Fibromyalgia: More Than "Aches & Pains"

Pain Points in Fibromyalgia

What Is It? Poorly understood by just about everyone, it is a chronic condition of widespread pain. The "Fibro" means fibrous tissues such as tendons and ligaments. "My" means muscle, and "algia" means pain. Pain (not just tenderness) is found on pressing at least 11 of 18 specific points (see diagram). FM patients usually have problems sleeping and fatigue. Often the same people have morning stiffness, irritable bowel syndrome and can be anxious. Occasionally it’s been called the "irritable everything" syndrome. The urge to urinate is frequent, as is numbness, dry skin, temperature sensitivity, chest pain, headache, fainting, and trouble with balance. Some report "spaciness" and difficulty concentrating: "fibro-fog."

Who Gets It? Fibromyalgia is thought to affect 3-8 million people in the U.S. Most (80%) are women Family clusters have been reported, suggesting a genetic factor.

What Causes It? The cause is not known. Theories abound: altered serotonin (a brain nerve transmitter) levels, immune or endocrine abnormalities (such as thyroid disorder), stress, trauma or a virus (no evidence so far). There is also a proposal that salicylate food preservatives are responsible.

What Is The Evidence?

A chemical nerve transmitter, Substance P (involved in pain) is elevated 3-fold in FM patients. There is also SPECT (brain) scan evidence of changes in regional brain blood flow in FM patients.

Lab Tests are mainly used to exclude other problems - there is no definitive "test" for FM. It is important to check for Lyme disease, systemic lupus, rheumatoid arthritis, low thyroid and some forms of viral hepatitis.

How Is It Treated?

Treatment is quite varied:

• Physical Maneuvers:

These include massage, ultrasound, hot/cold packs (warm-up/cool-down), myofascial release, postural training, aerobic exercise, stretching, relaxation therapy and occupational therapy (to adjust job-related tasks that contribute to pain such as repetitive motions).

• Acupuncture:

has been reviewed at the National Institutes of Health and a Consensus Panel found that FM is one of the conditions most successfully treated with acupuncture. The mechanism is not clear; there is fair evidence that the needles induce the release of the body’s own version of morphine.

• Medication:

 is often quite helpful, especially in patients with sleep disorders. The 2 best studied are amitriptyline (Elavil, others) and cyclobenzaprine (Flexeril). Elavil is an antidepressant that works on the serotonin disorder. Adding fluoxetine (Prozac) is more effective than either drug alone. Flexeril works best at night. Other drugs tested include Zoloft, Paxil, aspirin and other anti-inflammatories (such as Naprosyn, Vioxx, Celebrex etc), and the non-narcotic pain killer, tramadol (Ultram).