Are you exhausted? Do you have pain all over but can’t figure out what’s wrong? If so, you may be suffering from fibromyalgia, a chronic condition that causes exhaustion, sleep disturbances and diffuse pain in your muscles, tendons, and ligaments.
Fibromyalgia patients experience a range of symptoms of varying intensities that increase and decrease over time and often resemble other conditions. For years, because of their complex nature and a lack of research on the condition, many doctors misdiagnosed fibromyalgia symptoms or dismissed them as being in the patient’s head. Even today, it is estimated to take an average of five years for a fibromyalgia patient to get an accurate diagnosis.
There is no laboratory test available to diagnose fibromyalgia. Doctors must rely on patient histories, self-reported symptoms, a physical examination and an accurate manual tender point examination.
To receive a diagnosis of fibromyalgia, a patient must experience widespread pain in all four quadrants of the body for a minimum duration of three months and experience tenderness or pain in at least 11 of the 18 specified tender points when pressure is applied.
Fibromyalgia may affect as much as 3-6 percent of the U.S. population. It is more common in women than in men, but the reasons for this difference are unclear. “There are various theories, depending on which research you're looking at, but nothing absolutely definitive has come forward yet,” says Elisabeth Deffner, executive editor of Fibromyalgia AWARE, a publication of the National Fibromyalgia Association in Anaheim, Calif. Researchers are examining hormones, immune system differences, brain chemistry and genetics, among other areas, to shed light on the sex differences.
Although the cause of fibromyalgia is currently unknown, many researchers hypothesize that the symptoms result from “central sensitization.” According to this idea, sufferers of fibromyalgia have a heightened sensitivity in the brain to pain signals and as a result, have a lower pain threshold. As time goes on, the brain's pain receptors become conditioned to remember pain and potentially overreact to the brain's chemical signals or neurotransmitters. In other word, people with fibromyalgia may experience pain in stronger ways than others who don't have the condition.
Aside from predominantly affecting women, there are several risk factors for fibromyalgia:
• Age: the condition usually occurs in people between the ages of 20-60 years, although cases have been reported in children and elderly people. Some research studies have noted peaks around age 35.
• Family History: studies have shown that having a relative with fibromyalgia may put you at higher risk for developing the disorder.
• Other Rheumatic Diseases: a person who has other rheumatic diseases including rheumatoid arthritis and lupus may be more likely to develop fibromyalgia than those who do not have a rheumatic disease.
• Stress: although controversial, certain studies suggest that people who have had difficult or stressful past experiences may be at risk of developing fibromyalgia.
Because the causes of fibromyalgia are not clear and no cure exists, the goal of treating fibromyalgia is to control symptoms and minimize discomfort.
“Practitioners must diagnose and treat co-morbidities of fibromyalgia,” said Shanda Shribbs, Executive Director of the National Fibromyalgia Research Association in Salem, Ore. “Untreated restless legs, sleep apnea and upper airway resistance syndrome can have a dramatic impact on sleep and fatigue. Other conditions such as cervical cord compression, irritable bowel syndrome and myofascial pain syndrome are frequent co-morbidities which should be considered and treated when they are present.”
Common medications for treating fibromyalgia pain include analgesics (including NSAIDs or non-steroidal anti-inflammatory drugs), muscle relaxants and anti-seizure drugs. Medications to ease sleep disturbances include: anti-depressants and short-term use of sleeping pills. Some doctors recommend combining medication with therapy to help patients learn to techniques to cope with stress, which can exacerbate or trigger pain symptoms. Some patients have found relief through alternative treatments including: acupuncture and massage therapy.
May 12 is Fibromyalgia Awareness Day, a national health observance to raise awareness about the condition.
By Jennifer Wider, M.D.
Society for Women’s Health Research