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Fibromyalgia is a relatively new disease: It wasn’t until 1981 that the first controlled study to identify symptoms of fibromyalgia was published. And it wasn’t until 2005 that the American Pain Society issued the first treatment guidelines for fibromyalgia.
So exactly what is fibromyalgia? It’s “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,” says Lisa Witkin, MD, a pain medicine specialist at Weill Cornell Medicine. Fibromyalgia, she adds, is more likely to strike women than men (see “Fibromyalgia and Gender” sidebar below).
How Doctors Diagnose Fibromyalgia
How do we get fibromyalgia? There is likely a genetic predisposition in people to develop fibromyalgia, and it’s may be coupled with a triggering event, including physical and emotional trauma or infection, Dr. Witkin says. Another theory holds that fibromyalgia may be linked to a virus that could be responsible for chronic fatigue syndrome; however, the specific etiology is still unknown.
FIBROMYALGIA AND GENDER
Fibromyalgia affects women far more than men. Among patients treated for the condition, the female-to-male ratio is almost 10 to 1. “In general, women often disproportionately suffer when in pain,” Dr. Witkin says. “They report having more pain than men, as well as feeling it more intensely.”
Rheumatic diseases are also more likely to strike women than men, and patients with these conditions also have a higher risk of fibromyalgia. Rheumatic diseases are known to cause chronic, often intermittent pain in joints and/or connective tissue, including rheumatoid arthritis (RA), systemic lupus erythematosus (lupus), polymyalgia rheumatica, and scleroderma.
As a clinical diagnosis, fibromyalgia is based on signs and symptoms and a patient’s medical history rather than on results of lab or imaging tests. In fact, Dr. Witkin explains, the condition is often “a diagnosis of exclusion,” meaning that rather than using a test to diagnose the disease, “lab tests or x-rays are often performed to rule out other health problems. 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 fibromyalgia symptoms are often vague and are common to many other medical conditions, it often takes months—sometimes 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.
With fibromyalgia, early detection is important. Patients diagnosed within a year of developing the condition are less likely to experience severe symptoms in the future.
First-line treatment for fibromyalgia involves the use of SNRI medications, according to Dr. Witkin. Among them: 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).
Other Fibromyalgia Treatment Options
The diagnostic criteria for fibromyalgia issued by the American College of Rheumatology includes:
- 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.
Beyond medication, there are lifestyle changes that may help. You won’t be surprised, no doubt, that exercise is recommended. As Dr. Witkin explains, “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.”
Relaxation techniques also can help fibromyalgia patients learn skills that lessen pain, as can cognitive behavioral therapy. Complementary and alternative therapies such as acupuncture, chiropractic, and massage therapy also can be useful, although Dr. Witkin points out that such treatments have not been well-tested in fibromyalgia patients.
Other lifestyle modifications your doctor may recommend: 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.”