Fibromyalgia

The main symptoms of fibromyalgia are:

• Deep or burning pain in your muscles or joints. Pain can be in many places in your body.
• Tender points (or trigger points) on the body that hurt when pressed.

People with fibromyalgia may have other problems along with pain, such as:

• Anxiety or depression.
• Fatigue that gets in the way of work and daily activities.
• Sleep problems, such as trouble falling asleep or staying asleep, or waking up feeling tired.
• Headaches.
• Morning stiffness.
• Trouble thinking clearly.
• Irritable bowel syndrome.

Symptoms tend to come and go. You may have times when you hurt more, followed by times when symptoms happen less often, are milder, or are absent (remission). Some people find that their symptoms are worse in cold and damp weather, during times of stress, or when they try to do too much.

No one knows for sure what causes fibromyalgia. But experts have some ideas, such as:

• Nerve cells may be too sensitive.
• Chemicals in the brain (neurotransmitters) may be out of balance.

Many people connect the start of their symptoms to a certain event. Examples include the flu, an injury or surgery, or emotional trauma and stress. An event of this type combined with other things, such as being more sensitive to pain, may lead to fibromyalgia in some people.

There are no specific tests that can confirm a diagnosis of fibromyalgia. You will probably have lab tests to make sure that you don't have other conditions that cause pain. These include rheumatoid arthritis, polymyalgia rheumatica, lupus, and other autoimmune diseases. Your doctor will also ask questions about your medical history and do a physical exam.

Doctors use a set of guidelines to diagnose fibromyalgia. You may be diagnosed with fibromyalgia if you have:

• Widespread pain. Pain is widespread if it's above and below your waist and on the right and left sides of your body.
• Other symptoms such as fatigue, trouble sleeping, and trouble thinking.
• Symptoms that have lasted for at least 3 months.
• No other medical explanation for why you feel this way. (For example, you don't have another health condition or disease.)

Fibromyalgia is sometimes diagnosed or described using pain and tenderness at 18 specific spots on the body. These spots are called tender points. You may also hear these called trigger points.

Treatment is focused on managing pain, fatigue, depression, and other symptoms common in fibromyalgia. The goal is to break the cycle of increased sensitivity to pain and decreased physical activity.

There are many steps you can take to manage your symptoms. The treatment you need or want may be based on:

• How bad your symptoms are.
• Whether the condition is disrupting your daily life.
• What kinds of changes in your life you are willing and able to make.

Because the symptoms of fibromyalgia can come and go, you may find it hard to judge whether a certain treatment is really working. Different people may respond differently to each type of treatment. Many people with fibromyalgia have other joint or muscle diseases (such as rheumatoid arthritis or lupus) that need to be treated too.

Try to be patient. Finding the right treatment can take time. You may have to try several different treatments to find an approach that works for you.

Exercise

Getting regular exercise, especially cardiovascular exercise, is one of the best ways to manage fibromyalgia. Pool exercise, like water aerobics or swimming, is a good example.

It's important to build up your exercise program slowly so you don't get sore muscles that cause you to want to stop exercising. Working with a physical therapist familiar with fibromyalgia may be helpful.

Medicines

Medicines are part of the long-term treatment of fibromyalgia. They may help you sleep better, relax your muscles, or relieve muscle and joint pain. Your doctor may suggest prescription medicines, such as antidepressants, muscle relaxants, and anticonvulsants. Or your doctor may suggest nonprescription pain relievers.

Not all people with fibromyalgia will need, want, or benefit from medicines. You might need to try more than one medicine before you find one that works best for you. You may also find that a medicine that has been helping your symptoms seems to not work as well over time.

Counseling

Cognitive behavioral therapy and other forms of counseling, including relaxation therapy and biofeedback, can help people who have fibromyalgia. Counseling can help with the pain of fibromyalgia. It can also help with sleep problems and fatigue. And it may improve your mood.

Self-care

Taking care of yourself is an important part of managing fibromyalgia. For example, you can:

• Identify sleep problems, if you have them. Then learn about ways to get more restful sleep.
• Relieve pain and stiffness with medicines and heat.
• Identify "triggers" that seem to make your symptoms worse. Then you can learn to avoid or manage them. Triggers may be a change in the weather, certain activities, stress, or a lack of sleep.
• Talk to your doctor if you have signs of depression or anxiety.

With help, you can start working on most of these goals at home. You may have a team of health professionals to help you.