What Is Fibromyalgia and Who Gets It?

Fibromyalgia is a chronic pain disorder characterized by widespread pain and musculoskeletal tenderness. While it is a highly prevalent condition, identified in nearly 20% of patients visiting rheumatology clinics, fibromyalgia is often confused with other pain disorders, and little is known about its root cause. Remission of fibromyalgia is uncommon.

The vast majority of fibromyalgia sufferers (90%) are women. Most people are diagnosed while in their 40s and 50s. The condition is defined as either primary fibromyalgia, when no other musculoskeletal disorders are present, or secondary fibromyalgia, when there is evidence of other musculoskeletal problems. While anxiety and depression are very common among fibromyalgia sufferers, medical experts currently believe that psychological distress occurs as a result of the condition and is not a cause.

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Fibromyalgia -- The Symptoms and How They Develop

The dominating symptom of fibromyalgia is widespread pain and musculoskeletal tenderness. The pain is described as aching, exhausting and nagging, and the tenderness is readily felt at certain points around the body, particularly the joints and multiple organ regions. More than 75% of sufferers also experience fatigue, sleep disturbances and morning stiffness. Other symptoms may include irritable bowel or bladder syndromes, headache, swelling and paresthesia (tingling sensation). For some people, symptoms may worsen or subside as a result of stress, weather and noise.

Despite its prevalence, the pathogenesis or development of fibromyalgia is not well known. Studies suggest that this condition results from either brain dysfunction or muscle abnormalities or a combination of the two. Decreased levels of neurochemicals in the brain, such as serum and CSF serotonin, may lower pain thresholds or tolerance throughout the body. Recent studies suggest that patients with fibromyalgia may be hypervigilant -- that is, their brains turn up the volume on internal sensations. For instance, a normal person can learn to ignore a body ache, but a person with fibromyalgia may experience the same ache as a severe, debilitating pain. Reduced muscle strength, due to less oxygen and blood flow in the muscles, can influence tenderness. Psychological factors also have been linked to fibromyalgia, but not as a primary cause.

Fibromyalgia -- How Is It Diagnosed and Treated?

Diagnosis
While there are no laboratory tests to detect fibromyalgia, there are guidelines, developed in 1990 by the American College of Rheumatology (ACR), to assist physicians in diagnosing it. Having identified 18 "tender points" on the body, on both the right and left sides and above and below the waist, the ACR requires that at least 11 of these tender points produce pain on digital palpation. This technique, which involves applying pressure with the fingers and the thumb, is a reliable and simple method used by physicians to establish tenderness associated with fibromyalgia.

Another tool to help diagnose and regularly assess the disorder is the The Fibromyalgia Impact Questionnaire (FIQ), which measures pain, stiffness, sleep disturbance, psychological distress, general function and work ability. Other standard health status instruments that may aid in diagnosis include the Health Assessment Questionnaire, the Modified Health Assessment Questionnaire and the Arthritis Impact Measurement Scale.

Treatments
Although treatment does not provide a cure, much can be done to help alleviate the pain of fibromyalgia. Tricyclic antidepressants, such as amitriptyline, nortriptyline and doxepin, and SSRI antidepressants, such as sertraline and paroxetine, may help some patients. Other drugs, like tizanidine, may also be helpful. Non-pharmacologic treatments include hypnosis and psychological therapy. Perhaps one of the most important therapies to emerge is aerobic exercise, which, in releasing the body's natural painkillers, has been found to improve a patient's daily functioning. Patient education is also valuable to help reduce anxiety. Medical centers that combine exercise, psychological therapy and drug therapy may offer the best opportunity for improvement.

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