What is fibromyalgia?
Fibromyalgia is a condition characterized by aching and pain in muscles, tendons and joints all over the body, especially along the spine.

There are measurable changes in body chemistry and function in some people with fibromyalgia. These changes may be responsible for certain symptoms. However, fibromyalgia is not associated with muscle, nerve or joint injury; inadequate muscle repair; or any serious bodily damage or disease. Also, people who have fibromyalgia are not at greater risk for any other musculoskeletal disease.

Fig. 1

When stress continues without relief, your body doesn’t have time to relax or prepare for the next challenge. This is called distress. As you can see in Figure 1, distress can trigger a number of physical reactions and lead to the symptoms of fibromyalgia.

What are the symptoms of fibromyalgia?
Pain is the primary symptom in fibromyalgia.

Other symptoms are often associated with the pain, including:

Sleep disturbance
Daytime tiredness
Alternating diarrhea and constipation
Numbness and tingling in the hands and feet
Feelings of weakness
Having difficulty remembering
Increased sensitivity to light, odors and sound

What causes fibromyalgia?
The exact cause of fibromyalgia is unknown. There are, however, many theories about why people get fibromyalgia.

One theory suggests that stress contributes to the onset of fibromyalgia (see Figure 1).

When fibromyalgia begins, stresses in a person’s life are prominent. Stress often results in disturbed sleep patterns and a lack of restful sleep. When you don’t get enough sleep, your body does not produce the chemicals necessary to control or regulate pain. A lack of these pain-regulating chemicals results in tenderness in the upper back and forearms, leading to the symptoms of fibromyalgia.

Physical and emotional factors may also contribute to the onset of fibromyalgia. For example, a physical illness (such as an infection) could cause changes in your body chemistry that lead to pain and sleeplessness.

When you are sick, you may worry about your health and become anxious, depressed or inactive. These emotional factors could make your symptoms worse and aggravate fibromyalgia.

Who is affected by fibromyalgia?
Women tend to have fibromyalgia more often than men. In Europe, some studies suggest that as many as 14% of women may have fibromyalgia symptoms. In the United States, a much lower estimate – 2 to 4% of women and men – have fibromyalgia.

How is fibromyalgia diagnosed?
The diagnosis of fibromyalgia is based on a combination of factors, including:

Complete medical history and physical exam (to exclude other illnesses that may have similar symptoms such as rheumatoid arthritis, muscle inflammation, bursitis or tendinitis).
Presence of widespread pain together with some of the other symptoms of fibromyalgia (see list, above).
Presence of very tender areas (“tender points”) at specific locations (see Figure 2). People who have fibromyalgia experience abnormal sensitivity when light pressure is applied to many of the locations illustrated above.

Fig. 2: Common areas of pain and tenderness (called “tender points”) in people who have fibromyalgia.

How is fibromyalgia treated?
People with fibromyalgia receive individual treatment based on several factors including their overall health, medical history, number of tender points, severity of pain and presence of other symptoms.

Treatment for fibromyalgia includes:

Medications that decrease pain and improve sleep
Lifestyle changes including stress reduction
Exercises to improve cardiovascular (heart and lung) health
Relaxation techniques to relieve muscle tension

Medications that increase restful sleep, such as low doses of anti-depressant drugs taken before bedtime, may help. Other kinds of sleeping pills are not very helpful for people who have fibromyalgia.

Non-steroidal anti-inflammatory drugs including aspirin and ibuprofen may help decrease pain, but should be used sparingly. These drugs have many side effects such as stomach upset and fluid retention. They may also have unfavorable interactions with other drugs such as high blood pressure medications.

No currently existing medications completely relieve fibromyalgia pain. However, acetaminophen (such as Tylenol®) is both helpful and safer than other analgesics (pain-relieving medications).

Anti-inflammatory medications (such as cortisone derivatives) used to treat other rheumatic conditions have been tested in people with fibromyalgia and do not improve symptoms.

Brisk walking, biking, swimming and water aerobics are good activities to choose when starting your exercise program. Your physician can help you choose an exercise program that’s right for you.

Participating in aerobic exercise for half an hour, three times each week is an important step toward improving fibromyalgia symptoms. Exercise increases heart and lung function and stretches tight, sore muscles.

Coping with stress
Certain stress factors in life (such as financial burdens, difficulties with a boss, coworkers, or your spouse) may not be easily eliminated. Evaluating the causes of stress and learning new ways to cope may improve fibromyalgia. Anxiety and depression are major contributors to stress and must be treated to enable fibromyalgia to improve.

Relaxation techniques can help relieve muscle tension and reduce stress. Professionals trained in stress management can teach you these techniques.

Can fibromyalgia be prevented?
There is no known or specific way to prevent fibromyalgia. It is in your best interest, however, to remain as healthy as possible. Maintaining a good diet, doing safe exercise, and getting adequate rest are good rules to follow if you hope to prevent any medical condition, including fibromyalgia.

What is the long-term outlook for people with fibromyalgia?
Often, if the situations that caused stress are resolved, fibromyalgia may spontaneously improve and medications may not be necessary.

Many people with fibromyalgia will continue to have symptoms despite treatment, especially when life is stressful. However, medications that may alter the balance of pain-producing chemicals, (such as antidepressant drugs) should improve symptoms by 30%.

When other forms of therapy such as acetaminophen and aerobic exercise are combined to treat fibromyalgia, even more improvement can be expected. Those who are able to continue working and fulfilling their social obligations – despite their pain – do best.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Questions and Answers about Fibromyalgia. Accessed 7/5/2013.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. What Is Fibromyalgia? Fast Facts: An Easy-to-Read Series of Publications for the Public. Accessed 7/5/2013.
National Fibromyalgia Association. Fibromyalgia. Accessed 7/5/2013.
(from Cleveland Clinic)