If you've never heard of fibromyalgia, the disorder causes widespread pain and tenderness throughout the body, which can cause symptoms such as fatigue, stiffness, cognitive and memory problems, sleep disturbances, and additional symptoms of depression and anxiety. The widespread pain associated with fibromyalgia is usually described as a constant, dull ache that occurs on both sides of the body and above and below the waist. Other localized conditions such as migraines or tension headaches, TMJ disorder, irritable bowel syndrome, acid reflux, irritable bladder, and pelvic pain syndrome are also likely to coexist in patients with fibromyalgia. The signs and symptoms of fibromyalgia can vary, depending on the weather, stress, physical activity, or even the time of day.
The exact cause of fibromyalgia is still unknown. However, it's commonly believed that there is a genetic component that may make someone more susceptible to developing the disorder. Physical stressors such as trauma, arthritis, spine conditions, infections, or illnesses are also possible triggering factors for developing fibromyalgia; emotional stressors are also thought to play a role.
So where does the pain come from? It is often thought that people with fibromyalgia have a lower threshold for pain due to increased sensitivity in the brain to pain signals. We like the way the American College of Rheumatology puts it: "For the person with fibromyalgia, it is as though the 'volume control' is turned up too high in the brain's pain processing areas."
There are certain risk factors for fibromyalgia. These include female sex, age (fibromyalgia often develops in early and middle adulthood; however, adolescents and older adults can develop it as well), having a family member with fibromyalgia, or having a concurrent rheumatic disease such as osteoarthritis, lupus, or rheumatoid arthritis.
According to the National Fibromyalgia Association, a diagnosis of fibromyalgia should be made by a physician who is knowledgeable about the disorder, as most people with fibromyalgia tend to look healthy and conventional tests are typically normal. Fibromyalgia is usually a diagnosis of exclusion, and physicians should rule out other causes of the symptoms before making a diagnosis, such as hypothyroidism or other rheumatologic disorders. Blood tests can distinguish fibromyalgia from other causes. The American College of Rheumatology has established two criteria for the diagnosis of fibromyalgia: widespread pain lasting at least three months and at least 11 out of 18 "tender points" on exam. Tender points are specific points of tenderness that can be elicited with pressure (typically only enough pressure to whiten the nail bed of the physician performing the exam), and there are 18 points that are associated with fibromyalgia. Both the American College of Rheumatology and Mayo Clinic websites have diagrams of the 18 tender points of fibromyalgia.
There is no cure for fibromyalgia, so it must be managed with a comprehensive pain management plan, including medication and nondrug treatments for symptoms. In addition to lifestyle treatments, there are medications that are FDA-approved for fibromyalgia, such as Cymbalta, Savella, and Lyrica. These are prescription medications that would need to be started and managed by a physician. There are other medications that can be used, such as Tylenol, NSAIDS, and opioids; however, their effectiveness varies and may not be of great benefit to the patient. Alternative and complementary therapies can be useful, and these include physical therapy, massage, acupuncture, and yoga. Lifestyle modifications that can be useful include improving sleep, reducing stress, meditation, and a healthy diet.