Physician Focus: July 2011
By James Figueroa, M.D.
Fibromyalgia has been a misunderstood disease, sometimes described
as a "myth." Three decades ago, scarce science existed to support
fibromyalgia as an authentic disease, but the medical profession
has begun to understand more about it and how patients can be
successfully treated.
Fibromyalgia is a common syndrome in which people experience
long-term, body-wide pain in the form of "tender points" in
muscles, tendons, and other soft tissues. Besides an amplified
sensation of pain, patients can have a heightened sense of hearing,
touch, taste and visual perception.
The condition can have multiple causes, including mononucleosis,
Lyme disease, connective tissue disease (arthritis or lupus),
hormonal imbalance (hypothyroidism), excessive stress, depression,
anxiety, and Post Traumatic Stress Disorder (PTSD).
Traditionally considered to be a form of soft tissue rheumatism,
it has become increasingly clear that fibromyalgia is more complex.
It is now identified as a musculoskeletal condition related to the
body's central nervous system. No lab test or x-ray can indicate a
person has fibromyalgia, and many physicians are not trained in
diagnosing the disease. However, a trained rheumatologist, or
physician trained in diagnosing fibromyalgia, can do so.
In 1990, the American College of Rheumatology set the criteria
for a diagnosis: a history of at least three months of widespread
pain, and pain and tenderness in at least 11 of 18 "tender
points." These sites include fibrous tissue or muscles found
in the soft tissue on the back of the neck, shoulders, sternum,
lower back, hips, shins, elbows, and knees. The pain, which can
range from mild to severe, then spreads out from these areas and is
described as deep-aching, radiating, gnawing, shooting or
burning.
The actual manifestation of fibromyalgia is frequently
characterized by the presence of these symmetrically located
"tender points" throughout the body, overwhelming fatigue, and a
host of other symptoms, such as headache, irritable bowel or
bladder, problematic memory and concentration, numbness and
tingling in hands and legs, depression, anxiety, and profound
insomnia.
Fatigue and problems with sleep are seen in almost all patients
with fibromyalgia. Many complain they can't get to sleep or stay
asleep, and they feel tired when they wake up, with body aches and
stiffness. Clinically, the appearance of fibromyalgia strongly
suggests the need for a more detailed sleep history. For some
patients, pain improves during the day and increases again during
the evening, though many patients have day-long, non-stop pain.
Pain can increase with activity, cold or damp weather, anxiety, and
stress.
Fibromyalgia is most common among women aged 20 to 50, many with
serious, complex, underlying medical conditions that must be
diagnosed if the patient is to see any relief.
The latest trend in treating fibromyalgia is using multiple drug
therapy to control or manage the disease. Like treating
diabetics or people with high blood pressure, sometimes numerous
medications are needed to fit the patient's symptoms. What is best
is to treat the underlying cause of the problem.
Improving restorative sleep can reduce the symptoms. In
addition, the Food and Drug Administration has approved three
medications to treat fibromyalgia. The end result is not a cure,
but rather a means to contain the symptoms. Patients may require
ongoing medications for the rest of their lives, but sometimes only
intermittently.
Anyone experiencing the symptoms of fibromyalgia should seek
professional help that includes a multi-faceted approach to the
management and treatment of the disease. A visit to your primary
care physician would be the first step, with a referral to a
rheumatologist for further treatment. For more information on this
disease, visit the American College of Rheumatology at www.rheumatology.org.
James P. Figueroa, M.D., is a rheumatologist practicing at
Harrington Hospital in Southbridge, Mass. Physician Focus is a
public service of the Massachusetts Medical Society. Readers should
use their own judgment when seeking medical care and consult with
their physician for treatment. Send comments to PhysicianFocus@mms.org
