Fibromyalgia is characterized by poor sleep, fatigue, and widespread aching and stiffness in soft tissues, including muscles, tendons, and ligaments.

• Poor sleep, stress, strains, injury, and possibly certain personality characteristics may increase the risk of fibromyalgia.
• Pain is widespread, and certain parts of the body are tender to touch.
• Fibromyalgia is diagnosed when people feel pain in specific areas of the body and have typical symptoms.
  Improving sleep, exercising, applying heat, and getting massages usually help.

This disorder used to be called fibrositis or fibromyositis syndromes. But because inflammation (indicated by the “itis” suffix) is not present, the suffix was dropped, and the name became fibromyalgia.

Fibromyalgia is about 7 times more common among women. It usually occurs in young or middle-aged women but can also occur in men, children, and teenagers.

Fibromyalgia is not dangerous or life threatening. Nonetheless, persistent symptoms can be very disruptive.

Causes

Usually, the cause of fibromyalgia is unknown. However, certain conditions may contribute to developing the disorder. They include poor sleep, repetitive strains, an injury, and repeated exposure to dampness and cold. Mental stress may also contribute. However, stress per se may not be the problem. Rather it may be how people react to the stress. Many affected people are perfectionists or have a type A personality.

Some affected people may also have a connective tissue disorder, such as rheumatoid arthritis or systemic lupus erythematosus (lupus). Sometimes a viral or other infection (such as Lyme disease) or traumatic event can trigger fibromyalgia.

Symptoms

Most people feel a general achiness, stiffness, and pain. Symptoms can occur throughout the body. Any soft tissue (muscles, tendons, and ligaments) may be affected. But soft tissue of the neck, upper shoulders, chest, rib cage, lower back, thighs, arms, and joints are especially likely to be painful. Less often, the lower legs, hands, and feet are painful and stiff. Symptoms may occur periodically (in flare-ups) or most of the time (chronically).

Pain may be intense. It usually worsens with fatigue, straining, or overuse. Specific areas of muscle may be tender when firm fingertip pressure is applied. These areas are called tender points. During flare-ups, muscle become tight, or spasms may occur.

Many affected people do not sleep well and feel anxious, depressed, and tired. They may also have migraine or tension headaches and irritable bowel syndrome (with some combination of constipation, diarrhea, abdominal discomfort, and bloating—see Irritable Bowel Syndrome (IBS)).

The same conditions that may contribute to the development of fibromyalgia can make symptoms worse. They include being emotionally stressed, sleeping badly, being injured, getting damp or cold, and overdoing it. Being told that symptoms are all in the head can also worsen symptoms.

Fibromyalgia tends to be chronic but may resolve on its own if stress decreases. Even with appropriate treatment, most people continue to have symptoms to some degree.

Diagnosis

The diagnosis is based on the pattern and location of the pain, as well as the presence of tender points. To detect tender points, doctors firmly press specific areas of the body to determine whether the person feels pain in one spot (a tender point). The disorder is diagnosed if people feel tenderness at 11 or more of the 18 designated tender points or if they have some tender points plus other typical symptoms.

Doctors also make sure that another disorder (such as hypothyroidism, polymyalgia rheumatica, or another muscle disorder) is not causing the symptoms, often by doing blood tests.

Fibromyalgia may be more difficult to diagnose in people who also have rheumatoid arthritis or lupus because these disorders cause some symptoms that are similar.

Fibromyalgia: Finding the Tender Points Tender points are areas of tenderness that develop in people with fibromyalgia. Fibromyalgia is diagnosed when people feel pain in at least 11 of the 18 tender points or feel pain in fewer tender points but have other typical symptoms.

Treatment

People can feel better when treated appropriately. Usually, the most helpful approach includes the following:

• Reducing stress
• Stretching the affected muscles gently (holding the stretch about 30 seconds and repeating it 5 times)
• Doing exercises to improve physical conditioning (aerobic exercises) and gradually increasing the intensity (for example, by using a treadmill, exercise bicycle, or elliptical machine or by swimming)
• Applying heat to or gently massaging the affected area
• Keeping warm
• Getting enough sleep

Improving sleep is essential. For example, people should avoid caffeine and other stimulants in the evening and sleep in a quiet, dark room with comfortable bedding. They should not eat or watch TV in bed. Doctors may prescribe low doses of tricyclic antidepressants (see Mood Disorders: Drugs Used to Treat Depression). These drugs are taken 1 or 2 hours before bedtime and used to improve sleep rather than to relieve depression. They include trazodone, amitriptyline, and nortriptyline. Cyclobenzaprine, a muscle relaxant, can also help people sleep. These drugs are usually safer than sedatives, most of which can be habit-forming. However, tricyclic antidepressants and cyclobenzaprine can have side effects, such as drowsiness and dry mouth, particularly in older people.

Aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) are generally of limited benefit. Pain relievers, such as tramadol, propoxyphene, or acetaminophen, can help. Opioids, which can be habit-forming and become less effective over time, are usually not used to treat chronic disorders such as fibromyalgia. Pregabalin (an anticonvulsant sometimes used to relieve pain) may help. Occasionally, local anesthetics (such as lidocaine) are injected directly into a particularly tender area, but these injections should not be used repetitively.

Last full review/revision April 2008 by Joseph J. Biundo, MD