Getting the facts on fibromyalgia

Fibromyalgia affects millions of Americans every year, particularly women over 20 . . .

Fibromyalgia is the most common cause of generalized musculoskeletal pain in women between 20 and 55 years old in the United States. It affects two percent of people by age 20 and eight percent by age 70.

Fibromyalgia is more common in women than men. Most people initially develop symptoms between the ages of 30 and 55. The chance of developing fibromyalgia is increased eightfold in family members of a person with fibromyalgia compared to the general population.

The disease is a chronic pain disorder that affects connective tissues including muscles, bones and tendons. It causes widespread muscle pain “myalgia” and excessive tenderness in many areas of the body. Other common symptoms of fibromyalgia include fatigue, sleep disturbances, headaches and mood and anxiety disorders.

Various physical and emotional factors may play a role in triggering symptoms, and there are no visible abnormalities in muscles and soft tissues. Muscles and tendons are excessively irritated by various painful stimuli; this is thought to be a result of change in pain perception in a phenomenon called “central sensitization.”

There is no generally agreed upon explanation for how or why central sensitization develops. The most plausible theory suggests that some people have a genetic predisposition to fibromyalgia. In other people, various stressors — including infection, physical or emotional trauma, sleep disturbances or other medical conditions — predispose for the development of fibromyalgia. Indicators include:

• The primary symptom is widespread (diffuse), chronic and persistent pain.

• Pain may be deep muscular aching, soreness, stiffness, burning or throbbing.

• One may also feel numbness, tingling or “crawling” sensations.

• Pain may be present but vary in intensity and is aggravated by certain conditions such as anxiety or stress, poor sleep, exertion or exposure to cold or dampness.

• Muscle stiffness is present upon awakening and may improve throughout the day.

• Certain “tender points” feel painful even with slight pressure.

Patients with fibromyalgia are often affected by other pain syndromes, including migraines or muscular headaches, irritable bowels, interstitial cystitis/painful bladder, and facial and jaw pain or tenderness caused by TMJ. Persistent fatigue occurs in more than 90% of patients. They suffer from light, unrefreshing or nonrestorative sleep.

There appears to be a close relationship between fibromyalgia and chronic fatigue syndrome (CFS). Up to 70% of patients with fibromyalgia fulfill criteria for CFS. Most people with fibromyalgia have major depression at the time of their diagnosis. The incidence of depression in patients with fibromyalgia is 74% over a lifetime, and the incidence of anxiety is 60% over a lifetime.

There are no specific laboratory or imaging tests used to make the diagnosis. Diagnosis is based upon a thorough history, physical examination and blood tests, which are used to exclude conditions with similar symptoms.

Some of the conditions that share generalized muscle aches and fatigue include rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis, ankylosing spondylitis, polymyalgia rheumatica, hypothyroidism, myositis and some neurological disorders.

The American College of Rheumatology developed a classification criteria for fibromyalgia: Widespread musculoskeletal pain and excessive tenderness in at least 11 of 18 specific sites known as “tender points.”

Susan Locke, MD, is Healthnetwork Foundation’s Medical Director.

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