Fibromyalgia

The cause of fibromyalgia is not known, but studies show that people with the disorder have a heightened sensitivity to pain, so they feel pain when others do not. Brain imaging studies and other research have uncovered evidence of altered signaling in neural pathways that transmit and receive pain in people with fibromyalgia. These changes may also contribute to the fatigue, sleep disturbances and cognitive problems that many people with the disorder experience.

Fibromyalgia tends to run in families, so genetic factors are likely to contribute to the disorder, but little is known for sure about the specific genes involved. Researchers believe that environmental (nongenetic) factors also play a role in a person’s risk of developing the disorder. These environmental triggers may include having a disease that causes pain, such as rheumatoid arthritis, or mental health problems, such as anxiety or depression.

Some other factors have been weakly associated with the onset of fibromyalgia, but more research is needed to see if they are real. These possible risk factors include:

• Gender; women are twice as likely to have fibromyalgia as men
• Stressful or traumatic events, such as car accidents, and post-traumatic stress disorder (PTSD)
• Repetitive injuries, such as those from repetitive stress on a joint
• Illness (such as viral infections)
• Family history
• Obesity

Anyone can get fibromyalgia, but more women get it than men. It can affect people of any age, even children, but it usually starts in middle age, and the chance of having it increases as you get older. It occurs in people of all racial and ethnic backgrounds.

If you have other diseases, especially rheumatic diseases, mood disorders or conditions that cause pain, you may be more likely to have fibromyalgia. These diseases include:

• Rheumatoid arthritis
• Systemic lupus erythematosus (commonly called lupus)
• Ankylosing spondylitis
• Osteoarthritis
• Depression or anxiety
• Chronic back pain
• Irritable bowel syndrome

Fibromyalgia tends to run in families, and some scientists believe that certain genes could make you more likely to develop it. However, the disorder also occurs in people with no family history of the disorder.

Fibromyalgia is diagnosed based primarily on having pain all over the body, along with other symptoms. Currently, there are no specific laboratory or imaging tests for fibromyalgia. The main symptoms—pain and fatigue—are shared with many other conditions, so doctors typically try to rule out other causes for your symptoms.

Fibromyalgia cannot be prevented, but maintaining health with diet and exercise can relieve the pain symptoms.

Fibromyalgia is diagnosed based primarily on having pain all over the body, along with other symptoms. Currently, there are no specific laboratory or imaging tests for fibromyalgia. The main symptoms—pain and fatigue—are shared with many other conditions, so doctors typically try to rule out other causes for your symptoms.

Doctors may do the following to diagnose fibromyalgia:

• Take your medical history. Your doctor will likely ask about the location, severity and duration of pain, and whether you have experienced severe fatigue or cognitive problems, such as confusion or memory issues. They may also ask if you have other conditions, because some people with fibromyalgia have other diseases at the same time.
• Perform a physical exam. Your doctor will examine your joints to see if you may have another condition, such as rheumatoid arthritis or systemic lupus erythematosus.

Your doctor may order laboratory or imaging tests to help rule out other diseases and conditions.

There is no cure for fibromyalgia, so treatment focuses on relieving the symptoms. Your treatment plan will likely include a combination of psychological and behavioral therapy, medications and self-management approaches, such as physical exercise and other movement therapies like yoga or tai chi.

Cognitive behavioral therapies. A type of therapy called cognitive behavioral therapy, which aims to change the way you think about pain, can be helpful, especially when combined with other types of treatment. This type of therapy can be either one-on-one or in groups with a therapist. Other types of mental health counseling may also be helpful.

A number of medicines can help relieve the pain and improve sleep. You may be prescribed more than one type of medication at the same time, such as:

• Antidepressants: Drugs that treat depression may also work for fibromyalgia even if you are not depressed. Doctors may prescribe one of several classes of antidepressants.
• Antiseizure medicines: These medicines can lessen pain and improve sleep. They work by interfering with the transmission of pain signals to the brain.
• Analgesics (pain-relieving medicines): These may be used for people who need additional pain relief. Anti-inflammatory pain medications are usually not effective because fibromyalgia does not cause tissue inflammation, but they may help with other painful conditions that may coexist with fibromyalgia.

You may need to try different drug combinations and dosages before finding relief from symptoms, and improvement is often gradual. There are also complementary and integrative medical therapies, such as acupuncture, massage and hypnosis. However, many of these have not been well tested in people with fibromyalgia. Before using these therapies, talk to your doctor about the best options for you.

Fibromyalgia treatment often requires a team approach, but it is primarily treated by rheumatologists, who specialize in arthritis and other diseases of the bones, joints and muscles. Fibromyalgia is not a form of arthritis, nor does it damage the bones, joints or muscles, but rheumatologists usually treat it because the symptoms are similar to those of arthritis.

Other healthcare professionals who may be involved in your care include:

• Exercise physiologists, who are trained in understanding the body’s response to physical activity.
• Mental health professionals, who help people cope with difficulties in the home and workplace that may result from their medical conditions. A counselor trained in cognitive behavioral therapy can help you learn skills and techniques to better control the pain.
• Pain management specialists, who are trained in the evaluation and treatment of pain.
• Physical therapists, who improve quality of life through prescribed exercise, hands-on care and patient education.
• Primary healthcare providers, including family doctors, internists or pediatricians, who coordinate care between the different healthcare providers and treat other problems as they arise.
• Sleep specialists, who address problems related to sleep, sleep disorders and sleep health.

Having fibromyalgia can significantly affect your quality of life and your ability to take part in everyday activities. There are things you can do to help you live with fibromyalgia, including:

• Exercising
• Educating yourself and getting support
• Combating fatigue

Exercise is a mainstay of therapy for fibromyalgia. Although pain and fatigue may make exercise difficult, it is important for you to be as physically active as possible. Research shows that regular exercise is one of the most useful ways to combat fibromyalgia, and even modest levels are helpful. Aerobic activity can also improve sleep and lessen anxiety and depression.

You should start exercising at a low level and gradually increase over time. Low-impact aerobic activities—such as walking, biking, swimming and water exercises—are especially helpful. Activities that engage the mind and body, such as yoga and tai chi, are also helpful. Physical therapists or exercise physiologists can prescribe an exercise program and provide ongoing support. Be sure to check with your doctor before beginning an exercise routine.