Fibromyalgia

Overview, Causes, & Risk Factors

Fibromyalgia is a poorly understood condition that causes multiple tender points, called trigger points, in the muscles and soft tissues of the body.

What is going on in the body?

People who have fibromyalgia have chronic, widespread pain and stiffness in the muscles. Fatigue is a key factor in fibromyalgia. Some healthcare professionals believe that fatigue may occur because the person doesn't get enough deep, restful sleep. Others believe that the sleep disturbance may actually be a cause of the fibromyalgia.

Recent research has shown that people who have fibromyalgia have a decrease in blood flow to the parts of the brain involved with pain perception. They also have two times the normal level of a brain chemical known as substance P. This substance is involved in the transmission of pain messages from nerve cells to the brain.

Fibromyalgia may occur alone, or together with other disorders such as Borrelia burgdorferi. It is passed to humans through tick bites. ',CAPTION,'Lyme Disease');" onmouseout="return nd();">Lyme disease or rheumatoid arthritis.

What are the causes and risks of the condition?

No one knows for sure what causes fibromyalgia, but there are several theories. Some possible causes of fibromyalgia include the following:

autoimmune disorders, or a condition in which the body creates antibodies against its own tissues

endocrine abnormalities, which are problems with various glands in the body

biochemical abnormalities in the central nervous system, such as the elevated level of substance P in the brain

impaired blood flow to the brain

stress

mechanical stresses to the cervical and lumbar spine

history of abuse as a child

New research findings suggest that autoimmune disorders may be triggered by a transfer of cells between the fetus and the mother during pregnancy. The study involved women with scleroderma, an autoimmune disorder involving the skin. These women have more fetal cells in their blood decades after a pregnancy than women who don't have scleroderma. While further research is needed to substantiate these findings, the study does offer an explanation for the much higher incidence of autoimmune disorders in women than in men.

Women account for 75% of those who have the disease. It is most common in women of childbearing age.

Symptoms & Signs

What are the signs and symptoms of the condition?

Symptoms of fibromyalgia include prolonged pain and multiple trigger points in the muscles and soft tissues. These trigger points tend to be located in the shoulders, neck, upper and lower back, and hips.

People with fibromyalgia experience muscle pain and stiffness, especially in the morning. The pain is worse in the morning and worsens again at night. Other symptoms are as follows:

abdominal distress with constipation or diarrhea

depression

difficulty concentrating

fatigue, which is probably caused by disrupted sleep

headaches

tingling of the skin that involves numbness or burning

Diagnosis & Tests

How is the condition diagnosed?

Diagnosis of fibromyalgia begins with a medical history and physical examination. There are no laboratory tests such as biopsies or X-rays for this disease. These tests are sometimes used to rule out other medical illnesses.

The American College of Rheumatology recommends the following guidelines for a diagnosis:

widespread pain for more than three months

pain involving any or all areas of the spine

tenderness at 11 or more of the 18 tender points identified in people with fibromyalgia

fatigue

depressed mood or clinical depression

muscle stiffness

headaches

Prevention & Expectations

What can be done to prevent the condition?

There is no known way to prevent fibromyalgia.

What are the long-term effects of the condition?

The chronic pain of fibromyalgia may lead to clinical depression. Some individuals with fibromyalgia have committed suicide because of the chronic pain. The ability to work may be lost. Fibromyalgia is not thought to be a progressive disease, and it does not cause deformities.

What are the risks to others?

Fibromyalgia is not contagious and poses no risk to others.

Treatment & Monitoring

What are the treatments for the condition?

There is no cure for fibromyalgia. However, there are some treatments that can improve the symptoms and quality of life for someone with the condition. People with fibromyalgia have reported improvement from the following:

acupuncture

aerobic exercises, such as bicycling or jogging

antidepressant medications, such as amitriptyline and cyclobenzaprine, to improve sleep and relax muscles

biofeedback

chiropractic treatments

heat or cold treatments

hypnosis

injections of local anesthesia medications or corticosteroids into tender points

massage therapy

occupational therapy, which can teach individuals how to continue functioning in spite of pain

stretching and range of motion exercises, which involve moving joints through their normal movements

Some individuals may find one or more of these treatments helpful, while others may find that a particular treatment worsens symptoms. If a treatment is helping and the side effects are tolerable, the treatment should be continued.

What are the side effects of the treatments?

Side effects of antidepressants include dry mouth, sexual dysfunction, and constipation. Injecting local anesthetic medications can make the chronic pain worse in some cases and can cause an allergic reaction.

What happens after treatment for the condition?

The course of fibromyalgia is unpredictable and highly individualized. Treatment is lifelong.

How is the condition monitored?

Self-monitoring of symptoms is important. People can document the severity of pain, fatigue, stiffness, and mood in a daily log. This information can help in treatment plans. Any new or worsening symptoms should be reported to the healthcare provider.