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In the world of medicine, fibromyalgia is a relatively new disease. The first controlled study that validated the symptoms of fibromyalgia was published in 1981, and the American Pain Society issued the first treatment guidelines for fibromyalgia in 2005.
What is fibromyalgia? Lisa Witkin, MD, a pain medicine specialist at Weill Cornell Medicine, explains: “Fibromyalgia is a generalized soft tissue pain syndrome characterized by widespread or diffuse pain and symptoms from three key domains: mood symptoms (including anxiety/depression), sleep disturbances, and stress,”
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Women at Higher Risk
Among fibromyalgia patients, the female-to-male ratio is almost 10 to one. “In general, women often disproportionately suffer when in pain; they report having more pain than men, as well as feeling it more intensely,” says Dr. Witkin.
Rheumatic diseases—conditions that cause chronic, often intermittent pain in joints and/or connective tissue, including rheumatoid arthritis (RA), systemic lupus erythematosus (lupus), polymyalgia rheumatica, and scleroderma—are also far more common in women than in men, and patients with these conditions also have a higher risk of fibromyalgia.
According to Dr. Witkin, there is likely a genetic predisposition to develop fibromyalgia, which is then coupled with a triggering event, including physical and emotional trauma or infection. There is a theory that fibromyalgia may be linked to a virus that also may be responsible for chronic fatigue syndrome; however, the specific etiology is still unknown.
Fibromyalgia is a clinical diagnosis, meaning that it is based on signs and symptoms and a patient’s medical history rather than on results of lab or imaging tests.
“Fibromyalgia is often a diagnosis of exclusion; there is no test that detects this disease, but lab tests or X-rays are often performed to rule out other health problems,” Dr. Witkin says. “Other conditions such as hypothyroidism, polymyalgia rheumatica, RA, lupus, and other inflammatory or autoimmune disorders sometimes mimic fibromyalgia, but these conditions can be ruled out by a physical exam and blood tests,”
Because the symptoms of fibromyalgia are often vague and are common to many other medical conditions, it often takes months, or even years, to receive a diagnosis. In one national survey, one-quarter of the respondents said they suffered fibromyalgia symptoms for at least five years before being diagnosed.
Early diagnosis is important in fibromyalgia, because patients diagnosed within a year of developing the condition are less likely to experience severe symptoms in the future.
Fibromyalgia Treatment: Medications
According to Dr. Witkin, first-line treatment involves the use of SNRI medications including duloxetine (Cymbalta), milnacipran (Savella), and venlafaxine (Effexor), anticonvulsants such as pregabalin (Lyrica) and gabapentin (Neurontin), and tricyclic antidepressants such as amitriptyline (Elavil).
Other options include SSRIs such as fluoxetine (Prozac) and sertraline (Zoloft), and the muscle relaxants cyclobenzaprine (Flexeril) and tizanidine (Zanaflex).
The diagnostic criteria for fibromyalgia issued by the American College of Rheumatology include:
- Pain and symptoms over the past week, based on the total number of painful areas out of 19 parts of the body, plus the level of severity of these symptoms: fatigue, waking unrefreshed, cognitive (memory or thought) problems, and other general physical symptoms.
- Symptoms lasting at least three months at a similar level.
- No other health problem that would explain the pain and other symptoms.
Other Treatment Options
“Physical exercise should be used in addition to any drug treatment, with the most benefit gained from aerobic exercises. Other body-based therapies, including tai chi and yoga, can be helpful, as well as regular stretching/strengthening exercises,” says Dr. Witkin.
Cognitive behavioral therapy and relaxation techniques can help patients learn skills that lessen pain. Complementary and alternative therapies, such as acupuncture, chiropractic, and massage therapy, can be useful, but Dr. Witkin notes that many of these treatments have not been well tested in patients with fibromyalgia.
Lifestyle modifications also may be strongly recommended. Among them: Avoid stimulants, caffeine, and nicotine, and practice good sleep hygiene.
“While no cure exists for fibromyalgia, and [because] we are still learning a lot about causes and best treatments,” Dr. Witkin says, “education, lifestyle changes, and appropriate medication management by a specialist can help patients achieve significant improvement in symptoms and overall quality of life.”