What is fibromyalgia?

Fibromyalgia is chronic condition that causes pain all over the body, fatigue, and other symptoms. People with fibromyalgia may be more sensitive to pain than people who don't have it. This is called abnormal pain perception processing.

What causes fibromyalgia?

The exact cause of fibromyalgia is unknown. Researchers think that certain things might contribute to its cause:

• Stressful or traumatic events, such as car accidents
• Repetitive injuries
• Illnesses such as viral infections

Sometimes, fibromyalgia can develop on its own. It can run in families, so genes may play a role in the cause.

Who is at risk for fibromyalgia?

Anyone can get fibromyalgia, but it is more common in

• Women; they are twice as likely to have fibromyalgia
• Middle-aged people
• People with certain diseases, such as lupus, rheumatoid arthritis, or ankylosing spondylitis
• People who have a family member with fibromyalgia

What are the symptoms of fibromyalgia?

Common symptoms of fibromyalgia include

• Pain and stiffness all over the body
• Fatigue and tiredness
• Problems with thinking, memory, and concentration (sometimes called "fibro fog")
• Depression and anxiety
• Headaches, including migraines
• Irritable bowel syndrome
• Numbness or tingling in the hands and feet
• Pain in the face or jaw, including disorders of the jaw know as temporomandibular joint syndrome (TMJ)
• Sleep problems

How is fibromyalgia diagnosed?

Fibromyalgia can be hard to diagnose. It sometimes takes visits to several different health care providers to get a diagnosis. One problem is that there isn't a specific test for it. And the main symptoms, pain and fatigue, are common in many other conditions. Health care providers have to rule out other causes of the symptoms before making a diagnosis of fibromyalgia. This is called making a differential diagnosis.

To make a diagnosis, your health care provider

• Will take your medical history and ask detailed questions about your symptoms
• Will do a physical exam
• May do x-rays and blood tests to rule out other conditions
• Will consider the guidelines for diagnosing fibromyalgia, which include
  • A history of widespread pain lasting more than 3 months
  • Physical symptoms including fatigue, waking unrefreshed, and cognitive (memory or thought) problems
  • The number of areas throughout the body in which you had pain in the past week

What are the treatments for fibromyalgia?

Not all health care providers are familiar with fibromyalgia and its treatment. You should see a doctor or team of health care providers who specialize in the treatment of fibromyalgia.

Fibromyalgia is treated with a combination of treatments, which may include medicines, lifestyle changes, talk therapy, and complementary therapies:

• Medicines
  • Over-the-counter pain relievers
  • Prescription medicines that were specifically approved to treat fibromyalgia
  • Prescription pain medicines
  • Certain antidepressants, which may help with pain or sleep problems
• Lifestyle changes
  • Getting enough sleep
  • Getting regular physical activity. If you have not already been active, start slowly and gradually increase how much activity you get. You may want to see a physical therapist, who can help you create a plan that is right for you.
  • Learning how to manage stress
  • Eating a healthy diet
  • Learning to pace yourself. If you do too much, it can make your symptoms worse. So you need to learn to balance being active with your need for rest.
• Talk therapy, such as cognitive behavioral therapy (CBT), can help you learn strategies to deal with pain, stress, and negative thoughts. If you also have depression along with your fibromyalgia, talk therapy can help with that too.
• Complementary therapies have helped some people with the symptoms of fibromyalgia. But researchers need to do more studies to show which ones are effective. You could consider trying them, but you should check with your health care provider first. These therapies include
  • Massage therapy
  • Movement therapies
  • Chiropractic therapy
  • Acupuncture

Fibromyalgia is a long-lasting or chronic disorder that causes muscle pain and fatigue (feeling tired). If you have fibromyalgia, you have pain and tenderness throughout your body. Sometimes you may have two or more chronic pain conditions at the same time, such as:

• Chronic fatigue syndrome.
• Endometriosis.
• Irritable bowel syndrome.
• Interstitial cystitis.
• Temporomandibular joint dysfunction (TMJ).
• Vulvodynia.

