What is fibromyalgia?

Fibromyalgia is a painful condition that is not completely understood by medical experts. The cause of fibromyalgia is not known. It can make you feel tired and ache all over. It causes tender spots at specific points of the body that hurt only when you press on them. You may have trouble sleeping, as well as other symptoms. These problems can upset your work and home life.

Symptoms tend to come and go, although they may never go away completely. Fibromyalgia does not harm your muscles, joints, or organs.

Fibromyalgia involves a cycle of muscle pain and sensitivity to pain. Pain causes a person to become less active. This causes muscles to become more painful during activity. More pain then leads to even less activity. But symptoms can be controlled. And most people adjust to their symptoms and can keep doing daily activities.

The main symptoms of fibromyalgia are:

• Deep or burning pain in your muscles or joints. Pain can be in many places in your body.
• Tender points (or trigger points) on the body that hurt when pressed.

People with fibromyalgia may have other problems along with pain, such as:

• Anxiety or depression.
• Fatigue that gets in the way of work and daily activities.
• Sleep problems, such as trouble falling asleep or staying asleep, or waking up feeling tired.
• Headaches.
• Morning stiffness.
• Trouble thinking clearly.
• Irritable bowel syndrome.

Symptoms tend to come and go. You may have times when you hurt more, followed by times when symptoms happen less often, are milder, or are absent (remission). Some people find that their symptoms are worse in cold and damp weather, during times of stress, or when they try to do too much.

Treatment is focused on managing pain, fatigue, depression, and other symptoms common in fibromyalgia. The goal is to break the cycle of increased sensitivity to pain and decreased physical activity.

There are many steps you can take to manage your symptoms. The treatment you need or want may be based on:

• How bad your symptoms are.
• Whether the condition is disrupting your daily life.
• What kinds of changes in your life you are willing and able to make.

Because the symptoms of fibromyalgia can come and go, you may find it hard to judge whether a certain treatment is really working. Different people may respond differently to each type of treatment. Many people with fibromyalgia have other joint or muscle diseases (such as rheumatoid arthritis or lupus) that need to be treated too.

Try to be patient. Finding the right treatment can take time. You may have to try several different treatments to find an approach that works for you.

Exercise

Getting regular exercise, especially cardiovascular exercise, is one of the best ways to manage fibromyalgia. Pool exercise, like water aerobics or swimming, is a good example.

It's important to build up your exercise program slowly so you don't get sore muscles that cause you to want to stop exercising. Working with a physical therapist familiar with fibromyalgia may be helpful.

Medicines

Medicines are part of the long-term treatment of fibromyalgia. They may help you sleep better, relax your muscles, or relieve muscle and joint pain. Your doctor may suggest prescription medicines, such as antidepressants, muscle relaxants, and anticonvulsants. Or your doctor may suggest nonprescription pain relievers.

Not all people with fibromyalgia will need, want, or benefit from medicines. You might need to try more than one medicine before you find one that works best for you. You may also find that a medicine that has been helping your symptoms seems to not work as well over time.

Counseling

Cognitive behavioral therapy and other forms of counseling, including relaxation therapy and biofeedback, can help people who have fibromyalgia. Counseling can help with the pain of fibromyalgia. It can also help with sleep problems and fatigue. And it may improve your mood.

Self-care

Taking care of yourself is an important part of managing fibromyalgia. For example, you can:

• Identify sleep problems, if you have them. Then learn about ways to get more restful sleep.
• Relieve pain and stiffness with medicines and heat.
• Identify "triggers" that seem to make your symptoms worse. Then you can learn to avoid or manage them. Triggers may be a change in the weather, certain activities, stress, or a lack of sleep.
• Talk to your doctor if you have signs of depression or anxiety.

With help, you can start working on most of these goals at home. You may have a team of health professionals to help you.

There are no specific tests that can confirm a diagnosis of fibromyalgia. You will probably have lab tests to make sure that you don't have other conditions that cause pain. These include rheumatoid arthritis, polymyalgia rheumatica, lupus, and other autoimmune diseases. Your doctor will also ask questions about your medical history and do a physical exam.

Doctors use a set of guidelines to diagnose fibromyalgia. You may be diagnosed with fibromyalgia if you have:

• Widespread pain. Pain is widespread if it's above and below your waist and on the right and left sides of your body.
• Other symptoms such as fatigue, trouble sleeping, and trouble thinking.
• Symptoms that have lasted for at least 3 months.
• No other medical explanation for why you feel this way. (For example, you don't have another health condition or disease.)

Fibromyalgia is sometimes diagnosed or described using pain and tenderness at 18 specific spots on the body. These spots are called tender points. You may also hear these called trigger points.

Medicines are often part of the long-term treatment of fibromyalgia. They may help when symptoms flare up. But not all people with fibromyalgia will benefit from medicines.

