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Fibromyalgia

Fibromyalgia is a tough diagnosis even for the experienced physician. It is a disorder of musculoskeletal pain throughout the body that cannot be explained by another systemic or rheumatologic disorder and the discomfort must persist at least three months. It's also known as fibrositis, myofascial pain syndrome, chronic pain disorder, and muscular rheumatism. After osteoarthritis, is it the second most common rheumatic disorder and occurs in an estimated 5% of the population.

Fibromyalgia was historically a diagnosis of exclusion. After other systemic diseases were ruled out, fibromyalgia became the diagnosis by default. The diagnostic criteria originally published almost 25 years ago emphasized chronic widespread pain with a series of tender or trigger points. As these are far more common in women, the diagnosis criteria led to an almost exclusively female incidence. Today the criteria are more symptom-based and the occurrence estimate has been lowered to about two out of every three cases being in women. While development is most common between the ages of 30-50, fibromyalgia can develop at any age, even childhood, and there is no predominant culture or ethnic group.

Fibromyalgia is considered a disease of pain regulation. Centralized pain can be documented as early as adolescence and is experienced in different regions of the body at different times. There are different central nerve patterns of pain that don't respond to treatment or surgery on a specific trouble spot. The pain is mostly along muscles and ligaments and commonly occurs in the back, hips, neck, and shoulders. There can be multiple tender points on exam. Headaches, generalized fatigue, and sleep disorders often accompany this disease.

Fibromyalgia also has other characteristics that help in an earlier diagnosis. Family members with a history of chronic pain and genetic factors have been reported. Environmental factors that are stressors involving acute pain can be chronic fatigue syndrome, viral infections, or even psychological stress. Stressors have been found to be 50 percent genetic and 50 percent environmental, when twin studies were evaluated.

The diagnosis of fibromyalgia is made with a medical history and physical exam. Fibromyalgia is likely suspected in those with multifocal pain that has no specific explanation. Often blood tests ruling out systemic illness or autoimmune vascular diseases have to come back negative before the diagnosis is determined. There is no specific lab test for fibromyalgia. Widespread pain that is present for three months or more, without another disorder that would explain it, is the most logical diagnosis of this disease.

Though treatment for fibromyalgia remains difficult, medication such as antidepressants may help, as they aid in disrupting pain cycles. Gabapentin, given in seizure disorders but also in chronic neurologic pain, is also used with varying degrees of success. Education, cognitive behavioral therapy, and exercise have all been shown to have positive benefits. Straight pain medication has shown to be of only transient benefit and may sometimes even worsen the symptoms.

Treating fibromyalgia best requires a multifaceted approach. Most people do not spontaneously improve on medication alone. Complementary therapies are tailored to each patient and their individual response. Cognitive behavioral therapy has been shown to complement any of the other treatment modalities. Neurostimulatory therapy, avoidance of situations that worsen the pain, and supervised but regular exercise all work together in best treating the disorder. When doctors and patients both understand the disease, effective treatment is now more possible than at any time in the past as newer combinations of both drug and alternative non-drug therapies are combined for the best results.

Authored by Dr. Bob Goldstone, M.D.

The information contained on this page is not intended to provide medical advice, which should be obtained directly from your physician.