You’ve probably heard of fibromyalgia, but you may not know what it is. Fibromyalgia is a long-term (chronic) pain condition that affects 5 million or more Americans ages 18 and older. For unknown reasons, most people diagnosed with fibromyalgia are women, although men and children also can be affected. People with certain disorders, such as rheumatoid arthritis or lupus, may also have fibromyalgia, which can affect their disease course and treatment.

Fibromyalgia can take a powerful toll on health, well-being, and quality of life. “People with fibromyalgia suffer from severe, daily pain that is widespread throughout the body,” says Dr. Leslie J. Crofford, an NIH-supported researcher at Vanderbilt University. “Their pain is typically accompanied by debilitating fatigue, sleep that does not refresh them, and problems with thinking and memory.”

People with fibromyalgia often see many doctors before finally receiving a diagnosis. The main symptoms—pain and fatigue—overlap with those of many other conditions, which can complicate the diagnosis.

“To make things more challenging, there are no blood tests or X-rays that are abnormal in people with the disorder,” says Crofford. With no specific diagnostic test, some doctors may question whether a patient’s pain is real. “Even friends, family, and coworkers may have a difficult time understanding the person’s symptoms,” Crofford says.

A doctor familiar with fibromyalgia can make a diagnosis based on the criteria established by the American College of Rheumatology. Diagnostic symptoms include a history of widespread pain lasting more than 3 months and other symptoms such as fatigue. In making the diagnosis, doctors consider the number of areas throughout the body where the patient had pain in the past week, and they rule out other causes of disease.

What causes fibromyalgia isn`t fully understood. Many factors likely contribute. “We know that people with fibromyalgia have changes in the communication between the body and the brain,” Crofford says. These changes may lead the brain to interpret certain sensations as painful that might not be bothersome to people without the disorder.

Researchers have found several genes that may affect a person’s risk of developing fibromyalgia. Stressful life events may also play a role.

Fibromyalgia isn’t a progressive disease, so it doesn’t get worse over time and may even improve. It’s never fatal, and it won’t harm the joints, muscles, or internal organs.

Medications may help relieve some—but not all—symptoms of fibromyalgia. “Drug treatments by themselves don’t result in remission or cure of fibromyalgia,” says Crofford. “We’ve learned that exercise may work as well as or better than medications. In addition, therapies such as tai chi, yoga, and cognitive behavior therapy can also help to reduce symptoms.”

People with fibromyalgia often have the best results when treated with multiple therapies. “It’s critically important for health care providers to help patients develop an understanding of fibromyalgia, and to provide realistic information about treatments, with an emphasis on using exercise and other physical therapies in conjunction with medications,” Crofford says.

Crofford and her colleagues are exploring whether a treatment called TENS (transcutaneous electrical nerve stimulation) can help people with fibromyalgia exercise more comfortably and reduce pain. She and other NIH-funded teams are also seeking markers of fibromyalgia in the blood that might ultimately lead to more targeted and effective treatments.

If you or someone you know has fibromyalgia, see the “Wise Choices” box for tips on reducing its impact.

Feeling Better with Fibromyalgia

• Get enough sleep. Getting the right kind of sleep can help ease pain and fatigue. Discuss any sleep problems with your doctor.
• Exercise. Research has shown that regular exercise is one of the most effective treatments for fibromyalgia.
• Try a complementary health approach. Practices such as tai chi, qi gong, yoga, massage therapy, and acupuncture may help relieve some symptoms.
• Consider medicines. Talk to your health care provider about an approved medication for treating fibromyalgia.

Doctors don’t know the exact cause of fibromyalgia. Researchers continue to study fibromyalgia and think the following events may contribute to the cause of the disorder:

• Stressful or traumatic events, such as car accidents.
• Repetitive injuries.
• Illness.
• Certain diseases.

