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What is Fibromyalgia?

Fibromyalgia

Fibromyalgia explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Fibromyalgia’s name reflects its main characteristic, which is pain (-algia) associated with muscles (myo) and connective tissue (fibro), thus amalgamating the Latin or Greek roots of these words into a single medical term. The exact roots and causes of fibromyalgia are largely unknown, which makes this condition difficult to diagnose. The science of fibromyalgia has so far covered the main signs and symptoms of the condition, which include pain felt in many areas of the body that may be closely associated with depression, cognitive deficit, chronic fatigue, and sleep disturbances.

Fibromyalgia is currently regarded as a syndrome rather than a discrete condition, as all of these symptoms are not conclusively linked to a specific cause and is often seen as a coincidence of these signs rather than a correlation of them. However, it is a leading cause of consultations with rheumatology specialists, second only to osteoporosis.

Fibromyalgia shares some symptoms with a number of other disorders, including arthritis. In cases of arthritis, the pain is caused by inflammation or damage in joints or other peripheries of the body, which is transmitted by the brain. In the case of fibromyalgia, on the other hand, it is believed that the pain follows the opposite path. Therefore, the condition is not associated with joint damage. Fibromyalgia falls under the category of rheumatic disorders as it is associated with pain experienced in both joints and soft tissue.

Many fibromyalgia patients seek medical treatment with the goal of effective, long-term pain relief. A team of many healthcare professionals, including pain management specialists, primary care doctors, rheumatologists, and other professionals may be required to achieve this goal, and to address other symptoms of the condition that may also be present.

Epidemiology And Impact Of Fibromyalgia

7 Types of Fibromyalgia PainFibromyalgia is a widespread condition. There may be approximately 6.32 million people with the disorder in the United States. According to research by the National Fibromyalgia Association, however, this number may be closer to ten million. The risk of fibromyalgia development increases with age, but cases have been seen in people of any age. Most diagnoses of fibromyalgia are associated with the age group of those 20 and younger. Female gender is strongly linked to the risk of fibromyalgia. The National Fibromyalgia Association estimates that up to 90% of patients are women.

The study of new cases of fibromyalgia in the U.S. has been conducted and published in the Journal of Clinical Rheumatology. 62,000 health insurance claims were analyzed to give a possible incidence of fibromyalgia. The study indicated that between seven to eleven of each 1,000 cases (both male and female patients) could satisfy the diagnostic criteria for the condition. Claims from female patients were 1.6 times more likely than those filed by men to achieve this.

In addition, the socioeconomic effect of fibromyalgia on the country is significant. Government reports suggest that the condition is responsible for an average of 17 days of work missed every year. This translates to as much as 2% of the United States’ gross national product. National figures indicate that fibromyalgia can create a loss of $12 to $14 billion per year. This is accounted for by a number of factors, including indirect and direct healthcare burden. A study published by the International Journal of Clinical Practice analyzed health insurance information. The results indicated that the total healthcare expenditure associated with fibromyalgia was three times higher than for that spent on other disorders. The multiple consultations with the necessary multidisciplinary healthcare team, and the time and resources taken up in the course of fibromyalgia diagnosis, are main factors that contribute to this increased expense.

Causes Of Fibromyalgia

Fibromyalgia FactsMany scientists have attempted to find links to many factors and causes for fibromyalgia development, but this research is largely incomplete. Some external triggers, such as psychological factors including stress, viral infections, and repetitive strain have been associated, but not conclusively. Some research suggests that having certain pre-existing conditions, such as rheumatoid arthritis, arthritis of the spine, or systematic lupus erythromatosus, may lead to an increased susceptibility to developing fibromyalgia.

Some psychiatric disorders, such as depression, have also been linked to fibromyalgia in the literature. Some reviews claim a strong association of the condition with major depressive disorder. This is based on observations that both disorders have many symptoms, neuroendocrine profiles, and other physiological properties in common.

External environmental factors, such as lifestyle patterns, are also occasionally implicated in the etiology of fibromyalgia. Physicians often observe that other disorders such as irritable bowel syndrome, chronic fatigue syndrome, and post-traumatic stress syndrome are concomitant with diagnoses of fibromyalgia (or possibly vice versa).

