Johns Hopkins: Fibromyalgia: Understanding a Mysterious Ailment

Johns Hopkins: Fibromyalgia: Understanding a Mysterious Ailment

For years, fibromyalgia, which is characterized by fatigue and widespread pain, was considered a purely psychological condition. Now physicians understand that fibromyalgia involves the central nervous system; the brain controls the central nervous system, but this does not mean that symptoms are “all in your head.”

Physicians have been reporting symptoms of fibromyalgia since the 1800s, but it's only in the past few decades that the medical community has come to recognize and understand fibromyalgia as a unique condition. 
Fatigue; pain in the muscles, tendons, and ligaments; and multiple tender-to-the-touch spots are the most frequent and debilitating symptoms of fibromyalgia. Other common symptoms include: irritable bowel syndrome; headaches; temporomandibular joint (TMJ) dysfunction (“jawache”); oversensitivity to smells, noises, touch and light; depression, anxiety, and difficulty concentrating.
Fibromyalgia is often called a disease of exclusion because several conditions with comparable symptoms must be ruled out before fibromyalgia can be diagnosed. These include: underactive thyroid (hypothyroidism); rheumatoid arthritis (RA); polymyalgia rheumatica; lyme disease; lupus. 
Fibromyalgia overwhelmingly affects women. The condition may develop between the ages of 20 and 60. While the disease is chronic, it’s not progressive or life-threatening. 
It’s still not clear what causes fibromyalgia. Nerves register pain and these pain “signals” travel through the nerves and the spinal cord to the brain. Testing has found that fibromyalgia patients have overly sensitive pain receptors in their brain. Their brains also contain high levels of neurotransmitters that conduct pain signals. Possible explanations for what makes the brain more sensitive to pain include spinal trauma, bacterial or viral infection, chronic sleep disturbance, and nervous system malfunctions of unconscious actions (e.g., sweating, digestion, heartbeat).

Treating Fibromyalgia -- In June 2007, the drug Lyrica (pregabalin) became the first FDA-approved treatment for fibromyalgia. Previously approved as an anticonvulsant and to treat nerve pain from diabetes and shingles, pregabalin alters neurotransmitter levels in the brain. Though similar to pregabalin, gabapentin is not FDA approved for fibromyalgia; however, it may be prescribed off-label. 
Acetaminophen is the usual choice for lesser pains. Nonsteroidal antiinflammatory drugs probably won’t help, since fibromyalgia pain isn’t caused by inflammation. 
Strong prescription opioids can be used for severe fibromyalgia pain as a last resort. Benzodiazepines such as Klonopin (clonazepam) and Valium (diazepam) may help you sleep and relax muscles, but these drugs are usually not a doctor’s first choice because they can be addictive and their sedative effects can cause problems with balance.
Several complementary treatments, including exercise, have been reported to ease fibromyalgia. Muscle pain and fatigue may make exercising hard at first, but sticking with it will improve symptoms in the long run. Swimming and water exercises, which are easier on the joints, are especially good choices. Many people with fibromyalgia also try acupuncture, massage therapy, and chiropractic treatment. 
Finally, it’s important to find time to take it easy. Exercise and staying active matter, but so do getting enough rest and doing things that you find relaxing and enjoyable.

Posted in Arthritis on January 19, 2009