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Fibromyalgia

Fibromyositis; FM; Fibrositis

Fibromyalgia is a common syndrome in which a person has long-term pain that is spread throughout the body. The pain is most often linked to fatigue, sleep problems, headaches, depression, and anxiety.

People with fibromyalgia may also have tenderness in the joints, muscles, tendons, and other soft tissues.

 

Causes

The cause is unknown. Researchers think that fibromyalgia is due to a problem with how the central nervous system processes pain. Possible causes or triggers of fibromyalgia include:

  • Physical or emotional trauma.
  • Abnormal pain response: Areas in the brain that control pain may react differently in people with fibromyalgia.
  • Sleep disturbances.
  • Infection, such as a virus, although none has been identified.

Fibromyalgia is most common among women between ages 20 to 50.

The following conditions may be seen with fibromyalgia or have similar symptoms:

Symptoms

Pain is the main symptom of fibromyalgia. It may be mild to severe.

  • Painful areas are called tender points. Tender points are found in the soft tissue on the back of the neck, shoulders, chest, lower back, hips, shins, elbows, and knees. The pain then spreads out from these areas.
  • The pain may feel like a constant, dull ache, or a burning pain.
  • The joints are not affected, although the pain may feel like it is coming from the joints.

People with fibromyalgia tend to wake up with body aches and stiffness. For some people, pain improves during the day and gets worse at night. Some people have pain all day long.

Pain may get worse with activity, cold or damp weather, anxiety, and stress.

Fatigue, depressed mood, and sleep problems occur in almost all people with fibromyalgia. Many people say that they cannot get to sleep or stay asleep, and they feel tired when they wake up.

Other symptoms of fibromyalgia may include:

  • Irritable bowel syndrome (IBS)
  • Memory and concentration problems
  • Numbness and tingling in hands and feet
  • Reduced ability to exercise
  • Tension or migraine headaches

Exams and Tests

To be diagnosed with fibromyalgia, you must have had at least 3 months of widespread pain with one or more of the following:

  • Ongoing problems with sleep
  • Fatigue
  • Thinking or memory problems

It is no longer necessary to find tender points during the exam to make a diagnosis.

Results from the physical exam, blood and urine tests, and imaging tests are normal. However, these tests may be done to rule out other conditions with similar symptoms. Studies of breathing during sleeping may be done to find out if you have a condition called sleep apnea.

Fibromyalgia may also occur in people who have other forms of arthritis, such as:

  • Rheumatoid arthritis
  • Osteoarthritis
  • Spondyloarthritis
  • Systemic lupus erythematosus

Treatment

The goals of treatment are to help relieve pain and other symptoms, and to help the person cope with the symptoms.

The first type of treatment may involve:

  • Physical therapy
  • Exercise and fitness program
  • Stress-relief methods, including light massage and relaxation techniques

If these treatments do not work, your health care provider may also prescribe an antidepressant or muscle relaxant.

  • The goal of these medicines is to improve your sleep and help you better tolerate pain.
  • Medicine should be used along with exercise and behavior therapy.
  • Duloxetine (Cymbalta), pregabalin (Lyrica), and milnacipran (Savella) are drugs that are approved specifically for treating fibromyalgia.

Other drugs are also used to treat the condition, such as:

  • Anti-seizure drugs, such as gabapentin.
  • Other antidepressants, such as amytriptyline or nortriptyline.
  • Muscle relaxants, such as cyclobenzeprine.
  • Pain relievers, but avoid narcotics, since they usually do not help.
  • Sleeping aids: If you have sleep apnea, an apparatus called CPAP may be prescribed.

Cognitive-behavioral therapy is an important part of treatment. This therapy helps you learn how to:

  • Deal with negative thoughts.
  • Keep a diary of pain and symptoms.
  • Recognize what makes your symptoms worse.
  • Seek out enjoyable activities.
  • Set limits.

Support groups may also be helpful.

Things you can do to help take care of yourself include:

  • Eat a well-balanced diet.
  • Avoid heavy meals before bedtime.
  • Avoid caffeine.
  • Practice a good sleep routine to improve quality of sleep.
  • Exercise regularly, starting with low-level exercise.
  • Nighttime relaxation exercises.
  • Try acupressure and acupuncture treatments.

Your provider may refer you to a pain clinic if your condition is severe.

Outlook (Prognosis)

Fibromyalgia is a long-term disorder. Sometimes, the symptoms improve. Other times, the pain may get worse and continue for months or years.

When to Contact a Medical Professional

Call your provider if you have symptoms of fibromyalgia.

Prevention

There is no known prevention.

References

Bennett RM. Fibromyalgia, chronic fatigue syndrome, and myofascial pain. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 274.

Mbuyi N. Fibromyalgia. In: Ferri FF, ed. Ferri's Clinical Advisor 2018. Philadelphia, PA: Elsevier; 2017:491-492.

Selfridge NJ. Fibromyalgia. In: Rakel D, ed. Integrative Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 47.

Won C, Kirsch D. Fibromyalgia and chronic fatigue syndromes. In: Kryger M, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 131.

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Review Date: 7/14/2017

Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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