Other factors such as a smoking habit, high bodyweight, and low levels of daily activity have also been linked to the condition. Increases or decreases of certain biological markers in the body may also be associated with fibromyalgia development. Certain studies have claimed that abnormal levels of certain important molecules such as growth hormones, norepinephrine, and cortisol serotonin are caused by the condition. Substance P, a neuropeptide (which means it can activate or regulate neural cells) has also been reported as elevated in cases of fibromyalgia. This substance plays a role in pain perception in humans. Norepinephrine and serotonin are neurotransmitters thought to regulate mood and positive emotions.

Low levels of these neurotransmitters combined with high levels of substance P are associated with effects on how a person will feel pain. Health professionals often use techniques known as structural and imaging functional studies to analyze the pain perception and processing of the brain and spinal cord.

Functional MRI (fMRI) studies observed the cerebral blood flow (an indicator of brain activity) of fibromyalgia patients and found high activity in areas of the central nervous system associated with pain processing. This technique has also been used to show dysfunction of nervous tissue connecting these regions with other areas of the body in fibromyalgia patients. This may indicate a magnification of pain perception associated with this condition. This research indicates some proof that fibromyalgia is associated with abnormal pain regulation in the central nervous system.

Other studies analyze the role of genetic factors in the development of fibromyalgia. Some research has studied the genes of fibromyalgia patients and their close relatives (a common procedure in this field). This analysis revealed that the relatives of fibromyalgia patients are also at high risk of the condition and that their pain perception was at similar levels to their related sufferers. This may indicate a (heretofore undefined) genetic component of fibromyalgia etiology. Some scientists have drawn the conclusion that certain genes concerning neurotransmitter production (e.g. that of serotonin) are implicated in the disorder. More research to confirm this is required, however.

Symptoms Of Fibromyalgia

Tell-tale symptoms of fibromyalgia include complaints of musculoskeletal pain at many points in the body, sleep disturbances, and consistent fatigue. Reports of fibromyalgia warning signs may follow an event such as physical or psychological trauma or viral disease. For other patients, however, fibromyalgia symptoms may appear with none of these associated triggers and progress steadily over time.

The painful symptoms of fibromyalgia can be described as shooting, stabbing, aching, or throbbing, with occasional numbness, burning, or tingling in the affected areas. Chronic fatigue is defined as profound and intractable exhaustion and lethargy. This can considerably affect a patient’s professional or personal life. Sleep may have a positive effect on this symptom, which makes the often concomitant characteristic of sleep disorder particularly aggravating.

Fibromyalgia may also present with or without these additional symptoms:

  • Postural instability
  • Restless leg syndrome (RLS, which often accompanies sleep disorders)
  • Headache
  • Lack of concentration or attention
  • Tingling in the extremities
  • Heightened sensitivity to cold or heat
  • Cognitive deficits (“fibro fog”)
  • Stiffness
  • Muscle cramps
  • Anxiety
  • Depressive disorders
  • Mood swings
  • Stress
  • Muscular twitching or spasms
  • Bowel disorder
  • Flares of anger

Pathophysiology Of Fibromyalgia

Brain imaging may reveal important data about the development and progress of fibromyalgia. This has demonstrated some association between decreased blood flow in important central areas of the brain, including the thalamus and basal ganglia. Neural “pain” pathways have also been shown to be defective in cases of fibromyalgia, as have concentrations of certain neurotransmitters. These are associated with increased or defective perceptions of pain and may play a central role in the pathophysiology of this condition.

Positron emission tomography (PET) is a technique that generates three-dimensional images of the brain and other organs, thus giving effective yet non-invasive visualizations of these. PET scans of the brains of fibromyalgia patients have demonstrated an association between reductions of the neurotransmitters serotonin and dopamine and the disorder. Dopamine contributes to the regulation of pain perception by promoting the release of the body’s own natural analgesic processes.

Serotonin has a role in mood, sleep control, and pain perception, in addition to other biological functions. There is also an association between levels of the neuropeptide substance P, as outlined earlier. In addition to its role in pain perception, the molecule has a role in the production of inflammatory molecules.

