While the millions living with fibromyalgia are acutely aware of this multi-symptom syndrome, many others—including some physicians—are wholly unfamiliar with this complicated, somewhat mysterious condition.
Brief History, Broad Spectrum of Symptoms
This lack of familiarity can be traced to several factors. First, fibromyalgia only entered the medical lexicon relatively recently. "When I was a fellow 18 years ago, many physicians had never heard of fibromyalgia," explains Daniel Arkfeld, M.D., associate professor of clinical medicine at the Keck School of Medicine of USC.
Another lack-of-familiarity factor can be attributed to, as Arkfeld puts it, the fact that "fibromyalgia isn't neatly packaged." Arkfeld is referring to fibromyalgia's seeming smorgasbord of symptoms. According to the National Fibromyalgia Association (NFA), "Chronic, widespread body pain is the primary symptom of fibromyalgia. Most people with fibromyalgia also experience moderate to extreme fatigue; sleep disturbances; sensitivity to touch, light and sound; and cognitive difficulties."
Arkfeld, who has worked with thousands of fibromyalgia patients, says, "The most prevalent symptoms are pain and fatigue. Depression also is a very common symptom."
Further, many fibromyalgia suffers also experience a variety of other symptoms, including: irritable bowel and bladder; migraine headaches; impaired memory; skin rashes; dry eyes and mouth; anxiety; depression; ringing in the ears; dizziness; vision problems; and impaired coordination. Those with fibromyalgia often face additional, simultaneous medical challenges such as arthritis, chronic fatigue syndrome, lupus, restless leg syndrome and sleep apnea.
Women suffer disproportionately from fibromyalgia. Based on NFA statistics, between 75 percent and 90 percent of those with fibromyalgia are women. Arkfeld attributes this gender gap to female hormones. Most fibromyalgia patients are diagnosed between the ages of 20 to 50.
Not surprisingly, fibromyalgia's expansive spectrum of symptoms often stands as an obstacle to both diagnosis and treatment. Arkfeld points out, "By the time patients come to my office, they usually have been to 20 other doctors who haven't been able to help them." The NFA estimates that, on average, it takes five years for a fibromyalgia patient to receive an accurate diagnosis.
Although fibromyalgia presents in a plethora of forms, to meet the syndrome's diagnostic criteria patients must have widespread pain in all four quadrants of their body for a minimum of three months. Pain is considered widespread when all of the following are present:
- pain in the left side of the body;
- pain in the right side of the body;
- pain above the waist;
- pain below the waist;
- pain in the neck, front of the chest, mid-back or lower back.
As there currently are no laboratory tests to confirm fibromyalgia, physicians apply pressure at 18 locations on the body—based on American College of Rheumatology guidelines—to determine the existence of tender points. Fibromyalgia is diagnosed when tenderness or pain is found in at least 11 of the 18 specified locations. Doctors also take into account a patient's medical history and self-reported symptoms.
Given the multi-faceted nature of fibromyalgia, treatment doesn't come in a one-size-fits-all form. As Arkfeld observes, "There's no single treatment pathway, as patients present with a variety of symptoms."
For those requiring pain management, there are three FDA-approved prescription medications— pregabalin (Lyrica), duloxetine (Cymbalta), and milnacipran (Savella). Localized areas of pain also can be addressed through lidocaine injections.
Sleep disturbances commonly associated with fibromyalgia can be countered by prescription sleep medications or low-dosage antidepressants; patients experiencing depression might receive higher-dosage antidepressants. Lifestyle modification—such as avoiding caffeine, sugar and alcohol before bed—also can prove beneficial.
Arkfeld additionally advocates exercise. "Medication is one pathway," he explains, "but exercise is an important part of treatment as well. Fibromyalgia patients need to gradually build up their endurance. Exercise helps reduce sleep disturbances and tender points."
The NFA gives a nod to a variety of other treatments, including: physical therapy, therapeutic massage, water therapy, light aerobics, acupuncture, yoga, aromatherapy, biofeedback and osteopathic or chiropractic manipulation.
While the underlying cause of fibromyalgia remains somewhat elusive, recent research is shedding light on likely physiological suspects. "Findings are increasingly pointing to central pain mechanisms deep in the brain," says Arkfeld. Evidence indicates that fibromyalgia sufferers experience amplified pain due to abnormal sensory processing in the central nervous system. Looking ahead, Arkfeld is "optimistic for the future. Twenty years from now, we'll have fibromyalgia well figured out."
For more information about fibromyalgia, visit the National Fibromyalgia Association website.