Fibromyalgia is one of the most poorly understood, chronic, highly variable and devastating diagnoses that exist in the modern medical lexicon. Unfortunately, while there are a number of potential treatments available, they are focused only on treating the symptoms (and not the cause) and often can meet with little success. Because of this, it is not uncommon for people living with a diagnosis of fibromyalgia to become very disheartened and frustrated. The principal features of fibromyalgia (although they are much-debated within the medical community) include:

• Pain – for at least 3 months, widespread, on both sides of the body, above and below the waist, in at least 11 of 18 pre-determined “trigger points” and also in the spine and/or ribcage.
• Persistent fatigue, even after a full night’s sleep, and problems with sleep (insomnia, etc.).
• Morning stiffness
• Many patients diagnosed with fibromyalgia also report depression, chronic headache, numbness, and gastrointestinal symptoms (these can include diarrhea, constipation, abdominal discomfort, etc. – symptoms consistent with irritable bowel syndrome, or IBS).

What causes fibromyalgia? This remains unknown. But hypotheses included changes in pain perception and regulation, changes in muscle tissue, infection (fibromyalgia has been noted in patients diagnosed with certain viral infections, Lyme disease, and HIV), surgery and other types of trauma. A psychological or psychiatric component and a relationship with chronic illness are also postulated. Since the diagnostic criteria are debated, the exact number of people living with fibromyalgia is also debated, but estimates generally range from 2-3 out of every 100 people. Women are about 9 times more likely than men to be affected, however, and middle-age is the most commonly affected age group. There is no known genetic link, at this point, but research continues to uncover a hereditary component.

Lab testing is employed most often to eliminate other diagnoses. This includes tests of thyroid function (thyroid-stimulating hormone, or TSH, levels, T3 and T4 levels), erythrocyte sedimentation rate (ESR or “sed rate”) and rheumatoid factor levels (these can be elevated in rheumatoid arthritis and other autoimmune disorders), and tests for Lyme disease, HIV, or other infections. Treatments for fibromyalgia are varied, and can include:

• Pain relievers – nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and stronger pain relievers can help certain patients. Certain muscle-relaxing agents and antidepressants have also been useful to treat the pain associated with this disease.
• Problems associated with sleep have been treated with antidepressants, as well as instituting good sleep “hygiene” practices (having a fixed bedtime hour, no reading/TV in bed, a good sleeping environment, etc.).
• Depression – this can be treated similarly as above, with antidepressants from the serotonin and norepinephrine reuptake inhibitor class (SNRIs) showing the most promise at present.
• Support – fibromyalgia can be effectively treated and lived with, and support from family, friends, and healthcare providers is an essential component to successful treatment.
• Exercise – both light aerobic exercise (walking, etc.) and stretching can really help patients with fibromyalgia.
• Other – stress management, elimination of alcohol intake, and development of active and effective self-management techniques (often achieved through therapy) can also help. In addition, “alternative” therapies like massage, acupuncture, meditation and other relaxation techniques have also been shown to be of some benefit.

Is treatment effective? Yes, it most certainly can be. Patients can benefit, as well, from including exercise in their regimen, and can feel substantially better if their sleep disturbances are well-controlled. Although fibromyalgia can be a persistent and vexing diagnosis, it can also, with proper treatment, be one that can be lived with successfully. Additional resources are available. They include:

• The American College of Rheumatology has produced guidelines on the classification and diagnosis of fibromyalgia, available at http://www.rheumatology.org/publications/classification/fibro.asp and http://www.rheumatology.org/publications/guidelines/musc/musc-dis.asp
• The American Academy of Family Physicians has also produced a very readable article on the treatment of fibromyalgia, available at http://www.aafp.org/afp/20001001/1575.html
• The Fibromyalgia Network has a variety of useful information available on symptoms, treatment, and current research. Available at: http://www.fmnetnews.com
• The American Fibromyalgia Syndrome Association also has some valuable links as well as information on current research. Available at: http://www.afsafund.org

Finally, there are many, many other internet sources of “information” about fibromyalgia, but much of what is out there is not necessarily reliable. Be very careful in what you read and believe. In addition to just being inaccurate, it is also common for many web sites or other sources of information about fibromyalgia to also include additional symptoms that are not part of the clinical definition of fibromyalgia, which is well-defined. - Jonathan Fay, M.D., September 26, 2006.

Dr. Fay is a personal medical consultant, providing answers to patients' questions about their health, diagnosis, and well-being (available on the internet at http://www.doctorfay.com). He has helped thousands to better understand their health, and to be in a far better position to be highly involved in their own healthcare. As such, patients can make better decisions about treatment options, that better fit their own personal preferences (and not those of their physician, another provider, or anyone else). Dr. Fay is also the author of numerous articles about the state of healthcare today in the United States, new developments in medicine, and articles to help explain medical treatments and diagnoses in terms that patients can easily understand.