Fibromyalgia (pronounced fy-bro-my-AL-ja) is a complex chronic pain disorder that affects an estimated 2-4% of the world's population (~210 million in 2015; 3%). For example, In the United States, approximately 10 million Americans (3%) are afflicted with FM. While it occurs most often in women (80% women - 20% men), FM also strikes men and children of all ethnic backgrounds. For people with severe symptoms, fibromyalgia (FM) can be extremely debilitating and interfere with basic daily activities. Fibromyalgia is a condition which appears to involve disordered central afferent processing. This processing includes neuroplasticity (a physical change in the brain) that engages regions of the brain abnormally in processing external stimuli. The cause of FM remains uncertain.
- The FM diagnostic criteria, established by the American College of Rheumatology (ACR) in 1990, includes a history of widespread pain in all four quadrants of the body for a minimum duration of three months, and pain (not only tenderness) in at least 11 of the 18 designated tender points when 4 kg/cm2 or less pressure is applied. (The 1990 criteria was originally developed to standardize research of fibromyalgia.)
- In 2010, ACR diagnostic criteria recommended that focus on the number of tender points should be replaced by physician physical and interview examinations, including a widespread pain index (WPI) of the number of painful body regions. A diagnosis also includes scoring of cognitive symptoms, sleep disturbances, fatigue, and the number of of somatic (physical) symptoms. The category scoring is summed to create a symptom severity (SS) scale. The combination of the SS scale score and the WPI indicate a diagnosis of fibromyalgia where WP is greater than or equal to 7 and SS is greater than or equal to 5. (Click here for ACR excerpt of Preliminary Diagnostic criteria.)
- Developed in the late 1980s and later revised, the Fibromyalgia Impact Questionnaire, has been recognized for both research and clinical diagnosis criteria. (Click here for FIQR overview and scoring; click here for FIQR.)
- In 2013, the Fm/a test became available and is covered by some insurance companies for the diagnosis of fibromyalgia. (Click here for more information.)
- Using 1990 or 2010 criteria, the FIQR, and the Fm/a test is acceptable to make a diagnosis of FM.
- Since people with FM tend to look healthy and conventional tests are typically normal, a diagnosis by a physician knowledgeable about fibromyalgia is important.
- Physicians should rule out other causes of the symptoms before making a diagnosis of fibromyalgia.
- Fibromyalgia is a condition which appears to involve disordered central afferent processing. The major symptoms of FM include:
- chronic, widespread body pain
- moderate to severe fatigue
- sleep disorders and disturbances
- problems with cognitive functioning and memor.
Other symptoms may include:
- psychological distress (anxiety and depression)
- impaired functionality
- sensitivity to light, sound, and odors
- stiffness upon awakening
- sexual dysfunction
- stiffness after waking or resting for an extended period of time.
Often, overlapping conditions such as TMJD, IBS, headaches and migraines, anxiety and depression, and environmental sensitivities co-exist with fibromyalgia. Research has documented neuroendocrine physiological abnormalities that may contribute to the symptoms. Results of a recent NFMCPA/Oregon Health & Science University survey of people with fibromyalgia shows symptoms, helpful treatments, and problems other than pain. Please click here for Part I and Part II of the survey results.
- Recent research suggests a genetic component. The disorder is often seen in families, among siblings, or mothers and their children.
- Fibromyalgia often occurs following a physical trauma (especially involving the trunk), an acute illness (i.e., hepatitis C, Epstein-Barr virus, Lyme disease) or injury, which may act as a “trigger” in the development of the disorder.
- Environmental (psychological) stressors such as early life trauma and deployment to war are cited by experts as precipitating factors to developing FM.
- Increasing attention is being devoted to the central nervous system as the underlying mechanism of FM. Recent studies have suggested that FM patients have generalized disturbance in pain processing and an amplified response to stimuli that would not ordinarily be painful in healthy individuals.
- Since there is no known cure for FM, treatment focuses on relieving symptoms and improving function.
- A variety of prescription medications are often used to reduce pain levels and improve sleep. On June 21, 2007, the U.S. Food and Drug Administration approved Lyrica (pregabalin) as the first drug to treat fibromyalgia. Cymbalta (duloxetine HCl) was approved in June 2008; and Savella (milnacipran HCl) was approved in January 2009.
- Alternative therapies, such as massage, myofasical release, acupuncture, chiropractic, mindfulness, herbal supplements and yoga, can be effective tools in managing FM symptoms.
- Increasing rest, pacing activities, reducing stress, practicing relaxation and improving nutrition can help minimize symptoms and improve quality of life.
- The course of the illness varies greatly. While symptoms tend to wax and wane, most FM patients tend to improve over time with a multi-discplinary (integrative) team approach including patient education about fibromyalgia, self-management tools, low-impact exercise (start low, go slow), behavioral therapy and pharmacological therapies.
- Fibromyalgia sufferers should be reassured that although the condition is painful, it does not damage tissues; appropriate treatment and lifestyle changes can help patients manage the illness successfully.
- Better ways to diagnose and treat FM are on the horizon. Research and increased awareness are helping to improve the quality of life for people with FM.
- Early diagnosis and management leads to better symptom management and diminishes progression of the condition if left untreated.
- There is no known cure for fibromyalgia.
About the National Fibromyalgia & Chronic Pain Association
- The National Fibromyalgia and Chronic Pain Association (NFMCPA) is a non-profit 501(c)3 organization whose mission is to build a united patient and health care community to create a strong voice and organizational base to educate and execute advocacy programs regarding access to care, research, diagnosis and treatment for people suffering with chronic pain from fibromyalgia and overlapping conditions.