Fibromyalgia

Definition

Fibromyalgia is described as inflammation of the fibrous or connective tissue of the body. Widespread muscle pain, fatigue, and multiple tender points characterize these conditions. Fibrositis, fibromyalgia, and fibromyositis are names given to a set of symptoms believed to be caused by the same general problem.

Description

Fibromyalgia is more common than previously thought, with as many as 3-6% of the population affected by the disorder. Fibromyalgia is more prevalent in adults than children, with more women affected than men, particularly women of childbearing age.

Causes and symptoms

The exact cause of fibromyalgia is not known. Sometimes it occurs in several members of a family, suggesting that it may be an inherited disorder. People with fibromyalgia are most likely to complain of three primary symptoms: muscle and joint pain, stiffness, and fatigue.

Pain is the major symptom with aches, tenderness, and stiffness of multiple muscles, joints, and soft tissues. The pain also tends to move from one part of the body to another. It is most common in the neck, shoulders, chest, arms, legs, hips, and back. Although the pain is present most of the time and may last for years, the severity of the pain changes and is dependent on individual patient perception.

Symptoms of fatigue may result from the individual's chronic pain coupled with anxiety about the problem and how to find relief. The inflammatory process also produces chemicals that are known to cause fatigue. Other common symptoms are tension headaches, difficulty swallowing, recurrent abdominal pain, diarrhea, and numbness or tingling of the extremities. Stress, anxiety, depression, or lack of sleep can increase symptoms. Intensity of symptoms is variable ranging from gradual improvement to episodes of recurrent symptoms.

Diagnosis

Diagnosis is difficult and frequently missed because symptoms of fibromyalgia are vague and generalized. Coexisting nerve and muscle disorders such as rheumatoid arthritis, spinal arthritis, or Lyme disease may further complicate the diagnostic process. Presently, there are no tests available to specifically diagnose fibromyalgia. The diagnosis is usually made after ruling out other medical conditions with similar symptoms and using criteria physicians and researchers have defined.

Because of the emotional distress experienced by people with this condition and the influence of stress on the symptoms themselves, fibromyalgia has often been labeled a psychological problem. Recognition of the underlying inflammatory process involved in fibromyalgia has helped promote the validity of this disease.

In 1990, the America College of Rheumatology developed standards for fibromyalgia that health care practitioners can use to diagnose this condition. According to these standards, a person is thought to have fibromyalgia if he or she has widespread pain in combination with tenderness in at least 11 of the 18 sites known as trigger points. Trigger point sites include the base of the neck, along the backbone, in front of the hip and elbow, and at the rear of the knee and shoulder.

Treatment

There is no known cure for fibromyalgia. Therefore, the goal of treatment is successful symptom management. Treatment usually requires a combination of therapies, exercise, proper rest, and diet. A patient's clear understanding of his or her role in the recovery process is imperative for successful management of this condition. In 2004, a study demonstrated that a drug called paroxeteine HCI (Paxil CR) in controlled release tablet form significantly reduced symptoms in fibromyalgia patients. As of spring 2004, there were no FDA-approved treatments for fibromyalgia.

Treatments found to be helpful include heat and occasionally cold applications. A regular stretching program is often useful. Aerobic activities focusing on increasing the heart rate are the preferred forms of exercise over most other forms of exertion. Exercise programs need to include good warm-up and cool-down sessions, with special attention given to avoiding exercises causing joint pain. The diet should include a large variety of fruits and vegetables which provide the body with trace elements and minerals that are necessary for healthy muscles.

Adequate rest is essential in the treatment of fibromyalgia. Avoidance of stimulating foods or drinks (such as coffee) and medications like decongestants prior to bedtime is advised. If diet, exercise, and adequate rest do not relieve the symptoms of fibromyalgia, medications may be prescribed. Medications prescribed and found to have some benefit include antidepressant drugs, muscle relaxants, and anti-inflammatory drugs.

People with fibromyalgia often need a rheumatology consultation (a meeting with a doctor who specializes in disorders of the joints, muscles, and soft tissue) to decide the cause of various rheumatic symptoms, to be educated about fibromyalgia and its treatment, and to exclude other rheumatic diseases. A treatment program must be individualized to meet the patient's needs. The rheumatologist, as the team leader, enlists and coordinates the expertise of other health professionals in the care of the patient.

Alternative treatment

Massage therapy can be helpful, especially when a family member is instructed on specific massage techniques to manage episodes of increased symptoms. Specific attention to mental health, including psychological consultation, may also be important, since depression may precede or accompany fibromyalgia. Other alternative therapies, including hellerwork, rolfing, homeopathic medicine, Chinese traditional medicine (both acupuncture and herbs), polarity therapy, and Western botanical medicine, can assist the person with fibromyalgia to function day to day and can contribute to healing.

Prognosis

Fibromyalgia is a chronic problem. The symptoms sometimes improve and at other times worsen, but they often continue for months to years.

Prevention

There is no known or specific way to prevent fibromyalgia. However, similar to many other medical conditions, remaining as healthy as possible with a good diet, safe exercise, and adequate rest is the best prevention.

Resources

PERIODICALS

"Study: Paroxetine Seems to Reduce Fibromyalgia Symptoms." Obesity, Fitness & Wellness Week June 5, 2004: 803.

