Some health care providers may use these terms to refer to fibromyalgia: fibromyositis, fibrositis, periarticular fibrositis, muscular rheumatism, chronic muscle pain syndrome, musculoskeletal pain syndrome, or tension myalgia. However, "fibromyalgia," which means "pain of the muscles and other fibrous tissue," is the accepted term and has replaced some of the others. Terms ending in "-itis," which means "inflammation," are now considered incorrect because inflammation does not play a significant role in fibromyalgia.
Key Characteristics of Fibromyalgia
Muscle pain, either throughout the body or only at certain points, is the primary symptom of fibromyalgia. It may range from mild discomfort to pain severe enough to limit work, social activities, and everyday tasks. Pain commonly occurs in the neck, upper back, shoulders, chest, rib cage, lower back, and thighs and may feel like a burning, gnawing, throbbing, stabbing, or aching sensation and may develop gradually. It usually seems worse when a person is trying to relax and is less noticeable during activity.
A related, key aspect of fibromyalgia is the presence of "tender points," muscles and tendons that are tender when pressed. Typically, tender points are located in the neck, back, knee, shoulder, elbow, and hip.
People with fibromyalgia, which is also linked to depression, also feel moderately to severely fatigued and have sleep problems, including insomnia. This may result from restless legs and arms, which may disrupt their sleep, or they may suffer from sleep apnea or grind their teeth while they sleep.
Tender Points and Fibromyalgia
According to the American Academy of Rheumatology, for a diagnosis of fibromyalgia, you must have unusual tenderness at a minimum of 11 of 18 specific "tender points" associated with the condition. Some health care providers diagnose fibromyalgia in patients who have fewer tender points but who otherwise have severe, widespread (meaning upper and lower body occurring on both right and left sides) pain symptoms that are present for at least three months.
The standard tender points are located in the muscles or other soft tissue on both sides and the front and back of the body. Those who have fibromyalgia may have unusual tenderness at any of several other points on the body as well.
Who Is Affected by Fibromyalgia?
Experts estimate that 3 million to 6 million Americans have fibromyalgia. Of these, 80% are women. One of the main risk factors is being a woman between the age of 20 and 50. Another risk factor is having a rheumatic disease, such as rheumatoid arthritis, lupus, or Sjogren's syndrome. Fibromyalgia also seems to run in families, so a gene may be at least partly responsible for the condition. Most people with fibromyalgia begin to notice symptoms between the ages of 20 and 40, but children and older adults may also develop the condition. Women with fibromyalgia typically feel pain throughout their body, while men are more likely to have facial pain or pain and stiffness in a certain part of the body as a result of a work- or recreation-related muscle strain.
What Causes Fibromyalgia?
Experts do not know what causes fibromyalgia. There are several theories about possible causes or triggers. Inadequate sleep is a possible trigger. Another is suffering an injury such as physical or emotional trauma. Some experts believe that a viral or bacterial infection plays a part.
Abnormal production of pain-related chemicals in the brain and nerves also contributes to the symptoms of fibromyalgia.
Fibromyalgia Pain Treatment Options
If pain is the primary fibromyalgia symptom, dortors may prescribe a prescription pain reliever, an anticonvulsant, or an antidepressant.
Anticonvulsants, developed to treat seizures, help relieve many types of pain. Lyrica, an anticonvulsant, was the first medication approved by the FDA specifically for fibromyalgia pain.
Two more antiseizure drugs are being studied as fibromyalgia medications -- Neurontin and Ativan.
Antidepressants are very helpful in relieving fibromyalgia pain and improve deep restorative sleep. They work by balancing serotonin and other brain chemicals.
· The new selective SNRIs (serotonin and norepinephrine reuptake inhibitors) help relieve fibromyalgia pain, whether the patient is depressed or not. SNRIs include Cymbalta and Effexor. Cymbalta is the only antidepressant approved by the FDA to treat fibromyalgia pain. Effexor is also used to relieve fibromyalgia pain. The FDA has also approved the SNRI Savella to treat fibromyalgia. The only caveat for SNRIs: These drugs cannot be used if the patient has bipolar disorder as mood could become more unstable.
· Research shows that SSRIs (selective serotonin reuptake inhibitors) such as Prozac, Paxil, and Zoloft can help with sleep, overall well-being, and pain relief -- with lesser effects on fatigue and tender points from fibromyalgia. However, research indicates the SSRIs aren’t as effective as the SNRIs in treating fibromyalgia.
· Amitril, Elavil, and other tricyclic antidepressants are often prescribed for fibromyalgia, but many people don't like their side effects (weight gain, dizziness, fatigue). At low doses, these medications don't help mood or anxiety disorders, which fibromyalgia patients often have. However, this type of antidepressant can help with sleep.
Combination antidepressants: At times, a combination of antidepressants can help. Prozac plus low-dose Amitril or Elavil, for example, can reduce muscle pain, anxiety, and depression in fibryomyalgia. Patients also get more restful sleep, feel less fatigue, and have an overall better sense of well-being.
Pain relievers such as Ultram and Ultracet can help break cycles of fibromyalgia pain, relieve flare-up pain, and reduce muscle spasms. The muscle relaxant Flexeril can help reduce pain and improve sleep. Local injections of painkillers and/or cortisone at painful trigger points can be especially effective in breaking cycles of pain and muscle spasm.
Treating Insomnia From Fibromyalgia
Insomnia is a big problem in people with fibromyalgia. Research shows that frequent disruptions in sleep prevent growth hormone -- the important restorative hormone -- from being produced by the body. Without growth hormone, muscles don't heal and neurotransmitters (like serotonin) are not replenished.
Without deep sleep, the body can't recuperate from the day's stresses. This can overwhelm the body’s systems, creating a great sensitivity to pain.
In some patients with fibromyalgia, there is an underlying cause for insomnia, such as restless leg syndrome or sleep apnea. If it's not clear what's causing the sleep problem, dortors will prescribe one of several medications to help with sleep.
· A low-dose tricyclic antidepressant (like Amitril) can help improve deep, restorative sleep.
· A prescription sleep medication like Ambien, Lunesta, Rozerem and Sonata is not addictive in low doses. These are called "short-acting" drugs because they stay active in the body for the shortest amount of time. Each of these drugs works a bit differently. Some help people fall asleep more quickly; others make sure you stay asleep.
· The anticonvulsant drug, Lyrica, is also prescribed for insomnia and fatigue caused by fibromyalgia.
In small studies, the narcolepsy drug Xyrem has been reported to help both sleep and pain. Xyrem is a potent sleep medication that helps patients get the deep sleep they need.