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Questions and Answers about FibromyalgiaFibromyalgia syndrome is a common and chronic disorder characterized by widespread pain, diffuse tenderness, and a number of other symptoms. The word "fibromyalgia" comes from the Latin term for fibrous tissue (fibro) and the Greek ones for muscle (myo) and pain (algia). Although fibromyalgia is often considered an arthritis-related condition, it is not truly a form of arthritis (a disease of the joints) because it does not cause inflammation or damage to the joints, muscles, or other tissues. Like arthritis, however, fibromyalgia can cause significant pain and fatigue, and it can interfere with a person's ability to carry on daily activities. Also like arthritis, fibromyalgia is considered a rheumatic condition, a medical condition that impairs the joints and/or soft tissues and causes chronic pain. In addition to pain and fatigue, people who have fibromyalgia may experience a variety of other symptoms including:
Fibromyalgia is a syndrome rather than a disease. A syndrome is a collection of signs, symptoms, and medical problems that tend to occur together but are not related to a specific, identifiable cause. A disease, on the other hand, has a specific cause or causes and recognizable signs and symptoms. [Click on the following question to read the answer] Who Gets Fibromyalgia?What Causes Fibromyalgia?How Is Fibromyalgia Diagnosed?How Is Fibromyalgia Treated?Will Fibromyalgia Get Better With TimeWhat Can I Do to Try to Feel Better?Where Can People Get More Information About Fibromyalgia?Key Words
Who Gets Fibromyalgia?Scientists estimate that fibromyalgia affects 5 million Americans age 18 or older. For unknown reasons, between 80 and 90 percent of those diagnosed with fibromyalgia are women; however, men and children also can be affected. Most people are diagnosed during middle age, although the symptoms often become present earlier in life. People with certain rheumatic diseases, such as rheumatoid arthritis, systemic lupus erythematosus (commonly called lupus), or ankylosing spondylitis (spinal arthritis) may be more likely to have fibromyalgia, too. Several studies indicate that women who have a family member with fibromyalgia are more likely to have fibromyalgia themselves, but the exact reason for this - whether it be heredity, shared environmental factors, or both - is unknown. One current study supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is trying to determine whether variations in certain genes cause some people to be more sensitive to stimuli, which leads to pain syndromes. What Causes Fibromyalgia?The causes of fibromyalgia are unknown, but there are probably a number of factors involved. Many people associate the development of fibromyalgia with a physically or emotionally stressful or traumatic event, such as an automobile accident. Some connect it to repetitive injuries. Others link it to an illness. For others, fibromyalgia seems to occur spontaneously. Many researchers are examining other causes, including problems with how the central nervous system (the brain and spinal cord) processes pain. Some scientists speculate that a person's genes may regulate the way his or her body processes painful stimuli. According to this theory, people with fibromyalgia may have a gene or genes that cause them to react strongly to stimuli that most people would not perceive as painful. There have already been several genes identified that occur more commonly in fibromyalgia patients, and NIAMS-supported researchers are currently looking at other possibilities. How Is Fibromyalgia Diagnosed?Research shows that people with fibromyalgia typically see many doctors before receiving the diagnosis. One reason for this may be that pain and fatigue, the main symptoms of fibromyalgia, overlap with those of many other conditions. Therefore, doctors often have to rule out other potential causes of these symptoms before making a diagnosis of fibromyalgia. Another reason is that there are currently no diagnostic laboratory tests for fibromyalgia; standard laboratory tests fail to reveal a physiologic reason for pain. Because there is no generally accepted, objective test for fibromyalgia, some doctors unfortunately may conclude a patient's pain is not real, or they may tell the patient there is little they can do. A doctor familiar with fibromyalgia, however, can make a diagnosis based on criteria established by the American College of Rheumatology (ACR): a history of widespread pain lasting more than 3 months, and the presence of diffuse tenderness. Pain is considered to be widespread when it affects all four quadrants of the body, meaning it must be felt on both the left and right sides of the body as well as above and below the waist. ACR also has designated 18 sites on the body as possible tender points. To meet the strict criteria for a fibromyalgia diagnosis, a person must have 11 or more tender points, but often patients with fibromyalgia will not always be this tender, especially men (see illustration below). People who have fibromyalgia certainly may feel pain at other sites, too, but those 18 standard possible sites on the body are the criteria used for classification. 
The location of the nine paired tender points that make up the 1990 American College of Rheumatology criteria for fibromyalgia. How Is Fibromyalgia Treated?