ORGANIZATIONS

The American College of Rheumatology. 1800 Century Place, Suite 250, Atlanta, GA 30345. (404) 633-3777. 〈http://www.rheumatology.org〉.

Arthritis Foundation.1300 W. Peachtree St., Atlanta, GA 30309. (800) 283-7800. 〈http://www.arthritis.org〉.

KEY TERMS

Connective tissue— Tissue that supports and binds other body tissue and parts.

Lyme disease— An acute recurrent inflammatory disease involving one or a few joints, believed to be transmitted by a tickborne virus. The condition was originally described in the community of Lyme, Connecticut, but has also been reported in other parts of the United States and other countries. Knees, other large joints are most commonly involved with local inflammation and swelling.

Rheumatology— The study of disorders characterized by inflammation, degeneration of connective tissue, and related structures of the body. These disorders are sometimes collectively referred to as rheumatism.

Fibromyalgia

Definition

Fibromyalgia is described as inflammation of the fibrous or connective tissue of the body. Widespread muscle pain, fatigue , and multiple tender points characterize these conditions. Many individuals with fibromyalgia describe the symptoms as similar to the aches and pains of a severe case of the flu. Fibrositis, fibromyalgia, and fibromyositis are names given to a set of symptoms believed to be caused by the same general problem.

Description

Fibromyalgia is more common than previously thought, with as many as 3-6% of the population affected by the disorder. Fibromyalgia is more prevalent in adults than children, with more women affected than men, particularly women of childbearing age.

Causes & symptoms

The exact cause of fibromyalgia is not known. Sometimes it occurs in several members of a family, suggesting that it may be an inherited disorder. People with fibromyalgia are most likely to complain of three primary symptoms: muscle and joint pain, stiffness, and fatigue.

Pain is the major symptom with aches, tenderness, and stiffness of multiple muscles, joints, and soft tissues. The pain also tends to move from one part of the body to another. It is most common in the neck, shoulders, chest, arms, legs, hips, and back. Although the pain is present most of the time and may last for years, the severity of the pain may fluctuate.

Symptoms of fatigue may result from the individual's chronic pain coupled with anxiety about the problem and how to find relief. The inflammatory process also produces chemicals that are known to cause fatigue. Other common symptoms are tension headaches, difficulty swallowing, recurrent abdominal pain, diarrhea , and numbness or tingling of the extremities. Stress , anxiety, depression , or lack of sleep can increase symptoms. Intensity of symptoms is variable ranging from gradual improvement to episodes of recurrent symptoms.

Diagnosis

Diagnosis is difficult and frequently missed because symptoms of fibromyalgia are vague and generalized. Coexisting nerve and muscle disorders such as rheumatoid arthritis , spinal arthritis, or Lyme disease may further complicate the diagnostic process. Presently, there are no tests available to specifically diagnose fibromyalgia. The diagnosis is usually made after ruling out other medical conditions with similar symptoms.

Because of the emotional distress experienced by people with this condition and the influence of stress on the symptoms themselves, fibromyalgia has often been labeled a psychological problem. Recognition of the underlying inflammatory process involved in fibromyalgia has helped promote the validity of this disease.

The American College of Rheumatology has developed standards for fibromyalgia that health care practitioners can use to diagnose this condition. According to these standards, a person is thought to have fibromyalgia if he or she has widespread pain in combination with tenderness in at least 11 of the 18 sites known as trigger points. Trigger point sites include the base of the neck, along the backbone, in front of the hip and elbow, and at the rear of the knee and shoulder.

Treatment

There is no known cure for fibromyalgia. Therefore, the goal of treatment is successful symptom management. Treatment usually requires a combination of therapies, exercise , and lifestyle adjustments. Adequate rest is essential in the treatment of fibromyalgia. The diet should include a large variety of fruits and vegetables, which provide the body with trace elements and minerals that are necessary for healthy muscles. Avoidance of stimulating foods or drinks (such as coffee) and medications like decongestants prior to bedtime is advised. A patient's clear understanding of his or her role in the recovery process is imperative for successful management of this condition.

Treatments found to be helpful include heat and occasionally cold compress applications. A regular stretching program is often useful. Aerobic activities focusing on increasing the heart rate are the preferred forms of exercise over most other forms of exertion. Exercise programs need to include good warm-up and cool-down sessions, with special attention given to avoiding exercises causing joint pain. Hydrotherapy exercises (exercises in a pool or tub) may be useful in providing a low impact exercise environment while soothing muscle and joint pain.

Massage therapy can be helpful, especially when a family member is instructed on specific massage techniques to manage episodes of increased symptoms. Short sessions are most helpful as repetitious movement can aggravate the condition. Specific attention to mental health, including psychological consultation, may also be important, since depression may precede or accompany fibromyalgia. Relaxation exercises, yoga, aromatherapy, guided imagery , and other relaxation therapies can be useful in easing stress and promoting overall well-being. Acupuncture can be very helpful for symptom relief and in easing the general condition.

Herbalists and aromatherapists may recommend tub soaks or compresses with lavender (Lavandula angustifolia ), chamomile (Chamaemelum nobilis ), or juniper (Juniperus communis ) to soothe muscle and joint pain.

