tired woman massaging her painful neck

While much is still unknown about fibromyalgia, research over the past 10 years has shown that this is a real illness, not just a manifestation of depression as many in the medical field had proposed.  

Under the criteria established by the American College of Rheumatology, a patient can be diagnosed for fibromyalgia if s/he has widespread pain over seven of 19 areas of the body and also has symptoms of fatigue, poor sleep and cognitive changes. These symptoms must have been ongoing for three or more months and the patient has no other illness that would otherwise explain the pain. Fifteen years ago, this phenomenon was just being noted and there was little insight or research into its causes, treatment options, and prognosis. Today more people are being diagnosed based primarily on patient history. 

Fibromyalgia is pain in soft fibrous tissues of the body, muscles, tendons and ligaments. There are no diagnostic tests such as computerized tomography (CT) scans, magnetic resonance imaging (MRI) or blood work to pinpoint fibro. The symptoms define the illness. These include diffuse soft tissue pain and severe tenderness when at least 11 of 18 specific tender points on the body are palpated. 

Very commonly, patients also have a constellation of other symptoms which can contribute to the generalized pain. These symptoms can include low back pain, fatigue, poor sleep, irritable bowel syndrome, irritable bladder, chronic headaches, depression and anxiety. The pain is often very debilitating, and can interrupt one’s normal daily activities. Symptoms can be made worse by stress, physical exertion, weather changes, hormonal fluctuations, allergies, and a lack of sleep. 

We do not know its cause but have seen that in some people, the symptoms started after a flu-like illness or physical or emotional trauma. Lyme disease as a trigger has been studied, as has sleep apnea (heavy snoring, and a lack of enough oxygen during sleep). 

Some studies point to possible (not proven) systemic bacterial, viral or even fungal infections and some health care providers use medications to combat infection in their treatment of fibromyalgia.  Research continues to find causes, connections, and treatments.  Women with fibromyalgia far outnumber men with the illness. The ratios are estimated between 9:1 and 20:1 (women to men) and this disease is seen primarily between the ages of 20 and 50. 

For many years, women were told to “relax” or that it was “all in their heads” when standard diagnostic tests were inconclusive. This is now recognized as a real phenomenon even though we are still grappling with effective treatment options. 

The primary problem is that fibro patients have a heightened sensitivity to pain stimuli and develop a lowered pain threshold. The pain becomes more intense and lasts longer. 

Recent research has found that some people with fibromyalgia also have PTSD (post traumatic stress disorder), often stemming from abuse issues in childhood or adolescence. A number of women have suffered through domestic violence. Is fibromyalgia a manifestation of undertreated depression or other psychiatric condition?  While questions and research continue, it is important to realize that this syndrome is NOT “all in your head” as some physicians in the past have asserted.

Researchers and fibro patients themselves are finding ways to deal with this illness. The primary treatment goals are to reduce pain, enhance quality of life, and improve sleep. 

Non-pharmacological treatments such as yoga, daily walking, and low intensity/low impact exercise may relieve some of the pain and the fatigue associated with the disorder. People who exercise three to five times a week report a 25% reduction in most fibro symptoms and require less prescription medication.  

Unfortunately, some patients with fibro have increased pain with exercise. An altered exercise regimen such as tai chi and water aerobics, deep breathing and improved posture can reduce exercise discomfort. Acupressure, massage therapy, relaxation techniques, biofeedback and chiropractic care have also shown to be helpful, as has cognitive behavioral therapy. 

Many people benefit from medications that boost serotonin and norepinephrine. These are neurotransmitters that help to regulate sleep, the immune system and pain, and are effective in reducing some symptoms of depression. There are three FDA-approved medications currently available to treat fibromyalgia: Pregabalin (Lyrica), Duloxetine (Cymbalta) and Milnacipran (Savella). Many other drugs are used “off label” to treat fibro symptoms, including amitriptyline, trazodone and some SSRIs (selective serotonin reuptake inhibitors) like fluoxetine, sertraline and escitaprolam. Antianxiety medications such as clonazepam and diazepam also may aid sleep but are highly addictive so must be used with caution. 

Muscle relaxers may be helpful, as are anti-inflammatory medications (over the counter ibuprofen and naproxen) but some patients may need strong opioid pain medications to treat severe pain.

All of these medications can have serious adverse effects so it is very important to consult with your health care provider before starting any drug regimen and at regular intervals during treatment. (If your health care provider will not discuss fibromyalgia or dismisses the symptoms, find another one!) 

Mineral and vitamin supplements such as magnesium, zinc, malic acid, folic acid, creatine, vitamin C, vitamin B complex, vitamin E, calcium, melatonin (for sleep) and acidophilus have been examined for effectiveness, but there is little conclusive evidence for their efficacy.

Fibromyalgia Awareness Day is observed on May 12. It was started in Tucson by a support group organized in 1992. Support groups are invaluable in that they offer a place for fibro sufferers to receive and give emotional support by others who experience this disease. Support groups tend to be very energizing in the exchange of information and lifestyle advice. 

Mia Smitt is a nurse practitioner with a specialty in family practice.

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