Fibromyalgia

(FM; Fibromyalgia Syndrome; FMS)

Definition

Fibromyalgia is a complex, chronic, and disabling disorder. It causes widespread pain and stiffness in the muscles, tendons, and ligaments. It also causes poor sleep and fatigue.
Fibromyalgia Trigger Points
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Causes

The exact cause of fibromyalgia is unknown.
The following conditions are commonly associated with fibromyalgia:

Risk Factors

A risk factor is something that increases your chance of getting fibromyalgia. Risk factors include:
  • Sex: female
  • Age: 20-60 years old
  • Physical or mental stress
  • Physical trauma (eg, accident, injury, or severe illness)

Symptoms

Common symptoms include:
  • Generalized fatigue or tiredness
  • Reduced physical endurance
  • Generalized aches and pains of muscles, tendons, and ligaments
  • Muscle tightening or spasms
  • Pain in specific areas of the body, especially:
    • Neck
    • Shoulders
    • Chest
    • Back (upper and lower)
    • Hips and thighs
  • Insomnia or poor sleep
  • Sensations of numbness or swelling (although swelling is not actually present)
  • Chronic headaches, including migraines
  • Morning stiffness
Factors that may trigger or worsen symptoms include:
  • Weather changes, especially cold, damp weather
  • Stress or anxiety
  • Overexertion
  • Medical illness
  • Surgery

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. There are no specific tests for fibromyalgia.
The doctor will look for the following signs:
  • Widespread pain lasting three months or longer
  • Tenderness (on physical exam) in at least 11 of 18 specific areas of the body

Treatment

The goal of treatment is to relieve or control the symptoms. Treatments include:

Therapy Programs

Lifestyle Changes

Your doctor may also recommend that you make lifestyle changes, such as:
  • Eating a healthy diet
  • Learning to cope with physical and mental stress
  • Maintaining a regular sleep schedule
  • Participating in a regular exercise program that includes aerobic activity, strength training, and flexibility exercises. Gentle exercises that may not strain painful areas include walking, biking, and swimming. Talk to your doctor to make sure it is safe for you to start exercising.

Medications

These medicines may help to improve symptoms:
  • Antidepressants (eg, amitriptyline, fluoxetine, duloxetine, milnacipran, moclobemide)
  • Medicines to relieve pain (eg, acetaminophen, pramipexole, pregabalin, tramadol)
  • Sodium oxybate (eg, Xyrem), a central nervous system depressant

Prevention

Because the cause is unknown, there are no guidelines to prevent fibromyalgia.

RESOURCES

American College of Rheumatology http://www.rheumatology.org/

The American Fibromyalgia Syndrome Association http://www.afsafund.org/

CANADIAN RESOURCES

The Arthritis Society http://www.arthritis.ca/

Fibromyalgia Information and Local Support http://fibromyalgia.ncf.ca/

References

Buckhardt CS, Goldenberg D, Crofford L, et al. Guideline for the management of fibromyalgia syndrome pain in adults and children. Glenview (IL): American Pain Society (APS); 2005. as summarized in National Guideline Clearinghouse 2005;19:7298.

Carville SF, Arendt-Nielsen S, Bliddal H, et al. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis . 2008Íž67:536-541.

Fibromyalgia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 10, 2012. Accessed October 11, 2012.

Fibromyalgia. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Fibromyalgia/fibromyalgia%5Fff.asp. Updated July 2011. Accessed October 11, 2012.

Wierville L. Fibromyalgia: diagnosing and managing a complex syndrome. J Am Acad Nurse Pract. 2012;24(4):184-92.

2/17/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Russell IJ, Perkins AT, Michalek JE; Oxybate SXB-26 Fibromyalgia Syndrome Study Group. Sodium oxybate relieves pain and improves function in fibromyalgia syndrome: a randomized, double-blind, placebo-controlled, multicenter clinical trial. Arthritis Rheum. 2009;60:299-309.

4/14/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Munguía-Izquierdo D, Legaz-Arrese A. Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial. Arch Phys Med Rehabil. 2008;89:2250-2257.

4/22/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Sañudo B, Galiano D, Carrasco L, Blagojevic M, de Hoyo M, Saxton J. Aerobic exercise versus combined exercise therapy in women with fibromyalgia syndrome: a randomized controlled trial. Arch Phys Med Rehabil. 2010;91(12):1838-1843.

4/22/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Carson JW, Carson KM, Jones KD, Bennett RM, Wright CL, Mist SD. A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia. Pain. 2010;151(2):530-539.

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