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Fibromyalgia Syndrome Q & A

  • Latest Thoughts on a Complex Diagnosis

  • Fibromyalgia syndrome is a difficult and frustrating condition for everyone involved– certainly for the patient, the patient’s loved ones, and the medical professionals who are called on to help.

    MyLifeStages spoke with Palo Alto Rheumatologist Andrew Rozelle, MD, of Palo Alto Medical FoundationOpens new window, about fibromyalgia syndrome and the latest on diagnosing and treating this complex disease.

    What is fibromyalgia?

    Fibromyalgia is the name given to a certain set of symptoms that include chronic, wide-spread pain, fatigue, and sleep disturbances, among other issues. The term fibromyalgia derives from the Latin term fibro (referring to fibrous tissues) and the Greek term myo (referring to muscles) combined with the Greek term algos, meaning pain.

    Fibromyalgia does not appear to be an autoimmune or degenerative process in the body – it is not arthritis, lupus, MS or other autoimmune disorders.

    It seems to be a result of hypersensitivity of the body to pain signals, either in the body, arms and legs where the signals are generated, or in the brain where the signals are received. Accompanying the pain are other symptoms like extreme fatigue and sleep that does not seem to refresh the body. Patients with fibromyalgia may also suffer from anxiety and depression, which can be the result of coping with the ongoing, distressing symptoms.

    Women are diagnosed with fibromyalgia much more often than men.

    How is fibromyalgia diagnosed?

    The diagnosis of fibromyalgia is given when other conditions have been ruled out, and patients meet the criteria set by the American College of Rheumatology in 1990:

    • Widespread pain that lasts at least three months.
    • Pain identified in at least 11 of 18 distinct “tender points” on the body.

    Because the initial symptoms can also come from other diseases or conditions, a physician will conduct a thorough history and physical, as well as lab tests to rule out other diseases like hypothyroidism.

    Dr. Rozelle notes that fibromyalgia used to be called “the wastebasket diagnosis” out of frustration for both patient and physician that no clear test result could be the marker for the disease. While there is still no definitive test for fibromyalgia, criteria for diagnosis have developed over the last 5-10 years, and doctors now have a clearer understanding of the syndrome and several good approaches to treating it.

    What causes fibromyalgia?

    There is not yet a good molecular understanding of what causes fibromyalgia, which Dr. Roselle notes is frustrating for physicians as well as patients. While several circumstances can be tied to the onset of fibromyalgia, there is often no discernable cause. Some patients’ symptoms begin after physical trauma, severe illnesses or strong emotional trauma. There is also some thought that prolonged stress can result in the heightened sensitivity to pain that is a hallmark of fibromyalgia. For other patients, however, there is no identifiable “beginning” for the symptoms.

    What can be done to treat fibromyalgia?

    While there is no cure for fibromyalgia, there are several approaches to treatment that can help patients live functional and fulfilling lives. Dr. Rozelle outlines a four-pronged approach to treatment.

    1. Regular exercise: While patients with extreme fatigue may not find exercise the most logical suggestion, it does result in sustainable improvement in symptoms. Walking, swimming, yoga, tai chi and other gentle exercises seem to improve symptoms and help patients achieve better sleep. (For inspiration, see our collection of fitness videos and other fitness resources.)

    2. Promoting healthy sleep: Exercise helps here, as do regular bedtimes and other recommendations for good "sleep hygiene". Insomnia in women with fibromyalgia is common and fibromyalgia patients sometimes are suffering from sleep apnea. Treating these conditions can greatly improve overall health.

    3. Medications: There are several types of medications that can reduce fibromyalgia pain, treat the depression that accompanies fibromyalgia, and improve sleep. Patients should work with their physicians to find the right combination of effective drugs.

    4. Managing stress: People who have fibromyalgia can become overwhelmed by it and feel anxious and depressed. Meanwhile, stress from normal life events can exacerbate the symptoms of fibromyalgia, in a vicious circle. So learning how to cope with stress is crucial. Techniques from traditional “talk therapy” to yoga and mindfulness based stress reduction can be very effective treatment options.

    What is the outlook for fibromyalgia patients?

    Dr. Rozelle acknowledges the extreme discomfort of this condition, but also notes that fibromyalgia is not progressive – it doesn’t get worse with time – and is not, like cancer or heart disease, fatal. The disease also waxes and wanes, so patients can reasonably expect that the symptoms can lessen or even disappear in time.

    “Patients can expect to live healthy and fulfilling lives, even with fibromyalgia,” says Dr. Rozelle. Seeing a health care provider for diagnosis and treatment options is the first, important step.