Fibromyalgia

Fibromyalgia is a condition of generalized body pain. It is usually associated with tender points. Patients may complain of swelling or of parathesiae (electrical shock like symptoms). Patients often complain of fatigue or a sleep disturbance.

The American College of Rheumatology identified 18 typical tender points and considers it necessary to have 11 of the 18 points present to make a diagnosis. This is primarily a distinction made for research purposes and it is possible to have fibromyalgia while not satisfying this criteria.


  • Q: Are there any conditions associated with fibromyalgia?

    A: Irritable bowel syndrome and interstitial cystitis seem to be associated with fibromyalgia and may be part of the spectrum of fibromyalgia.

    Chronic fatigue syndrome is believed by some to be associated with fibromyalgia and many patients suffer from both conditions, however a linkage between the two conditions has never been conclusively established.

    Sleep apnea may cause or be associated with fibromyalgia especially in males.

    Many patients with fibromyalgia have a depression. This may be as a consequence of their pain and sleep disturbance or may be present as a primary condition. Treatment of the depression is an important component of any pain management program.

  • Q: Are there any special diets for fibromyalgia?

    A: There is no evidence of any dietary modifications that will reduce symptoms in fibromyalgia. You should eat a balanced diet and try to maintain your ideal body weight.

  • Q: Are there tests for fibromyalgia?

    A: At the present time fibromyalgia remains a clinical diagnosis based on your symptoms and the doctor’s findings on examination. Some diagnostic tests may be indicated depending on your circumstances to rule out other conditions.

  • Q: What are the non drug treatments for fibromyalgia?

    A:

    Exercise

    Exercise remains the primary treatment for fibromyalgia. Many patients have allowed themselves to become deconditioned due to their pain. Exercise should start with the maximum amount tolerated and gradually increase each day. An intense exercise session that leaves you on the couch for several days is of no help. It may be worthwhile dividing your exercise into several brief sessions every day. Walking is the best exercise. Swimming or aquacize can be useful.

    Stretching can be done by itself or in conjunction with an exercise program. There are many good books on stretching available. We have a sheet of stretches available at the Pain Clinic. Stretching should be done several times a day for short periods of time. It is a good idea to stretch before your exercise session.

    Therapies such as yoga or Tai Chi may be appropriate. The GET SET program offered at the Edmonton General Hospital and the Gerald Zetter Centre is useful in fibromyalgia.

    Proper sleep

    Given that fibromyalgia may be due to a sleep disturbance and that many fibromyalgia sufferers complain of problems sleeping, it makes sense to try to improve your sleep. The Pain Clinic has a handout available on proper sleep hygiene.

    A small number of patients with fibromyalgia may suffer from sleep apnea. This is more common in male patients. You may benefit from investigation and treatment of this condition.

    Psychology

    You can be taught relaxation and coping skills that you will be able to use on a daily basis. You may benefit from a formal pain management group such as the Life Despite Pain program or other similar programs. There are support groups for patients with fibromyalgia.

    Trigger point injections

    Trigger point injections are usually not useful in fibromyalgia due to the widespread nature of the pain. If a certain area of your body is more tender, trigger point injections may be useful as part of your therapy.

    Acupuncture

    Despite little experimental evidence that acupuncture is effective in fibromyalgia, many of our patients find it to be effective. Intramuscular stimulation (IMS) which uses acupuncture needles may also be effective.

  • Q: What drugs are useful in fibromyalgia?

    A:

    Antidepressants

    The older anti-depressants such as amitryptiline, nortryptiline, desipramine, clomipramine or doxepin have been shown to be effective in fibromyalgia. These drugs are usually given in smaller doses than were formally used to treat depression. You will usually take them once a day before bed time so they will help you sleep. These drugs have side effects of drowsiness, dizziness, constipation and a dry mouth. These side effects often become more tolerable with time. If one drug doesn’t work or has intolerable side effects, it is usually worthwhile trialling one or more other drugs. The newer antidepressants are less effective in the treatment of fibromyalgia. Just because you are prescribed anti-depressants does not mean your doctor feels you are depressed or it is all in your head.

    Cyclobenzaprine (Flexeril R)

    Cyclobenzaprine is chemically similar to the amitryptiline and other drugs and have a similar mechanism of action and effect in fibromyalgia

    Non steroidal anti-inflammatories

    Drugs such as ibuprofen, Naprosyn and similar drugs may be useful for exacerbations but should not be used daily for prolonged periods. Acetaminophen may be useful for acute flare-up but should not be used for prolonged periods. COX 2 Inhibitors such as Cellebrex or Bextra should probably be only used for acute flare-ups.

    Tizanidine (Zanaflex R)

    Tizanidine has been shown in some studies to be effect for the treatment of fibromyalgia. Tizanidine has side effects of drowsiness, and dry mouth.

    Magnesium

    In one study high doses of magnesium were effective in the treatment of fibromyalgia. These doses are much higher than supplied in most supplements. Many magnesium supplements contain calcium and you should not take such supplements in large quantities. It may take several months of therapy before you notice any difference.

    Narcotics

    Our experience in the Pain Clinic suggests that narcotics can, in certain cases, be a useful part of a treatment program for fibromyalgia. We prefer to prescribe long-acting preparations of medications. Methadone which is a narcotic may also be useful. In our experience addiction to narcotics when prescribed for chronic pain is rare if proper screening is performed prior to prescribing.

  • Q: What is the prognosis for fibromyalgia?

    A: Fibromyalgia is a chronic disease. This means that there is no treatment that will "cure" it. There are a wide variety of treatments that can reduce your pain, improve your function and enable you to lead a full life.

  • Q:What causes fibromyalgia?

    A: While the exact cause of fibromyalgia is uncertain, it seems apparent that the symptoms may be due to what is known as central sensitivity. Central sensitivity sensations that are normally not painful, such as touch, become interpreted as painful.

    It is also believed that fibromyalgia may be caused by a sleep disturbance and there does seem to be a sleep disturbance in many patients with fibromyalgia.

    Fibromyalgia may arise out of a specific injury or illness or may develop without an apparent cause.