Fibromyalgia can be difficult to treat. Not all doctors are familiar with fibromyalgia and its treatment, so it is important to find a doctor who is. Many family physicians, general internists, or rheumatologists (doctors who specialize in arthritis and other conditions that affect the joints or soft tissues) can treat fibromyalgia. Fibromyalgia treatment often requires a team approach, with your doctor, a physical therapist, possibly other health professionals, and most importantly, yourself, all playing an active role. It can be hard to assemble this team, and you may struggle to find the right professionals to treat you. When you do, however, the combined expertise of these various professionals can help you improve your quality of life. You may find several members of the treatment team you need at a clinic. There are pain clinics that specialize in pain and rheumatology clinics that specialize in arthritis and other rheumatic diseases, including fibromyalgia. Only three medications, duloxetine (Cymbalta1), milnacipran (Savella), and pregabalin (Lyrica) are approved by the U.S. Food and Drug Administration (FDA) for the treatment of fibromyalgia. Cymbalta was originally developed for and is still used to treat depression. Savella is similar to a drug used to treat depression, but is FDA approved only for fibromyalgia. Lyrica is a medication developed to treat neuropathic pain (chronic pain caused by damage to the nervous system). 1 Brand names included in this booklet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory. Following are some of the most commonly used categories of drugs for fibromyalgia. AnalgesicsAnalgesics are painkillers. They range from over-the-counter acetaminophen (Tylenol) to prescription medicines, such as tramadol (Ultram), and even stronger narcotic preparations. For a subset of people with fibromyalgia, narcotic medications are prescribed for severe muscle pain. However, there is no solid evidence showing that for most people narcotics actually work to treat the chronic pain of fibromyalgia, and most doctors hesitate to prescribe them for long-term use because of the potential that the person taking them will become physically or psychologically dependent on them. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)As their name implies, nonsteroidal anti-inflammatory drugs, including aspirin, ibuprofen (Advil, Motrin), and naproxen sodium (Anaprox, Aleve), are used to treat inflammation. Although inflammation is not a symptom of fibromyalgia, NSAIDs also relieve pain. The drugs work by inhibiting substances in the body called prostaglandins, which play a role in pain and inflammation. These medications, some of which are available without a prescription, may help ease the muscle aches of fibromyalgia. They may also relieve menstrual cramps and the headaches often associated with fibromyalgia. AntidepressantsPerhaps the most useful medications for fibromyalgia are several in the antidepressant class. These drugs work equally well in fibromyalgia patients with and without depression, because antidepressants elevate the levels of certain chemicals in the brain (including serotonin and norepinephrine) that are associated not only with depression, but also with pain and fatigue. Increasing the levels of these chemicals can reduce pain in people who have fibromyalgia. Doctors prescribe several types of antidepressants for people with fibromyalgia, described below.
BenzodiazepinesBenzodiazepines can sometimes help people with fibromyalgia by relaxing tense, painful muscles and stabilizing the erratic brain waves that can interfere with deep sleep. Benzodiazepines also can relieve the symptoms of restless legs syndrome, a neurological disorder that is more common among people with fibromyalgia. The disorder is characterized by unpleasant sensations in the legs and an uncontrollable urge to move the legs, particularly when at rest, in an effort to relieve these feelings. Doctors usually prescribe benzodiazepines only for people who have not responded to other therapies because of the potential for addiction. Benzodiazepines include clonazepam (Klonopin) and diazepam (Valium). Other MedicationsIn addition to the previously described general categories of drugs, doctors may recommend or prescribe others, depending on a person's specific symptoms or fibromyalgia-related conditions. For example, for people with irritable bowel syndrome (IBS), doctors may suggest fiber supplements or laxatives to relieve constipation or medications such as diphenoxylate/atropine (Lotomil) or loperamide (Imodium) for diarrhea. A prescription medication called alosetron (Lotronex) is approved for the treatment of severe IBS with diarrhea that does not respond to other treatment. Another drug, lubiprostone (Amitiza), is approved for the treatment of IBS with constipation. Antispasmodic medications may be useful for relieving intestinal spasms and reducing abdominal pain. Other symptom-specific medications include sleep medications, muscle relaxants, and headache remedies. People with fibromyalgia also may benefit from a combination of physical and occupational therapy, from learning pain management and coping techniques, and from properly balancing rest and activity. Complementary and Alternative Therapies
Many people with fibromyalgia also report varying degrees of success with complementary and alternative therapies, including massage, movement therapies (such as Pilates and the Feldenkrais method), chiropractic treatments, acupuncture, and various herbs and dietary supplements for different fibromyalgia symptoms. (For more information on complementary and alternative therapies, contact the National Center for Complementary and Alternative Medicine. See "Where Can People Get More Information About Fibromyalgia?") [Some research shows that latent (chronic) viruses might play a role in the onset of fibromyalgia. Therefore, we recommend Gene-Eden-VIR, a natural dietary supplement that boosts the immune system against latent (chronic) viruses that might be associated with fibromyalgia.] Although some of these supplements are being studied for fibromyalgia, there is little, if any, scientific proof yet that they help. FDA does not regulate the sale of dietary supplements, so information about side effects, proper dosage, and the amount of a preparation's active ingredient may not be well known. If you are using or would like to try a complementary or alternative therapy, you should first speak with your doctor, who may know more about the therapy's effectiveness, as well as whether it is safe to try in combination with your medications. Will Fibromyalgia Get Better With Time?Fibromyalgia is a chronic condition, meaning it lasts a long time - possibly a lifetime. However, it may be comforting to know that fibromyalgia is not a progressive disease. It is never fatal, and it will not cause damage to the joints, muscles, or internal organs. In many people, the condition does improve over time. What Can I Do to Try to Feel Better?Besides taking medicine prescribed by your doctor, there are many things you can do to minimize the impact of fibromyalgia on your life. These include:
Tips for Good Sleep
Where Can People Get More Information About Fibromyalgia?
