Unknown: Fibromyalgia

Definition
Description
Demographics
Causes and Symptoms
Diagnosis
Treatment
Prognosis
Prevention
The Future
For more information

Definition

Fibromyalgia is a chronic pain disorder characterized by muscle pain throughout the person's body, general tiredness, and soreness at specific locations of the body known as pressure points. The Centers for Disease Control and Prevention (CDC) categorizes fibromyalgia as a type of arthritis; however, fibromyalgia does not cause damage to the joints or other tissues the way that other types of arthritis do.

Fibromyalgia was first defined as a disease in 1976 and accepted as a cause of workers' disability in 1987. Because fibromyalgia does not have symptoms that are unique to it, however, some doctors question whether it is really a distinctive disorder. The controversy became heated in January 2008, when Dr. Frederick Wolfe, one of the doctors who had been responsible for the diagnostic criteria drawn up by the American College of Rheumatology (ACR) in 1990, stated that he had changed his mind about the disorder. He now regards it as a physical reaction to stress, worry, and depression. Dr. Wolfe was quoted as saying, “Some of us in those days thought that we had actually identified a disease, which [fibromyalgia] clearly is not. To make people ill, to give them an illness, was the wrong thing.”

Description

Fibromyalgia is a chronic disorder characterized by widespread muscle pain, chronic fatigue, and specific areas or points of soreness on the body. It is considered a syndrome because it is a collection of signs and symptoms that occur together but cannot be traced to an identifiable cause. Most people who develop fibromyalgia are middle-aged adults. It may appear either gradually or suddenly, and may be accompanied by headaches, insomnia, and other symptoms. Most people with fibromyalgia are able to continue working, but some end up working only part-time or changing to a less demanding job.

Demographics

Fibromyalgia can affect anyone in any age group, but it is most common in women between the ages of twenty and fifty. According to the ACR, between 3 and 6 million people in the United States have fibromyalgia,

or one person in every fifty in the general population. Females are nine time more likely to have fibromyalgia; some of the men who are diagnosed with it are Gulf War veterans.

Causes and Symptoms

Researchers do not agree about the possible causes of fibromyalgia, partly because it often occurs together with such other disorders as irritable bowel syndrome, rheumatoid arthritis, and restless legs syndrome, and partly because many do not think of it as a separate disorder in its own right. Fibromyalgia has been attributed to a number of different psychological as well as physical causes:

• Genetic factors
• A virus that affects the patient's perception of pain
• Childhood abuse or other traumatic incidents
• Lyme disease
• High levels of substance P in the spinal fluid (Substance P is a chemical that transmits and intensifies pain signals between the brain and the rest of the body.)
• Female sex hormones
• Emotional stress
• Sleep disorders
• A buildup of excess calcium and phosphate in the muscles
• Psychological depression
• Toxic substances in the environment

In addition to muscle pain and fatigue, people with fibromyalgia may have the following symptoms:

• Headaches
• Irritable bowel syndrome
• Disturbed sleep
• Problems with memory and concentration (This symptom is sometimes called “fibro fog.”)

• Chronic pain in the chest, abdomen, or pelvic region
• Changes in body weight
• Allergies; hypersensitivity to light, noises, and odors
• Shortness of breath
• Having to urinate more often
• Dizziness

Diagnosis

There is no laboratory test or imaging study that can detect fibromyalgia. The diagnosis is based on the patient's history and a physical examination. In 1990 the American College of Rheumatology (ACR) specified that the patient must have widespread pain for at least three months and soreness at eleven out of eighteen specific pressure points. These points are located on the neck, shoulders, chest, rib cage, lower back, thighs, knees, elbows, and buttocks. Diagrams of these pressure points are available on the ACR website at http://www.rheumatology.org/public/factsheets/fibromya_new.asp?aud=pat.

Treatment

Treatment of fibromyalgia is usually broad-based, consisting of recommendations about exercise and regular sleeping habits as well as medications. A variety of different drugs have been prescribed for fibromyalgia, including muscle relaxants, tranquilizers, antidepressants, and pain relievers; however, many doctors are cautious about these drugs because of the possibility that the patient will become dependent on them.

What Is Pain?

There is some evidence that fibromyalgia is associated with increased sensitivity to pain in some patients. Pain is, however, more than a physical process. Studies of the brain have shown that people's perception of pain has emotional and cognitive (thought-related) dimensions as well. In other words, a person's feelings and thoughts about pain have some influence on how intensely they experience pain. Some people grow up in families in which their relatives frequently complain about pain, while others are taught to ignore physical discomfort. Because of the different ways that people learn to cope with pain as they are growing up, some doctors think that people with fibromyalgia are focusing too much on aches and pains that others take in stride as part of life.

The relationship between thoughts and feelings on the one hand and perception of physical pain on the other explains why patient education and stress management programs are often recommended for people with fibromyalgia. People can learn to cope more effectively with the physical pain they experience and avoid reinforcing it by allowing it to control their lives. As one doctor explains it, health care professionals can help patients with fibromyalgia “to not choose illness as a way to deal with difficult life situations.”