Allopathic treatment

People with fibromyalgia often need a rheumatology consultation (a meeting with a doctor who specializes in disorders of the joints, muscles, and soft tissue) to decide the cause of various rheumatic symptoms, to be educated about fibromyalgia and its treatment, and to exclude other rheumatic diseases. A treatment program must be individualized to meet the patient's needs. The rheumatologist, as the team leader, enlists and coordinates the expertise of other health professionals in the care of the patient.

If diet, exercise, and adequate rest do not relieve the symptoms of fibromyalgia, medications may be prescribed. Medications prescribed and found to have some benefit include antidepressant drugs, muscle relaxants, and anti-inflammatory drugs.

Expected results

Fibromyalgia is a chronic health problem. The symptoms sometimes improve and at other times worsen, but they often continue for months to years.

Prevention

There is no known or specific prevention for fibromyalgia. However, similar to many other medical conditions, remaining as healthy as possible with a good diet, safe exercise, and adequate rest is the best prevention.

Resources

BOOKS

Skelly, Mari et al. Alternative Treatments for Fibromyalgia & Chronic Fatigue Syndrome: Insights from Practitioners and Patients. Alameda, CA: Hunter House, 1999.

ORGANIZATIONS

The American College of Rheumatology. 60 Executive Park S., Ste. 150, Atlanta, GA 30329. (404) 633-3777. http://www.rheumatology.org.

Arthritis Foundation. 1330 W. Peachtree Street, Atlanta, GA 30309. (800) 283-7800. http://www.arthritis.org.

Paula Ford-Martin

Fibromyalgia

What Is Fibromyalgia?

What Causes Fibromyalgia?

How Do People Know If They Have Fibromyalgia?

How Is Fibromyalgia Treated?

Living with Fibromyalgia

What Progress Is Being Made in Treating Fibromyalgia?

Resources

Fibromyalgia (fi-bro-my-AL-ja) is a chronic* disorder that causes widespread aching, stiffness, and fatigue in the muscles and joints.

KEYWORDS

for searching the Internet and other reference sources:

Musculoskeletal system

Rheumatic disorders

* chronic

(KRON-ik) means long lasting.

What Is Fibromyalgia?

Fibromyalgia is a relatively new term for an old disorder. It means pain in the muscles and joints*. The term fibrositis (fi-bro-SY-tis) was once used to describe the same condition. Three to 6 million Americans are thought to be affected by fibromyalgia. It occurs mostly in women aged 50 and older. Fibromyalgia is found throughout the world, among all ethnic groups. It is only rarely seen in children.

* joints

are places in the body where two bones fit together, usually in such a way as to allow motion.

What Causes Fibromyalgia?

No one knows what causes fibromyalgia, but there are several theories. One is that fibromyalgia is caused by injury to the central nervous system (the brain and spinal cord), which sends messages to the muscles. A second theory is that biochemical changes in muscle tissue cause fatigue and loss of strength. A third theory suggests that fibromyalgia may be caused by a virus. Some patients with fibromyalgia have psychological problems, but it is unclear whether there is any relationship between the two.

How Do People Know If They Have Fibromyalgia?

Fibromyalgia begins gradually. The main symptom is pain in the muscles and joints. The pain moves around but is most common in the neck, chest, arms, legs, hips, and back. In addition, patients may complain of headaches, tiredness, sleep disorders, digestive disturbances, anxiety, or depression.

Fibromyalgia can be frustrating to diagnose for both the doctor and the patient. The muscles hurt, but they look normal. Blood and x-ray tests are also normal. The symptoms can resemble those of a variety of illnesses, including infections, and the doctor needs to rule out such possibilities. Fibromyalgia also shares similarities with chronic fatigue syndrome. If no other explanation for a patient’s symptoms is found, a doctor may diagnose fibromyalgia if the pain keeps coming back, occurs in many different muscles, and has lasted for more than 3 months.

How Is Fibromyalgia Treated?

A doctor who suspects fibromyalgia will reassure the patient that the condition will not harm the muscles. The most effective treatment is a combination of exercise, medication (sometimes including antidepressant medications), physical therapy, and relaxation. Other approaches, such as massage and acupuncture, do not seem to be particularly helpful. There is no known way to prevent the condition.

Living with Fibromyalgia

Fibromyalgia is a chronic disorder, which means that the symptoms may get better or worse but can last for months to years. Many communities have support groups for patients with fibromyalgia.

What Progress Is Being Made in Treating Fibromyalgia?

Because fibromyalgia is a source of serious disability for many people, organizations such as the National Institute of Arthritis and Musculoskeletal and Skin Diseases are sponsoring research to help diagnose, treat, and prevent it. For example, researchers are studying how structures of the brain are involved in the painful symptoms of fibromyalgia. They are also using sophisticated imaging technologies to study how the muscles perform.

See also

Arthritis

Chronic Fatigue Syndrome

Resources

Book

Mcllwain, Harris H., and Debra Fulghum Bruce. The Fibromyalgia Handbook. New York: Owl Books, 1996.

