Fibromyalgia

WHAT IS FIBROMYALGIA?
Fibromyalgia, sometimes called fibrositis, is a common condition that is associated with widespread aching, stiffness and fatigue, and originates in muscles and soft tissues. People with fibromyalgia are found to have multiple tender points in specific muscle areas. Most individuals complain of aching and stiffness in areas around the neck, shoulders, upper back, lower back and hip areas. Many patients have no underlying disorders while others who develop fibromyalgia may have conditions such as rheumatoid arthritis, spinal arthritis or Lyme disease. Some people have symptoms of irritable bowel syndrome, tension headaches and numbness or tingling of the extremities.

CAUSE
The cause of fibromyalgia is unknown. There may be a link between fibromyalgia and a sleep disturbance, since most patients have disruptive sleep patterns. Other factors that may contribute to the development of fibromyalgia or sustain symptoms are psychological stress, immune or endrocrine abnormalities, or biochemical abnormalities in the central nervous system, such as altered serotonin levels.

HEALTH IMPACT
Fibromyalgia is common, affecting approximately two percent of the U.S. population.

DIAGNOSIS
Diagnosis is based on the patient’s description of chronic widespread pain and the finding of tender points at specific locations by a physician. There are no blood or x-ray tests that are abnormal in fibromyalgia.
Common conditions that may mimic fibromyalgia include hypothyroidism, lupus, rheumatoid arthritis and infections. These can usually be excluded by examination and laboratory tests.

TREATMENT
There is no known cure for fibromyalgia. Patients may be reassured that the condition, while painful, does not damage tissues and that it can be managed successfully in many cases.

Physical modalities are often beneficial, including heat treatments, occasionally cold application, massage, and regular stretching and range-of-motion exercises. Supervised aerobic conditioning exercises are valuable. Occupational therapy, such as adaptive activities, can improve functional performance.

Certain medications have an important role. Various medications to improve sleep and relax muscles, such as amitriptyline and cyclobenzaprine, are widely used. Hypnotic agents, anxiolytic drugs and anti-depressant medications may be appropriate. Local anesthetic or corticosteroid injections may be appropriate for painful local tender points.

Attention to mental health, including psychological consultation, is also important, since depression may precede or accompany fibromyalgia.

THE PHYSICIAN’S ROLE IN TREATING FIBROMYALGIA
People with fibromyalgia often need a rheumatology consultation to determine the cause of multiple rheumatic symptoms, to be educated about fibromyalgia and its treatment, and to exclude other potentially progressive rheumatic diseases. A treatment program must be planned to meet the patient’s needs. The physician, as the team leader, enlists and coordinates the expertise of other health care professionals in the care of the patient.

Websites:
www.arthritis.org.