Fibromyalgia

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What is fibromyalgia?

Fibromyalgia is a syndrome associated with chronic, widespread disabling pain. Those who have fibromyalgia have aching muscles and sore necks, shoulders, and backs. They sleep poorly and are often stiff when they wake up or when they move after sitting for long periods of time. The intensity and location of the pain and the degree of fatigue may vary from day to day and may become worse with excessive exercise and with stress. Although rarely talked about, fibromyalgia is a relatively common disorder that affects about 3.4% of all women and 0.5% of all men in the United States, primarily those of early middle age. It has been estimated that on a typical day, about 5% of the people in a doctor's waiting room are affected by fibromyalgia. For most rheumatologists, doctors who specialize in rheumatic diseases, it is the second or third most common condition diagnosed.

The pain, fatigue, and numerous other symptoms that are associated with fibromyalgia can frustrate both patient and physician. The condition often makes the affected individuals miserable but does not cause inflammation or visible damage to the affected tissues. While the pain and other symptoms come and go at random, they do not progress to a disease state or remit over time. In the past, people were frequently told that there was nothing wrong with them – that it was "all in their head" or that their symptoms were due to depression or to stress. While some depression is associated with fibromyalgia, it does not cause the condition; the prevalence of depression is about the same as it is with any chronic illness.

The general medical community and major health organizations now acknowledge the existence of fibromyalgia although there is still much to be learned about the condition. In 1990, the American College of Rheumatology (ACR) established an official definition of fibromyalgia that has been widely adopted for use by clinicians and researchers (see Tests). This definition may be modified in the near future as it was in 2010 when the ACR provisionally accepted somewhat different diagnostic criteria. Both versions identify common symptoms of fibromyalgia but not the cause, which is still unknown. It is thought that there are both genetic and environmental components - that something acts as a trigger in people who are predisposed to the condition. Some families have a higher incidence of the disorder. Many cases appear to start with a physical trauma or a severe illness, while other cases arise without a discernable "event."

Some researchers think that the symptoms may be due to sleep disorders, while others believe that fibromyalgia may be due to a microorganism. Still others suspect altered skeletal muscle metabolism or chronic overreaction of the immune system to be the cause. Many investigators believe that fibromyalgia is "all in the head" in a sense – not due to depression or stress but to altered pain processing and to changes in neurochemicals in the brain. While answers to what is causing the condition may be years away, doctors can identify people with fibromyalgia and try to help them live relatively normal lives.

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