What is Fibromyalgia?
Fibromyalgia is a common chronic condition that is characterized by a widespread aching pain and sensitivity to touch. The pain often comes and goes and can move to different parts to the body. People with fibromyalgia often suffer from fatigue, problems with sleep, digestive problems, anxiety, morning stiffness, and headaches. The pain is not thought be caused by peripheral damage or inflammation.
It is estimated that fibromyalgia affects around 2 to 4 percent of the population and effects mostly women of childbearing age. There is still much that is unknown about the condition. While it is not life-threatening, fibromyalgia is responsible for a great deal of suffering.
Causes and Symptoms
No underlying cause of fibromyalgia has been found. It is thought that it often starts with some trigger or triggering event like an infection (bacteria, virus) or an injury (surgery, automobile accident). Theories abound with suggestions of hypersensitivity of nerves, brain chemical imbalances, sleep disturbances and while all of these have been identified in people with fibromyalgia they have not proved helpful in understanding the cause or guiding treatment.
Typically, symptoms of fibromyalgia develop slowly over time and may experience times of relief followed by times of excess pain.
Symptoms typically include:
- Pain: While there is wide variation from person to person, most people with fibromyalgia describe the pain as a deep muscular ache, similar to what most people feel after overexerting themselves. The pain is sometimes described as throbbing, burning, or stabbing. It is typically worse in the morning. Patients with fibromyalgia have a higher level of a neuropeptide called Substance P than other people. Substance P helps the body communicate pain signals. Fibromyalgia can be thought of as a centralized pain state, meaning that the pain seems to originate in brain.
- Sleep: People with fibromyalgia typically sleep poorly and wake feeling exhausted and not refreshed. Low serotonin, a brain neurotransmitter, has been reported in people with fibromyalgia. Serotonin plays a role in sleep maintenance.
- Anxiety: There is a strong link between fibromyalgia and depression and anxiety. Research has shown functional changes in the hypothalamic-pituitary-adrenal (HPA) axis in people with fibromyalgia. Abnormalities of HPA axis may also increase pain.
- Fatigue: Consistent debilitating fatigue and lack of energy is a key feature of fibromyalgia.
- Digestive Complaints: Many people with fibromyalgia experience some digestive complaint including diarrhea, constipation, gas, bloating and pain. Around 32% to 70% of people with fibromyalgia also meet the diagnostic criteria for Irritable Bowel Syndrome (IBS). 
- Other: Chemical sensitivities, chronic headaches, dizziness, numbness and tingling sensations are all possible in people with fibromyalgia.
Medical practitioners have difficulties in diagnosing fibromyalgia because they symptoms are common to so many other conditions. Rheumatoid arthritis, lupus, chronic fatigue syndrome, and polymyalgia rheumatica can mimic fibromyalgia There is no diagnostic tests or procedures (test, x-ray) for the condition, although tests are generally run to rule out other conditions.
Diagnosis is based on the American College of Rheumatology guidelines and includes the following criteria:
- Widespread pain index (WPI) ≥7 and symptom severity (SS) scale score ≥5 or WPI 3 – 6 and SS scale score ≥9.
- Symptoms have been present at a similar level for at least 3 months.
- The patient does not have a disorder that would otherwise explain the pain.
Because the underlying cause of the disease has yet to be discovered, there is no standardized conventional treatment for fibromyalgia. Each patient seems to respond differently and physicians work to find the right combination of approaches to help people with this condition.
Only one drug, Pregabalin (Lyrica), has been approved by the FDA for treatment of fibromyalgia.
The most frequent drugs used are these:
- Painkillers: Over-the-counter drugs such as Tylenol (acetaminophen) and non-steroidal-anti-inflammatories (NSAIDS) aspirin, Advil, Motrin (ibuprofen), and Anaprox, Aleve (naproxen sodium) are often tried first. Prescription medicine, including narcotics may be used for those with severe pain. Many of these medications shouldn’t be used long-term, and none of them have been shown to alter the course of the disease. It is best to use these only when absolutely necessary.
- Antidepressants: Drugs that help increase the levels of serotonin and norepinephrine in the brain are thought to be helpful because these neurotransmitters are low in people with fibromyalgia and depression, anxiety, and poor sleep are common. To date, though, treatments with drugs that increase serotonin have only limited success.Serotonin/norepinephrine reuptake inhibitors (duloxetine, milnacipran)have shown some success. A combination of the tricyclic (amitriptyline) and the SSRI (fluoxetine) seems to relieve symptoms better than either drug alone.
- Gabapentinoids: Gabapentinoids (pregabalin, gabapentin) block the release of excitatory neurotransmitters such as glutamate, substance P, and calcitonin and seem to work best for neurological pain.
- Opioid antagonist: Low-dose naltrexonehas showed some promise in a new small trial treatment
- Benzodiazepines: muscle relaxants such as valium are sometime prescribed with varying efficacy.
- Exercise: While often hard to perform, mild exercise has been shown to be one of the best treatment options for people with fibromyalgia. Exercise helps reduce the pain and increase physical capacity of fibromyalgia. Muscle pain can increase with exercise, but generally dissipates with exercise longer than 30 minutes.
- Sleep: Sleep is important for both mental and physical wellness. The body repairs damage done during the day with a good night’s sleep. Practice good sleep hygiene by going to bed the same time every night, sleeping in a dark room, avoiding caffeine in the afternoon, and using a white noise generator (like a fan) to help waking.
- Digestion: Since IBS is often associated with fibromyalgia, it is a good idea to focus on treatment of digestive complaints as well. Many people with IBS respond to a diet low in common food allergies and by taking probiotics and digestive enzymes.
- 5 Hydroxytryptophan (5-HTP): 5-HTP, a serotonin precursor, was shown to decrease the symptoms of fibromyalgia in one small study.
- Acetyl-L-Carnitine: This amino acid derivative has been shown to be helpful in reducing pain and improving the mental health of patients with fibromyalgia. 
- S-adenosylmethionine (SAMe): SAMe has demonstrated improved pain reduction, reduced morning stiffness and improved the mood of patients with fibromyalgia. 
- Coenzyme Q10: A small study using (100 mg three times per day for three months) showed improvement headaches and pain in people with fibromyalgia. 
- Magnesium/Malic Acid: A small study supplementing 300–600 mg of elemental magnesium and 1,200–2,400 mg of malic acid per day for eight weeks showed moderate improvement. Another study by the same group using the same protocol failed to show improvement.
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