Some clinical studies have found fluctuations in certain hormone levels of fibromyalgia patients that are also associated with the physiological consequences of sleep disturbances. For example, growth hormone that is normally released in the course of a sleep episode has been found to be decreased in cases of fibromyalgia. Growth hormone is required for normal development and tissue healing.

Fibromyalgia patients may also suffer dysfunctions in automatic body functions, i.e. muscle contractions that are not under conscious control, such as the beating of the heart. These can produce adverse effects such as changes in heart rate or blood pressure. Research published in the American Journal of Medicine showed that approximately 60% of fibromyalgia patients included in the study had abnormally low blood pressure. This suggests a reason for symptoms such as fatigue that are associated with blood flow impairments.

Risk Factors For Fibromyalgia

Fibromyalgia IllustrationRisk factors are external or biological factors that can increase the probability that an individual will develop a syndrome or illness. Some fibromyalgia patients start to experience symptoms independently of any risk factors. On the other hand, some studies have identified risk factors for the condition. These include physical condition, trauma, gender, and genetics.

Much of the research on fibromyalgia concerns the investigation or identification of these risk factors. A recently published article studied the link between fibromyalgia and certain potential triggers. The experiment involved 896 people starting in 12 different new workplaces. Data from these workers was collected over two years, concerning the probability of the emergence of fibromyalgia symptoms and any corresponding stressors. These included occupational hazards such as repetitive motion, lifting of heavy weight, and remaining in the same posture (e.g. standing) for protracted lengths of time. The data was collected at 12 months and then again at 24 months into the study. At 12 months, the rate of new pain development was found to be 15% on average. Results were also significantly different in terms of gender of the workers (12% for men as compared to 19% for women). At 24 months, the rate of new pain symptoms was recorded at 12% for both men and women.

Data was also collected on potential psycho-social risk factors, such as conflict between colleagues or decreases in job satisfaction. As with the results on physical strain, employees experiencing these problems also gradually developed fibromyalgia-related pain. The analysis of this data indicated that these stressors interact deleteriously on pain severity in cases of fibromyalgia. The workers were asked to discuss a traumatic life experience for 30 minutes, to simulate the effects of stress. The researchers found a correlation between this stress induction and the magnification of pain in workers exhibiting symptoms as part of the analysis.

Another article described research on further psychological trauma in relation to fibromyalgia symptoms. Rheumatology scientists selected fibromyalgia patients to take part in an experiment involving a randomized controlled trial. The subjects were selected if they had anxiety and depressed mood symptoms in addition to pain. The results suggested that “pain acceptance” and social support were the most prominent risk factor for pain identified. For example, if patient perceived that they had low levels of support from others around them and had a poor psychological response to their pain this may have links to increased pain perception.

Scientists have also investigated more psychosocial detractors for their effects on fibromyalgia. An article reported the effects of the experience of violence in women as a potential risk factor. This study collected data on women who had been in relationships involving violent abuse. The research indicated a positive association between this and the increased risk of fibromyalgia development.

Conditions Related To Fibromyalgia

There may also be a range of other conditions that present with, exacerbate, or are exacerbated by fibromyalgia. A physician may have to eliminate the possibility of these when diagnosing a potential case of fibromyalgia.

These include:

  • Polymyalgia rheumatica; widespread rheumatic pain that occurs in many joints, mainly associated with the age group of 50 or more
  • Chronic fatigue syndrome; consistent levels pain in addition to sleep problems and mood problems
  • Osteoarthritis; joint pain associated with cartilage degeneration
  • Rheumatoid arthritis; joint pain associated with inflammation
  • Irritable bowel syndrome; abdominal discomfort or pain accompanied by constipation or diarrhea, which generally lasts at least three months
  • Tension headaches; mild to moderate headache pain that can last for 30 minutes or more
  • Migraine; a severe subtype of headache that often occurs in regular episodes
  • Localized myo-fascial pain disorder; pain in muscles and other tissues often also associated with sleep loss and fatigue

Many of these conditions have symptoms similar to those thought to be associated with fibromyalgia. Physicians may need to resort to blood, renal, and gastrointestinal tests to differentiate all of these from fibromyalgia.