Organizations

American College of Rheumatology, 1800 Century Place, Suite 250,Atlanta, GA 30345.http://www.rheumatology.org

Arthritis Foundation, 1330 West Peachtree Street, Atlanta, GA 30309. http://www.arthritis.org

fibromyalgia (fy-broh-my-al-jiă) n. a disorder characterized by pain in the fibrous tissue components of muscles without any inflammation (compare fibromyositis). Widespread aching and stiffness are accompanied by extreme fatigue and often associated with headache and various other symptoms. Fibromyalgia is frequently triggered by anxiety, stress, sleep deprivation, and straining or overuse of muscles; it appears to be closely related to CFS/ME/PVF.

fi·bro·my·al·gia / ˌfībrōmīˈalj(ē)ə/ • n. a chronic disorder characterized by musculoskeletal pain, fatigue, and tenderness in localized areas.

Fibromyalgia

Definition

Fibromyalgia (formerly known as fibrositis) is an inflammation of the fibrous or connective tissue (muscles, joints, ligaments, and tendons) of the body. Widespread pain, fatigue, and multiple tender points characterize this condition. Other symptoms may include sleep disturbance, headache, and bowel disturbances.

Description

Fibromyalgia is more common than previously thought, with as many as 3-6% of the population affected by the disorder. Fibromyalgia is more prevalent in adults than children, with more women affected than men—particularly women aged 35 to 55. Fibromyalgia symptoms have often been characterized as psychosomatic in origin. Recent research has proved that belief false, and fibromyalgia is now regarded as a disorder that can be diagnosed and treated effectively with ongoing care and follow-up.

Causes and symptoms

The exact cause of fibromyalgia is not known. There are events that can precipitate the symptoms of fibromyalgia, including sports injuries, car accidents, falls, or other trauma to the body. Sometimes it occurs in several members of a family, suggesting that there may be an inherited tendency for the disorder. People with fibromyalgia are most likely to complain of three primary symptoms: pain in muscles, joints, and ligaments; stiffness; and excessive fatigue. Widespread, ongoing pain is characteristic of fibromyalgia. A careful history and physical examination may uncover additional areas of pain when the chief complaint lies in only one area of the body. The most significant area of pain may shift over time, and the pain can be intermittent.

Pain is the major symptom of fibromyalgia, with aches, tenderness, and stiffness of multiple muscles, joints, and soft tissues. The pain may also tend to move from one part of the body to another. It is most common in the neck, shoulders, chest, arms, legs, hips, and back. Although the pain is present most of the time and may last for years, the severity of the pain is variable and dependent on individual patient perception.

Symptoms of sleeplessness and overall fatigue may result from the individual's chronic pain, coupled with anxiety about the problem and how to find relief. The body's inflammatory response also produces chemicals in the brain that are known to contribute to fatigue. Other common symptoms are tension headaches, difficulty swallowing, recurrent abdominal pain, diarrhea (irritable bowel syndrome), and numbness or tingling of the extremities. Stress, anxiety, depression, lack of dietary control, or lack of sleep can increase symptoms. Intensity of symptoms varies. Some patients gradually improve, while others have recurrent episodes of their symptoms.

Diagnosis

Diagnosis is difficult, and the disease may be overlooked because symptoms of fibromyalgia are vague and general. In addition, fibromyalgia may mimic symptoms of other diseases and conditions. Support staff should question the patient regarding sleep and exercise patterns, diet, and emotional conditions. Coexisting nerve and muscle disorders, such as rheumatoid arthritis, spinal arthritis, or Lyme disease, may further complicate the diagnostic process. Presently, there are no tests available to specifically diagnose fibromyalgia. The final diagnosis is frequently made after a period of time in which the physician observes the patient and rules out other medical conditions with similar symptoms.

Because of the emotional distress experienced by people with this condition and the influence of stress on the symptoms themselves, fibromyalgia has often been labeled a psychosomatic condition. Recognition of the underlying inflammatory process involved in fibromyalgia has helped promote the validity of this disease. Nurses, nurse practitioners or physician's assistants should inquire into the emotional state of the patient, and be prepared to note it in the chart. Mental health consultation may be necessary due to depression or anxiety, and emphasis on the importance of a support group for fibromyalgia patients should be given.

In 1990, the America College of Rheumatology developed standards for fibromyalgia that health care practitioners can use to diagnose this condition. According to these standards, a person is thought to have fibromyalgia if he or she has widespread pain in combination with tenderness for at least three months in at least 11 of the 18 sites known as trigger points. Trigger point sites include the neck, spine, hip, elbow, knee, and shoulder.

Treatment

There is no known cure for fibromyalgia. Therefore, the goal of treatment is successful symptom management. Treatment usually requires a combination of therapies, including exercise, proper rest, and diet, and pharmacologic treatment. Patient education by the health care team is imperative so that the patient has a clear understanding of his or her role in the recovery process and the successful management of this condition.

Physical regimens found to be helpful include a regular stretching program and low-impact aerobic activities that increase the heart rate. Exercise programs should be approved by a physician or physical therapist, and include both warm-up and cool-down sessions, with special attention given to avoiding exercises that cause joint pain. Adequate rest is essential in the treatment of fibromyalgia.

