this website was helpful, Please Click
Fibromyalgia (FMS) is one of the most common
rheumatic syndromes and mimics symptoms of other chronic diseases such
as chronic fatigue syndrome (CFS) in which there is increased urinary
frequency and lethargy in people typically between the ages of 20 to 50
years old. FMS patients tend to be bothered by considerable muscular
aching pain and burning, but joints may not be directly affected as in
matter Quick Links for this
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.
You may wonder what exactly rheumatic means. Even physicians do not
always agree on whether a disease is considered rheumatic. If you look
up the word in the dictionary, you'll find it comes from the Greek word
rheum, which means flux—not an explanation that gives you a better
understanding. In medicine, however, the term rheumatic means a medical
condition that impairs the joints and/or soft tissues and causes
In addition to pain and fatigue, people who have fibromyalgia may
People with certain rheumatic diseases, such as rheumatoid
lupus erythematosus (commonly called lupus), or ankylosing
spondylitis, (spinal arthritis) may be more likely to have
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 hereditary or caused by
environmental factors or both—is unknown. One study supported by the
National Institute of Arthritis and Musculoskeletal and Skin Diseases
(NIAMS) is trying to identify if certain genes predispose some people
Many researchers are examining other causes, including problems with
how the central nervous system (the brain and spinal cord) processes
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. However, those genes—if they, in fact, exist—have not been
A doctor familiar with fibromyalgia, however, can make a diagnosis
based on two criteria established by the ACR: a history of widespread
pain lasting more than 3 months and the presence of tender points. Pain
is considered to be widespread when it affects all four quadrants of
the body; that is, you must have pain in both your right and left sides
as well as above and below the waist to be diagnosed with fibromyalgia.
The ACR also has designated 18 sites on the body as possible tender
points. For a fibromyalgia diagnosis, a person must have 11 or more
tender points. (See illustration on page 5.) One of these predesignated
sites is considered a true tender point only if the person feels pain
upon the application of 4 kilograms of pressure to the site. 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
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,
At present, there are no medications approved by the U.S. Food and Drug
Administration (FDA) for treating fibromyalgia, although a few such
drugs are in development. Doctors treat fibromyalgia with a variety of
medications developed and approved for other purposes. See
more about Pharmaceutical drugs here.
Following are some of the most commonly used categories of drugs for
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.
Perhaps the most useful medications for fibromyalgia are several in the
antidepressant class. Antidepressants elevate the levels of certain
chemicals in the brain, including serotonin and norepinephrine (which
was formerly called adrenaline). Low levels of these chemicals 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.
Tricyclic antidepressants have been around for almost half a century.
Some examples of tricyclic medications used to treat fibromyalgia
include amitriptyline hydrochloride (Elavil, Endep), cyclobenzaprine
(Cycloflex, Flexeril, Flexiban), doxepin (Adapin, Sinequan), and
nortriptyline (Aventyl, Pamelor). Both amitriptyline and
cyclobenzaprine have been proved useful for the treatment of
• Selective serotonin reuptake inhibitors - If a
tricyclic antidepressant fails to bring relief, doctors sometimes
prescribe a newer type of antidepressant called a selective serotonin
reuptake inhibitor (SSRI). As with tricyclics, doctors usually
prescribe these for people with fibromyalgia in lower dosages than are
used to treat depression. By promoting the release of serotonin, these
drugs may reduce fatigue and some other symptoms associated with
fibromyalgia. The group of SSRIs includes fluoxetine (Prozac),
paroxetine (Paxil), and sertraline (Zoloft).
SSRIs may be prescribed along with a tricyclic
antidepressant. Doctors rarely prescribe SSRIs alone. Because they make
people feel more energetic, they also interfere with sleep, which often
is already a problem for people with fibromyalgia. Studies have shown
that a combination therapy of the tricyclic amitriptyline and the SSRI
fluoxetine resulted in greater improvements in the study participants'
fibromyalgia symptoms than either drug alone.
• Mixed reuptake inhibitors -
Some newer antidepressants raise levels of both serotonin and
norepinephrine, and are therefore called mixed reuptake inhibitors.
Examples of these medications include venlafaxine (Effexor) and
nefazadone (Serzone). Researchers are actively studying the efficacy of
these newer medications in treating fibromyalgia.