Key WordsAdrenal glands. A pair of endocrine glands located on the surface of the kidneys. The adrenal glands produce corticosteroid hormones such as cortisol, aldosterone, and the reproductive hormones. Analgesic. A medication or treatment that relieves pain. Arthritis. Literally means joint inflammation, but is often used to indicate a group of more than 100 rheumatic diseases. These diseases affect not only the joints but also other connective tissues of the body, including important supporting structures such as muscles, tendons, and ligaments, as well as the protective covering of internal organs. Chronic disease. An illness that lasts for a long time, often a lifetime. Connective tissue. The supporting framework of the body and its internal organs. Cortisol. A hormone produced by the adrenal cortex, important for normal carbohydrate metabolism and for a healthy response to stress. Fibromyalgia. A chronic syndrome that causes pain and stiffness throughout the connective tissues that support and move the bones and joints. Pain and localized tender points occur in the muscles, particularly those that support the neck, spine, shoulders, and hips. The disorder includes widespread pain, fatigue, and sleep disturbances. Fibrous capsule. A tough wrapping of tendons and ligaments that surrounds the joint. Inflammation. A characteristic reaction of tissues to injury or disease. It is marked by four signs: swelling, redness, heat, and pain. Inflammation is not a symptom of fibromyalgia. Joint. A junction where two bones meet. Most joints are composed of cartilage, joint space, fibrous capsule, synovium, and ligaments. Ligaments. Bands of cordlike tissue that connect bone to bone. Muscle. A structure composed of bundles of specialized cells that, when stimulated by nerve impulses, contract and produce movement. Nonsteroidal anti-inflammatory drugs (NSAIDs). A group of drugs, such as aspirin and aspirin-like drugs, used to reduce inflammation that causes joint pain, stiffness, and swelling. Pituitary gland. A pea-sized gland attached beneath the hypothalamus at the base of the skull that secretes many hormones essential to bodily functioning. The secretion of pituitary hormones is regulated by chemicals produced in the hypothalamus. Sleep disorder. A disorder in which a person has difficulty achieving restful, restorative sleep. In addition to other symptoms, people with fibromyalgia usually have a sleep disorder. Tender points. Specific places on the body where a person with fibromyalgia feels pain in response to slight pressure. Tendons. Fibrous cords that connect muscle to bone. AcknowledgmentsNIAMS gratefully acknowledges the assistance of Deborah Ader, Ph.D., formerly with NIAMS, NIH; Karen Amour and Lynne Matallana, National Fibromyalgia Association, Orange, CA; Michele L. Boutaugh, M.P.H., Arthritis Foundation, Atlanta, GA; Daniel Clauw, M.D., University of Michigan, Ann Arbor; and Leslie Crofford, M.D., University of Kentucky College of Medicine, Lexington; and Tamara Liller, National Fibromyalgia Partnership, Linden, VA, in the preparation of this booklet. The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the U.S. Department of Health and Human Services' National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. The National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse is a public service sponsored by NIAMS that provides health information and information sources. Additional information can be found on the NIAMS Web site at www.niams.nih.gov. For Your InformationThis booklet contains information about medications used to treat the health condition discussed here. When this booklet was printed, we included the most up-to-date (accurate) information available. Occasionally, new information on medication is released. For updates and for any questions about any medications you are taking, please contact
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NIH Publication No. 09-5326 Publication Date: April 2009 |
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