Nutrition is an important component in the management of this condition. The patient's diet should include a wide variety of fruits and vegetables to provide the body with trace elements and minerals that are necessary for healthy muscles. Avoidance of stimulating drinks (such as coffee, tea, or any drink containing caffeine ), avoidance of alcohol (may lead to sleeplessness) and medications, such as decongestants, prior to bedtime is advised. If diet, exercise, and adequate rest do not relieve the symptoms of fibromyalgia, medication may be prescribed.

Medications that have been found to have some benefit include antidepressant drugs, muscle relaxants, and nonsteroidal anti-inflammatory drugs (NSAIDs).

People with fibromyalgia often need a rheumatology consultation (a meeting with a doctor who specializes in disorders of the joints, muscles, and soft tissue) to decide the cause of various rheumatic symptoms, to be educated about fibromyalgia and its treatment, and to exclude other rheumatic diseases. A physician must recommend a treatment program that is individualized to meet the patient's needs.

Alternative treatment

Massage therapy can be helpful, especially when a family member is instructed on specific massage techniques to manage episodes of increased symptoms. Specific attention to mental health, including behavior modification and psychological consultation, may also be important because depression and anxiety may precede or accompany an incident of fibromyalgia. Other alternative therapies, including homeopathic medicine, Chinese traditional medicine (both acupuncture and herbs), polarity therapy, and Western botanical medicine, can assist the person with fibromyalgia in day-to-day functioning and contribute to the alleviation of symptoms.

Prognosis

Fibromyalgia is a chronic condition, but causes no body damage or deformity. It does not cause damage to internal organs, as opposed to conditions such as rheumatoid arthritis, which leads to joint deformity. Treatment is based on the relief of symptoms, so a cure is not a realistic goal. Management of the condition may allow patients to return to a higher level of function at work, play, and home.

Health care team roles

Fibromyalgia can be a stressful and frustrating condition for a majority of patients. Successful treatment often requires a period of trial and error to pinpoint which agents and activities work best for the individual patient. Patience while waiting for diagnosis and treatment should be stressed by support staff, along with reassurance that the physician is working to find a treatment regimen that will provide relief. However, there is no set treatment that works for every patient. Even the process of diagnosing fibromyalgia can take time, which also leads to patient frustration. Therefore, support from the health care team and coordination of care through follow-up calls to outside health care providers is needed to avoid actually worsening the patient's condition due to undue stress. Nursing parameters are pain management, improved sleep management, introduction of relaxation techniques (including massage and biofeedback if needed), and monitoring alternative treatments and medication. There could be a wide variety of health care providers on a patient's health care team: nurses, physicians, a rheumatologist or other subspecialist, nutritionist, physical therapist, alternative medicine caregiver, or mental health care providers. This requires that the health care providers who most frequently see the patient coordinate and record in the patient's medical chart all treatments being undertaken at any given time. Coordination of care increases patient compliance, and may boost the patient's perception of his or her level of function. Patient education is an integral part of the treatment and management of fibromyalgia and its symptoms. Patients should be supported both physically and emotionally. Chronic pain may make it more difficult to communicate with a patient in a manner that promotes professionalism and optimal care. Constant cognizance of the treatment goals (to control pain and increase level of function) is needed, as well as positive reinforcement of compliance with treatment suggestions and monitoring of patient milestones.

Prevention

There is currently no way to specifically prevent fibromyalgia. However, adequate sleep and nutrition, stress management, safe levels of exercise, and annual check-ups are important in the avoidance of this condition.

Resources

PERIODICALS

"Information for Patients Living with Fibromyalgia." American Family Physician 62, no. 7 (2000):1587.

Millea, P.J., and R.L. Holloway. "Treating fibromyalgia." American Family Physician 62, no. 7 (2000):1575-1587.

Wolfe, F., and H.A. Smythe, et al. "1990 Criteria for the Classification of Fibromyalgia." American College of Arthritis and Rheumatology 33 (1990):160-172.

OTHER

"Fibromyalgia: What it is and how to manage it." 〈http://www.familydoctor.org.〉

Fibromyalgia

Definition

Fibromyalgia (formerly known as fibrositis) is an inflammation of the fibrous or connective tissue (muscles, joints, ligaments, and tendons) of the body. Widespread pain , fatigue, and multiple tender points characterize this condition. Other symptoms may include sleep disturbance, headache, and bowel disturbances.

Description

Fibromyalgia is more common than previously thought, with as many as 3–6% of the population affected by the disorder. Fibromyalgia is more prevalent in adults, with more women affected than men—particularly women aged 35 to 55. Fibromyalgia symptoms have often been characterized as psychosomatic in origin. Recent research has proved that belief false, and fibromyalgia is now regarded as a disorder that can be diagnosed and treated effectively with ongoing care and follow-up.

Causes and symptoms

The exact cause of fibromyalgia is not known. There are events that can precipitate the symptoms of fibromyalgia, including sports injuries, car accidents, falls , or other trauma to the body. Sometimes it occurs in several members of a family, suggesting that there may be an inherited tendency for the disorder. People with fibromyalgia are most likely to complain of three primary symptoms: pain in muscles, joints, and ligaments; stiffness; and excessive fatigue. Widespread, ongoing pain is characteristic of fibromyalgia. A careful history and physical examination may uncover additional areas of pain when the chief complaint lies in only one area of the body. The most significant area of pain may shift over time, and the pain can be intermittent.

