Fibromyalgia

Fibromyalgia is a chronic condition that causes pain and tenderness throughout the body. It affects an estimated 5 million Americans, according to the National Institutes of Health (NIH). The disorder typically starts in middle age and is most common in women, but it can also strike men and people of all ages, including children. People with autoimmune conditions like lupus or rheumatoid arthritis are more prone to the disorder than the general population.

What are the symptoms of fibromyalgia?

The primary symptoms of fibromyalgia are:

• Widespread pain throughout the body
• A heightened, painful response to pressure at many tender points on the body

Individuals with fibromyalgia may also experience these symptoms:

• Moderate to severe fatigue
• Difficulty sleeping
• Joint stiffness
• Headaches
• Tingling, numbness, or a burning or prickling sensation in hands and feet
• Painful menstrual periods
• Irritable bowel
• Problems with thinking and memory

How is fibromyalgia diagnosed?

There is no blood test, other lab or diagnostic test, or imaging study that can identify fibromyalgia. That’s why doctors must rule out other possible causes of symptoms like pain and fatigue before making a fibromyalgia diagnosis. Pain and fatigue are symptoms of many conditions, including chronic fatigue syndrome, rheumatoid arthritis, and lupus.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases, which is part of NIH, notes certain guidelines doctors use to help diagnose fibromyalgia. These include:

• A history of widespread pain lasting more than three months
• Feelings of fatigue and waking unrefreshed
• Cognitive (memory or thought) problems
• Pain in a high number of areas throughout the body in the previous week

The National Fibromyalgia Association advises patients to look for a doctor who has a lot of experience with fibromyalgia: “Since people with fibromyalgia tend to look healthy and conventional tests are typically normal, a physician knowledgeable about the disorder is necessary to make a diagnosis.”

One method that had been widely used for diagnosing fibromyalgia — a tender point exam — is no longer considered the preferred diagnostic test. In this tender point exam, developed in 1990, a doctor applies pressure to 18 specific points on the body; a patient who feels pain in at least 11 of these points was believed to have fibromyalgia. As research provided more insight into the causes of fibromyalgia, in 2010 the American College of Rheumatology published new diagnostic criteria. These criteria advise physicians to replace the tender point exam with a self-report survey, in which patients are asked whether they have experienced pain in any one of 19 different body parts in the past week. Patients are also asked to rate the severity of certain symptoms, such as fatigue.

What is the difference between fibromyalgia and myofascial pain syndrome?

Myofascial pain syndrome is similar to fibromyalgia, but there are important differences in symptoms and treatment. One big difference is that myosfascial pain is confined to a specific area and is associated with trigger points. For more information, see the Made for This Moment myofascial pain syndrome page.

A person can have both fibromyalgia and myofascial pain syndrome. That makes it especially important to consult with a medical specialist who can diagnose the difference and apply the proper treatments for each condition.

What causes fibromyalgia?

The general consensus is that fibromyalgia is the result of a hypersensitive and hyperactive central nervous system, with the brain and spinal cord having developed heightened pain activity. Various risk factors have been suggested, such as genetic predisposition, trauma, multiple surgeries, or chronic stress, but these are not definitive.

What are the best treatments?

At this time, there is no cure for fibromyalgia. However, there are ways to manage the pain and other symptoms. Pain management specialists understand the full range of pain relief options, including how to use them in combination to achieve a successful outcome.

As a medical doctor, anesthesiologists specialize in pain control, and some focus their practices on treating patients with chronic pain. Ask your doctor about a referral to an anesthesiologist who specializes in treating chronic pain.

Treatment options generally fall into three categories: medicines, lifestyle changes, and complementary therapies. Most patients do best when they use components from all three options. Patients may also need to try different medications to find the one that is the most effective for them.

Medicines

• Nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen
• Muscle relaxants
• Steroids
• Pregabalin
• Duloxetine or milnacipran
• IV infusions of lidocaine
• Low-dose naltrexone
• Tricyclic antidepressants like amitriptyline and nortriptyline

Lifestyle changes

• Getting plenty of exercise, which NIH says has been shown by research to be one of the most effective treatments
• Developing better sleep habits and bedtime rituals
• Eating foods that reduce inflammation in the body
• Identifying and avoiding foods and ingredients that seem to trigger pain
• Quitting smoking
• Reducing stress with meditation, mindfulness, yoga, or other techniques
• Adjusting work demands

Complementary therapies

• Acupuncture
• Chiropractic therapy
• Massage
• Qi gong
• Tai chi
• Herbal supplements
• Cognitive behavioral therapy

Anesthesiologists are committed to patient safety and high-quality care, and have the necessary knowledge to understand and treat the entire human body.