Chronic pain and fatigue

What is fibromyalgia?

Fibromyalgia is a chronic condition causing widespread pain and fatigue as well as any number of other symptoms. The name fibromyalgia come from fibro, meaning fibrous tissues such as ligaments and tendons, my, meaning muscles, and algia meaning pain. Fibromyalgia produces extreme pain and tenderness in multiple muscles and joints, as well as in skin, organs, and soft tissues throughout the body.¹ Pain occurs in areas where muscles attach to bone or ligaments, causing pain similar to the pain of arthritis. Unlike arthritis, however, fibromyalgia does not produce pain and swelling in the joints. In fibromyalgia, joints are not affected and they therefore do not become deformed, nor do they deteriorate as in arthritis.²

In fibromyalgia, pain is not localized to specific areas or joints. Instead, it consists of diffuse aching or burning that is felt "all over", radiating outward from the spine over large areas of the body, especially the lower back and arms. Pain can vary in intensity from muscle twitching or muscle spasm to a burning sensation. Pain can also vary in location, becoming more severe in the neck, shoulders, and feet. Pain can also vary depending on the time of day, changes in weather, physical activity, and stress.³

The pain of fibromyalgia can interfere with the performance of even simple tasks and people with fibromyalgia may also be susceptible to other chronic conditions such as osteoarthritis and migraine. Fibromyalgia is a chronic condition, and pain continues throughout a person's lifetime.

Symptoms of fibromyalgia

In addition to the pain and fatigue already described, fibromyalgia also has a number of other symptoms whose severity can fluctuate over time. Not everyone with fibromyalgia will experience the same symptoms, and individuals may differ in the extent to which they are troubled by various symptoms. Typically, people suffering from fibromyalgia experience:⁴

Table 1. Symptoms of Fibromyalgia

Stiffness, particularly on waking up and after prolonged periods of sitting or standing in one position. Stiffness may also coincide with changes in relative humidity. Frequent urination or urgency to urinate Painful menstrual periods or increase in pain during mentrual periods Painful vulvar region and painful sexual intercourse in women Increased headaches Facial pain or tingling in the face resulting from extreme stiffness of neck and/or shoulder muscles which refer pain upwards Paresthesia, a prickling or tingling sensation in the arms, hands, and feet Abdominal pain Bloating Diarrhea Alternate periods of diarrhea and constipation

Sleep disturbances in which, despite adequate sleep, patients wake up feeling unrefreshed or in which they have difficulty falling and staying asleep Cognitive disorders including an inability to concentrate, difficulty thinking of words or names, and feeling overwhelmed when engaged in multiple tasks Anxiety or depression Chest or thoracic problems, particularly in patients who engage in activities such as typing or sitting in which they have a forward body posture. There is often muscle pain where the ribs meet the chest bone. Lightheadedness or dysequilibrium /p> Hypersensitivity to light, sound, touch, and odors, often thought to be the result of a hyperactive nervous system Feeling chilled or cold Nasal congestion/discharge and sinus pain Itchy, dry, or blotchy skin

Who's at risk?

Women are twenty times more likely than men to develop fibromyalgia, and this risk increases with age.

What causes fibromyalgia?

It is still unclear what causes fibromyalgia, although it's believed physical or emotional trauma may play a role in development of the disease. Empirical evidence suggests that fibromyalgia patients have abnormal pain transmission responses and that sleep disturbances, common in fibromyalgia patients, may actually cause the condition. Another theory suggests that changes in skeletal muscle metabolism, possibly caused by decreased blood flow, may cause the chronic fatigue and weakness commonly associated with fibromyalgia. Although no virus or microbe has been identified, some scientists have suggested that an infectious microbe causes fibromyalgia.⁵

Diagnosis

It wasn't until 1990 that the American College of Rheumatology established official diagnostic criteria for fibromyalgia. These criteria include:⁶

A history of widespread pain

Chronic widespread musculoskeletal pain lasting longer than three months in all four quadrants of the body—in other words, pain above or below the waist on both sides of the body as well as pain in the neck, chest, spine, and lower back.

Pain in 11 of 18 tender point sites

In making a diagnosis of fibromyalgia, doctors look for a series of 18 tender points. A patient must have 11 of 18 points in order to be diagnosed with fibromyalgia. Approximately 9 pounds (4 kilograms) of pressure must be applied to a tender point and the patient must indicate that the tender points are painful.

Fibromyalgia tender points identified by
The American College Of Rheumatology in 1990

(1 & 2) Occiput: bilateral, at the sub-occipital muscle insertions (3 & 4) Low Cervical: bilateral, at the anterior aspects of the inter-transverse spaces at C5-C7 (5 & 6) Trapezius: bilateral, at the midpoint of the upper border (7 & 8) Supraspinatus: bilateral, at origins, above the scapula spine near the medial border (9 & 10) Second Rib: bilateral, at the second costochondral junctions, just lateral to the junctions on upper surfaces (11 & 12) Lateral Epicondyle: bilateral, 2 cm distal to the epicondyles. (13 & 14) Gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle (15 & 16) Greater Trochanter: bilateral, posterior to the trochanteric prominence (17 & 18) Knee: bilateral, at the medial fat pad proximal to the joint line

(Source: Frederick Wolfe, MD, et al., "The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia: Report of a Multicenter Criteria Committee," Arthritis & Rheumatism, Vol. 33, No. 2, February 1990, pp. 160-172.)

Diagnosis requires physical examination by a skilled health professional, typically a rheumatologist. A physical examination, complete medical history, x-rays, and routine laboratory tests are required for proper diagnosis. As in chronic fatigue syndrome, diagnosis is usually made through exclusion, since symptoms of fibromyalgia mimic those of other conditions such as systemic lupus, polymyalgia rheumatica, myositis/polymyositis, thyroid disease, rheumatoid arthritis, and multiple sclerosis. It is necessary to rule out other diseases before making a diagnosis of fibromyalgia.⁷

Treatment of fibromyalgia

Treatment of fibromyalgia focuses on alleviating pain and sleeplessness. When pain is severe, it interferes with sleep and can cause mood shifts and cognitive difficulties. Treatment, therefore, strives to break this cycle. Treatments also include carefully planned exercise, including gentle stretching. Because exercising while in pain is difficult, patients with fibromyalgia need to approach exercise gradually, progressing toward aerobic conditioning. Exercise provides many benefits including improved strength, the release of natural painkillers, and improved overall well-being and fitness. It can also help improve sleep quality and daily stamina.⁸

Patients with fibromyalgia also benefit from drug therapy. Medications are typically prescribed to improve sleep, since sleep deprivation can induce fibromyalgia-like symptoms. Many patients suffer from nonrestorative sleep, waking up feeling unrefreshed or as though they've not slept at all. Many medications can help improve sleep quality, although it may take several tries to find the right one. Patients are encouraged to limit daytime naps, to relax with a hot bath, and to avoid exercise before sleep.⁹

Pain relief can be achieved through heat and/or gentle stretching. Some patients also report decreased pain through meditation, hypnotherapy/self-hypnosis, breathing exercises, and massage therapy. Your doctor may prescribe pain medications such as analgesics or stronger narcotics to help you manage pain.¹⁰

The key is to listen to your body and to carefully pace yourself physically, emotionally, and intellectually. Taking breaks throughout the day as you need them may allow you to find additional energy. By keeping track of your pain and activity levels, you will be better able to organize your days in order to take full advantage of the energy you have. Pacing and scheduling and knowing when you need to rest will allow you to engage in a full life.¹¹

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   Fibromyalgia symptoms, diagnosis, treatment and research. A National Fibromyalgia Partnership Publication.
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