Fibromyalgia

Definition
Fibromyalgia is a condition characterized by chronic aches, pain and stiffness in the muscles.

Causes/associated factors
The cause of fibromyalgia is unknown, but research continues. Some researchers believe there's a genetic predisposition to fibromyalgia because the risk of developing the disorder may be higher if you have a close family member who has fibromyalgia. The illness may be triggered by certain stressors, such as injury, infection or emotional stress. Other diseases may also act as triggers. For example, certain endocrine disorders, such as hypothyroidism (an underactive thyroid gland) and certain autoimmune disorders (in which the body produces antibodies to fight against its own tissues), such as rheumatoid arthritis or lupus, may play a role. Other research has indicated that many symptoms of fibromyalgia may result from changes in brain chemicals and the body's own stress response.
Fibromyalgia is most common in women of childbearing age, but it can affect anyone. It doesn't cause muscle or organ damage, and it often improves over time -- possibly over the course of years -- but it rarely goes away completely.


Signs/symptoms
The chronic pain of fibromyalgia is typically described as an aching stiffness or weakness, often all over the body. The American College of Rheumatology (ACR) has identified 18 tender points that can be affected, including areas around the neck, upper chest, shoulders, elbows, hips, upper legs and knees. Pain is typically worse in the morning, when the weather changes, and after overexertion, stress or anxiety. There are usually no outward physical signs of the pain.
Other common symptoms include:

fatigue
interrupted sleep
numbness in the hands or feet
memory and attention span difficulties
headaches
jaw pain
dizziness
sensitivity to stimuli, such as loud noise, bright light, smells, chemicals and medications
chest pain (noncardiac)
shortness of breath
heartburn
pelvic pain
urinary frequency and urgency
weight changes
The condition can be stressful, often leading to anxiety, depression, social isolation and time missed from work. Many people who have fibromyalgia also have additional conditions, such as irritable bowel syndrome (a condition that causes stomach pain, diarrhea and constipation), migraine headaches, temporomandibular joint syndrome (TMJ) or restless legs syndrome.


Diagnosis
The doctor will review your medical history, do a physical exam, and rule out other conditions with similar symptoms. According to the ACR, a diagnosis of fibromyalgia can be made when you have a history of at least three months of widespread pain and 11 of the 18 tender points hurt when pressure is applied. Pain is considered widespread when it's present on both sides of the body, as well as above and below the waist.

Treatment
Although there's no cure for fibromyalgia, treatment is available. Combination forms of treatment are typically the most helpful. Medications such as low-dose antidepressants can help promote sleep and ease chronic pain. Muscle relaxants may also make it easier to sleep for some people. Sometimes, anesthetics or steroids are directly injected into the tender point.
Regular aerobic exercise has been shown to significantly decrease pain and improve quality of sleep. Before you start an exercise program, talk to your doctor. He or she may ask a physical therapist to help you plan an appropriate exercise program. For best results, exercise 30 minutes or more at least four times a week. Appropriate types of exercise may include water aerobics, swimming, bicycling or walking.

Other techniques that may be helpful include:

applying heat or massaging the painful area
local electrical stimulation (applying brief pulses of electricity to nerve endings)
acupuncture
Learning techniques for stress management, relaxation and/or biofeedback (a technique that trains a person to voluntarily control bodily functions, such as blood pressure, muscle tension or heart rate) works for some people. Emotional support and reassurance that the condition is not life-threatening or progressive is also important. Participating in a support group for people who have fibromyalgia may also be helpful. Avoid substances that can interfere with sleep, such as caffeine and alcohol, especially near bedtime. Get plenty of rest, and try not to isolate yourself from others.


Complications
Fibromyalgia is chronic, but symptoms don't usually become progressively worse. Symptoms may lead to anxiety, depression, social isolation and time missed from work. Remember, anxiety and depression can be treated.

Pregnancy-specific information
Pregnancy is not a risk factor for fibromyalgia.

Senior-specific information
Because fibromyalgia can affect older adults, it's important to consult your doctor if you have any symptoms of the condition.

Prevention
There is no known way to prevent fibromyalgia. Seek medical attention as soon as possible for any pain that lasts longer than you think it should. Early intervention may help prevent complications that can develop as a result of chronic pain.