Fibromyalgia

Fibromyalgia is a syndrome characterized by chronic, sometimes debilitating muscle pain and fatigue. Pain, often the predominant symptom may be either localized at so-called “tender points” or generalized throughout the body. Widespread pain is often described as stiffness, burning, radiating and aching. Pain intensity can easily vary based on the time of day, weather, physical activity, stress and after poor sleep.

Another major complaint is fatigue, which to some may be more debilitating than pain. Sleep disturbances, particularly restless leg syndrome, are also very common. Fatigue and sleep disturbances are, in fact, almost universal in patients with fibromyalgia.

Other frequently associated symptoms include depression or other mood disturbances, headaches, tingling or numbness in the extremities, gastrointestinal or urinary symptoms and/or painful menstrual periods in women.

Studies report that between 1.3% and 2% of the general population meet criteria for fibromyalgia. Some evidence has suggested a number of factors that may predispose an individual to fibromyalgia including female gender, psychological stress and difficult childhood experiences. The syndrome is most often found in people between 20-60 years of age with a peak at age 35. Some studies report a higher incidence of fibromyalgia in family members but it is not clear whether genetic factors are involved.

Causes

Fibromyalgia is sometimes categorized as primary or secondary; primary fibromyalgia is the more common form. The cause or causes of primary fibromyalgia (also called idiopathic fibromyalgia ) are not known. Many experts believe that fibromyalgia is not a disease but rather a dysfunctional disorder caused by an abnormal response to stress in individuals who are more susceptible to such stress because of negative personal histories, genetic factors, or both. Physical trauma, emotional trauma, or viral infections, such Epstein-Barr, may act as triggers for the onset of the disorder, but none have proven to be a cause of primary fibromyalgia.

Multiple theories exist on the exact cause for fibromyalgia, but is is more likely a combination of several factors. These theories include: chronic sleep disturbance, hormonal abnormalities. abnormal pain perception, immune abnormalities, and psychologic and social effects.

Secondary fibromyalgia is a condition with fibromyalgia symptoms caused by specific disorders, including multiple autoimmune diseases (ie. Rheumatoid arthritis, lupus, ankylosing spondylitis, etc…), surgery, physcical injury and lyme disease.

Diagnosis

The American College of Rheumatology as of 2010 revised their fibromyalgia diagnostic criteria. Unfortunately, there is no unequivocal objective method for diagnosing fibromyalgia. A thorough medical history and physical examination are extremely important to give a clinical suspicion for fibromyalgia, but more importantly to rule out any similarly presenting more serious condition.   Frequently blood urine and radiologic studies may be required, however none can confirm a diagnosis of fibromyalgia.

Essentially, the diagnosis of fibromyalgia is met when the patient satisfies several conditions including:

• Symptoms present for at least 3 months
• A specified number of pain areas experienced within the last week
• The presence of fatigue, waking unrefreshed, cognitive symptoms, muscle pain/weakness, headaches, depression, gastrointestinal symptoms, etc…
• There is no other disorder that would explain the pain

Several conditions have overlapping presentation and symptoms with fibromyalgia including but not limited to chronic fatigue syndrome, myofascial pain syndromes and depression. Other conditions such as irritable bowel syndrome, chronic headaches and TMJ are very common in fibromyalgia and In fact some experts believe these disorders so commonly interact that they may all be part of one general condition.

Prognosis

Fibromyalgia can be mild or disabling, and the emotional repercussions can be substantial. About half of all patients have difficulty with or are unable to perform routine daily activities. The pain, emotional repercussions, or sleep disturbances may lead to self-medication and overuse of sleeping pills, alcohol, drugs, or caffeine.

The long-term outlook in adults but most studies indicate that fibromyalgia symptoms remain stable over the long term, while others report a better outlook, with 25% of patients in remission two years after diagnosis. Although the disease is chronic, it is neither progressive nor fatal, and remission can occur in many patients who participate in disease management programs. Patients with secondary fibromyalgia, particularly when it is caused by injury, tend to have a more severe and less easily treated condition than those with primary fibromyalgia.

Treatment

The primary goal of drug therapy is to improve sleep and decrease widespread pain, but many of the medications may relieve other symptoms of fibromyalgia, including depression and low energy.

Trigger-Point Injections “Trigger-point injections” of an anesthetic may be used for particularly painful tender points as an aid to stretching. It should be noted that the benefits of this treatment may not be apparent immediately.

Antidepressants – Studies suggest that antidepressants help between a third and a half of patients. Doses used for fibromyalgia are generally lower than for depression. There are several classes of antidepressants used to treat fibromyalgia suffers ranging from tricyclic antidepressants (TCAs), to selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs – ie. duloxetin or Cymbalta, milnacipran or Savella)

Anti-seizure medications (ie. gabapentin or Neurontin, pregabalin or Lyrica) and Sleeping-aids/hypnotics are also frequently utilized.

Pain Relievers – For pain relief, acetaminophen (Tylenol) is most often recommended. Frequently however, this is not sufficient. Other classes of analgesic medications frequently used in fibromyalgia including anti-inflammatory medications (ie. NSAIDs), tramadol (Ultram) and less frequently opiates.