A new drug called Lyrica was approved by the FDA in the summer of 2007 as a treatment for fibromyalgia. The new drug was originally developed to treat seizures and nerve pain associated with diabetes. It is controversial as a treatment for fibromyalgia, however, because it has

several potentially serious side effects, such as weight gain, blurred vision, swelling of tissue, sleepiness, and dizziness. In addition, Lyrica may not provide patients with long-lasting benefits, as people with fibromyalgia frequently change from one drug to another every few months.

In some cases the patient's doctor may recommend psychotherapy to help the patient regain a sense of control over his or her life and to learn better ways to cope with physical pain. Relaxation techniques may be useful.

Some complementary and alternative treatments appear to be beneficial to people with fibromyalgia. These include therapeutic massage, acupuncture, and chiropractic. It is better, however, for patients to use approaches that get them involved in their own healing, such as regular exercise, losing weight if they are too heavy, and endurance and strength training, rather than therapies in which they are simply receiving treatment from another person.

Prognosis

Fibromyalgia can last for years but is rarely fatal. The patient's symptoms may get better on occasion and then worsen again during stressful periods; one survey found that fibromyalgia patients average ten outpatient visits to their doctor every year and are hospitalized once every three years.

Prevention

There is no known way to prevent fibromyalgia.

The Future

It is uncertain whether fibromyalgia will be diagnosed more frequently in the future. Since the disorder was identified only a few decades ago, it is possible that it will be redefined at some point, along with other similar pain and chronic fatigue syndromes.

SEE ALSO Chronic fatigue syndrome; Gulf War syndrome; Irritable bowel syndrome; Lyme disease; Restless legs syndrome; Rheumatoid arthritis

WORDS TO KNOW

Acupuncture: A form of alternative medicine in which very fine needles are inserted into the skin at specific points on the body for pain relief.

Chiropractic: A form of alternative medicine that treats disorders of the joints and muscles by adjusting the patient's spine or other joints.

Fibro fog: A term that has been coined to describe memory loss and difficulty concentrating in fibromyalgia patients.

Pressure points: Specific locations on the body where people with fibromyalgia feel pain even with light pressure.

Rheumatology: The branch of medicine that deals with disorders of the muscles, joints, and connective tissue.

Substance P: A chemical in the central nervous system that transmits pain signals back and forth between the brain and the rest of the body.

For more information

BOOKS

Staud, Roland, and Christine Adamec. Fibromyalgia for Dummies, 2nd ed. Indianapolis, IN: Wiley Publishing, 2007.

Wallace, Daniel J., and Janice Brock Wallace. Fibromyalgia: An Essential Guide for Patients and Their Families. New York: Oxford University Press, 2003.

PERIODICALS

Berenson, Alex. “Drug Approved. Is Disease Real?” New York Times, January 14, 2008. Available online at http://www.nytimes.com/2008/01/14/health/14pain.html?ei=5124&en=0c71a04fe1a4cee9&ex=1358053200&partner=permalink&exprod=permalink&pagewanted=all (accessed April 18, 2008).

Campos, Paul. “The Controversy over Fibromyalgia.” Abilene Reporter-News, January 17, 2008. Available online at http://www.reporternews.com/news/2008/jan/17/the-controversy-over-fibromyalgia/ (accessed April 18, 2008).

Food and Drug Administration (FDA). “Living with Fibromyalgia, First Drug Approved.” FDA Consumer Health Information, June 21, 2007. Available online in PDF format at http://www.fda.gov/consumer/updates/fibromyalgia062107.pdf (accessed April 18, 2008).

Wang, Shirley S. “Fibromyalgia Pioneer Rethinks Disorder.” Wall Street Journal, January 14, 2008. Available online at http://blogs.wsj.com/health/2008/01/14/fibromyalgia-pioneer-rethinks-disease-as-pfizer/ (accessed April 18, 2008).

WEB SITES

American Academy of Family Physicians (AAFP). Information for Patients Living with Fibromyalgia. Available online at http://www.aafp.org/afp/20001001/1587ph.html (posted October 1, 2000; accessed April 18, 2008).

American College of Rheumatology (ACR). Patient Education: Fibromyalgia. Available online at http://www.rheumatology.org/public/factsheets/fibromya_new.asp?aud=pat (updated June 2006; accessed April 18, 2008).

Centers for Disease Control and Prevention (CDC). Arthritis Types: Fibromyalgia. Available online at http://www.cdc.gov/arthritis/arthritis/fibromyalgia.htm (updated January 11, 2008; accessed April 17, 2008).

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Questions and Answers about Fibromyalgia. Available online at http://www.niams.nih.gov/Health_Info/Fibromyalgia/default.asp (updated 2007; accessed April 18, 2008). This document includes a diagram of the pressure points that a doctor tests for fibromyalgia.