In addition to the previously described general categories of drugs,
doctors may prescribe others, depending on a person's specific symptoms
or fibromyalgia-related conditions. For example, in recent years, two
medications— tegaserod (Zelnorm) and alosetron (Lotronex) - have been
approved by the FDA for the treatment of irritable bowel syndrome.
Gabapentin (Neurontin) currently is being studied as a treatment for
fibromyalgia. 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, diet
and dietary supplements for different fibromyalgia symptoms.
Though some of these supplements are being studied
for fibromyalgia, there is little, if any, scientific proof yet that
they help. The FDA does not regulate the sale of dietary supplements,
so information about side effects, the proper 12 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.
- Though pain and fatigue may make exercise and daily activities
difficult, it's crucial to be as physically active as possible.
Research has repeatedly shown that regular exercise is one of the most
effective treatments for fibromyalgia. People who have too much pain or
fatigue to do vigorous exercise should begin with walking or other
gentle exercise and build their endurance and intensity slowly.
Although research has focused largely on the benefits of aerobic and
flexibility exercises, a new NIAMS-supported study is examining the
effects of adding strength training to the traditionally prescribed
aerobic and flexibility exercises.
• Making changes at work - Most people with
fibromyalgia continue to work, but they may have to make big changes to
do so; for example, some people cut down the number of hours they work,
switch to a less demanding job, or adapt a current job. If you face
obstacles at work, such as an uncomfortable desk chair that leaves your
back aching or difficulty lifting heavy boxes or files, your employer
may make adaptations that will enable you to keep your job. An
occupational therapist can help you design a more comfortable
workstation or find more efficient and less painful ways to lift.
If you are unable to work at all due to a medical condition, you may
qualify for disability benefits through your employer or the Federal
• Eating well
- Although some people with fibromyalgia
report feeling better when they eat or avoid certain foods, no specific
diet has been proven to influence fibromyalgia. Of course, it is
important to have a healthy, balanced diet. Not only will proper
nutrition give you more energy and make you generally feel better, it
will also help you avoid other health problems.
• Avoid caffeine and alcohol in the late afternoon
and evening. If consumed too close to bedtime, the caffeine in coffee,
soft drinks, chocolate, and some medications can keep you from sleeping
or sleeping soundly. Even though it can make you feel sleepy, drinking
alcohol around bedtime also can disturb sleep.
• Time your exercise. Regular daytime exercise can
improve nighttime sleep. But avoid exercising within 3 hours of
bedtime, which actually can be stimulating, keeping you awake.
• Avoid daytime naps. Sleeping in the afternoon can
interfere with nighttime sleep. If you feel you can't get by without a
nap, set an alarm for 1 hour. When it goes off, get up and start
• Reserve your bed for sleeping. Watching the late
news, reading a suspense novel, or working on your laptop in bed can
stimulate you, making it hard to sleep.
• Keep your bedroom dark, quiet, and cool.
• Avoid liquids and spicy meals before bed.
Heartburn and latenight trips to the bathroom are not conducive to good
• Wind down before bed.
Avoid working right up to bedtime. Do relaxing activities, such as
listening to soft music or taking a warm bath, that get you ready to
sleep. (An added benefit of the warm bath: It may soothe aching
The NIAMS sponsors research that will
improve scientists' understanding of the specific problems that cause
or accompany fibromyalgia, in turn helping them develop better ways to
diagnose, treat, and prevent this syndrome.
The research on fibromyalgia supported by NIAMS covers a broad
spectrum, ranging from basic laboratory research to studies of
medications and interventions designed to encourage behaviors that
reduce pain and change behaviors that worsen or perpetuate pain.
Following are descriptions of some of the promising research now being
• Understanding pain - Because research suggests
that fibromyalgia is caused by a problem in how the body processes
pain—or more precisely, a hypersensitivity to stimuli that normally are
not painful—several NIAMS-supported researchers are focusing on ways
the body processes pain to better understand why people with
fibromyalgia have increased pain sensitivity.
Previous research has shown that people with fibromyalgia have reduced
blood flow to parts of the brain that normally help the body deal with
pain. In one new NIAMS-funded study, researchers will be using imaging
technology called positron emission tomography (PET) to compare blood
flow in the brains of women who have have fibromyalgia with those who
do not. In both groups, researchers will study changes in blood flow
that occur in response to painful stimuli.