Pain is the major symptom of fibromyalgia, with aches, tenderness, and stiffness of multiple muscles, joints, and soft tissues. The pain may also tend to move from one part of the body to another. It is most common in the neck, shoulders, chest, arms, legs, hips, and back. Although the pain is present most of the time and may last for years, the severity of the pain is variable and dependent on individual patient perception.

Symptoms of sleeplessness and overall fatigue may result from the individual's chronic pain, coupled with anxiety about the problem and how to find relief. The body's inflammatory response also produces chemicals in the brain that are known to contribute to fatigue. Other common symptoms are tension headaches , difficulty swallowing, recurrent abdominal pain, diarrhea (irritable bowel syndrome ), and numbness or tingling of the extremities. Stress , anxiety, depression , lack of dietary control, or lack of sleep can increase symptoms. Intensity of symptoms varies. Some patients gradually improve, while others have recurrent episodes of their symptoms.

Diagnosis

Diagnosis is difficult, and the disease may be overlooked because symptoms of fibromyalgia are vague and general. In addition, fibromyalgia may mimic symptoms of other diseases and conditions. Support staff should question the patient regarding sleep and exercise patterns, diet , and emotional conditions. Coexisting nerve and muscle disorders, such as rheumatoid arthritis , spinal arthritis, or Lyme disease , may further complicate the diagnostic process. Presently, there are no tests available to specifically diagnose fibromyalgia. The final diagnosis is frequently made after a period of time in which the physician observes the patient and rules out other medical conditions with similar symptoms.

Because of the emotional distress experienced by people with this condition and the influence of stress on the symptoms themselves, fibromyalgia has often been labeled a psychosomatic condition. Recognition of the underlying inflammatory process involved in fibro-myalgia has helped promote the validity of this disease. Nurses, nurse practitioners or physician's assistants should inquire into the emotional state of the patient, and be prepared to note it in the chart. Mental health consultation may be necessary due to depression or anxiety, and emphasis on the importance of a support group for fibromyalgia patients should be given.

In 1990, the America College of Rheumatology developed standards for fibromyalgia that health care practitioners can use to diagnose this condition. According to these standards, a person is thought to have fibromyalgia if he or she has widespread pain in combination with tenderness for at least three months in at least 11 of the 18 sites known as trigger points. Trigger point sites include the neck, spine, hip, elbow, knee, and shoulder.

Treatment

There is no known cure for fibromyalgia. Therefore, the goal of treatment is successful symptom management. Treatment usually requires a combination of therapies, including exercise, proper rest, and diet, and pharmacologic treatment. Patient education by the health care team is imperative so that the patient has a clear understanding of his or her role in the recovery process and the successful management of this condition.

Physical regimens found to be helpful include a regular stretching program and low-impact aerobic activities that increase the heart rate. Exercise programs should be approved by a physician or physical therapist , and include both warm-up and cool-down sessions, with special attention given to avoiding exercises that cause joint pain. Adequate rest is essential in the treatment of fibromyalgia.

Nutrition is an important component in the management of this condition. The patient's diet should include a wide variety of fruits and vegetables to provide the body with trace elements and minerals that are necessary for healthy muscles. Avoidance of stimulating drinks (such as coffee, tea, or any drink containing caffeine ), avoidance of alcohol (may lead to sleeplessness) and medications, such as decongestants, prior to bedtime is advised. If diet, exercise, and adequate rest do not relieve the symptoms of fibromyalgia, medication may be prescribed.

Medications that have been found to have some benefit include antidepressant drugs, muscle relaxants , and nonsteroidal anti-inflammatory drugs (NSAIDs).

People with fibromyalgia often need a rheumatology consultation (a meeting with a doctor who specializes in disorders of the joints, muscles, and soft tissue) to decide the cause of various rheumatic symptoms, to be educated about fibromyalgia and its treatment, and to exclude other rheumatic diseases. A physician must recommend a treatment program that is individualized to meet the patient's needs.

Alternative treatment

Massage therapy can be helpful, especially when a family member is instructed on specific massage techniques to manage episodes of increased symptoms. Specific attention to mental health, including behavior modification and psychological consultation, may also be important because depression and anxiety may precede or accompany an incident of fibromyalgia. Other alternative therapies, including homeopathic medicine , Chinese traditional medicine (both acupuncture and herbs), polarity therapy, and Western botanical medicine, can assist the person with fibromyalgia in day-to-day functioning and contribute to the alleviation of symptoms.

Prognosis

Fibromyalgia is a chronic condition, but causes no body damage or deformity. It does not cause damage to internal organs, as opposed to conditions such as rheumatoid arthritis, which leads to joint deformity. Treatment is based on the relief of symptoms, so a cure is not a realistic goal. Management of the condition may allow patients to return to a higher level of function at work, play, and home.

