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.
 Russell IJ, Orr MD, Littman B, et al. Elevated cerebrospinal fluid levels of substance P in patients with the fibromyalgia syndrome. Arthritis Rheum. 1994 Nov;37(11):1593-601. PubMed PMID: 7526868.
 Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014 Apr 16;311(15):1547-55.PubMed PMID: 24737367.
 Russell IJ, Michalek JE, Vipraio GA, et al. Platelet 3H-imipramine uptake receptor density and serum serotonin levels in patients with fibromyalgia/fibrositis syndrome. J Rheumatol. 1992 Jan;19(1):104-9.
 Arnold LM. Management of fibromyalgia and comorbid psychiatric disorders. J Clin Psychiatry. 2008;69 Suppl 2:14-9
 Tanriverdi F, Karaca Z, Unluhizarci K, Kelestimur F. The hypothalamo-pituitary-adrenal axis in chronic fatigue syndrome and fibromyalgia syndrome. Stress. 2007 Mar;10(1):13-25.
 McBeth J, Chiu YH, Silman AJ, et al. Hypothalamic-pituitary-adrenal stress axis function and the relationship with chronic widespread pain and its antecedents. Arthritis Res Ther. 2005;7(5):R992-R1000.
 Wallace DJ, Hallegua DS. Fibromyalgia: the gastrointestinal link. Curr Pain Headache Rep. 2004 Oct;8(5):364-8.
 Arnold LM. Biology and therapy of fibromyalgia. New therapies in fibromyalgia. Arthritis Res Ther. 2006;8(4):212
 Arnold LM, Clauw DJ, Wohlreich MM, Wang F, Ahl J, Gaynor PJ, Chappell AS. Efficacy of duloxetine in patients with fibromyalgia: pooled analysis of 4 placebo-controlled clinical trials. Prim Care Companion J Clin Psychiatry. 2009;11(5):237-44. PubMed PMID: 19956462.
 Geisser ME, Palmer RH, Gendreau RM, Wang Y, Clauw DJ. A pooled analysis of 2 randomized, double-blind, placebo-controlled trials of milnacipran monotherapy in the treatment of fibromyalgia. Pain Pract. 2011;11(2):120-131.
 Goldenberg D, Mayskiy M, Mossey C, Ruthazer R, Schmid C. A randomized, double-blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia. Arthritis Rheum. 1996 Nov;39(11):1852-9. PubMed PMID: 8912507.
 Tzellos TG, Toulis KA, Goulis DG, et al. Gabapentin and pregabalin in the treatment of fibromyalgia: a systematic review and a meta-analysis. J Clin Pharm Ther. 2010;35(6):639-656.
 Younger J, Noor N, McCue R, Mackey S. Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels. Arthritis Rheum. 2013;65(2):529-538.
 Busch A, Schachter CL, Peloso PM, Bombardier C. Exercise for treating fibromyalgia syndrome. Cochrane Database Syst Rev. 2002;(3):CD003786.
 Caruso I, Sarzi Puttini P, Cazzola M, Azzolini V. Double-blind study of 5-hydroxytryptophan versus placebo in the treatment of primary fibromyalgia syndrome. J Int Med Res 1990;18:201–9.
 Rossini M, Di Munno O, Valentini G, et al. Double-blind, multicenter trial comparing acetyl l-carnitine with placebo in the treatment of fibromyalgia patients. Clin Exp Rheumatol 2007;25:182–8.
 Jacobsen S, Danneskiold-Samsoe B, Andersen RB. Oral S-adenosylmethionine in primary fibromyalgia: Double-blind clinical evaluation. Scand J Rheumatol 1991;20:294–302.
 Cordero MD, Cano-Garcia FJ, Alcocer-Gomez E, et al. Oxidative stress correlates with headache symptoms in fibromyalgia: coenzyme Q10 effect on clinical improvement. PLoS One 2012;7:e35677.
 Russell IJ, Michalek J, Flechas J, et al. Treatment of fibromyalgia syndrome with SuperMalic: A randomized, double-blind, placebo-controlled, crossover pilot study. J Rheumatol 1995;22(5):953-7.