Sometimes, fibromyalgia can develop on its own. Fibromyalgia tends to run in families, and some scientists think that a gene or genes could make you more likely to develop fibromyalgia. The genes could make you react strongly to things that other people would not find painful.

Anyone can get this disorder, though it occurs most often in women and often starts in middle age. If you have certain other diseases, you may be more likely to have fibromyalgia. These diseases include:

• Rheumatoid arthritis.
• Systemic lupus erythematosus (commonly called lupus).
• Ankylosing spondylitis (spinal arthritis).

If you have a family member with fibromyalgia, you may be more likely to get the disorder.

The symptoms of fibromyalgia are pain and tenderness throughout your body. Other symptoms may also include:

• Trouble sleeping.
• Morning stiffness.
• Headaches.
• Painful menstrual periods.
• Tingling or numbness in hands and feet.
• Problems with thinking and memory (sometimes called “fibro fog”).

Currently there aren’t any laboratory tests to diagnose fibromyalgia.

You may see many doctors before receiving the diagnosis. This can happen because the main symptoms of fibromyalgia, pain and fatigue, are similar to many other conditions. Doctors often have to rule out other causes of these symptoms before making a diagnosis of fibromyalgia.

Doctors use guidelines to help diagnose fibromyalgia, which can include:

• A history of widespread pain lasting more than 3 months.
• Physical symptoms including fatigue, waking unrefreshed, and cognitive (memory or thought) problems.
• The number of areas throughout the body in which you had pain in the past week.

Fibromyalgia is a chronic condition, meaning it lasts a long time – possibly throughout your life. However, it is important to remember that fibromyalgia is not a progressive disease. It is never fatal, and it will not cause damage to the joints, muscles, or internal organs. In many people, the condition does improve over time.

Doctors usually work with a team of health care providers and treat fibromyalgia with:

• Medications.
• Lifestyle changes.
• Complementary therapies.

Fibromyalgia can be difficult to treat because not all doctors are familiar with fibromyalgia and its treatment. You should find a doctor who understands the treatment of fibromyalgia, which may include several treatment team members.

Medications

Doctors may prescribe one of the three medications currently approved by the U.S. Food and Drug Administration (FDA) for the treatment of fibromyalgia:

• Duloxetine, an antidepressant.
• Milnacipran, similar to other antidepressants, but is only approved to treat fibromyalgia.
• Pregabalin treats neuropathic pain (chronic pain caused by damage to the nervous system).

In addition, your doctor may also treat fibromyalgia with other medications developed and approved for other purposes.

Analgesics

Analgesics are painkillers. They range from over-the-counter products to prescription medications. Your doctor may prescribe an analgesic to help manage your pain. When your pain is severe, your doctor may recommend a narcotic medication. However, there is no solid evidence showing that narcotics actually work to treat the chronic pain of fibromyalgia. Most doctors hesitate to prescribe them for long-term use because you could become physically or psychologically dependent on them.

Nonsteroidal anti-inflammatory drugs

Doctors prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen sodium, to treat inflammation. Although inflammation is not a symptom of fibromyalgia, NSAIDs may help relieve your pain. NSAIDs work by inhibiting prostaglandins, a substance found in your body that plays a role in pain and inflammation.These medications, some of which are available without a prescription, may help ease the muscle aches of fibromyalgia. NSAIDs may also relieve menstrual cramps and the headaches that you may experience with fibromyalgia.

Lifestyle changes

Making lifestyle changes can also help you manage your fibromyalgia, including:

• Getting enough sleep.
• Exercising.
• Making changes at work.
• Eating well.

Complementary therapies

Your doctor may recommend treating your fibromyalgia with complementary therapies, including:

• Massage.
• Movement therapies, such as Pilates and the Feldenkrais method.
• Chiropractic treatments.
• Acupuncture.
• Herbal and dietary supplements.