Caregiver concerns

Fibromyalgia can be a stressful and frustrating condition for a majority of patients. Successful treatment often requires a period of trial and error to pinpoint which agents and activities work best for the individual patient. Patience while waiting for diagnosis and treatment should be stressed by support staff, along with reassurance that the physician is working to find a treatment regimen that will provide relief. However, there is no set treatment that works for every patient. Even the process of diagnosing fibromyalgia can take time, which also leads to patient frustration. Therefore, support from the health care team and coordination of care through follow-up calls to outside health care providers is needed to avoid actually worsening the patient's condition due to undue stress. Nursing parameters are pain management, improved sleep management, introduction of relaxation techniques (including massage and biofeedback if needed), and monitoring alternative treatments and medication. There could be a wide variety of health care providers on a patient's health care team: nurses, physicians, a rheumatologist or other subspecialist, nutritionist, physical therapist, alternative medicine caregiver, or mental health care providers. This requires that the health care providers who most frequently see the patient coordinate and record in the patient's medical chart all treatments being undertaken at any given time. Coordination of care increases patient compliance, and may boost the patient's perception of his or her level of function. Patient education is an integral part of the treatment and management of fibromyalgia and its symptoms. Patients should be supported both physically and emotionally. Chronic pain may make it more difficult to communicate with a patient in a manner that promotes professionalism and optimal care. Constant cognizance of the treatment goals (to control pain and increase level of function) is needed, as well as positive reinforcement of compliance with treatment suggestions and monitoring of patient milestones.

Prevention

There is currently no way to specifically prevent fibromyalgia. However, adequate sleep and nutrition, stress management, safe levels of exercise, and annual check-ups are important in the avoidance of this condition.

Resources

PERIODICALS

“Information for Patients Living with Fibromyalgia.” American Family Physician 62, no. 7 (2000):1587.

Millea, P.J., and R.L. Holloway. “Treating fibromyalgia.” American Family Physician 62, no. 7 (2000): 1575–1587.

Wolfe, F., and H.A. Smythe, et al. “1990 Criteria for the Classification of Fibromyalgia.” American College of Arthritis and Rheumatology 33 (1990): 160–172.

OTHER

“Fibromyalgia: What it is and how to manage it.” http://www.familydoctor.org.

Michele R. Webb

Fibromyalgia

Definition

Fibromyalgia (formerly known as fibrositis) is an inflammation of the fibrous or connective tissue (muscles, joints, ligaments, and tendons) of the body. Widespread pain , fatigue, and multiple tender points characterize this condition. Other symptoms may include sleep disturbance, headache, and bowel disturbances.

Description

Fibromyalgia is more common than previously thought, with as many as 3–6% of the population affected by the disorder. Fibromyalgia is more prevalent in adults than children, with more women affected than men—particularly women aged 35 to 55. Fibromyalgia symptoms have often been characterized as psychosomatic in origin. Recent research has proved that belief false, and fibromyalgia is now regarded as a disorder that can be diagnosed and treated effectively with ongoing care and follow-up.

Causes and symptoms

The exact cause of fibromyalgia is not known. There are events that can precipitate the symptoms of fibromyalgia, including sports injuries , car accidents, falls , or other trauma to the body. Sometimes it occurs in several members of a family, suggesting that there may be an inherited tendency for the disorder. People with fibromyalgia are most likely to complain of three primary symptoms: pain in muscles, joints, and ligaments; stiffness; and excessive fatigue. Widespread, ongoing pain is characteristic of fibromyalgia. A careful history and physical examination may uncover additional areas of pain when the chief complaint lies in only one area of the body. The most significant area of pain may shift over time, and the pain can be intermittent.

Pain is the major symptom of fibromyalgia, with aches, tenderness, and stiffness of multiple muscles, joints, and soft tissues. The pain may also tend to move from one part of the body to another. It is most common in the neck, shoulders, chest, arms, legs, hips, and back. Although the pain is present most of the time and may last for years, the severity of the pain is variable and dependent on individual patient perception.

Symptoms of sleeplessness and overall fatigue may result from the individual's chronic pain, coupled with anxiety about the problem and how to find relief. The body's inflammatory response also produces chemicals in the brain that are known to contribute to fatigue. Other common symptoms are tension headaches, difficulty swallowing, recurrent abdominal pain, diarrhea (irritable bowel syndrome), and numbness or tingling of the extremities. Stress , anxiety, depression, lack of dietary control, or lack of sleep can increase symptoms. Intensity of symptoms varies. Some patients gradually improve, while others have recurrent episodes of their symptoms.

Diagnosis

Diagnosis is difficult, and the disease may be overlooked because symptoms of fibromyalgia are vague and general. In addition, fibromyalgia may mimic symptoms of other diseases and conditions. Support staff should question the patient regarding sleep and exercise patterns, diet, and emotional conditions. Coexisting nerve and muscle disorders, such as rheumatoid arthritis, spinal arthritis, or Lyme disease, may further complicate the diagnostic process. Presently, there are no tests available to specifically diagnose fibromyalgia. The final diagnosis is frequently made after a period of time in which the physician observes the patient and rules out other medical conditions with similar symptoms.

Because of the emotional distress experienced by people with this condition and the influence of stress on the symptoms themselves, fibromyalgia has often been labeled a psychosomatic condition. Recognition of the underlying inflammatory process involved in fibromyalgia has helped promote the validity of this disease. Nurses, nurse practitioners or physician's assistants should inquire into the emotional state of the patient, and be prepared to note it in the chart. Mental health consultation may be necessary due to depression or anxiety, and emphasis on the importance of a support group for fibromyalgia patients should be given.

