Fibromyalgia is a condition that causes widespread pain throughout the body. It may also be associated with fatigue, emotional or mental stress, and sleep disorders.
Other disorders associated with it include GERD, migraine headaches, pelvic pain and jaw pain (TMJ).
Fibromyalgia may effect up to 4 percent of the population of all ages. It is predominately seen in the middle age group and more often females than males. It may be precipitated by trauma, emotional distress, illness or have a family predisposition. There is a higher incidence in individuals with rheumatoid arthritis and Lupus although the condition itself is not felt to be auto immune.
The cause of fibromyalgia is unknown. It is theorized to be originating from the central nervous system where there is a heightened response to pain. It is not a disease of the joints or muscles or an autoimmune disorder.
The diagnosis is made from the history and physical exam. Pain must be present for a minimum of three months and involve 4 out of 5 body regions. Palpable trigger points may aid in the diagnosis but are no longer considered a diagnostic criteria. There are no present clinical tests to make the diagnosis but a work up to exclude other conditions is warranted. Blood tests, autoimmune panels and x-rays are needed for the work up to exclude inflammatory disorders.
Management and treatment revolve around reducing pain, depression and maximizing sleep in order to improve quality of life and maintain a high level of function.
Nonpharmacological treatments can include:
Daily aerobic exercise such as bicycling, swimming and walking - all considered to be low impact activities.
Behavioral therapies to maximize biofeedback to help control pain.
Yoga and Tai Chi
Practicing good sleeping habits.
Acupuncture for pain control.
Pharmacological treatment may be used as an adjunct to the above therapies. There are 3 FDA approved medications for the treatment of fibromyalgia. Narcotics are not recommended or usually not indicated. FDA approved medication include duloxetine (Cymbalta), and milmacipran (Savella) for pain control and depression management. Pregabalin ( Lyrica) for pain management. Other medication that maybe helpful include gabapentin and muscle relaxants which may aid in reducing pain. NSAIDS such as ibuprofen and naproxen sodium have not been found to be of benefit.
Complications from the condition may cause higher hospitalization rates and lower quality of life. Depression is three times more likely leading to higher suicide rates and self-inflicted injury. It is important that it is recognized early and treated aggressively.
CDC Division of Population Health January 6, 2020
American College of Rheumatology updated March 2019