Fibromyalgia

Fibromyalgia (FM) is a common cause of chronic widespread musculoskeletal pain, often accompanied by fatigue, cognitive disturbance, psychiatric symptoms, and multiple somatic symptoms. The etiology of the syndrome is unknown, and the pathophysiology is uncertain [1,2]. Despite symptoms of soft tissue pain affecting the muscles, ligaments, and tendons there is no evidence of tissue inflammation.

Due to lack of any laboratory and diagnostic findings, the role of organic illness had been questioned in FM, and it was often been considered to be psychogenic or psychosomatic. However, ongoing research suggests that FM is a disorder of pain regulation, often classified as a form of central sensitization.

Fibromyalgia (FM) is a common cause of chronic pain and the most common cause of generalized, musculoskeletal pain in women between ages of 20 and 55 years; in the United States and in other countries, the prevalence is approximately 2 to 3 percent and increases with age [3-6]. It is six times more common in women in reports from specialty clinics, although the female predominance is not as striking in the community and when using survey criteria that do not require a tender point examination [6].

Fibromyalgia (FM) is characterized by widespread musculoskeletal pain and fatigue, often accompanied by other somatic symptoms, as well as cognitive and psychiatric disturbances [1,2,7]. Physical examination reveals tenderness in multiple soft tissue anatomic locations. Laboratory testing is normal in the absence of other illnesses.

It is associated with anxiety, depression, and sleep disorders. Constipation, diarrhea, and abdominal pain associated with irritable bowel syndrome (IBS) are also typical in people with fibromyalgia. People generally experience pain in specific locations of the body when pressure is applied. These locations are commonly the back of the head (occiput), upper back, neck, elbows, hips, and knees. The pain generally persists for weeks to months and is often accompanied by stiffness. Signs of inflammation are particularly absent.

Another frequently reported complaint of patients with fibromyalgia is headaches with associated facial pain that may be related to the tenderness they are experiencing in their neck and shoulders. Fibromyalgia can also predispose someone to an increased sensitivity to noises, bright lights, odors, and touch, similar to experiences during a severe migraine headache.

A common complication of chronic pain, particularly fibromyalgia, is central sensitization. This is a development involving both the peripheral nervous system (PNS) and the central nervous system (CNS). Local tissue injury and inflammation activate the PNS, which sends signals through the spinal cord to the brain. Central sensitization occurs when there is an increase in the excitability of neurons within the CNS, so that normal inputs from the PNS begin to produce abnormal responses. Low-threshold sensory fibers activated by very light touch of the skin activate neurons in the spinal cord that normally only respond to noxious, or more severe, stimuli.

As a result, an input that would normally produce a harmless sensation now produces significant pain. Although many complaints are common and reported among people with fibromyalgia, the diagnostic criteria are less extensive.

The American College of Rheumatology has established general classification guidelines for the diagnosis of fibromyalgia. According to these guidelines, the diagnosis is made clinically by the physician based upon a history of multiple areas of aches or pain for at least three months and patients who have a minimum of 11 of 18 locations on the body that are abnormally tender under relatively mild pressure. Current criteria have been modified to be based on cognitive issues. The fibromyalgia specialist is able to make the diagnosis of fibromyalgia in a patient based upon the history of symptoms and by eliciting the specific tender points on physical exam. If the patient has a history associated with fibromyalgia, but has less than the 11 tender spots, or are tender in non-fibromyalgia locations, then this is considered “myofascial pain syndrome” and is managed and treated similar to fibromyalgia.

Treatment of Fibromyalgia Symptoms

Although the intensity and frequency of the symptoms may vary, they probably never disappear completely on their own. It may be encouraging to know, however, that this is not a progressive or life-threatening condition and certain fibromyalgia treatments can significantly improve symptoms. People may experience a remission period, where they are free from symptoms without treatment or have much lower levels of pain.

Most commonly, the symptoms return and treatment is needed to alleviate the physical and emotional complaints.

One of the most difficult aspects for fibromyalgia specialists in treating patients is that they experience both physical discomfort and psychological/emotional hardships. Both the body and the mind need to be addressed for successful treatment. This may include:

  • Antidepressants
  • Analgesics (NSAIDs)
  • Muscle relaxants
  • Acetaminophen
  • Membrane-stabilizing drugs
  • Sleeping aids

Mixed outcomes are seen with drug treatments alone and emerging data favors pharmacological treatments with other modalities. Treatment goals of patients with fibromyalgia include the improvement of physical pain, increasing daily activities, and restoration of normal sleep cycles. A combination of treatments including pharmacotherapy with alternative therapies such as acupuncture, physical therapy, and activities increasing physical movement (Rooks 2007) is increasing in popularity.

Fibromyalgia treatments for pain and stress management are not new. Some alternative therapies have been practiced for thousands of years, but their use has become more popular in recent years, especially with people who have chronic illnesses, such as fibromyalgia, arthritis, headaches, and chronic back pain, among many other conditions.

These therapies can be especially beneficial for those with fibromyalgia:

  • Physical therapy
  • Acupuncture
  • Yoga
  • Massage therapy
  • Meditation
  • Cognitive behavioral therapy
  • Infusions of membrane stabilizing drugs
  • Exercise therapy
  • Aquatic therapy
  • Tens UNIT
  • Trigger point injections

Several of these therapies do safely and effectively reduce pain and the associated complaints, and are quickly gaining acceptance in the practice of medicine. Acupuncture, massage therapy, cognitive behavioral therapy, transcutaneous electrical nerve stimulation (TENS), and heat application have all been shown to decrease some of the symptoms associated with fibromyalgia as well as alleviate some of the mental strains experienced by these patients. Ginkgo biloba, which has been used as a sleep aid, has also been known to improve sleep and some of the associated complaints of fibromyalgia.

If you have fibromyalgia, contact us today to schedule an appointment. We are happy to offer these treatment options for fibromyalgia to the Twin Cities area.

 

  1. Goldenberg DL. Fibromyalgia syndrome. An emerging but controversial condition. JAMA 1987; 257:2782.
  2. Clauw DJ. Fibromyalgia: A clinical review. JAMA 2014; 311:1547.
  3. Pomares FB, Funck T, Feier NA, et al. Histological Underpinnings of Grey Matter Changes in Fibromyalgia Investigated Using Multimodal Brain Imaging. J Neurosci 2017; 37:1090.
  4. Wolfe F, Ross K, Anderson J, et al. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum 1995; 38:19.
  5. Jones GT, Atzeni F, Beasley M, et al. The prevalence of fibromyalgia in the general population: a comparison of the American College of Rheumatology 1990, 2010, and modified 2010 classification criteria. Arthritis Rheumatol 2015; 67:568.
  6. Walitt B, Nahin RL, Katz RS, et al. The Prevalence and Characteristics of Fibromyalgia in the 2012 National Health Interview Survey. PLoS One 2015; 10:e0138024.
  7. Bennett RM. Clinical manifestations and diagnosis of fibromyalgia. Rheum Dis Clin North Am 2009; 35:215.
The Minnesota Institute for Pain Management strives to improve the quality of life for it's patients by restoring normal function by relieving pain. Contact Us today to schedule a consultation with our pain experts.