There are no diagnostic tests that will diagnose fibromyalgia. The illness is diagnosed by physical examination and ruling out other medical conditions.
Fibromyalgia is diagnosed by the presence of widespread body pain for at least 3 months plus tenderness of at least 11 out of 18 designated tender point sites as defined by the American College of Rheumatology 1990 Classification Criteria.
The overall prevalence of fibromyalgia is the U.S. is approximately 2% of the population, but higher in women (3.5%) than in men (0.5%). Age of onset is usually between 20 and 60 years old, but occurs in children and the elderly.
Cause of Fibromyalgia
The specific cause of fibromyalgia is unknown. It is believed that the brain does not process pain properly with exaggerated response to mechanical and thermal stimuli. Fibromyalgia patients have larger amounts of substance P in their spinal fluid. This substance is used by the body to transmit and amplify pain signals to and from the brain.
Disrupted sleep is often present in fibromyalgia patients and this may play a role in causing the disorder or occur by having the disorder.
Fibromlyalgia runs in families, pointing to a possible genetic predisposition.
Symptoms of Fibromyalgia
- Overall body pain. Pain occurs when pressure is applied to the back of the head, upper back and neck, upper chest, elbows, hips and knees. Morning stiffness often accompanies the pain.
- Fatigue. Patients usually feel tired most of the time.
- Sleep disturbance. Patients are not able to get restorative sleep and often have nighttime leg cramps and restless leg syndrome.
- Headaches. This may be related to tenderness and stiffness of the neck and shoulders.
- Irritable bowel syndrome. The presence of alternating constipation and diarrhea with bloating characterizes this problem.
- Facial pain. The presence of TMJ dysfunction (pain in the joints of the jaw) is common.
- Heightened sensitivity. Patients can be overly sensitive to odors, bright lights, touch and noise.
Other common symptoms include:
- Mood swings
- Depression
- Tingling and numb sensations in the hands and feet
- Difficulty thinking and remembering
- Anxiety
- Dizziness
- Chest pain
- Dry eyes, skin and mouth
- Painful menstrual periods
Treatments for Fibromyalgia
The Federal Drug Administration (FDA) has approved two drugs for the treatment of fibromyalgia.
- Lyrica - Approved in June, 2007 by the FDA as the first drug specifically to treat fibromyalgia. Lyrica has previously been used to treat seizures, nerve pain in diabetics, and the pain associated with shingles. Side effects from this drug include sleepiness, dizziness, blurry vision, weight gain, trouble concentrating, swelling of the hands and feet and dry mouth.
- Cymbalta - Approved in June, 2008, this drug has previously been used to treat depression, anxiety and diabetic nerve pain. Side effects include nausea, dry mouth, sleepiness, constipation, decreased appetite and increased sweating. It can also rarely increase the risk of suicidal thinking and behavior in people who use it to treat depression.
Both drugs reduce pain and improve function in people with fibromyalgia. They are approved for adult use only. Their mechanism of action is unknown, but they may increase neurotransmitters in the brain that decrease the perception of pain.
Other activities that have been used to help with the symptoms of fibromyalgia include the following:
- Cognitive behavior therapy - teaches methods for dealing with stressful situations.
- Exercise - walking, jogging, biking, gentle stretching exercises.
- Analgesics - acetaminophen (Tylenol) and prescription tramadol (Ultram) help relieve pain. Aspirin and ibuprofen (Motrin) are not helpful if taken alone.
- Antidepressants - help promote sleep and relieve depression associated with fibromlyalgia.
- Muscle relaxants - medications like Flexeril taken at bedtime may help relieve muscle pain and spasms.
Self-care methods that have helped with symptoms include reducing stressful situations. However, quitting work and other activities altogether appears to worsen symptoms. Getting sufficient sleep can reduce fatigue. Eating healthy foods and limiting caffeine intake are additional recommendations.
Resources
National Fibromyalgia Association