Diagnosis And Classification Of Fibromyalgia

Up to about 20 years ago, fibromyalgia detection relied heavily on non-objective analysis, including patient reports, that may have been unreliable and confusing. The American College of Rheumatology (ACR) has established generally standard criteria for the diagnosis of fibromyalgia, though there is no one distinct test for the condition.

These widely-used ACR guidelines are a checklist of symptoms, including:

  • A documented history of widespread pain, lasting three months or more
  • Pain that is felt above and below the waist, and on both sides of the body; pain must be in some or all of the following locations: cervical spine, thoracic spine chest, lower back, and in the shoulder joint
  • Pain in 11 of the 18 characteristic “tender points” associated with fibromyalgia that are mostly located in the muscular attachment surfaces in joints
  • Clinical manifestations, including the other main symptoms of fibromyalgia

The physician will run tests for fibromyalgia based on the recommendations, including a tender point test, which is a physical examination of all these areas, to elicit a pain response. This response is a request from the patient to stop palpating the region or withdrawal of the area away from the doctor. The physician includes this result in the patient’s records.

“Widespread pain,” a term often used in fibromyalgia research, is defined as pain in three of all four quadrants in the scale of fibromyalgia tender-point pain as outlined below:

  • 0 – Absence of pain or tenderness
  • 1 – Tenderness but no withdrawal
  • 2 – Tenderness causing withdrawal
  • 3 – Tenderness causing a significant response
  • 4 – Examination is intolerable to the patient (i.e. maximal response)

The ACR classification incorporates the locations in the diagram below into its tender point examination system.

Source: American College of Rheumatology

The ACR also added a battery of questions, known as the Symptom Severity (SS) scale and Widespread Pain Index (WPI) to the guidelines in 2010, in order to refine and improve the system of testing. Their criteria to diagnose a case of fibromyalgia are:

  1. An SS score of five or more
  2. A WPI score of seven or more
  3. Symptoms are present for three months or more

4. Conclusive elimination of other conditions that present similar pain types (e.g. arthritis)

Physicians using the WPI must enumerate the points in which pain has been felt by the patients in the week prior to testing. The rating of this index goes from zero to 19. The areas examined include:

  • Left axis of the shoulder
  • Right axis of the shoulder
  • Left trochanter (top of the thigh bone)
  • Right trochanter
  • Left mandibular (jaw) joint
  • Right mandibular joint
  • Left side of the thoracic spine
  • Right side of same
  • Lumbar region
  • Upper arms, both sides
  • Upper legs, both sides
  • Left frontal thorax
  • Cervical (neck) region
  • Right side of the abdomen
  • Lower arms, both sides
  • Lower legs, both sides

Physicians will also examine these areas using the severity scale. This will result in a score based on these responses:

  • 0 – No pain
  • 1 – Mild/slight and usually intermittent pain
  • 2 – Moderate number of painful regions in which moderate pain is felt
  • 3 – Large amount of painful areas in which significant pain is felt

Other major and minor non-symptoms will be documented also. These may include headache, nausea, blurry vision, fatigue, mild to moderate breathing problems, weak muscles, muscle pain, bowel problems including IBS, unusually frequent urination, spasms, seizure, eye dryness, loss of appetite, altered taste perception, bruising, and heartburn.

While the renewed system introduced in 2010 complements the original guidelines, it is still unclear if these scales will be adopted over those developed in a 1990 scale among physicians. Other modern diagnostic tests including those for thyroid function, C-reactive protein, various blood tests, and muscle enzyme levels often accompany these classifications. Physicians will arrange tests, such as PET, radiography studies, or functional imaging, if another similar condition is suspected instead of or in addition to fibromyalgia. These studies detect osteoarthritis, nerve impingement, ankylosing spondylosis, carpal tunnel syndrome, cervical radiculopathy, and so on.

In the course of patient interviews when investigating the possibility of fibromyalgia, physicians may be aided by listening for statements conforming to typical complaints from patients that have the condition. Fibromyalgia sufferers often describe their symptoms with phrases similar to some classic examples, such as “Everything hurts,” “I always feel tired or mildly ill,” and “I can’t face getting up or moving around because of the pain.” Physicians may also apply the American Psychological Association’s Diagnostic Statistical Manual of Mental Disorder (DSM-V, 2013 edition) to diagnose symptoms of depression or anxiety if they suspect the patient may also have these based on their interview responses.

