Dear Doctors: I had muscle pain and exhaustion for two years, and no one could figure out what was wrong. A rheumatologist recently diagnosed me with fibromyalgia. I would appreciate any information you have about this, including what the treatment options are.
Dear Reader: Fibromyalgia is a chronic disorder in which someone experiences widespread tenderness and pain throughout the muscles of the body. This is often coupled with persistent fatigue, exhaustion and sleep disruption, and it may also include changes to mood and cognition. Some people also experience pain or stiffness in their joints, tingling or numbness in the limbs, digestive problems such as bloating or constipation, and a heightened sensitivity to light, color and sound. The condition is seen more often in women than in men, and the average age of diagnosis is between 35 and 45.
Descriptions of this unique collection of symptoms date back at least to 1880, at which time they were given the name of neurasthenia. By 1987, when the condition was recognized by the American Medical Association, the name had evolved to fibromyalgia. However, due to a lack of diagnostic tests for the condition -- it cannot be identified via imaging, blood or other laboratory tests -- there continues to be skepticism about the diagnosis. Detractors see fibromyalgia as a cluster of vague and unrelated symptoms that have been turned into a fad disease. The estimated 4 million Americans living with the condition feel otherwise.
The causes of fibromyalgia are not yet understood. One theory suggests a glitch in the neural pathways that carry sensory signals between the body and the brain. This malfunction would make someone living with fibromyalgia hypersensitive to ordinary stimuli. For example, a pat on the arm or a splash of cool water would be interpreted by the body as pain. The condition has been found to run in families, so a genetic component may be involved. Some patients say an inciting incident, such as a physical accident or severe emotional trauma, immediately preceded the onset of symptoms. Living with an autoimmune disease, such as lupus or rheumatoid arthritis, may increase the risk of developing fibromyalgia. A link to IBS, or irritable bowel syndrome, is also suspected.
As we mentioned, there are no tests for fibromyalgia. Diagnosis is via a detailed description of the individual’s symptoms, along with a medical and family history. Many of the symptoms of the syndrome match those of other conditions, such as arthritis, some autoimmune diseases and a range of neurological conditions. Blood tests to check hormone levels, blood components, thyroid function and inflammation levels can be required to help rule those out. Imaging tests may be used to exclude arthritis and other degenerative conditions.
There is at this time no cure for fibromyalgia. Treatment consists of a multidisciplinary approach of medications, behavioral and occupational therapy and counseling to address pain, ease stress and anxiety and improve sleep and mood. A class of antidepressants known as serotonin norepinephrine reuptake inhibitors, or SNRIs, which affect levels of certain brain chemicals, have been found to ease pain and improve mood and sleep. Symptoms vary from person to person, so fibromyalgia treatment is tailored to each patient’s individual needs.
(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
