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Fibromyalgia is a poorly understood, but common and painful condition that causes a defined pattern of multiple tender points, called trigger points, in the muscles and soft tissues of the body.

What is going on in the body?

People who have fibromyalgia have chronic, widespread pain and stiffness in the muscles.

Fatigue is a key factor in fibromyalgia. Some healthcare professionals believe that fatigue may occur because the person doesn't get enough deep, restful sleep. Others believe that the sleep disturbance may actually be a cause of the fibromyalgia.

Research has shown that people who have fibromyalgia have a decrease in blood flow to the parts of the brain involved with pain perception. They also have two times the normal level of a brain chemical known as substance P. This substance is involved in the transmission of pain messages from nerve cells to the brain.

Fibromyalgia may occur alone, or together with other disorders such as depression, Lyme disease, chronic fatigue syndrome, or rheumatoid arthritis.

What are the signs and symptoms of the condition?

Symptoms of fibromyalgia include prolonged pain and multiple trigger points in the muscles and soft tissues. These trigger points tend to be located in the shoulders, neck, upper and lower back, and hips.

People with fibromyalgia experience muscle pain and stiffness, especially in the morning. The pain is worse in the morning and worsens with weather changes, anxiety, stress or again at night. The pain is often improved to varying degrees with mild physical activity and stress reduction.

Other symptoms are as follows:

• non-restorative sleep, with early morning awakening in a unrefreshed state
• abdominal distress with constipation or diarrhea
• depression
• difficulty concentrating
• generalized fatigue, which is probably caused by disrupted sleep
• anxiety
• chronic headaches
• irritable bowell syndrome
• reduced physical endurance
• intermittent swelling
• tingling of the skin that involves numbness or burning

What are the causes and risks of the condition?

No one knows for sure what causes fibromyalgia, but there are several theories.

Some possible causes of fibromyalgia include the following:

• autoimmune disorders, or a condition in which the body creates antibodies against its own tissues
• endocrine abnormalities, which are problems with various glands in the body
• biochemical abnormalities in the central nervous system, such as the elevated level of substance P in the brain
• impaired blood flow to the brain
• stress
• mechanical stresses to the cervical and lumbar spine
• history of abuse as a child

Research findings suggest that autoimmune disorders may be triggered by a transfer of cells between the unborn child and the mother during pregnancy. The study involved women with scleroderma, an autoimmune disorder involving the skin. These women have more cells from the unborn child in their blood decades after a pregnancy than women who don't have scleroderma.

While further research is needed to substantiate these findings, the study does offer an explanation for the much higher incidence of autoimmune disorders in women than in men. Women account for 75% of those who have the disease. It is most common in women of childbearing age.

What can be done to prevent the condition?

There is no known way to prevent fibromyalgia.

How is the condition diagnosed?

Diagnosis of fibromyalgia begins with a medical history and physical examination. There are no laboratory tests such as biopsies or X-rays for this disease. These tests are sometimes used to rule out other medical illnesses.

• widespread pain for more than three months
• pain involving any or all areas of the spine
• tenderness at 11 or more of the 18 tender points identified in people with fibromyalgia
• fatigue
• depressed mood or clinical depression
• muscle stiffness
• headaches

What are the long-term effects of the condition?

The chronic pain of fibromyalgia may lead to clinical depression. Some individuals with fibromyalgia have committed suicide because of the chronic pain. The ability to work may be lost. Fibromyalgia is not thought to be a progressive disease, and it does not cause deformities.

What are the risks to others?

Fibromyalgia is not contagious and poses no risk to others.

What are the treatments for the condition?

There is no cure for fibromyalgia. However, there are some treatments that can improve the symptoms and quality of life for someone with the condition.

People with fibromyalgia have reported improvement from the following:

• acupuncture
• aerobic exercises, such as bicycling or jogging
• antidepressant medications, such as amitriptyline (i.e., Elavil)
• muscle relaxants, such as cyclobenzaprine (i.e., Flexeril)
• biofeedback
• chiropractic treatments
• heat or cold treatments
• hypnosis
• injections of local anesthesia medications or corticosteroids into tender points
• massage therapy
• occupational therapy, which can teach individuals how to continue functioning in spite of pain
• sleep medications which are not benzodiazepines, such as zolpidem (i.e., Ambien), zaleplon (i.e., Sonata) and eszopiclone (i.e., Lunesta)
• sleep medications which are benzodiazepines, such as flurazepam (i.e., Dalmane), temazepam (i.e., Restoril) and triazolam (i.e., Halcion)
• antihistamines, such as diphenhydramine (i.e., Benadryl)
• non-addicting sedatives, such as chloral hydrate (i.e., Notec)
• stretching and range of motion exercises, which involve moving joints through their normal movements

Other therapies found helpful by some patients with fibromyalgia include:

• electroprobe, a direct current technique using small currents of electricity over 15 minutes, four times a week, for several weeks, to break the cycle of pain
• electrical stimulation pads
• ultrasound
• hot packs
• gradually increasing physical conditioning exercise
• water aerobics
• stress management
• TENS therapy

The experts at the Natural Medicines Comprehensive Database (NMCD) have looked at the studies evaluating the use of herbs, vitamins and supplements in fibromyalgia and judged the following as "Possibly Effective:"

• 5_HTP
• Capsicum
• Gamma-hydroxybutrate (GHB)
• Magnesium
• SAMe

The NMCD has concluded that the following have "Insufficient Evidence" to recommend in fibromyalgia:

• Alpha hydroxyl acids
• Chlorella
• Melatonin

Some individuals may find one or more of these treatments helpful, while others may find that a particular treatment worsens symptoms. If a treatment is helping and the side effects are tolerable, the treatment should be continued.

What are the side effects of the treatments?

Side effects of antidepressants include dry mouth, sexual dysfunction, and constipation. Injecting local anesthetic medications can make the chronic pain worse in some cases and can cause an allergic reaction. Taking pain pills regularly over a long period of time can produce kidney damage.

What happens after treatment for the condition?

The course of fibromyalgia is unpredictable and highly individualized. Treatment is lifelong.

How is the condition monitored?

Self-monitoring of symptoms is important. People can document the severity of pain, fatigue, stiffness, and mood in a daily log. This information can help in treatment plans. Any new or worsening symptoms should be reported to the healthcare professional.