Treatment For Fibromyalgia

BioFeedbackCurrently, there are no outright cures for fibromyalgia. Therefore, treatment focuses on reducing symptoms such as pain, the retention of normal movement and function, and improving the quality of life for patients. This goal often requires a tailored plan developed by a team of medical professionals. This may include conventional drug therapy, including non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, or opioids for more severe cases. Drugs that treat other symptoms of fibromyalgia include benzodiazepines, antidepressants, and sleep medicines. Drug therapy can be a stand-alone option or used in conjunction with other treatments such as alternative and environmental treatment programs, physical conditioning, cognitive behavioral therapy, acupuncture, biofeedback, relaxation and guided imagery, and yoga.

The multidisciplinary medical panel may include pain specialists, physical therapists, occupational therapists, primary caregivers, exercise physiologists, and chiropractors. Their task is to improve the quality of life, functional status, and symptom severity of the patient and also to educate or re-train him or her in pursuing a lifestyle that promotes the amelioration of their pain, psychological problems, and other adversities caused by fibromyalgia. A lack of treatment can lead to a significant loss of normal abilities or even disability in some cases.

Pharmacological Treatments For Fibromyalgia

This line of treatment is associated with effective pain treatment and the improvement of sleep- and mood-related symptoms. Drug therapy may take the form of multiple drugs combined in a single regimen.

Tricyclic Antidepressants (TCAs)

These are older forms of antidepressant developed to reduce symptoms often shared by both fibromyalgia and depression, such as sleep disturbances, fatigue, negative mood, and pain in some cases. Antidepressants act to increase the levels of “good mood” neurotransmitters in the central nervous system. As discussed above, decreases in these can result in depressive symptoms and pain.

There has been recent review and analysis of the literature testing the effects of TCAs (mostly placebo-controlled trials) on fibromyalgia symptoms. This demonstrated that these drugs may be affected. Common examples of TCAs include doxepin (marketed as Sinequan); lofepramine (Lomont or Gamanil); imipramine (Tofranil); amitriptyline (or Endep); lomipramine (Anafranil); and nortriptyline (Aventyl, among others).

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs interfere with the breakdown of serotonin in the body (by malfunctioning regulatory processes) thus increasing its availability to perform its functions in the CNS. This may be associated with improvements in mood and reduction of pain symptoms. SSRIs were developed some time after TCAs, and superseded them in treating many cases of depression. However, both types of drugs are prescribed at low doses to treat fibromyalgia. Both are associated with positive effects on the relevant symptoms at clinical levels. Sub-types of SSRI include escitalopram (marketed as Lexapro); citalopram (also known as Celexa); sertraline (Zoloft); paroxetine (Paxil); and fluoxetine (Prozac).

Selective Serotonin And Norepinephrine Reuptake Inhibitors (SSNRIs)

As with SSRIs, these drugs promote the availability of both norepinephrine and serotonin and prevent their reuptake. Popular variations of these include venlafaxine (also known as Effexor); duloxetine (or Cymbalta); pregabilin (Lyrica); and milnacipran (Savella). Some of these drugs have been investigated as potential treatments for fibromyalgia over the last number of years. One of these, venlafaxine, was the first SSNRI approved for use by the FDA. Studies have been published testing its effects on fibromyalgia symptoms. One involved 15 patients and another recruited 20. In the first, subjects took 37.5 to 375 mg immediate-release venlafaxine-HCl per day for eight weeks. The second had the subjects take 75 mg daily for 12 weeks. The results of both gave some evidence that venlafaxine is effective in treating this condition.

There is also good-quality evidence for the effects of duloxetine to be found in five separate studies. These demonstrated the efficacy and tolerability of the SSNRI when administered to treat fibromyalgia pain. All of these also indicated that a course of duloxetine is associated with an increase in quality of life.

There are also some randomized controlled trials investigating the possible benefits of milnacipran in fibromyalgia patients. A study of 125 subjects taking either 100mg twice a day or 200mg once a day over 12 weeks indicated a positive effect of this regimen on fatigue and pain symptoms. This suggests that milnacipran is also a viable pharmacotherapy option when treating fibromyalgia.

