Fibromyalgia is a poorly understood but increasingly recognized condition characterized by muscle pain and stiffness, troubled sleeping patterns, and fatigue. Most often people with fibromyalgia complain of widespread pain and achiness, similar to symptoms associated with a bad case of flu or with certain forms of arthritis. However, the pain (algia) is not in the joints (as it is in arthritis), but in the body’s fibrous (fibro) ligaments and tendons as well as in the muscles (my).
Most people with fibromyalgia report that some level of pain is present much or all of the time. The severity of pain may vary from day to day, however, and may flare up under certain circumstances, such as sudden physical exertion. Often there is aching and fatigue upon waking up. Depression may also accompany fibromyalgia, but it isn’t clear whether depression causes the disorder or is a consequence of it.
According to the American College of Rheumatology, three to six million Americans are affected; other estimates put the figure as high as 10 percent of the general population. Most patients (70 to 90 percent) are women of childbearing age, but men, children, and the elderly can also be affected.
Fibromyalgia is considered a syndrome rather than a discrete disease, with symptoms that exist on a continuum—much like chronic fatigue syndrome, which has some of the same symptoms. Diagnosing fibromyalgia is further complicated by the fact that its symptoms mimic or overlap those associated with a number of other more established diseases, most especially rheumatoid arthritis, but also osteoarthritis, Lyme disease, sleep apnea, restless leg syndrome, Sjögren’s syndrome, and irritable bowel syndrome. Moreover, fibromyalgia does not produce physiological changes that can be detected through conventional diagnostic tools. Blood tests, x-rays, and biopsy tissue samples will all be normal (unless another condition is also present).
In 1990 the American College of Rheumatology developed criteria for diagnosing fibromyalgia that include checking for tenderness that occurs in precise, localized areas, particularly in the neck, spine, shoulders, and hips. The existence of these “tender points” is considered a distinguishing feature.
Nevertheless, because symptoms of the syndrome mimic those of other disorders, and because fibromyalgia often occurs in association with other disorders, arriving at the diagnosis is difficult. Many people who eventually are found to have fibromyalgia have been misdiagnosed by physicians not familiar with the syndrome. And although more and more doctors are informed about fibromyalgia, there continues to be much controversy about how to classify, diagnose, and treat the condition.
Symptoms of Fibromyalgia
- Chronic and widespread musculoskeletal pain and stiffness (often worst in the morning)
- Extreme sensitivity to pressure at multiple specific sites (tender points) on the body
- Chronic or occasional deep fatigue
- Numbness or tingling in parts of the body
- Unrefreshing, fragmented, non-dreaming sleep
- Common associated symptoms include tension-type headaches, sensitivity to cold, low-grade depression and anxiety, alternating diarrhea and constipation and recurring abdominal pain
- Increased sensitivity to bright lights, noise, odors, and various foods
What Causes Fibromyalgia?
Doctors still don’t know what causes fibromyalgia. It was once thought to be an inflammatory condition, but no good evidence of inflammation has been discovered. Because anxiety and depression often accompany it, some experts suggested it was a psychiatric disorder. However, studies have shown that people with fibromyalgia are not any more likely to be depressed than people with arthritis or other chronic painful disorders.
Some cases, researchers think, may be caused by an injury or trauma, possibly affecting the central nervous system. Another theory links fibromyalgia to abnormal patterns of deep sleep, which may affect levels of growth hormone that in turn affect muscle health. The frequency of depression has led some researchers to propose that the mechanisms that trigger depression may be similar to those causing fibromyalgia. Still others suggest that fibromyalgia causes changes in the immune system as if the body is fighting a virus (though no virus or other infectious agent has been identified).
Many experts have come to believe that a number of such factors, rather than a single cause, may contribute to fibromyalgia. As with other chronic disorders such as diabetes or heart disease, a genetic predisposition may also play a role.
What If You Do Nothing?
Fibromyalgia does not appear to progressively worsen over time, it does not damage or deform joints or muscles, nor is it life-threatening. But without treatment, symptoms may become more irritating or new symptoms may develop. In addition, most patients find it increasingly hard psychologically to deal with a frustrating condition that health-care providers and others may regard with skepticism. Once they are accurately diagnosed and treated, most fibromyalgia sufferers have a positive response to self-care measures and proper medical intervention, though improvement can take months.
Home Remedies for Fibromyalgia
If you have symptoms of fibromyalgia, it’s important that you see a doctor to rule out other disorders. Never assume that chronic pain is due to fibromyalgia. If fibromyalgia is diagnosed, you may benefit from medication, but active self-care plays a critical role in managing the condition.
- For immediate relief, try heat. To relieve pain and stiffness, soak in a hot bath or apply a heating pad on low heat. On days you awaken with a lot of discomfort, take a hot shower right away.
