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Fibromyalgia is a chronic disorder most commonly associated with generalized pain and tenderness of the muscles and bone. It has not been associated with damage of the joints, muscles or other tissues and is not associated with inflammation of the tissues. Individuals with fibromyalgia commonly have “tender points,” which are specific places that hurt when pressure is applied to the spot. Because of the chronic pain, fibromyalgia can significantly interfere with one’s ability to go about daily activities. It has often been associated as starting with trauma, surgery, stress or infection. Current studies have suggested that fibromyalgia increases painful sensations by changing the process of pain signal processing in the brain. Women are more commonly affected than men. Fibromyalgia is often associated with conditions such as temporomandibular joint (TMJ) disorders, tension headaches, anxiety, depression, irritable bowel syndrome, rheumatoid arthritis and lupus. It has been estimated that more than 5 million adults in the U.S. are affected, and the disorder can occur in anyone over age 18. Family history of fibromyalgia often is observed with individuals who are diagnosed with the disorder.

Symptoms associated with fibromyalgia
In addition to pain, individuals with fibromyalgia often report:

  • Difficulty staying asleep after initially falling asleep
  • Memory and cognitive problems – sometimes referred to as “fibro fog”
  • Headaches
  • Morning stiffness of muscles and joints
  • Painful menstruation
  • Irritable bowel syndrome
  • Sensitivity to mild changes in temperature
  • Restless legs syndrome
  • Sensitivity to bright lights and loud noise
  • People with fibromyalgia also may experience fatigue, anxiety, depression, headaches, irritable bowel syndrome and endometriosis. The causes are unknown but infections and post trauma stress seem to be two major precipitating factors.

Diagnosing fibromyalgia
Individuals with fibromyalgia often have many symptoms that overlap with other conditions making it difficult to diagnose. They often see many doctors because other conditions have to be ruled out before the disorder can be labeled fibromyalgia. There are no diagnostic tests to diagnosis the disorder and current lab tests do not provide a plausible reason for the pain. In 1990, the American College of Rheumatology established criteria for diagnosis including widespread pain for at least three months and at least 11 positive tender points out of a possible 18. The problem with these criteria was that symptoms can come and go making it difficult to diagnose the problem. Now the criteria have been modified to be widespread pain for at least three months with no other underlying condition causing the pain.

Treatments for fibromyalgia
Fibromyalgia is a difficult condition to treat and often requires participation by a physician, a physical therapist and other health professionals. There are three medications that have been approved by the FDA for pain management of fibromyalgia – duloxetine (Cymbalta), pregebalin (Lyrica) and minacipran (Savella). Analgesics (pain medications) such as acetaminophen, Ibuprofen and narcotics are often used. Sleep management is an important part of therapy, as individuals diagnosed with fibromyalgia should try to get eight hours of sleep every night. Support groups for fibromyalgia are available as well as counseling and may be helpful in understanding and working with the disorder. Physical therapy has been shown to keep the muscles and joints active and may help with pain control. Massage, water therapy, light aerobic exercise and myofacial release therapy often ease the pain and relax the muscles. Acupressure and acupuncture for many individuals have been helpful for pain control and muscle function. Relaxation techniques such as yoga and breathing exercises help channel stress and relax muscle tension. Eating well with no specific diet has helped with energy and wellbeing. Individuals have to find the things that work for them.

Experts do not recommend that a person diagnosed with fibromyalgia go on disability. Work helps keep the person moving and helps provide a sense of purpose in life, and contact with other people helps channel stress.

If you are concerned about whether fibromyalgia is a possible problem, contact your physician and keep a diary of symptoms for your doctor.

More about Dr. Aulds

Donald G. Aulds, MD is an Obstetrician and Gynecologist and currently serves as the Medical Director for both the Women's Center and the Best Start Program of North Alabama. He is a Diplomat of the American Board of Obstetrics and Gynecology and Fellow of the American College of Obstetricians and Gynecologists.

Dr. Aulds completed his medical education at Louisiana State University School of Medicine, New Orleans, LA and his Internship and Residency in Obstetrics and Gynecology at Ochsner Medical Foundation, New Orleans, LA.

Dr. Aulds has been an active member of the Huntsville Hospital Medical Staff since 1980.