US Pharm. 2021;46(9):15-16.
Chronic, Widespread Pain
Fibromyalgia is a condition with chronic muscle and joint pain, extreme fatigue, trouble with concentration and memory (mental fog), and depression that significantly affects overall quality of life. It impacts more than 4 million people in the United States and is twice as common in women as in men. Most people are diagnosed with fibromyalgia in middle age, but the risk increases with age. People with autoimmune diseases such as lupus or rheumatoid arthritis are at a higher risk of developing fibromyalgia symptoms. It does not worsen over time or cause serious complications or death, but it is a chronic and debilitating disorder. Early diagnosis and prevention are the goals for managing fibromyalgia.
Role of Genetic Factors and Stress Response
It is mainly unknown why fibromyalgia develops or what causes its symptoms. Symptoms can sometimes be traced to an injury or trauma, an infection, or an emotionally stressful incident, any of which may have triggered the increased sensitivity to pain that is characteristic of fibromyalgia. Individuals who develop fibromyalgia may also have a genetic condition that predisposes them to problems with sensation. More recent evidence suggests that fibromyalgia may be a disease of the immune system, with many of the symptoms of fibromyalgia caused by antibodies that increase the activity of pain-sensing nerves throughout the body. This new evidence will open up new approaches to treatment and prevention.
General Symptoms Can Lead to Misdiagnosis
Fibromyalgia can be difficult to diagnose and treat because it has no obvious root cause. There is no specific laboratory test used for diagnosis. To further complicate matters, patients’ pain and fatigue are frequently dismissed as psychological because no physical cause can be found.
The pain of fibromyalgia is described as burning, throbbing, aching, or tenderness upon pressure. Common sites of pain are the shoulders, back, neck, jaw, hip joints, arms, and legs. Many people experience overwhelming fatigue; about 70% to 80% of those with fibromyalgia also have fatigue and problems sleeping. Other common symptoms are morning stiffness, restless legs syndrome, headaches, poor concentration, numbness or tingling in the extremities, irritable bowel syndrome, pelvic pain, painful menstrual periods, and depression.
Specific criteria should be met to diagnose fibromyalgia, including muscle and joint pain above and below the waist, on both sides of the body, for at least 3 months. However, many physicians make the diagnosis of fibromyalgia through the patient’s history, physical examination, and normal laboratory results.
Treatment Is Individualized
There is no medication or other therapy available to treat the underlying cause of fibromyalgia, so treatment is aimed at relieving symptoms.
Three medications are approved for the specific treatment of fibromyalgia symptoms: One is pregabalin (Lyrica), a seizure medication that also relieves pain caused by damaged nerve endings in diabetes and shingles; the other two are duloxetine (Cymbalta) and milnacipran (Savella), antidepressant and antianxiety medications that also are used to relieve diabetic nerve pain. Since these medications can cause serious side effects, they should be prescribed only when necessary and continued only if they provide relief. Many patients with fibromyalgia experience an improvement in symptoms with one of these medications. However, they do not work for everyone. Physicians may prescribe other medication classes besides the approved medications to manage the symptoms.
Other approaches such as exercise, mindfulness techniques, acupuncture, and others are as effective as medications for managing fibromyalgia symptoms. Exercise helps aching muscles become stronger and more flexible and also helps to reduce stress. Mindfulness techniques have been shown to reduce the stress and anxiety response in those with fibromyalgia. Acupuncture studies demonstrate a reduction in pain and an overall improvement in health-related quality of life. Stress relief through such methods as biofeedback therapy or cognitive behavior therapy also can be an effective part of the comprehensive treatment program for fibromyalgia.
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