Although researchers are studying the use supplements for fibromyalgia, there is little, if any, scientific proof yet that they help. The FDA does not regulate the sale of dietary supplements, so information about side effects, proper dosage, and the amount of a preparation’s active ingredients may not be well known.

If you are using or would like to try a complementary or alternative therapy, you should first speak with your doctor, who may know more about the therapy’s effectiveness and if it is safe to try in combination with your medications.

Many family doctors, general internists, or rheumatologists (doctors who specialize in arthritis and other conditions that affect the joints or soft tissues) can treat fibromyalgia.

Fibromyalgia treatment often requires a team approach, with your doctor, a physical therapist, possibly other health professionals, and most importantly, yourself, all playing an active role. It can be hard to assemble this team, and you may struggle to find the right professionals to treat you. When you do, however, the combined expertise of these various professionals can help you improve your quality of life.

There are pain clinics that specialize in pain and rheumatology clinics that specialize in arthritis and other rheumatic diseases, including fibromyalgia.

In addition to taking medications to treat your fibromyalgia, there are many things you can do to minimize the impact of the disorder on your life.

Getting enough sleep

Getting enough sleep and getting the right kind of sleep can help you ease the pain and fatigue of fibromyalgia. However, many people with fibromyalgia can that interfere with restful sleep, such as

• Pain.
• Restless legs syndrome.
• Brainwave irregularities.

Try following these tips for good sleep:

• Keep regular sleep habits. You should try to get to bed at the same time and get up at the same time every day—even on weekends and vacations.
• Avoid caffeine and alcohol in the late afternoon and evening. If you consume caffeine found in coffee, tea, soft drinks, and chocolate you may not get a good night’s sleep. Even though it can make you feel sleepy, if you drink alcohol around bedtime it also can disturb your sleep.
• Time your exercise. Regular daytime exercise can improve your nighttime sleep. However, you should avoid exercising within 3 hours of bedtime because it can be stimulating, keeping you awake.
• Avoid daytime naps. Sleeping in the afternoon can interfere with your nighttime sleep. If you feel you cannot get by without a nap, set an alarm for 1 hour. When it goes off, get up and start moving.
• Reserve your bed for sleeping. Watching the late news, reading a suspense novel, or working on your laptop in bed can stimulate you, making it hard to sleep.
• Keep your bedroom dark, quiet, and cool.
• Avoid liquids and spicy meals before bed. Heartburn and late-night trips to the bathroom are not conducive to good sleep.
• Wind down before going to bed. Avoid working right up to bedtime. Instead try some relaxing activities, such as listening to soft music or taking a warm bath, that get you ready to sleep. A warm bath also may soothe aching muscles.

It is important to discuss any sleep problems with your doctor, who can prescribe or recommend treatment for them.

Exercising

Pain and fatigue may make exercising and your daily activities difficult, however, it is important that you try to be as physically active as possible. Research has repeatedly shown that regular exercise is one of the most effective treatments for fibromyalgia. If you have too much pain or fatigue to do vigorous exercise, try starting with walking or other gentle exercise and build your endurance and intensity slowly.

Making changes at work

You can continue to work when you have fibromyalgia, but may have to make some changes to do so. For example, you may need to

• Lower the number of hours you work.
• Switch to a less demanding job.
• Make changes in your current job.

If you face obstacles at work, such as an uncomfortable desk chair that leaves your back aching or difficulty lifting heavy boxes or files, your employer may make adaptations that will enable you to keep your job. An occupational therapist can help you design a more comfortable workstation or find more efficient and less painful ways to lift.

Eating well

Although some people with fibromyalgia report feeling better when they eat or avoid certain foods, no specific diet has been proven to influence fibromyalgia. Of course, it is important to have a healthy, balanced diet. Not only will proper nutrition give you more energy and make you generally feel better, it will also help you avoid other health problems.