In 1990, the America College of Rheumatology developed standards for fibromyalgia that health care practitioners can use to diagnose this condition. According to these standards, a person is thought to have fibromyalgia if he or she has widespread pain in combination with tenderness for at least three months in at least 11 of the 18 sites known as trigger points. Trigger point sites include the neck, spine, hip, elbow, knee, and shoulder.

Treatment

There is no known cure for fibromyalgia. Therefore, the goal of treatment is successful symptom management. Treatment usually requires a combination of therapies, including exercise, proper rest, and diet, and pharmacologic treatment. Patient education by the health care team is imperative so that the patient has a clear understanding of his or her role in the recovery process and the successful management of this condition.

Physical regimens found to be helpful include a regular stretching program and low-impact aerobic activities that increase the heart rate. Exercise programs should be approved by a physician or physical therapist, and include both warm-up and cool-down sessions, with special attention given to avoiding exercises that cause joint pain. Adequate rest is essential in the treatment of fibromyalgia.

Nutrition is an important component in the management of this condition. The patient's diet should include a wide variety of fruits and vegetables to provide the body with trace elements and minerals that are necessary for healthy muscles. Avoidance of stimulating drinks (such as coffee, tea, or any drink containing caffeine ), avoidance of alcohol (may lead to sleeplessness) and such medications as decongestants prior to bedtime is advised. If diet, exercise, and adequate rest do not relieve the symptoms of fibromyalgia, medication may be prescribed.

Medications that have been found to have some benefit include antidepressant drugs , muscle relaxants , and nonsteroidal anti-inflammatory drugs (NSAIDS).

People with fibromyalgia often need a rheumatology consultation (a meeting with a doctor who specializes in disorders of the joints, muscles, and soft tissue) to decide the cause of various rheumatic symptoms, to be educated about fibromyalgia and its treatment, and to exclude other rheumatic diseases. A physician must recommend a treatment program that is individualized to meet the patient's needs.

Alternative treatment

Massage therapy can be helpful, especially when a family member is instructed on specific massage techniques to manage episodes of increased symptoms. Specific attention to mental health, including behavior modification and psychological consultation, may also be important because depression and anxiety may precede or accompany an incident of fibromyalgia. Other alternative therapies, including homeopathic medicine, Chinese traditional medicine (both acupuncture and herbs), polarity therapy, and Western botanical medicine, can assist the person with fibromyalgia in day-to-day functioning and contribute to alleviation of symptoms.

Prognosis

Fibromyalgia is a chronic condition, but causes no body damage or deformity. It does not cause damage to internal organs, as opposed to conditions such as rheumatoid arthritis, which leads to joint deformity. Treatment is based on the relief of symptoms, so a cure is not a realistic goal. Management of the condition may allow patients to return to a higher level of function at work, play, and home.

Health care team roles

Fibromyalgia can be a stressful and frustrating condition for a majority of patients. Successful treatment often requires a period of trial and error to pinpoint which agents and activities work best for the individual patient. Patience while waiting for diagnosis and treatment should be stressed by support staff, along with reassurance that the physician is working to find a treatment regimen that will provide relief. However, there is no set treatment that works for every patient. Even the process of diagnosing fibromyalgia can take time, which also leads to patient frustration. Therefore, support from the health care team and coordination of care through followup calls to outside health care providers is needed to avoid actually worsening the patient's condition due to undue stress. Nursing parameters are pain management , improved sleep management, introduction of relaxation techniques (including massage and biofeedback if needed), and monitoring alternative treatments and medication. There could be a wide variety of health care providers on a patient's health care team: nurses, physicians, a rheumatologist or other subspecialist, nutritionist, physical therapist, alternative medicine caregiver, or mental health care providers. This requires that the health care providers who most frequently see the patient coordinate and record in the patient's medical chart all treatments being undertaken at any given time. Coordination of care increases patient compliance, and may boost the patient's perception of his or her level of function. Patient education is an integral part of the treatment and management of fibromyalgia and its symptoms. Patients should be supported both physically and emotionally. Chronic pain may make it more difficult to communicate with a patient in a manner that promotes professionalism and optimal care. Constant cognizance of the treatment goals (to control pain and increase level of function) is needed as and well as positive reinforcement of compliance with treatment suggestions and monitoring of patient milestones.

Prevention

There is currently no way to specifically prevent fibromyalgia. However, adequate sleep and nutrition, stress management, safe levels of exercise, and annual check-ups are important in the avoidance of this condition.

Resources

PERIODICALS

"Information for Patients Living with Fibromyalgia." American Family Physician 62, no. 7 (2000):1587.

Millea, PJ, Holloway RL. "Treating fibromyalgia." American Family Physician 62, no. 7 (2000):1575-1587.

Wolfe, F., and H.A. Smythe, et al. "1990 Criteria for the Classification of Fibromyalgia." American College of Arthritis and Rheumatology 33 (1990): 160-172.

OTHER

"Fibromyalgia: What it is and how to manage it." <http://www.familydoctor.org>.

Michele R. Webb