Fibromyalgia is a syndrome characterized by chronic pain, stiffness, and tenderness of muscles, tendons, and joints without detectable inflammation. It affects an estimated 3 to 6 million Americans. Fibromyalgia is the second most common disorder seen by rheumatologists. It predominantly affects women at a rate of 3.4%, and less commonly, men at 0.5%, children at 1.2% to 6.2%, and the elderly. Prevalence increases with age, and diagnosis is most common between ages 60 and 79, although symptoms are often present years prior to diagnosis. It can occur independently or can be associated with another rheumatic disease, such as systemic lupus or rheumatoid arthritis.
Alternative therapies, such as massage, myofascial release, acupuncture, chiropractic adjustment, herbal supplements, and yoga can be effective tools in managing fibromyalgia symptoms. Home remedies can also be effective in reducing pain; heat, especially moist heat, can ease pain and stiffness by boosting blood flow. Cold packs can also reduce deep muscle pain.
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The overall improvement of health and wellness is an important factor in improving fibromyalgia symptoms. Increasing rest, pacing activities, reducing stress, and improving nutrition all can help minimize symptoms and improve quality of life. Research has shown that a higher level of physical fitness is associated with lower levels of pain and pain-related catastrophizing in women with fibromyalgia.
While the specific causes of fibromyalgia remain unknown, it is most likely caused by a variety of factors working together. These may include genetics (relatives of those with fibromyalgia have an 8.5 fold higher risk of developing the disease), infections (which sometimes appear to trigger fibromyalgia), and physical or emotional trauma. Researchers believe that in people with fibromyalgia, repeated nerve stimulation causes abnormal increases in neurotransmitters in the brain, and that pain receptors become more sensitive.
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In some patients, fibromyalgia may have a neuropathic basis, according to research published in Seminars in Arthritis and Rheumatism. Women with fibromyalgia exhibited corneal nerve atrophy consistent with neuropathic pain, suggesting that some patients may actually have small fiber polyneuropathy (SFPN), a disease with potentially treatable causes. Many clinicians are also reviewing how they address fibromyalgia symptoms, with both nonpharmacologic and pharmacologic therapies. CBT and aerobic exercise show evidence of effectiveness, as do dual-reuptake inhibitors, anticonvulsants, and selective serotonin reuptake inhibitors (SSRIs).
The 2010 American College of Rheumatology (ACR) fibromyalgia diagnostic criteria admits the importance of tender points, but reduces their role in diagnosis. Diagnosis now involves both a checklist of 19 potential areas of pain in the body (the widespread pain index, or WPI) and severity of symptoms (SS) in 4 categories unrelated to pain, including fatigue and cognitive problems. If for 3 months, either the WPI score has been greater than 7 (out of 19) and the SS score has been greater than 5, OR the WPI score has been between 3 and 6 and the SS score has been greater than 9, then fibromyalgia can be diagnosed. Other disorders that could otherwise explain the pain must also be ruled out to make a diagnosis.
Comorbidities and Differential Diagnosis
Conditions that frequently occur with fibromyalgia include osteoarthritis, autoimmune disease, lupus, myalgic encephalomyelitis / chronic fatigue syndrome, migraines, irritable bowel syndrome, sleep problems, mood disturbances, neuroendocrine disorders, and hypothyroidism. Fibromyalgia is also frequently misdiagnosed as rheumatoid arthritis, which has several key differences not found in fibromyalgia: joint inflammation, illness progression, and noticing pain on one side and then the other. The easiest way to differentiate between fibromyalgia and lupus is if lupus rash or lupus kidney disease is present.
Although chronic, widespread body pain is the primary symptom of fibromyalgia, a variety of other symptoms are common. Approximately 90% experience trouble sleeping. Other symptoms include: problems with cognitive functioning, irritable bowel syndrome, headaches and migraines, anxiety and depression, and environmental sensitivities.
Drug therapies including analgesics, sleep aids, antidepressants, nonsteroidal anti-inflammatory drugs (NSAIDs), and benzodiazepines have been shown to be mildly effective at treating some symptoms of fibromyalgia in some patients. More recently, anticonvulsants, including gapapentin and pregabalin, have been shown to be effective as well.
A woman aged 53 presents with fatigue, tingling in the hands and feet, and muscular pain, particularly in the lower back. Symptoms have been present for 6 months, but have not become worse or better. Upon questioning, the patient admits to feeling a lack of initiative to engage in her typical activities, including moderate exercise.
What other symptoms might suggest the patient has fibromyalgia?
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Fibromyalgia symptoms can encompass the whole body, extending far beyond characteristic widespread muscle pain. While it is important to assess tender points through physical examination, a thorough questionnaire completed by the patient can help reveal other symptoms, such as bowel problems, headache, anxiety, and fatigue that may aid in the differential diagnosis.