Fibromyalgia

People with fibromyalgia seem to have a heightened sensitivity to pain. That is, areas in their brain that process pain interpret painful sensations as being more intense than seems to occur in people who do not have fibromyalgia. Usually, the cause of fibromyalgia is unknown. However, certain conditions may contribute to developing the disorder. They include poor sleep, repetitive strains, or an injury. Mental stress may also contribute. However, the amount of stress may not be the problem. Rather it may be how people react to the stress.

Some affected people may also have a connective tissue disorder, such as rheumatoid arthritis or systemic lupus erythematosus (lupus). Sometimes a viral or other infection (such as Lyme disease or perhaps COVID-19 infection) or traumatic event can trigger fibromyalgia.

Most people feel a general achiness, stiffness, and pain. Symptoms can occur throughout the body. Any soft tissue (muscles, tendons, and ligaments) may be affected. But soft tissue of the neck, upper shoulders, chest, rib cage, lower back, thighs, arms, and areas around certain joints are especially likely to be painful. Less often, the lower legs, hands, and feet are painful and stiff. Symptoms may occur periodically (in flare-ups) or most of the time (chronically).

Pain may be intense. It usually worsens with fatigue, straining, or after overuse. Specific areas of muscle are often tender when firm fingertip pressure is applied. These areas are called tender points. During flare-ups, muscles become tight, or spasms may occur.

Many affected people do not sleep well and feel anxious, and sometimes depressed or tense. Fatigue is common, as are mental problems such as difficulty concentrating and a general feeling of mental cloudiness. Many affected people are perfectionists, or have a type A personality. They may also have migraines or tension headaches, interstitial cystitis (a bladder condition that may include pain when urinating), and irritable bowel syndrome (with some combination of constipation, diarrhea, abdominal discomfort, and bloating). People may have pins-and-needles sensations, typically affecting both sides of the body.

Symptoms can be made worse by a person's other disorders, such as an inflammatory arthritis (for example, rheumatoid arthritis) or sleep disturbances caused by obstructive sleep apnea or depression.

• Established criteria

• A doctor's examination and testing to rule out other disorders

Doctors suspect fibromyalgia in people who have the following:

• Generalized pain and tenderness

• Negative laboratory test results despite widespread symptoms

• Fatigue as a main symptom

Doctors consider the diagnosis of fibromyalgia in people who have had widespread pain for at least 3 months, particularly when it is accompanied by various other physical symptoms such as fatigue. Pain is considered widespread when people have pain in the left and right side of the body, above and below the waist, and in the top of the spine, wall of the chest or middle of the spine, or low back.

In the past, doctors based the diagnosis in part on the presence of tenderness at some of 18 designated tender points. Now, however, the number of tender points is not considered as important as the presence of typical symptoms, especially widespread pain not limited to the joints.

There is no diagnostic test for fibromyalgia. However, doctors want to be sure that another disorder (such as hypothyroidism, polymyalgia rheumatica, or another muscle disorder) is not causing the symptoms, often by doing blood tests. Blood tests can detect antinuclear antibodies (ANA), which are present in many people with connective tissue disorders, such as lupus. However, having a positive ANA test is so common, especially in women, that a positive test alone is not sufficient to diagnose the disease.

Fibromyalgia may not be easily recognized in people who also have rheumatoid arthritis, ankylosing spondylitis, or systemic lupus erythematosus because these disorders cause some similar symptoms, such as fatigue and pain in the muscles, joints, or both. However, a doctor's examination can often distinguish fibromyalgia from these disorders.

• Stretching, heat therapy, and massage

• Managing stress

• Medications to improve sleep

• Medications to relieve pain

People can feel better when treated appropriately. Usually, the most helpful approach includes the following:

• Reducing stress

• Deep breathing exercises, meditation, mindfulness-based cognitive therapy (MBCT), mental health support, and counseling

• Stretching the affected muscles gently (holding the stretch about 30 seconds and repeating it 5 times)

• Doing exercises regularly on a strict schedule to improve physical conditioning (aerobic exercises) and very gradually but steadily increasing the intensity (for example, by using a treadmill, exercise bicycle, or elliptical machine or by swimming)

• Applying heat to or gently massaging the affected area

• Getting enough sleep

Medications may be used together with exercise to improve sleep and manage stress.

Fibromyalgia tends to be chronic but may resolve on its own if stress decreases. Even with appropriate treatment, many people continue to have symptoms to some degree.