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Fibromyalgia

Fibromyalgia

Definition

Fibromyalgia is a condition in which a person has long-term pain that is spread throughout the body. The pain is most often linked to fatigue, sleep problems, difficulty concentrating, headaches, depression, and anxiety.

People with fibromyalgia may also have tenderness in the joints, muscles, tendons, and other soft tissues.

Alternative Names

Fibromyositis; FM; Fibrositis

Causes

The cause is not known. Researchers think that fibromyalgia is due to a problem with how the central nervous system processes pain. Possible causes or triggers of fibromyalgia include:

Fibromyalgia is more common in females as compared to males. Women ages 20 to 50 are most affected.

The following conditions may be seen with fibromyalgia or have similar symptoms:

Symptoms

Widespread pain is the main symptom of fibromyalgia. Fibromyalgia appears to belong in a range of chronic widespread pain, which may be present in 10% to 15% of the general population. Fibromyalgia falls on the far end of that pain severity and chronicity scale and occurs in 1% to 5% of the general population.

The central feature of fibromyalgia is chronic pain in multiple sites. These sites are the head, each arm, the chest, the abdomen, each leg, the upper back and spine, and the lower back and spine (including the buttocks).

The pain may be mild to severe.

People with fibromyalgia tend to wake up with body pain and stiffness. For some people, pain improves during the day and gets worse at night. Some people have pain all day long.

Pain may get worse with:

Most people with fibromyalgia have fatigue, depressed mood, and sleep problems. Many people say that they cannot get to sleep or stay asleep, and they feel tired when they wake up.

Other symptoms of fibromyalgia may include:

Exams and Tests

To be diagnosed with fibromyalgia, you must have had at least 3 months of widespread pain with one or more of the following:

It is not necessary for the health care provider to find tender points during the exam to make a diagnosis.

Results from the physical exam, blood and urine tests, and imaging tests are normal. These tests may be done to rule out other conditions with similar symptoms. Studies of breathing during sleeping may be done to find out if you have a condition called sleep apnea.

Fibromyalgia is common in every rheumatic disease and complicates diagnoses and therapy. These disorders include:

Treatment

The goals of treatment are to help relieve pain and other symptoms, and to help the person cope with the symptoms.

The first type of treatment may involve:

If these treatments do not work, your provider may also prescribe an antidepressant or muscle relaxant. Sometimes, combinations of medicines are helpful.

Other medicines are also used to treat the condition, such as:

If you have sleep apnea, a device called continuous positive airway pressure (CPAP) may be prescribed.

Cognitive-behavioral therapy is an important part of treatment. This therapy helps you learn how to:

Complementary and alternative treatments may also be helpful. These may include:

Support groups may also help.

Things you can do to help take care of yourself include:

There is no evidence that opioids are effective in the treatment of fibromyalgia, and studies have suggested possible adverse effects.

Referral to a clinic with interest and expertise in fibromyalgia is encouraged.

Outlook (Prognosis)

Fibromyalgia is a long-term disorder. Sometimes, the symptoms improve. Other times, the pain may get worse and continue for months or years.

When to Contact a Medical Professional

Call your provider if you have symptoms of fibromyalgia.

Prevention

There is no known prevention.

References

Arnold LM, Clauw DJ. Challenges of implementing fibromyalgia treatment guidelines in current clinical practice. Postgrad Med. 2017;129(7):709-714. PMID: 28562155 pubmed.ncbi.nlm.nih.gov/28562155/.

Borg-Stein J, Brassil ME, Borgstrom HE. Fibromyalgia. In: Frontera, WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 102.

Clauw DJ. Fibromyalgia and related syndromes .In: Hochberg MC, Gravallese EM, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 91.

Gilron I, Chaparro LE, Tu D, et al. Combination of pregabalin with duloxetine for fibromyalgia: a randomized controlled trial. Pain. 2016;157(7):1532-1540. PMID: 26982602 pubmed.ncbi.nlm.nih.gov/26982602/.

Goldenberg DL. Diagnosing fibromyalgia as a disease, an illness, a state, or a trait? Arthritis Care Res (Hoboken). 2019;71(3):334-336. PMID: 30724034 pubmed.ncbi.nlm.nih.gov/30724034/.

Lauche R, Cramer H, Häuser W, Dobos G, Langhorst J. A systematic overview of reviews for complementary and alternative therapies in the treatment of the fibromyalgia syndrome. Evid-Based Complement Alternat Med. 2015; 2015:610615. doi:10.1155/2015/610615. PMID: 26246841 pubmed.ncbi.nlm.nih.gov/26246841/.

López-Solà M, Woo CW, Pujol J, et al. Towards a neurophysiological signature for fibromyalgia. Pain. 2017;158(1):34-47. PMID: 27583567 pubmed.ncbi.nlm.nih.gov/27583567/.

Wu YL, Chang LY, Lee HC, Fang SC, Tsai PS. Sleep disturbances in fibromyalgia: a meta-analysis of case-control studies. J Psychosom Res. 2017;96:89-97. PMID: 28545798 pubmed.ncbi.nlm.nih.gov/28545798/.


Review Date: 1/21/2020
Reviewed By: Gordon A. Starkebaum, MD, MACR, ABIM Board Certified in Rheumatology, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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