Fibromyalgia is a term referring to a pattern of generalized pain all over the body, without any visible signs of inflammation or change. It affects 2% to 4% of people of all ages, but occurs predominantly in women.
An important component of fibromyalgia is that, besides pain, it affects functioning in many ways. Mood disorders (such as depression), sleep disturbances, chronic fatigue, headaches and high sensitivity to touch are some of the ways fibromyalgia seems to affect how people function.
The exact cause of fibromyalgia is unknown, but it has been linked to depression, anxiety, other pain problems, and emotional stress. People with fibromyalgia do not have visible signs of abnormality, but early studies have shown subtle abnormalities in sleep studies, electroencephalograms (EEGs; a test that measures electrical activity of the brain), nerve conduction, hormones, and tests that measure nerve pain conduction and other parameters of the pain pathway.
These abnormal tests suggest that fibromyalgia is a distinct disorder, but the problem researchers have is deciding which comes first. Is there a current unknown disorder that is causing these abnormalities, or are these abnormalities the result of an emotional disorder or reaction to chronic pain or difficult life events? All of the abnormalities reported in research studies involving people with fibromyalgia are also linked to emotional disorders.
Are brain, hormone, and nerve disorders the disease or the result of stress, anxiety, or depression? This uncertainty of what causes fibromyalgia shapes how therapy is approached. Currently, treatment may involve lifestyle changes, exercise, stress management, psychotherapy, and medications.
Genetics may also play a role and may increase the risk of fibromyalgia. Research shows that fibromyalgia is diagnosed in 28% of children of women with fibromyalgia.
Symptoms and Complications
The main symptoms of fibromyalgia are achy pain; tenderness to touch; and stiffness in the muscles, tendons, and ligaments. The neck, shoulders, abdomen, lower back, and thighs are the parts most likely to be affected. The pain may be spread out evenly over a large area.
Other symptoms of fibromyalgia include difficulty sleeping and lack of energy, chronic fatigue, anxiety and depression, headaches, bowel problems, and breathing disorders. People who experience these other symptoms often do not have painful, tender, red, or hot joints.
It was believed for a long time that "tender points," which refer to 18 areas in specified parts of the body that are sensitive to a measured amount of point pressure, were hallmarks of the disease and necessary for the diagnosis of fibromyalgia. This is now recognized to be incorrect. People with fibromyalgia have tenderness all over the body that is not just limited to 18 tender points.
The symptoms of fibromyalgia come and go over time, but they seldom disappear completely. The pain may also vary from day to day in where it's located and in intensity, and it can be worsened by outside factors such as stress.
Making the Diagnosis
There is no definitive medical test for fibromyalgia. The diagnosis of fibromyalgia is made by doing a physical exam and a thorough history. While there is no specific test for fibromyalgia, your doctor may use blood tests to rule out other causes of chronic pain.
Not all people with unclassified pain should be diagnosed with fibromyalgia. Rather, diagnosing fibromyalgia requires the recognition of the characteristic patterns and the absence of any other physical factor that may be causing symptoms.
Treatment and Prevention
Though there is no cure, fibromyalgia is often treated in a multifaceted fashion, using both medications and non-medication methods to improve individual symptoms. Treatment is individualized to each person depending on their symptoms. Non-medication methods to manage symptoms include sleep hygiene, stretching and aerobic exercises, stress reduction, and massages.
Counselling can also be very helpful. Counsellors help people find ways to address problems that may be playing a role in their condition. Psychotherapy with talk therapy may also be used.
Medication is used in fibromyalgia to manage symptoms on an individual basis. Painkillers, such as acetaminophen,* and nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen and naproxen) are generally not helpful in fibromyalgia. Narcotic painkillers (except tramadol) should be avoided because of the risk of dependence and they have not been shown to be effective. Tramadol may be helpful in reducing pain for some people, although it has not been approved by Health Canada for use in fibromyalgia.
There are medications available specifically for fibromyalgia, including pregabalin and duloxetine. They work by affecting different pain pathways in the body and help to improve pain in some patients with fibromyalgia.
Severe persistent pain that's focused in one point is sometimes treated with an injection of lidocaine, which may be used in combination with hydrocortisone.
Low doses of antidepressant medications (e.g., amitriptyline, fluoxetine, paroxetine) are often used to treat fibromyalgia, but are not approved by Health Canada for fibromyalgia. Antidepressants can improve sleep and may help with the pain. In higher doses, they can also be used to treat mood disorders in people who develop them along with their fibromyalgia.
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