Cognitive behavioral therapy
Lifestyle Changes
- Eating a healthful diet
- Learning to cope with physical and mental stress
-
Doing
regular, moderate, low-impact exercise with your doctor's approval
-
Try gentle exercise that does not strain painful areas, such as:
- Walking
- Biking
- Swimming, preferably in warmer water
-
Try gentle exercise that does not strain painful areas, such as:
- Doing regular stretching exercises
- Maintaining a regular sleep schedule
Medications
These medications may help to improve symptoms:
- Weak opioids (eg, tramadol, paracetamol)
- Antidepressants (eg, amitriptyline, fluoxetine, duloxetine, milnacipran, moclobemide, pirlindole)
- Pain relievers (eg, tropisetron, pramipexole, pregabalin)
- Sodium oxybate (eg, Xyrem), a central nervous system depressant
Prevention
Since the cause is unknown, there are no guidelines for preventing fibromyalgia.
RESOURCES:The American Fibromyalgia Syndrome Association
http://www.afsafund.org/
National Fibromyalgia Partnership, Inc.
http://www.fmpartnership.org/
The Arthritis Society
http://www.arthritis.ca/
Fibromyalgia Information and Local Support
http://fibromyalgia.ncf.ca/
REFERENCES:
Berkow R. The Merck Manual of Medical Information . New York, NY: Pocket; 2000.
Carville SF, Arendt-Nielsen S, Bliddal H, et al. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis . 2008;67:536-541.
Edema. Cleveland Clinic website. Available at: http://www.mayocli... . Updated November 2005. Accessed June 19, 2008.
Fibromyalgia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated June 2008. Accessed June 19, 2008.
Fibromyalgia. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/ . Updated August 2007. Accessed June 19, 2008.
Fibromyalgia update. Bandolier website. Available at: http://www.jr2.ox.ac.uk/bandolier/band149/b149-7.html .
Myofascial pain syndrome. Mayo Clinic website. Available at: http://www.mayocli... . Updated May 2007. Accessed June 19, 2008.
Paresthesias. MedHelp website. Available at: http://www.mayocli... . Accessed June 19, 2008.
Periodic limb movement disorder (PLMD) or nocturnal myoclonus. Eastern Virginia Medical School website. Available at: http://www.evms.edu/sleep/disorders-limb.html . Updated March 2006. Accessed June 19, 2008.
¹2/17/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Russell IJ, Perkins AT, Michalek JE; Oxybate SXB-26 Fibromyalgia Syndrome Study Group. Sodium oxybate relieves pain and improves function in fibromyalgia syndrome: a randomized, double-blind, placebo-controlled, multicenter clinical trial. Arthritis Rheum. 2009;60:299-309.
²4/14/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Munguía-Izquierdo D, Legaz-Arrese A. Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial. Arch Phys Med Rehabil. 2008;89:2250-2257.
Last reviewed October 2009 by Jill D. Landis, MD
Last Updated: 10/28/2009
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