Medicines may be used to improve sleep, relieve pain and fatigue, and (in some cases) treat depression. These improvements in symptoms may allow you to feel better and to be more active. Medicines used for fibromyalgia include:

• Cyclobenzaprine (Amrix).
• Antidepressants, such as duloxetine (Cymbalta), milnacipran (Savella), and amitriptyline (Elavil).
• Anticonvulsants (seizure medicines), such as pregabalin (Lyrica) and gabapentin (Neurontin).

Tramadol (Ultram) is sometimes used for pain. Sometimes it is combined with acetaminophen.

Your doctor may try more than one medicine before finding one that works best for your symptoms. Sometimes a medicine that has been helping your symptoms doesn't seem to work as well over time. Talk with your doctor if you aren't getting relief.

Health professionals who may be able to help you with fibromyalgia include:

• Family medicine physicians.
• Internists.
• Nurse practitioners.
• Physician assistants.

You may need to see a specialist who has experience with fibromyalgia. These include:

• Rheumatologists, who have the most experience with diagnosing fibromyalgia.
• Pain management specialists, who have experience with treatment.

Pain management programs can be helpful too. These typically include a team of doctors, counselors, physical therapists, nurses, and pharmacists who can help you develop a strategy for pain management. Your personal program may include medicines, complementary therapies, diet, exercise, and counseling.

• Exercise often. Walk, swim, or bike to help with pain and sleep problems and to make you feel better.
• Try to get a good night's sleep. Go to bed and get up at the same time each day, whether you feel rested or not. Make sure you have a good mattress and pillow.
• Reduce stress. Avoid things that cause you stress, if you can. If not, work at making them less stressful. Learn to use biofeedback, guided imagery, meditation, or other methods to relax.
• Make healthy changes. Eat a balanced diet, quit smoking, and limit alcohol and caffeine.
• Use a heating pad set on low or take warm baths or showers for pain. Using cold packs for up to 20 minutes at a time can also relieve pain. Put a thin cloth between the cold pack and your skin. A gentle massage might help too.
• Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. Your doctor may talk to you about taking antidepressant medicines. These medicines may improve sleep, relieve pain, and in some cases treat depression.
• Learn about fibromyalgia. This makes coping easier. Then, take an active role in your treatment.
• Think about joining a support group with others who have fibromyalgia to learn more and get support.

Certain things may make you more likely to have fibromyalgia. Things that increase your risk (risk factors) include:

• Being female.
• Having certain health problems, such as rheumatoid arthritis, lupus, mononucleosis, or depression.
• Having been through a traumatic event (such as a car accident).
• Having problems with sleep.
• Having a family history of fibromyalgia.

Exercise is one of the most important treatments for fibromyalgia. Regular exercise will strengthen your muscles, increase blood flow to the muscles, and increase your endurance. It also may reduce the risk of tiny injuries to the muscles that may cause more pain. Exercise may also help you sleep better and improve your overall sense of well-being.

Mild to moderate exercise is appropriate for most people with this condition. A balanced exercise program should include:

• Low-impact aerobic exercise, such as walking, swimming, biking, or water aerobics. This is the most helpful type of exercise for people who have fibromyalgia. That is because it builds general strength and endurance.
• Stretching exercises. This can help relax tight muscles and ease spasms.
• Strengthening exercises to build stronger muscles.

Moderate activity is safe for most people. But it's always good to talk to your doctor before you start an exercise program.

The pain and other symptoms of fibromyalgia can get worse during stressful times. The good news is that there are a lot of things you can do to lower your stress. For example, research shows that you can change how you think. And how you think affects how you feel.

Here are some techniques you can try on your own or with help from a therapist or counselor trained in muscle relaxation, meditation, biofeedback, or cognitive behavioral therapy:

• Biofeedback
• Breathing exercises for relaxation
• Cognitive behavioral therapy for pain management
• Guided imagery to relax
• Progressive muscle relaxation
• Mindfulness-based stress reduction
• Reframing negative thoughts

Complementary treatments that have been used to treat fibromyalgia include:

• Acupuncture.
• Chiropractic therapy.
• Dietary supplements, herbal products, and vitamins.
• Massage therapy.
• Meditation.
• Tai chi and qi gong.
• Yoga.

Most mind and body practices—such as acupuncture, tai chi, and yoga—are safe when used under the care of a well-trained professional. Choose an instructor or practitioner as carefully as you would choose a doctor.

No one knows for sure what causes fibromyalgia. But experts have some ideas. For example, nerve cells may be too sensitive. Or chemicals in the brain (neurotransmitters) may be out of balance.

Fibromyalgia is a condition that causes widespread pain in the muscles and soft tissues. This pain is felt above and below the waist and on both sides of the body. People with fibromyalgia feel pain, tenderness, or both even when there is no injury or inflammation. The pain can be long-lasting (chronic). But fibromyalgia isn't life-threatening, and it doesn't damage the muscles, joints, or internal organs.

Fibromyalgia is a syndrome or a set of symptoms that occur together. It has no cure. When it's not controlled, you may not have any energy. Or you may feel depressed or have trouble sleeping. But with treatment, most people with fibromyalgia are able to work and do their regular activities.