Understanding Fibromyalgia: From Common Symptoms to Treatment Options

Fibromyalgia affects nearly 5 million Americans every day—roughly one in every 50 people. Although sometimes referred to as a disease, fibromyalgia is in fact a syndrome, or a collection of symptoms. Symptoms may come and go, however, and often vary from person to person, making a diagnosis of fibromyalgia difficult. For this reason, doctors typically apply a differential diagnosis to rule out other conditions that have similar symptoms.

Characteristics and Symptoms

While there is no known cause of fibromyalgia, the syndrome is more common in women than in men. Classic symptoms are generalized pain all over and fatigue, but other characteristics may include:

• Stiffness
   
• Headaches
  
• Memory and concentration problems
   
• Sleep disorders
   
• Dizziness
   
• Numbness
   
• Tingling/itching
   
• Fluid retention
   
• Abdominal and pelvic pain/cramping
   
• Diarrhea

To help understand what people with fibromyalgia experience, imagine the worst case of the flu you have ever had—where every muscle in your body ached and your energy level was so low that raising your head off the pillow was a major effort. That is what every day feels like for many fibromyalgia sufferers.

Diagnosis Then and Now

In 1990 the American College of Rheumatology (ACR) established two specific criteria for the diagnosis of fibromyalgia: widespread pain lasting at least three months and at least 11 positive tender points (out of a total possible of 18). The second criterion was later changed to “no other underlying condition that might be causing the pain” due to doctors’ uncertainty about pressure point exams.

Today, two new fibromyalgia assessment methods exist: the widespread pain index (WPI) and the symptom severity (SS) scale score. The WPI lists 19 areas of the body and asks the patient to say where he or she has had pain in the last week, applying one point for each specific area.

The SS scale score is the sum of the severity of the 3 symptoms (fatigue, waking unrefreshed, cognitive symptoms) plus the extent (severity) of somatic symptoms in general. The final score is between 0 and 12. Somatic symptoms that might be considered include muscle pain, irritable bowel syndrome, fatigue/tiredness, thinking or remembering problem, muscle weakness, headache, pain/cramps in the abdomen, numbness/tingling, dizziness, insomnia, depression, constipation, pain in the upper abdomen,

nausea, nervousness, chest pain, blurred vision, fever, diarrhea, dry mouth, itching, wheezing, Raynaud’s phenomenon, hives/welts, ringing in ears, vomiting, heartburn, oral ulcers, loss of/change in taste, seizures, dry eyes, shortness of breath, loss of appetite, rash, sun sensitivity, hearing difficulties, easy bruising, hair loss, frequent urination, painful urination, and bladder spasms.[i]

Effective Treatment Options

Effective fibromyalgia treatment must be tailored to the needs of each individual; some patients have mild symptoms and require less intensive treatment, while others exhibit more severe symptoms and thus require a more comprehensive treatment plan.

Treatment is generally geared toward improving quality of sleep and pain reduction. Because sleep disorders are thought to be a major contributing factor to the symptoms of fibromyalgia, medications that increase the body’s serotonin and norepinephrine levels are commonly prescribed to modulate sleep, pain and immune system function. Other treatment methods include trigger point injections with lidocaine, physical therapy, acupuncture, relaxation techniques, osteopathic manipulation, chiropractic care, massage and a regular exercise program. The following is a step-by-step clinical guideline for fibromyalgia management developed from evidence-based modalities.

Step 1

• Confirm the diagnosis
   
• Explain the condition
   
• Evaluate and treat comorbid illness (such as mood disturbances and primary sleep disturbances)

Step 2 

• Trial with low-dose tricyclic antidepressant or cyclobenzaprine
   
• Begin cardiovascular fitness exercise program
   
• Refer for cognitive behavior therapy or combine that with exercise

Step 3 

• Specialty referral (e.g., rheumatologist, physiatrist, psychiatrist, pain management)
   
• Trial with selective serotonin reuptakes inhibitors, serotonin and norepinephrine reuptake inhibitors, or tramadol
   
• Consider combination medication trial or anticonvulsant

One Patient at a Time

Because fibromyalgia affects so many people and in so many different ways, it is extremely important for those with the condition to better understand what types of things can trigger symptom flare-ups and how to effectively manage symptoms and improve quality of life. The healthcare team plays a critical role in this process of ongoing education, and by working with their physicians, therapists, and other care providers, many fibromyalgia sufferers are able to alleviate symptoms and improve their overall condition.

For a more detailed look at working with fibromyalgia patients—including common factors that trigger fibromyalgia flare-ups as well as proven treatment options and how to provide ongoing care—view our comprehensive course Fibromyalgia: The Missed Diagnosis.