Researchers speculate that female reproductive hormones may be involved
in the increased sensitivity to pain characteristic of fibromyalgia.
New research will examine the role of sex hormones in pain sensitivity,
in reaction to stress, and in symptom perception at various points in
the menstrual cycles of women with fibromyalgia and of women without
it. The results from studying these groups of women will be compared
with results from studies of the same factors in men without
fibromyalgia over an equivalent period of time.
Another line of NIAMS-funded research involves developing a rodent
model of fibromyalgia pain. Rodent models, which use mice or rats that
researchers cause to develop symptoms similar to fibromyalgia in
humans, could provide the basis for future research into this complex
• Understanding stress - Medical evidence suggests
that a problem or problems in the way the body responds to physical
and/or emotional stress may trigger or worsen the symptoms of any
illness, including fibromyalgia. Researchers funded by NIAMS are trying
to uncover and understand these problems by examining chemical
interactions between the nervous system and the endocrine (hormonal)
system. Scientists know that people whose bodies make inadequate
amounts of the hormone cortisol experience many of the same symptoms as
people with fibromyalgia, so they also are exploring if there is a link
between the regulation of the adrenal glands, which produce cortisol,
Another NIAMS-funded study suggests that exercise improves the body's
response to stress by enhancing the function of the pituitary and
adrenal glands. The hormones produced by these two endocrine glands are
essential to regulating sleep and emotions, as well as processing pain.
• Improving sleep - Researchers supported by NIAMS
are investigating ways to improve sleep for people with fibromyalgia
whose sleep problems persist despite treatment with medications. One
team has observed that fibromyalgia patients with persistent sleep
problems share characteristics with people who have insomnia, such as
having erratic sleep and wake schedules and spending too much time in
bed. This team is testing whether strategies developed to help insomnia
patients will also help people with fibromyalgia achieve deep sleep,
which eases pain and fatigue. Preliminary results show that sleep
education, which teaches good sleep habits, and cognitive behavioral
therapy, which includes sleep education and a regimen to correct poor
habits and improper sleep schedules, both reduce insomnia.
• Looking for the family connection - Because
fibromyalgia appears to run in families, one group of NIAMS-supported
researchers is working to identify whether a gene or genes predispose
people to the condition.
Another team is trying to determine if fibromyalgia is more common in
people with other conditions, such as serious mood disorders, that tend
to run in families. Specifically, the group is studying the prevalence
of psychiatric disorders and arthritis and related disorders in people
with fibromyalgia and their first-degree relatives (parents, children,
sisters, brothers) as compared to people with rheumatoid arthritis and
their relatives. The group is exploring whether clusters of conditions
exist in families, which might shed light on shared common risk factors
or disease processes.
• Studying and targeting treatments - NIAMS
recently funded its first study of a drug treatment for fibromyalgia.
The study will measure the effectiveness of gabapentin, an
anticonvulsant medication, in reducing symptoms of fibromyalgia.
Gabapentin has been found to relieve chronic pain caused by nervous
system disorders, and it was recently approved by the FDA for the
treatment of persistent, severe pain that can follow an episode of
Scientists recognize that people with fibromyalgia often fall into
distinct subgroups that adapt to and cope with their symptoms
differently. They also realize that these subgroups may respond to
treatments differently. One NIAMS-funded team of researchers has
divided people with fibromyalgia into three groups based on how they
cope with the condition. Relative to other chronic pain patients, those
in the first group have higher levels of pain and report more
interference in their life due to pain. They also have higher levels of
emotional distress, and feel less control over their lives and are less
active. The second group reports receiving less support from others,
higher levels of negative responses from significant others, and lower
levels of supportive responses from significant others. Those in the
third group are considered adaptive copers; they have less pain, report
less interference in their lives due to pain, and have less emotional
distress. Members of this last group feel more control over their lives
and are more active. On the premise that the better you understand the
subgroups, the better you can tailor treatments to fit them, the
researchers now are trying to design and test different programs for
each group, combining physical therapy, interpersonal skills training,
and supportive counseling.
The mission of the National
Institute of Arthritis
and Musculoskeletal and Skin Diseases (NIAMS), a part of the 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 the
NIAMS that provides health information and information sources.
Map | CONTACT