What is it?
Fibromyalgia (FM), previously referred to as fibrositis, is a common condition that is characterized by widespread aching and stiffness in muscles and soft tissues and fatigue. The pain is felt around the neck, shoulders, upper back, elbows, lower back and hip girdle. Many people with FM have no underlying disorders while others who develop FM may have conditions such as rheumatoid arthritis or lupus erythematosus. Some people also have symptoms of irritable bowel syndrome, tension headaches, and numbness or tingling in the extremities.
What causes it?
The cause of fibromyalgia is unknown. There may be a link between FM and a sleep disturbance, since most patients have disruptive sleep patterns. Psychological stress and deconditioning (lack of exercise) are often associated with FM. Altered pain processing is thought to be a possible cause rather than contributor.
Who gets it?
FM is common, affecting approximately two percent of the U.S. population.
It occurs seven times more frequently in women than in men.
It occurs most frequently in women of childbearing age.
Adolescents may also develop FM.
How is it diagnosed?
Diagnosis is based on the patient’s description of chronic widespread pain for at least three months and the finding of many areas of muscle tenderness on examination. There are no blood or x-ray tests that are abnormal in FM. In fact, abnormal blood tests may suggest a diagnosis other than fibromyalgia. Other conditions may mimic FM, such as hypothyroidism and hyperparathroidism. These can usually be excluded by examination and laboratory tests.
How is it treated?
There is no known cure for fibromyalgia. Patients may be reassured that the condition, while painful, does not damage tissues and that it can be managed successfully in many cases. The most successful treatment of fibromyalgia is a comprehensive team approach focusing on cognitive behavioral therapy, stress reduction, and medication to help with sleep.
Physical modalities (e.g., heat treatments, cold application, massage) can provide some temporary relief from symptoms but they should not be the focus of treatment. Gentle and regular stretching can be used to decrease tight muscles. Strength training activities help support the areas that have pain to help make muscles work more efficiently since those areas may be weak from inactivity. Supervised aerobic conditioning exercises are valuable since most people are deconditioned (out of shape). These endurance activities can help facilitate sleep, which often improves fatigue. The aquatic environment provides another option since the water allows you to tolerate more activity due to the effects of buoyancy. Aquatic exercises or swimming laps can be used. Start very gradually with any of these activities so you don’t set yourself back from ‘overdoing’ it. Moderation is the key to finding the balance between rest and activity.
Occupational therapy, including the use of adaptive devices and instruction in lifestyle modification, energy conservation, pacing and relaxation training can improve functional performance. Learning better coping skills and eliminating negative self-talk are beneficial. Attention to mental health, including psychological consultation, is also important, since depression may precede or accompany fibromyalgia.
Certain medications have an important role. Various medications to improve sleep and relax muscles, such as amitriptyline and cyclobenzaprine, are widely used. Hypnotic agents, anxiolytic drugs and anti-depressant medications may be appropriate. Local anesthetic or corticosteroid injections may be appropriate for painful local tender points. Pain may also be managed by non-steroidal anti-inflammatory drugs (ibuprofen, naproxen, others) or tramadol. Long-term opioid analgesics are rarely indicated.
A psychologist is often helpful in utilizing cognitive-behavioral techniques and relaxation training to reduce the pain. Psychological consultation may also identify an underlying component of depression, which can then be treated.
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