What Is Fibromyalgia?

Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple tender points. "Tender points" refers to tenderness that occurs in precise, localized areas, particularly in the neck, spine, shoulders, and hips. People with this syndrome may also experience sleep disturbances, morning stiffness, irritable bowel syndrome, anxiety, and other symptoms.

How Many People Have Fibromyalgia?

According to the American College of Rheumatology, fibromyalgia affects 3 to 6 million Americans. It primarily occurs in women of childbearing age, but children, the elderly, and men can also be affected.

What Causes Fibromyalgia?

Although the cause of fibromyalgia is unknown, researchers have several theories about causes or triggers of the disease. Some scientists believe that the syndrome may be caused by an injury or trauma. This injury may affect the central nervous system. Fibromyalgia may be associated with changes in muscle metabolism, such as decreased blood flow, causing fatigue and decreased strength. Others believe the syndrome may be triggered by an infectious agent such as a virus in susceptible people, but no such agent has been identified.

How Is Fibromyalgia Diagnosed?

Fibromyalgia is difficult to diagnose because many of the symptoms mimic those of other diseases. The physician reviews the patient's medical history and makes a diagnosis of fibromyalgia based on a history of chronic widespread pain that persists for more than 3 months. The American College of Rheumatology (ACR) has developed criteria for fibromyalgia that physicians can use in diagnosing the disease. According to ACR criteria, a person is considered to have fibromyalgia if he or she has widespread pain in combination with tenderness in at least 11 of 18 specific tender point sites.

How Is Fibromyalgia Treated?

Treatment of fibromyalgia requires a comprehensive approach. The physician, physical therapist, and patient may all play an active role in the management of fibromyalgia. Studies have shown that aerobic exercise, such as swimming and walking, improves muscle fitness and reduces muscle pain and tenderness. Heat and massage may also give short-term relief. Antidepressant medications may help elevate mood, improve quality of sleep, and relax muscles. Fibromyalgia patients may benefit from a combination of exercise, medication, physical therapy, and relaxation.

What Research Is Being Conducted on Fibromyalgia?

The NIAMS is sponsoring research that will increase understanding of the specific abnormalities that cause and accompany fibromyalgia with the hope of developing better ways to diagnose, treat, and prevent this disorder.

Recent NIAMS studies show that abnormally low levels of the hormone cortisol may be associated with fibromyalgia. At Brigham and Women's Hospital in Boston, Massachusetts, and at the University of Michigan Medical Center in Ann Arbor, researchers are studying regulation of the function of the adrenal gland (which makes cortisol) in fibromyalgia. People whose bodies make inadequate amounts of cortisol experience many of the same symptoms as people with fibromyalgia. It is hoped that these studies will increase understanding about fibromyalgia and may suggest new ways to treat the disorder.

Other NIAMS research studies are looking at different aspects of the disease. At the University of Alabama in Birmingham, researchers are concentrating on how specific brain structures are involved in the painful symptoms of fibromyalgia. Researchers at Vanderbilt University in Nashville, Tennessee, are using magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) techniques to study patients with fibromyalgia. MRI and MRS are powerful tools that have been shown to be useful in evaluating muscle disorders and muscle performance. At the New York Medical College in Valhalla, scientists are investigating the causes of a post-Lyme disease syndrome as a model for fibromyalgia. Some patients develop a fibromyalgia-like condition following Lyme disease, an infectious disorder associated with arthritis and other symptoms.

NIAMS-supported research on fibromyalgia also includes several projects in the Institute's Multipurpose Arthritis and Musculoskeletal Diseases Centers. Researchers at these centers are studying individuals who do not seek medical care, but who meet the criteria for fibromyalgia. (Potential subjects are located through advertisements in local newspapers asking for volunteers with widespread pain or aching.) Other studies at the Centers are attempting to uncover better ways to manage the pain associated with the disease through behavioral interventions such as relaxation training.

The NIAMS supports and encourages outstanding basic and clinical research that increases the understanding of fibromyalgia. However, much more research needs to be done before fibromyalgia can be successfully treated or prevented.

The Federal Government, in collaboration with researchers, physicians, and private voluntary health organizations, is committed to research efforts that are directed to significantly improving the health of all Americans afflicted with fibromyalgia.

Source:  National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, December 1999