- Use over-the-counter pain relievers sparingly. Nonprescription NSAIDs such as aspirin and ibuprofen, as well as acetaminophen, may provide limited relief from pain and stiffness (though since there is little or no inflammation, NSAIDs seldom help much). Don’t take any OTC drug on a long-term basis without consulting your doctor. Generally, prescription medications are more effective for easing fibromyalgia pain.
- Get enough sleep. Interrupted sleep is often a consequence of—and may contribute to—the pain of fibromyalgia. Though medication may be needed to restore normal sleeping patterns, before considering that step, try lifestyle measures. These include maintaining a regular wake/sleep schedule and avoiding heavy meals, alcohol, or caffeine before bedtime.
- Exercise provides real benefits. Lack of physical activity appears to make symptoms get worse, perhaps because unconditioned muscles are more pain sensitive. Exercise may increase your pain at first, but studies have shown that symptoms improve after six to eight weeks of moderate aerobic exercise such as brisk walking, swimming, or cycling. Stretching and strengthening exercises can also help reduce pain and stiffness, but it’s a good idea to develop this kind of exercise program with your doctor or a physical therapist.
- Be careful not to overdo it. Start with 5-to-10-minute sessions of low-intensity aerobic exercise and gradually increase your exercise time to 30 or 40 minutes per session. Try to exercise at least three times a week.
- Pace yourself each day. Fatigue and emotional stress can aggravate physical discomfort, so it’s important to balance daily activities with periods of rest. Prolonged or repetitive tasks, such as sitting and typing for hours, can also make symptoms worse. You can avoid this by frequently rotating the types of tasks you perform.
- Get support and information. Fibromyalgia has received a great deal of attention in recent years, and there are now many books, newsletters, Web sites, and organizations that can help you educate yourself about the condition and also provide psychological support. It can also be helpful to provide family, friends, and co-workers with information in asking for their support.
- Be skeptical of alternative remedies. Like other conditions whose chief symptom is chronic pain, fibromyalgia has attracted its share of unproven treatments. Claims are made for vitamin and herbal supplements, dietary regimens, antiviral drugs, and body therapies that have not been scientifically tested. Some of these remedies may be helpful, but many will not. Some can also have adverse effects. If you do try alternative remedies, be sure to tell your physician. And don’t substitute unproven treatments for medical care from a knowledgeable practitioner.
- Be patient. Dealing with fibromyalgia can have many frustrations—from trying to find a sympathetic physician to day-to-day coping with pain and fatigue. But many people with fibromyalgia can improve how they feel given enough time, effort, and understanding.
Finding The Right Doctor
If you suspect you have fibromyalgia, it’s important to consult a doctor who is experienced at diagnosing and managing the syndrome. If your primary-care doctor isn’t knowledgeable, look for a fibromyalgia specialist. This may be a rheumatologist (a physician who specializes in joint diseases) or a physiatrist (a practitioner who specializes in physical medicine and rehabilitation). Some internists and neurologists are also skilled at treating fibromyalgia.
You can also check with a local support group and ask for recommendations.
There is no known way to prevent fibromyalgia.
Beyond Home Remedies: When To Call Your Doctor
You should see a physician if you experience any symptoms related to fibromyalgia for three months. Call your doctor sooner if pain, sleeping difficulty, depression, or other symptoms interfere with daily activities.
What Your Doctor Will Do
Your doctor should review your symptoms and take a careful history of any other medical problems you’ve had. Some basic diagnostic tests, including x-rays and blood tests, may be ordered to see if your symptoms are due to another ailment with similar symptoms such as rheumatoid arthritis or Lyme disease.
Once other medical conditions have been ruled out, your doctor will evaluate you using a number of diagnostic guidelines. These include applying consistent pressure at specific sites on your body to see whether you have pain at sensitive tender points. Your doctor will also ask you about secondary symptoms, such as headaches, depression, anxiety, and diarrhea or constipation, to see if any are related to fibromyalgia or might signal a coexisting condition.
Your doctor will develop a treatment plan with you. Typically, this will include guidelines for an exercise program and for getting enough sleep, along with therapies (such as heat) to help reduce pain. Depending on the severity of your symptoms, medications may be prescribed to help control pain and improve sleep. If depression is a component of your fibromyalgia, your doctor may prescribe an antidepressant medication and/or recommend that you see a psychologist or other licensed counselor for therapy.
In addition, your doctor may recommend that you see a physical therapist, who can design stretching and strengthening exercises and also treat acute flare-ups of muscle pain. A physical therapist can also advise you about how to best manage work or recreational activities that aggravate symptoms.
Treating fibromyalgia often entails trying a number of strategies to see which one—or which combination—offers the most help. You can also discuss alternative therapies with your doctor. Massage therapy and acupuncture may be effective at helping control pain associated with fibromyalgia. In particular, pinching and lifting the skin and subcutaneous tissue at tender points is often helpful. But any alternative therapy should complement, not replace, the treatment plan your doctor has recommended.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media