Antidepressants are also associated with adverse effects and reactions, however. The prescription of these drugs can appear to backfire, and potentiate ideations of suicide and self-harm, particularly in very young, adolescent, or young adult patients. Serotonin syndrome is another severe adverse effect that may be associated with SSRIs. This is an “overdose” of serotonin that results in unusual and often distressing neurological events. The risk of serotonin syndrome is magnified if the patient somehow takes a serotonin reuptake inhibitor at the same time as another medication eliciting a similar effect, such as a serotonin receptor agonist. A patient may have incurred these effects if they present signs such as blood pressure fluctuations, coordination problems, rapid heartbeat, agitation, diarrhea, vomiting, and loss of consciousness.

Benzodiazepines

These are sedative-type drugs that can also relieve muscle pains in conditions such as fibromyalgia. Benzodiazepines also have anxiolytic (anti-anxiety) and hypnotic (sleep-promoting) effects. They contribute to the release of a neurotransmitter called gamma-aminobutyric acid (GABA) that plays a role in sleep regulation. However, these drugs have a high addictive index, and as a result, patients who are prescribed these may be closely monitored and have their doses tightly controlled by their physician(s). Benzodiazepines in use as prescription medications include clonazepam (Klonopin) and diazepam (Valium).

Analgesics

Tylenol is also known as paracetamol or acetominaphen. It is one of many basic analgesics that may be recommended for mild to moderate fibromyalgia-associated pain. If the pain is more severe, a physician may consider the possibility of more effective and powerful narcotic medications to relieve this symptom. Opioids are a class of these that bind to receptors in the brain and spinal cord to inhibit the transmission of pain signals. Types of opioids include morphine, hydrocodone, propoxyphene, and oxycodone. Opioids are also associated with risks of addition and tolerance, which may impact the lives of patients taking them.

Muscle Relaxants 

Physicians occasionally recommend short courses of muscle relaxants to relieve the muscle spasms and pain often associated with fibromyalgia. One muscle relaxant commonly used is cylcobenzaprine. Five studies comparing this drug to placebo treatments indicated that it had some positive effects on the symptoms of the condition. Other examples of muscle relaxants are orphenadrine citrate (Norflex); carisopeodol (Soma); and tizadine (or Zanaflex).

Antiepileptic Drugs

Some fibromyalgia patients may suffer seizures as the disorder progresses, but drugs that reduce these may also be associated with pain relief. The basis for this theory is the inhibition by antiepileptics of many excitatory neurotransmitters that may contribute to pain signals reaching the brain. Some randomized controlled trials have investigated the veracity of these observations in terms of fibromyalgia. These may indicate that there is indeed a positive association between the reduction of pain and anti-epileptic medications. Common examples of these include pregabilin and gabapentin.

Atypical Antipsychotics

These drugs are conventionally prescribed to treat serious psychiatric disorders. They may also have other applications, such as the treatment of autism. This class of drugs mainly blocks the D2 receptor, which is one of many receptor types in the body activated by dopamine. Since fibromyalgia may be associated with an abnormally high rate of D2 activity, there may be a viable cause to use them in treating the condition. A recent study concluded that atypical antipsychotic intake was linked to improvements in some symptoms such as depression, fatigue, and stiffness. Pain relief, however, is not associated with antipsychotic drug therapy. Commonly available atypical antipsychotics include aripiprazole, quetiapine, rispiridone, and ziprasidone.

Other Treatment And Management Strategies For Fibromyalgia

Alternatives or adjuncts to drug therapy are also often recommended for treatment of symptoms. Improved quality of life and functional abilities are associated with increased education about their symptoms, and lifestyle interventions that can help manage them. Recent literature has shown that patients who are passive or become apathetic in controlling their symptoms may suffer more negative effects of the syndrome than those who are not. Healthcare teams may recommend patients start out by making small changes that can have a positive impact on their symptoms, such as pursuing a healthier lifestyle, and then build on this in the future.

One of the main characteristics of fibromyalgia, sleep disturbances can be thus improved by education about achieving healthy sleep patterns. Measures that may be learned include establishment and maintenance of regular sleeping patterns, avoiding caffeine intake in the evening, avoiding daytime naps (if applicable), not consuming spicy or large amounts of food before bed, taking part in more physical activity or exercise, and limiting exercise immediately before bed if possible.

