Fibromyalgia (FM) is a syndrome that gets very little respect. Causing a host of symptoms including muscle aches, severe fatigue, sleep disturbance, dry mouth/eyes, dizziness, and memory loss, FM is a syndrome that oftentimes eludes diagnosis. The person looks healthy. Physical exam and laboratory evaluation usually reveals no objective abnormalities. Women young and old who report symptoms of FM may be labeled as chronic complainers, difficult patients, and even they themselves think they are going crazy.
Fibromyalgia affects both women and men, but women to a great extent at an estimated ratio of 7:1. FM is now considered to be the most common cause of generalized, musculoskeletal pain in women between ages of 20 and 55 years and incidence increases with age. To diagnose FM a physician will use the American College of Rheumatology Fibromyalgia Criteria (1990). Briefly this criterion includes a history of widespread pain and at least 11 out of 18 tender points at specified locations on the body which are painful when examined.
Marauding under the guise of a host of other diseases such as low thyroid, Parkinson’s disease, celiac disease, rheumatoid arthritis, and vitamin deficiency, years may pass before the proper diagnosis is made. FM can also occur in a “cluster” with other diseases such as irritable bowel syndrome, migraine headache and interstitial cystitis. One can imagine being plagued by one of these ailments, yet many individuals suffer from several.
During the time of searching for the cause of their multitude of symptoms the FM sufferer continues to experience significant pain and fatigue which may limit daily activities and impair the quality of life. Many FM patients also suffer from depression. The depression can be worsened by the sense of helplessness patients feel as they struggle with this syndrome and the FM worsened by the inability of the depressed patient to focus on the disease with a healthy emotional outlook. It can be a vicious cycle.
The cause of FM is unknown. A common theme in FM is a lower threshold to the perception of pain. In approximately one-half of cases, the symptoms appeared to begin after a specific event, most often some form of physical or emotional trauma or a flu-like illness. FM may also be a form of sleep disorder. In a study where healthy subjects were sleep deprived they began exhibiting symptoms of fatigue, muscular pain, joint stiffness, and mood swings. One of the goals of treatment for FM sufferers is to provide them with a good night’s sleep. Physicians and patients will report a FM “flare up” during times of stress and/or sleep deprivation.
Fibromyalgia will wax and wane, flaring as noted above during times of stress, fatigue, other illness, and even weather fluctuations. Treatments are limited and total recovery from FM does not typically occur. I realize it sounds like a hopeless process. However, one study reported that after a 14 year period the majority of a group of FM patients reported still experiencing symptoms related to their disease; but 66% percent reported that FM interfered only modestly with their daily activities and the same percentage reported being able to work full-time. So, although this is a long-term illness with little chance for 100% recovery the proper attitude and approach can reap benefits. Both physician and the patient need to accept this fact at the beginning of the process.
Positive lifestyle changes are the cornerstone to successful FM treatment. Exercise is usually beneficial for FM patients. Sometimes FM patients do not think that they can exercise because of the pain they have in their muscles or bones. However, FM pain responds to exercise by decreasing in severity and duration. FM sufferers should start slow and pace themselves. It can take an entire year to reach your goal of exercising 4-5 times a week for 30-45 minutes. Alternative therapies such as heat, massage, biofeedback and acupuncture have not been studied extensively, but some of my patients report great benefit from these treatments.
Medications used to treat FM focus on diminishing pain and aiding sleep. Options include amitryptiline, a tricyclic antidepressant used in low doses several hours prior to bedtime. Anti-inflammatory agents such as ibuprofen and SSRI antidepressants do not appear to work well as solo agents for treatment, but may be beneficial in combination with amitryptilline. Other medications include gabapentin (Neurontin) and venlafaxine (Effexor), both are helpful in the treatment of chronic pain.
In conclusion, FM sufferers want and need to hear “I believe you” and “Your pain is real”. A thorough history and physical should be performed to rule out other causes for the patient’s symptoms. Finding a treatment regimen that works can take months or years so it requires patience from both the physician and patient. Once the diagnosis is made the patient should partner with their healthcare provider and take an active role. Focus on designing a treatment plan which diminishes pain and improves quality of life, not “curing the disease”.