Spotlight on fibromyalgia

Fibromyalgia is a condition characterized primarily by chronic widespread pain (CWP) in the muscles, ligaments and tendons, and a heightened sensitivity to touch resulting in pain that can last for months.

There are also other common signs and symptoms of fibromyalgia, which can include1:
  • Depression
  • Mood changes
  • Numbness or tingling sensations in the hands and feet
  • Concentration problems
  • Pain in the chest
  • Dry eyes, skin and mouth
  • Painful menstrual periods
  • Dizziness
  • Anxiety
  • Overwhelming fatigue, even after a good night's sleep

The prevalence of fibromyalgia ranges from 0.5% to 5.8% and is more common in women than in men2.

The cause of fibromyalgia remains unknown, but several theories exist. One is called "central sensitization"3. The thinking behind this idea is that people with fibromyalgia have a lower threshold for pain due to an increased sensitivity to pain signals in the brain. It has been suggested that this may be related to the presence of higher than normal levels of a nerve chemical, called "substance P", in the spinal fluid of people with fibromyalgia. This chemical transmits and amplifies pain signals to and from the brain. In other words, for someone with fibromyalgia, this theory suggests that the "volume control" for pain is turned up too high in the brain4.

Other ideas about the cause of fibromyalgia include:
  • Dysfunction of the autonomic nervous system, which controls bodily functions that you don't consciously control
  • Chronic sleep disorders
  • Emotional stress or trauma
  • Immune or endocrine system dysfunction

The diagnosis of fibromyalgia is difficult because there is no specific diagnostic laboratory test. Therefore, a doctor makes a diagnosis of fibromyalgia based on the patient's history and physical examination. The American College of Rheumatology (ACR) has created guidelines to help with assessment and diagnosis of fibromyalgia, and to assist in the assessment and study of the condition. According to the ACR, to be diagnosed with fibromyalgia a person must:
  • have experienced widespread aching pain for at least three months, and
  • have a minimum of 11 locations on your body that are abnormally tender under relatively mild, firm pressure.

Treatment of fibromyalgia

While there is no known cure for fibromyalgia, treatments exist that can help to manage the symptoms of the disease. In general, treatment for fibromyalgia includes both medication (for symptom management) and self-care.

Lifestyle changes can have a strong positive impact on the relief of fibromyalgia symptoms and enable a person to better cope with their disease. These include:
  • Exercise - this is perhaps the single most effective "treatment"; exercise helps with managing the symptoms of the disease as well as contributes to emotional well being
  • Reducing stress-find ways to deal with or minimize the stress in your life
  • Getting enough sleep - because fatigue is such a central aspect of fibromyalgia, it is important to make sure that you get enough sleep.
  • Balanced life - pace yourself, try not to take too much on in your work or family life
  • Healthy lifestyle - eat healthy foods

When exercise and other lifestyle approaches are not enough, medications can be added to a person's treatment plan to help reduce the pain of fibromyalgia and improve sleep. Some common medication choices your doctor may prescribe include5 6 7:
  • Analgesics - such as acetaminophen (such as Tylenol®)
  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen (or Advil®) and naproxen (or Naprosyn®),
  • Antidepressants - such as tricyclic anti-depressants (TCA), selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Muscle relaxants - to help treat pain and muscle spasms.
  • Antiepileptic medications - such as gabapentin (Neurontin®) and pregabalin (Lyrica®), which was the first drug approved by the Food and Drug Administration (FDA) to treat fibromyalgia

In addition to the medications listed above, prescription sleeping pills have been used to help deal with sleep disturbances; however, it is important to note that many doctors advise against their long-term use because the body can become resistant to them, which may result in more sleeping problems.

Benzodiazepines have also been used, but like with sleeping pills, doctors often avoid using these medications because they are addictive and can become habit forming.

Cognitive behavior therapy can also be useful as it helps a person with fibromyalgia to develop self-management skills for dealing with stressful situations.

1Mayo Clinic website
2Uceyler et al. (2008). "A systematic review on the effectiveness of treatment with antidepressants in Fibromyalgia Syndrome" in Arthritis and Rheumatism, vol. 59, 9:1279-1298.
3Mayo Clinic website
4American College of Rheumatology website
6Uceyler et al. (2008)
7Mayo Clinic website