Fibromyalgia: What You Need to Know
Fibromyalgia is not always easy to diagnose and can be confused with other conditions
Nadia Benlarbi, 52, received a fibromyalgia diagnosis in 2001 at age 32. A year before that, the Brooklyn, N.Y. resident was hit by a car in 2000 as a pedestrian. She says her doctor believed the constant stress of the pain from her back and neck from soft tissue injuries from the accident triggered her fibromyalgia.
What is Fibromyalgia and Who Has It?
The CDC (Centers for Disease Control and Prevention) website defines fibromyalgia as "a condition that causes pain all over the body (also referred to as widespread pain), sleep problems, fatigue and often emotional and mental distress."
Symptoms can also include headaches (including migraines) and problems with thinking, memory and concentration. Having a parent or sibling with fibromyalgia increases the chances of developing it.
According to the Mayo Clinic's website, symptoms often begin after "physical trauma, surgery, infection or significant psychological stress," but may "gradually accumulate over time with no single triggering event."
Benlarbi says the injuries from the accident feel worse when she has a flare-up of her fibromyalgia, which causes constant pain and skin sensitivity. She says that stress is a trigger for her flare-ups.
"Some patients with this illness have depression and anxiety and were often viewed as having psychiatric, and not medical, illness."
The CDC reports that about four million adults (about 2%) in the U.S. have fibromyalgia and it affects women twice as often as men. Dr. Houman Danesh, director of integrative pain management for the Mount Sinai Health System in New York City says, "Most of the diagnoses are made in women at around ninety percent. However, men may actually account for as many as forty percent of cases."
Dr. Bruce Solitar, chief of rheumatology at NYU Langone's Tisch Hospital in New York City says, "Fibromyalgia is underdiagnosed in men. One reason is that men tend to be less tender in general than women and less likely to have classic tender points."
Sometimes doctors will give male patients a lot of tests to look for conditions other than fibromyalgia, when the correct diagnosis should be fibromyalgia, he adds.
Difficult to Diagnose
Fibromyalgia was once diagnosed by checking 18 points on the body to see if pressure made them worse (a tender point exam). "The main factor needed for a fibromyalgia diagnosis is widespread pain throughout your body for at least three months," according to the Mayo Clinic website.
Danesh says, "You should see your doctor if you have been experiencing pain for two months and it's limiting things you want to do or enjoy doing."
"We have learned in the last ten years or so that fibromyalgia is caused by abnormal pain processing often related to increased release of substance P (a neurotransmitter and a modulator of pain perception) within the spinal cord and reduced levels of serotonin and neoepinephrine in the brain," Solitar explains. "There is now significant evidence that fibromyalgia is a medical illness caused by abnormal neuro transmission."
"As fibromyalgia patients age, they will develop arthritis or structural problems like back pain that worsen their overall pain and cause fibromyalgia to become more symptomatic."
During an office visit, the physician will take a medical history, do a physical exam and order X-rays and blood work. If the doctor suspects sleep apnea, they may order a sleep study. It's also helpful to see a rheumatologist or a team of health care providers who specialize in fibromyalgia.
"Because the illness typically has no abnormal physical findings other than tenderness and because there are typically no laboratory findings, the illness was often dismissed as being psychosomatic," Solitar says. "Some patients with this illness have depression and anxiety and were often viewed as having psychiatric, and not medical, illness."
This may explain why some physicians have considered women's symptoms all in their heads.
"Fibromyalgia symptoms may mirror muscle pain, trigger points and joint pain," Danesh adds. "Other conditions such as hypothyroidism sometimes mimic fibromyalgia, and sometimes fibromyalgia is confused with rheumatoid arthritis or lupus or polymyalgia rheumatica. A blood test can help differentiate this."
Most fibromyalgia diagnoses occur at middle age and while the condition peaks in the 50s, people can have symptoms in their 60s and 70s, according to Danesh. In fact, according to the CDC, "you are more likely to have fibromyalgia as you get older." If you have lupus or rheumatoid arthritis (RA), you are at risk for developing fibromyalgia.
"As fibromyalgia patients age, they will develop arthritis or structural problems like back pain that worsen their overall pain and cause fibromyalgia to become more symptomatic," Solitar explains. "It is also important in older patients to look for other causes of pain and not assume that all pain is a manifestation of fibromyalgia."
Standard and Non-Traditional Treatments for Fibromyalgia
Danesh reports that fibromyalgia treatment includes over-the-counter medications like acetaminophen, ibuprofen or naproxen sodium for pain relief. There are also medicines that can help sleep problems, and antidepressants can ease pain and fatigue.
"In general, research on complementary health approaches for fibromyalgia is preliminary."
Anti-seizure medications may help with pain or other symptoms. "Recent breakthroughs in treating fibromyalgia with medication include duloxetine, milnacipran and amitriptyline and cyclobenzaprine and the gabapentin family of drugs," Danesh reports. Gabapentins can reduce the excitability of nerve cells in the brain, according to The Cleveland Clinic's website.
The Mayo Clinic website recommends physical therapy, occupational therapy and stress management. Some non-traditional treatments, also known as complementary, alternative, or integrative therapies, can be helpful to treat the pain and stress associated with fibromyalgia.
Danesh reports that these non-traditional treatments include "increase activity, cardio, relaxation, hypnosis, biofeedback, stretching, acupuncture, graded exercise therapy and massage."
He adds that it's also helpful to get seven to eight hours of sleep each night and keep hydrated.
The National Center for Complementary and Integrative Health (NCCIH), a branch of the National Institutes of Health, suggests that deep breathing and meditation can help with managing stress, as well as avoiding tobacco products, limiting caffeine and eating healthy foods.
"In general, research on complementary health approaches for fibromyalgia is preliminary," the NCCIH reports. There is some evidence, though, that vitamin D, Tai Chi, massage, and myofascial release may be helpful in treating fibromyalgia.