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Fibromyalgia: Causes, Diagnosis and Treatments

A women looks distressed in bed.
A distressed woman in bed.
Credit: Supri Suharjoto, Shutterstock

Fibromyalgia is a chronic condition characterized mainly by fatigue and widespread pain in muscles and joints. It affects about 2 percent of the U.S. population and seven times more women than men, according to the Centers for Disease Control and Prevention. It is also associated with other inflammatory disorders. For example, 17 percent of patients with arthritis and also suffer from fibromyalgia, according to a study published by the National Institutes of Health

Symptoms & causes

Fibromyalgia is mainly defined by chronic widespread muscular pain and tenderness, but it can also include a wide variety of symptoms, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Symptoms include:

  • Headaches
  • Morning stiffness
  • Irritable bowel syndrome
  • Tingling in the fingers and extremities
  • Sensitivity to loud noises or bright lights
  • Cognitive and memory problems known as "fibro fog"
  • Trouble sleeping
  • Painful menstrual periods
  • Restless legs syndrome
  • Sensitivity to hot or cold

Very little is known about the exact cause of fibromyalgia. In fact, debates persist on whether fibromyalgia is an actual disease that can be clearly defined and cured, or if it's a catch-all diagnosis based on vague clinical criteria. Experts today think fibromyalgia could be associated with genetics, infections, physical or emotional trauma, or a combination of all these, according to the Mayo Clinic. Some researchers also believe that fibromyalgia may be due to problems with the neuroendocrine and autonomic nervous systems.

Complications

On its own, fibromyalgia is usually a nonfatal disease. It accounted for about 23 deaths a year between 1979 and 1998, according to the CDC. In fact, the CDC has found that the mortality rate of fibromyalgia patients is comparable to that of the general population.

A study published in the journal Arthritis Care & Research found that out of 8,186 fibromyalgia patients seen between 1974 and 2009, fibromyalgia did not increase the likelihood of death. The study did find that the risk of death from suicide and accidents was increased, though.

Fibromyalgia is also often associated with psychiatric disorders. Adults with fibromyalgia are 3.4 times more likely to be diagnosed with depression than people without the disease, according to the CDC. A 2008 study published in the Clinical Journal of Pain looked at 76 adolescents with fibromyalgia found that 67.1 percent of patients had at least one current psychiatric diagnosis, and 71.5 percent had at least one lifetime psychiatric diagnosis. More than half of the psychiatric diagnoses were anxiety disorder.

Diagnosis & tests

In 2010, the American College of Rheumatology released guidelines for the diagnosis of fibromyalgia. Following the guidelines, doctors use a checklist of areas of the body — lower left leg, upper right arm, left hip, for example — to find out how widespread the pain is. They also ask, on a scale from 0 to 3, how severe symptoms are. They then tally the results into a widespread pain index (WPI) and symptom severity (SS) score. According to the guidelines, a patient "satisfies diagnostic criteria" if three conditions are met:

  1. The WPI and SS scores indicate a certain level of pain and severity.
  2. The symptoms have been consistent for at least three months.
  3. The patient does not have a disorder that would explain the pain.

Treatments & medication

Anti-seizure drugs have shown promise for the treatment of fibromyalgia. Pregabalin (marketed as Lyrica) and two antidepressants, duloxetine (Cymbalta) and milnacipran (Savella), are currently approved by the Food and Drug Administration for treating fibromyalgia, according to the Mayo Clinic. Over-the-counter painkillers, including acetaminophen (such as Tylenol) or nonsteroidal anti-inflammatory drugs (such as aspirin and ibuprofen), may slightly ease the pain and stiffness caused by fibromyalgia.

Since fibromyalgia has a variety of symptoms, a combination of treatments is often recommended in addition to medication. A 2011 study published in the Journal of Clinical Rheumatologyshows that increasing the number of steps a patient walked by 54 percent helped improve the patient's body functions by 18 percent and reduced the participant's pain by 35 percent.

Exercising for 45 minutes every day is helpful, said Dr. Kevin Hackshaw, a rheumatologist at the Ohio State University Wexner Medical Center. "Helpful exercises like tai-chi or yoga are also beneficial. The worst thing to do is nothing," Hackshaw told Live Science. 

An alternative therapy, acupuncture, reduced pain in patients with fibromyalgia, according to a 2006 study conducted by the Mayo Clinic. However, its positive effects on fibromyalgia are still uncertain since another review published in the journal Rheumatology points out that the small therapeutic effect of acupuncture is not clearly distinguishable from experimental bias. 

There are some at-home treatments that may be useful, as well, according to Dr. Jacob Teitelbaum, director of the Annapolis Center for Effective CFS/Fibromyalgia Therapies in Maryland. "Herbal pain relief can be found with special highly absorbed curcumin products (a substance found in turmeric), willow bark, Comfrey cream and soaking in a hot bath with 2 cups of Epsom (magnesium) salts," he told Live Science.

Additional resources

NIAMS has a booklet titled Questions and Answers About Fibromyalgia.

These organizations provide information and support for people with the disorder:

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