Fibromyalgia is a medical disorder characterized by chronic widespread pain and a heightened, painful response to pressure. Fibromyalgia symptoms are not restricted to pain, leading to the use of the alternative term, “fibromyalgia syndrome,” for the condition. Other symptoms include debilitating fatigue, sleep disturbance, and joint stiffness. Some patients may also report difficulty with swallowing, bowel and bladder abnormalities, numbness and tingling, and cognitive dysfunction. Fibromyalgia is frequently experienced simultaneously with psychiatric conditions, such as depression, and anxiety and stress-related disorders such as post-traumatic stress disorder. Not all people with fibromyalgia experience all associated symptoms. Fibromyalgia is estimated to affect 2–4% of the population, with a female-to-male incidence ratio of approximately 9:1. It is most commonly diagnosed in individuals between the ages of 20 and 50, although onset can occur in childhood.
What are the causes of fibromyalgia?
The cause of fibromyalgia is currently unknown. However, several hypotheses have been developed including “central sensitization”. This theory proposes that fibromyalgia patients have a lower threshold for pain because of increased sensitivity in the brain-to-pain signals. This altered sensitivity can present as increased muscle tone and exquisite tenderness, especially in certain areas such as the trapezius muscles, levator scapulae, paralumbar muscles, and forearm extensors.
Fibromyalgia can sometimes occur in several members of the same family, suggesting that there may be a genetic factor. Often the pain is initiated by a trauma to a single muscle group, and slowly the pain spreads to other locations. Neck trauma seems to increase the risk of developing fibromyalgia. Stress may also be an important precipitating factor. Post-traumatic stress, particularly from childhood or adolescent physical/emotional abuse, is such a common precursor to the development of fibromyalgia that it is tempting to view it as a major causal agent. Fibromyalgia is frequently co-morbid with other stress-related disorders such as chronic fatigue and irritable bowel syndrome.
There is strong evidence that major depression is associated with fibromyalgia, although the nature of the association is controversial. A comprehensive review into the relationship between fibromyalgia and major depressive disorder (MDD) found substantial similarities in neuroendocrine abnormalities, psychological characteristics, and physical symptoms and treatments between fibromyalgia and MDD. It remains uncertain whether depression causes fibromyalgia, or whether fibromyalgia causes depression.
What treatment options are available?
Exercise improves fitness and sleep and may reduce pain and fatigue in some people with fibromyalgia. Some medications have reduced symptoms in some patients, but the results of pharmacological interventions must be weighed against side effects. At PainCare, treatment of this problem always involves a graded aerobic exercise program, and often an antidepressant, muscle relaxant, and anti-inflammatory.
Trigger point injections with local anesthetic (occasionally Botox) can be very effective for weeks or months, especially for more localized symptoms. Physical therapy can also be a useful treatment for select patients, and is offered through Somersworth Physical Therapy and Total Body Therapy.
Narcotics are used as a last resort, but are unfortunately necessary in many severe cases. Opioids are considered only after all other medicinal and nonmedicinal therapies have been exhausted.