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Fibromyalgia
Fibromyalgia


Definition:

Fibromyalgia is a common condition characterized by long-term, body-wide pain and tender points in joints, muscles, tendons, and other soft tissues. Fibromyalgia has also been linked to fatigue, morning stiffness, sleep problems, headaches, numbness in hands and feet, depression, and anxiety.

Fibromyalgia can develop on its own or along with other musculoskeletal conditions such as rheumatoid arthritis or lupus.



Alternative Names:

Fibromyositis; Fibrositis



Causes, incidence, and risk factors:

The cause of this disorder is unknown. Physical or emotional trauma may play a role in development of the syndrome. Some evidence suggests that fibromyalgia patients have abnormal pain transmission responses.

It has been suggested that sleep disturbances, which are common in fibromyalgia patients, may actually cause the condition. Another theory suggests that the disorder may be associated with changes in skeletal muscle metabolism, possibly caused by decreased blood flow, which could cause chronic fatigue and weakness.

Others have suggested that an infectious microbe, such as a virus, triggers the illness. At this point, no such virus or microbe has been identified.

Pilot studies have shown a possible inherited tendency toward the disease, though evidence is very preliminary.

Men and women of all ages get fibromyalgia, but the disorder is most common among women aged 20 to 50.



Symptoms:

The overwhelming characteristic of fibromyalgia is long-standing, body-wide pain with defined tender points. Tender points are distinct from trigger points seen in other pain syndromes. Unlike tender points, trigger points can occur in isolation and represent a source of radiating pain, even in the absence of direct pressure.

Fibromyalgia pain can mimic the pain that occurs with various types of arthritis. However, the significant swelling, destruction, and deformity of joints seen in diseases such as rheumatoid arthritis does not occur with fibromyalgia syndrome alone.

The soft-tissue pain of fibromyalgia is described as deep-aching, radiating, gnawing, shooting or burning, and ranges from mild to severe. Fibromyalgia sufferers tend to wake up with body aches and stiffness.

For some patients, pain improves during the day and increases again during the evening, though many patients with fibromyalgia have day-long, unrelenting pain. Pain can increase with activity, cold or damp weather, anxiety, and stress.

Specific symptoms:

  • Body aches
  • Chronic facial muscle pain or aching
  • Fatigue
  • Irritable bowel syndrome
  • Memory difficulties and cognitive difficulties
  • Multiple tender areas (muscle and joint pain ) on the back of the neck, shoulders, sternum, lower back, hips, shins, elbows, knees
  • Numbness and tingling
  • Palpitations
  • Reduced exercise tolerance
  • Sleep disturbances
  • Tension or migraine headaches


Signs and tests:

Diagnosis of fibromyalgia requires a history of a least 3 months of widespread pain, and pain and tenderness in at least 11 of 18 tender-point sites. These tender-point sites include fibrous tissue or muscles of the:

  • Arms (elbows)
  • Buttocks
  • Chest
  • Knees
  • Lower back
  • Neck
  • Rib cage
  • Shoulders
  • Thighs

Sometimes, laboratory and x-ray tests are done to help confirm the diagnosis by ruling out other conditions that may have similar symptoms. The following conditions have been associated with fibromyalgia or mimic its symptoms:

  • Cancer
  • Cervical and low-back degenerative disease
  • Chronic fatigue syndrome
  • Depression
  • HIV infection
  • Hypothyroidism
  • Irritable bowel syndrome
  • Lyme disease
  • Rheumatoid arthritis
  • Sleep disorders


Treatment:

In mild cases, symptoms may go away when stress is decreased or lifestyle changes are implemented. A combination of treatments including medications, patient education, physical therapy, and counseling are usually recommended. Many fibromyalgia sufferers have found support groups helpful.

In 2007, the Food and Drug Administration approved Pregabalin (Lyrica) as the first drug for the treatment of fibromyalgia. In June 2008, a second drug, Cymbalta, which was previously approved for treating depression, was FDA approved for treating fibromyalgia as well. In 2009 the FDA approved milnacipran (Savella) for the treatment of fibromyalgia.

Certain classes of antidepressant medications are sometimes prescribed for the disorder. Studies show that antidepressants in low doses can decrease depression, relax craniofacial and skeletal muscles, improve sleep quality, and release pain-killing endorphins. Other medications that are used include anti-inflammatory pain medications and medications that work on pain transmission pathways, such as Gabapentin.

Eating a well-balanced diet and avoiding caffeine may help with problems sleeping, and may help reduce the severity of the symptoms. Lifestyle measures to improve the quality of sleep can be effective for fibromyalgia.

Some reports indicate that fish oil, magnesium/malic acid combinations, or vitamins may be effective. Reducing stress and improving coping skills may also help reduce painful symptoms.

Improved fitness through exercise is recommended. Studies have shown that fibromyalgia symptoms can be relieved by aerobic exercise. The best way to begin a fitness program is to start with short sessions of just a few minutes of gentle, low-impact exercises such as walking and swimming. The length of each session can be increased slowly, as tolerated. Attempts at keeping to an exercise program often fail because they are begun too aggressively, with sessions that are too long or too intense. Starting out slowly and gently can help ease you into an effective program you can stick with.

Starting slowly helps stretch and mobilize tight, sore muscles. High-impact aerobics and weight lifting could cause increased discomfort. Symptoms may be relieved by gentle stretching and light massage, as well as acupressure, acupuncture, and relaxation techniques.

Severe cases of fibromyalgia may require a referral to a pain clinic.



Support Groups:



Expectations (prognosis):

Fibromyalgia is a common and chronic problem. The symptoms sometimes improve. At other times, the symptoms may worsen and continue for months or years. The key is seeking professional help which includes a multi-faceted approach to the management and treatment of the disease. There is no proof that fibromyalgia syndrome results in an increased death rate.



Calling your health care provider:

Call your health-care provider if you have symptoms of fibromyalgia.



Prevention:

There is no proven prevention for this disorder. However, over the years, the treatment and management of the disease has improved.



References:

Abeles M, Solitar BM, Pillinger MH, Abeles AM. Update on fibromyalgia therapy. Am J Med. 2008;121:555-561.

Mease P. Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment. J Rheumatol. 2005;32)10):2063.

Rooks DS, Gautam S, Romeling M, Cross ML, et al. Group exercise, education, and combination self-management in women with fibromyalgia. Arch Intern Med. 2007;167:2192-2200.

Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis and Rheumatism. 33(2):160-172.




Review Date: 2/22/2009
Reviewed By: Ariel D. Teitel, MD, MBA, Chief, Division of Rheumatology, St. Vincent’s Hospital, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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