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Fibromyalgia

(FM; Fibromyalgia Syndrome; FMS)

Pronounced: FI-bro-my-OWL-jah

by Rick Alan

En Español (Spanish Version)More InDepth Information on This Condition

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

Causes

The exact cause of fibromyalgia is unknown.

The following conditions are commonly associated with fibromyalgia:

Depression and anxiety
Muscle pain
Chronic headache, such as tension headaches (frequently beginning with neck discomfort)
Nocturnal myoclonus (moving legs involuntarily during sleep)
Irritable bowel syndrome (IBS)
Complex regional pain syndrome
Substance abuse
Premenstrual syndrome
Female urethral syndrome (irritable bladder)
Raynaud's disease

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

Physical therapy (gradual aerobic exercise and stretching)
Heated pool treatments—Aquatic training in warm water (eg, strength, aerobic, and relaxation exercises)
Applying heat to painful areas
Alternative treatments, such as massage, acupuncture, relaxation training, trigger point therapy, biofeedback, and yoga
Cognitive behavioral therapy (CBT)

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.

American College of Rheumatology

http://www.rheumatology.org/

The American Fibromyalgia Syndrome Association

http://www.afsafund.org/

The Arthritis Society

http://www.arthritis.ca/

Fibromyalgia Information and Local Support

http://fibromyalgia.ncf.ca/

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. 2008;67:536-541.

Fibromyalgia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. 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_Info/Fibromyalgia/fibromyalgia_ff.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 http://www.ebscohost.com/dynamed/: 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 http://www.ebscohost.com/dynamed/: 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.

Last reviewed September 2012 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.