What Is Fibromyalgia? What Causes Fibromyalgia?

The word fibromyalgia comes from the Greek myos meaning "muscle", Greek algosmeaning "pain", and New Latin fibromeaning "fibrous tissue". According to MediLexicon's medical dictionary, fibromyalgia is "A common syndrome of chronic widespread soft-tissue pain accompanied by weakness, fatigue, and sleep disturbances; the cause is unknown."

Fibromyalgia is a common and chronic disorder. When a health illness or condition is chronic it means it is long-lasting. 

Even though fibromyalgia is frequently referred to as an arthritis-related condition, it does not cause joint damage orinflammation, as arthritis does. Neither does fibromyalgia cause damage to muscle and other tissues. However, it is similar to arthritis because it causes severe pain and tiredness, and can undermine the patient's ability to go about his daily activities. Fibromyalgia is seen as a rheumatic condition. A rheumatic condition is one that causes joint and soft tissue pain.

What are the signs and symptoms of fibromyalgia?

• Morning stiffness

• Headaches

• Irregular sleep patterns

• IBS (irritable bowel syndrome)

• Painful menstrual periods (Dysmenorrhea)

• Hands and feet tingle and can feel numb

• Restless leg syndrome

• Sensitivity to cold or heat

• Fibro fog (memory problems, cognitive problems)

The following signs and symptoms are also possible

• Widespread pain

• Problems with vision

• Nausea

• Pelvic and urinary problems

• Weight gain

• Dizziness

• Cold/flu like symptoms

• Jaw pain and stiffness

• Skin problems

• Chest symptoms

• Depression

• Anxiety

• Myofascial pain syndrome (pain/tiredness in muscles and adjacent fibrous tissues)

• Breathing problems

Fibromyalgia is a syndrome

A syndrome is a collection of signs, symptoms and medical problems. A disease is a medical condition with defined causes and clear signs and symptoms. Fibromyalgia is a syndrome.

How common is Fibromyalgia? Who gets Fibromyalgia?

According to reported cases in the USA, approximately 1 in every 73 American adults suffers from fibromyalgia. The American College of Rheumatology says that between 3 and 6 million Americans have fibromyalgia. 

The NIH (National Institutes of Health, USA) says 90% of fibromyalgia patients are women. Men and children may also be affected. 

Although symptoms may become present at any time during a person's life, they are most commonly reported when the patient is middle-aged. 

People who suffer from rheumatoid arthritis, lupus (systemic lupus erythematosus), or spinal arthritis (ankylosing spondylitis) have a higher risk of developing fibromyalgia, as well as patients with some other rheumatic diseases. 

Studies indicate fibromyalgia may also be hereditary. Females who have a close relative with fibromyalgia have a significantly higher risk of suffering from it themselves. Experts are not certain whether the link is genetic, circumstantial, or both.

What Causes Fibromyalgia?

Experts say there are probably a number of factors. However, nobody is really sure what causes fibromyalgia. Factors such as a traumatic, stressful, or emotional event may be linked to developing fibromyalgia. Possible causal factors currently include:

• A stressful, traumatic physical or emotional event (e.g. Post-traumatic stress disorder, a car accident)

• Repetitive injuries

• Rheumatoid arthritis

• Lupus

• CNS (central nervous system) problems

• The way our genes regulate how we process painful stimuli

How Is Fibromyalgia Diagnosed?

A patient with fibromyalgia will usually keep going back to the doctor many times before a proper diagnosis is made. This is because the symptoms are similar to other conditions. Before diagnosing fibromyalgia the doctor needs to rule out other conditions and illnesses. 

As laboratory tests do not show a physical reason for the pain that goes with fibromyalgia, there are not any diagnostic laboratory tests for it. This can be frustrating for the patient and the doctor as well. Unfortunately, the patient still runs the risk of being told by an untrained doctor that his pain is not real and that there is therefore no treatment.

The American College of Rheumatology has established two criteria for diagnosing fibromyalgia:

1. A history of widespread pain that has lasted over three months. Widespread means the pain affects the four parts (quadrants) of your body - the left, right, top and bottom sides. 

2. The presence of tender points in 18 sites of the body. These sites are located at the back and front of the neck, between the neck and chest, just below the neck on the back, the knees, the inside of the elbows, just above the buttocks (where two dimples are usually located), just below the buttocks at the top of the back thighs at their furthest point from the crotch. At least 11 of these points need to be tender for a fibromyalgia diagnosis to be confirmed. For a point to be tender the patient should feel pain if 4gk of pressure is applied to it. It is possible that a fibromyalgia patient feels pain at other points - however, for a diagnosis to be confirmed tenderness needs to be limited to those 18 points (at least 11 of them).

What is the treatment for Fibromyalgia?

It is important that the patient's doctor is trained in treating fibromyalgia, as it is not an easy condition to treat. Fortunately, more and more doctors, including GPs (general practitioners) know what to do. For best results the patient should be treated by the doctor, a physical therapist, and possibly some other health care professionals simultaneously. Patient compliance is crucial for good results. Patient compliance means that the patient is actively involved and does not forget to follow instructions. 

Each patient is different and will require individualized treatment. Treatment will usually include some or all of the following:

• An active exercise program

• Low-dose anti-depressants

• Acupuncture

• Psychotherapy

• Behavior modification therapy

• Chiropractic care

• Massage

• Physical therapy (UK term is called physiotherapy)

Drugs

Various studies have indicated that pharmacologic treatment (drugs) for fibromyalgia helped between one-third and one-half of all patients. However, some of them experienced worsening symptoms. 

One study demonstrated that taking a tricyclic antidepressant, 25 mg of amitriptyline (Elavil), with a selective serotonin reuptake inhibitor, 20 mg of fluoxetine (Prozac), all in combination was twice as effective as either one taken alone. 

Exercise

Aerobic exercise combined with resistance training (strength-training) have been linked to a significant improvement in pain, tender point counts, and sleep disturbance. Unfortunately, a large percentage of patients do not keep up the exercises. Studies have shown that working out with a partner or personal trainer helps to keep the program active. 

Acupuncture

Many patients have experienced improvements in their quality of life after starting acupuncture therapy. How often sessions should be depends on the individual. 

Painkillers

If the pain is severe, and other therapies have not been effective or cannot be utilized, chronic opioid analgesic therapy - oral painkillers - may be an option. Aspirin and ibuprofen are generally not very effective. 

Behavior modification therapy

This includes learning new coping skills, relaxation exercises and self-hypnosis. Patients have commented that pain perception, which is a very complicated phenomenon, may be altered with experience. 

Growth hormone therapy

Growth hormone therapy has been shown in one study to be effective in reducing symptoms, without serious side-effects. However, the treatment is extremely expensive.

What is the prognosis for Fibromyalgia?

There is no definitive cure for fibromyalgia. However, treatment is a lot better today than it used to be. Clinical studies have shown that your symptoms can improve significantly if you follow all your treatment to the letter. Keep working with trained health care professionals, as well as informed and motivated patients and you will experience significant improvements in your symptoms and quality of life.