Exercise

Patient participation in more regular exercise is associated with effective control of fibromyalgia symptoms. The benefits of exercise in other similar conditions have also been confirmed by some research. A study in the American Journal of Medicine indicates that a lack of physical fitness is a potential risk factor for fibromyalgia development. Another article linked the effects of a 12 week training program applied to fibromyalgia patients to some improvements in functional status and quality of life.

Further research suggests that 30 to 60 minutes’ worth of exercise of moderate intensity is required for maximal symptom relief. Conditioning for fibromyalgia patients may include low-impact activities such as walking, cycling, and water-resistance training. Research published by the American Journal of Lifestyle Medicine indicated that other forms of resistance training, yoga, and Pilates may also be beneficial to patients wishing to actively reduce pain and other symptoms.

Moderation in exercise may yield the best results. A well-designed program also includes adequate rest for the muscles and joints being conditioned. The guidelines supplied by the Centers for Disease Control and Prevention suggest that adults should engage in an average of 2.5 hours a week of moderately intense exercise, in addition to two or more daily bouts of additional muscle conditioning a week. Alternatively, a program of 1.25 hours’ worth of higher-intensity training per week, in addition to the two muscle-training sessions, is equally effective. These apply to people of between 18 and 64 years, and differ for senior individuals and children.

Complementary Treatments

Other alternative treatments, such as biofeedback or acupuncture, may also be associated with improvements in fibromyalgia symptoms. A thorough review of the literature concerning this link indicated the positive effect of acupuncture on the pain caused by the condition.

Biofeedback is a term referring to the education of patients on their symptoms. This is achieved by their familiarization with measures of vital signs, including electroencephalograms (EEGs) and electrocardiograms (ECGs). By observing recordings of these associated with the experience of symptoms, such as pain, patients may gain a positive effect. They can then apply techniques taught in the course of biofeedback, such as relaxation and breathing control, to have an effect on pain severity. This may have an effect similar to guided imagery. One article reported the effect of several mind-associated techniques, including both of these. The results showed positive effects of all of these on pain perception in fibromyalgia patients.

Cognitive behavioral therapy (CBT) is a popular technique applied to many disorders and syndromes in the last ten years. This focuses on the education of patients affected by often painful conditions in improved coping techniques. CBT practitioners help patients to reorder and impose better structure on thought patterns that may be associated with pain episodes, with the goal of improved reactions to pain and more ability to enact lifestyle changes that may reduce it. A trial of a CBT program involving 71 patients over ten weeks demonstrated that it had a positive effect on fibromyalgia pain severity. CBT may also have benefits in treating psychological symptoms of the condition, such as negative mood induction.

Conclusion

Fibromyalgia may be a collection of symptoms including consistent pain levels, sleep disturbances, fatigue, and cognitive deficits, rather than a single condition. However, the symptoms occur concomitantly and reproducibly in a large number of patients, and are therefore accorded the term of “syndrome.” Fibromyalgia, which may present as some or all of its associated characteristics, can be a source of significant functional deficit.

Diagnosis and treatment may require a large team of healthcare professionals with different specialties, including rheumatology, pain, psychotherapy, and other disciplines. This is associated with an increasingly significant healthcare and socioeconomic deficit, however.

The symptoms of fibromyalgia may appear insurmountable to patients (based on self-reports) but can be managed by adequate treatment. This begins with diagnosis, which may be time-consuming, but can be aided by guidelines supplied by the American College of Rheumatology. These include rating and scoring systems that measure pain and other symptoms reproducibly and accurately.

Treatment for fibromyalgia may take the form of one or more options including pharmacotherapy, patient education, and behavioral therapies. This may be associated with the preconception that this involves a high volume of physician consultations, appointments with a range of different practitioners, and protracted periods of treatment effect latency. However, the research and treatment process is increasingly more streamlined and effective in order to help patients manage this often very difficult and deleterious syndrome.

At Pain Doctor our goal is to relieve your fibromyalgia pain and improve function to increase your quality of life.
Give us a call today at 480-563-6400.

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