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Fibromyalgia: Causes, Diagnosis and Treatments

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 affects seven times more women than men, according to the Centers for Disease Control and Prevention. It is also associated with other inflammatory disorders. Twenty percent of patients with rheumatoid arthritis and 50 percent of patients with systemic lupus erythematosus also suffer from fibromyalgia, according to a 2009 article in Nature Reviews Rheumatology.

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

Symptoms & Causes

Even though fibromyalgia is mainly defined by chronic widespread muscular pain and fatigue, it can also include a wide variety of symptoms, according to the National Institute of Arthritis and Muscoloskeletal and Skin Diseases. Symptoms include migraine or tension headaches, morning stiffness, irritable bowel syndrome, gastroesophageal reflux disorder and sensitivity to loud noises or bright lights.

Very little is known about the exact cause of fibromyalgia. In fact, there are still persistent debates 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, according to the Nature Reviews Rheumatology article. Experts today think fibromyalgia could be associated with genetics, viral infections, repetitive injuries, other diseases, post traumatic disorders or a combination of all these, according to the Mayo Clinic.

Complications

On its own, fibromyalgia is usually a nonfatal disease. It only accounted for about 23 deaths a year between 1979 and 1998, according to the CDC. The mortality rate of fibromyalgia patients is comparable to patients with osteoarthritis, but their risk of death from suicide and accidents is higher than the general population, according to a 2010 study that followed 8,186 U.S. fibromyalgia patients between 1974 and 2009.

These results are echoed by a smaller population study in Denmark that similarly analyzed records between 1984 and 1999. There was no overall increase in mortality for fibromyalgia patients but there a marked increase in suicide rate, specifically among female patients. The study also showed an increased chance of developing liver cirrhosis/biliary tract disease and cerebrovascular disease in male and female patients.

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 that 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, with more than half of the psychiatric diagnoses being anxiety disorder.

Diagnosis & Tests

There is no single, definitive test for diagnosing fibromyalgia. Instead, doctors can only base their diagnosis on a set of common symptoms associated with fibromyalgia, some of which overlap with other diseases and conditions, according to the Mayo Clinic. Until recently, the standard criteria for diagnosing fibromyalgia was based on a set of guidelines set out by the American College of Rheumatology  in 1990 where doctors test 18 areas on your body, including spots around the shoulders, neck, hips and inner knee, for tenderness. Patients with fibromyalgia will likely experience pain when light pressure is applied on 11 or more of those 18 spots.

However, the American College of Rheumatology has since released new guidelines in May 2010, which replaced the tender spot test with an index based on the number of spots, out of 19, where patients experienced pain over the course of a week. It also includes a scale that measures the severity of other concurrent symptoms including fatigue, unrefreshed sleep, cognitive problems and physical symptoms including muscle weakness, chest pains and seizures. Results from these two criteria determine whether the person has fibromyalgia.

Treatments & Medication

One anti-seizure drug, pregabalin (marketed as Lyrica) and two antidepressants, duloxetine (Cymbalta) and milnacipran (Savella), are currently approved by the Food and Drug Administration for treating fibromyalgia. These drugs work by increasing the supply of serotonin and norepinephrine to the brain and, might relieve fibromyalgia by dampening the brain's exaggerated reaction to pain signals, 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 2010 study at Johns Hopkins University shows that even short bouts of moderate physical activity, such as brisk walks, yard work and using the stairs more frequently, can improve symptoms without being too mentally or physically taxing to the patients.

Although there has been a handful of positive studies on homeopathic therapies such as capsaicin, anthocyanidins and soy, a 2010 review published in the journal Rheumatology suggests that these studies have yet to be replicated and more high-quality trials are needed. Another alternative therapy, acupuncture, had promising results in a few trials, including a 2004 study conducted by the Mayo Clinic. However its positive effects on fibromyalgia are still uncertain since another review published in Rheumatology in 2010 points out that the small therapeutic effect of acupuncture is not clearly distinguishable from experimental bias.

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