The following are questions and answers regarding Fibromyalgia (FM). Contact us if you have a question you'd like answered. Select from the table below for more FAQ's.

Fibromyalgia (FM) is a syndrome characterized by chronic pain, stiffness, and tenderness of muscles, tendons, and joints without detectable inflammation. FM does not cause deformity or death. However, FM is a disabling disease which can last a lifetime.

The cause of FM remains elusive, but there are many triggered events thought to precipitate its onset. FM can be triggered in pre-disposed individuals by a traumatic injury to the body or brain (i.e., a vehicular accident or fall), a severe illness or surgery, or acute emotional stress. These triggered events don't cause FM, but they may awaken the underlying physiological abnormalities that are already present in the body of an FM patient.

FM occurs more often, but not exclusively, in women, possibly due to immunological factors or hormonal changes. FM is most easily diagnosed when formerly active adults become ill, but it has been reported in persons of all ages, including young children and particularly teenagers.

FM diagnosis requires a hands on evaluation by a skilled medical professional. This evaluation usually consists of:

1. Ruling out medical conditions whose symptoms mimic FM (i.e., thyroid disease, MS, lupus, etc.)

2. An extensive medical history which includes a discussion of the nature and duration of specific symptoms.

3. A physical examination which includes a tender point exam - The criteria used for diagnosis is widespread pain for a duration of more than 3 months. Also, pain in 11 of the 18 tender point locations when a pressure of 4 kgs is used in the tender point location. (click here for more about FM Tender Points)

Fibromyalgia (FM) is characterized by the presence of multiple symptoms. The severity of symptoms can change depending on stress levels, your activity level, the weather, and other illnesses. There's a link between FM flare-ups and the menstrual cycle. Many women who suffer from FM report an increase in headaches, body pain, memory problems and sleep difficulties, in the period leading up to, and during the first half of their menses.

In an article published in PubMed, researchers concluded, "The menstrual cycle and the onset of menopause affect pain and the severity of other FM-related symptoms in approximately one half of the subjects. "

Ninety percent of FM sufferers also are afflicted with Chronic Fatigue Syndrome. In addition to pain and fatigue, common symptoms include malaise, headaches, numbness and tingling, dizziness, sleep disturbance, swollen feeling in tissues, stiffness, sensitivity to noise and stress, and cognitive impairment.

Click here for more information about individual symptoms.

Since there is no cure for Fibromyalgia (FM), treatments are geared towards improving the quality of sleep and reducing pain. Treatments take on several different forms. There are medications, trigger-point injections, physical therapy, occupational therapy, acupuncture, acupressure, relaxation techniques, biofeedback techniques and osteopathic manipulative medicine.

Deep level sleep (stage 4 sleep) is crucial for many body functions such as tissue repair, antibody production, and the regulation of various neurotransmitters, hormones, and immune system chemicals. Therefore, sleep disorders that occur in FM are treated first because they may be a strong contributing factor to the symptoms of FM. There are many different types of treatments for sleep disorders to be considered.

Click here for more information about individual treatments.

Tender points are areas that cause pain but do not display the typical signs of discomfort, such as heat, redness, or swelling.

The eighteen tender points consist of nine bilateral sites adding up to eighteen in total. The picture to your right shows the 18 tender point sites that have been identified by the American College of Rheumatology (ACR). According to the ACR criteria, FM is present when a patient suffers widespread pain for at least three months and feels pain in 11 or more of the 18 pressure point sites.

Doctors measure these tender points in one of two ways:

• by simply pressing the site with a finger or
• by using a slightly higher-tech method called dolorimetry

In the dolorimetry method, the examiner presses a rubber endplate, attached to a spring-loaded force gauge, into the tender point site with increasing force. Patients are then asked to say when they stop feeling pressure and start feeling pain.

Click here for more information about FM tender points.

Yes, stress worsens FM symptoms. If you have ongoing problems with depression or anxiety, consider seeking help for them from your family doctor or a psychiatrist.

Anxiety and depression may arise as symptoms of FM and in turn cause insomnia, leading to worsening of the underlying problem. Relaxation techniques or a chronic pain program can also help lower your stress level and are of proven benefit in treating FM.

Although there is currently no cure for FM, symptoms can be substantially controlled by comprehensive treatment that includes education, medication, physical conditioning to improve aerobic capacity and flexibility, and psychological intervention aimed at stress management.

5-HTP (5-Hydroxytryptophan) is a building block of serotonin. Serotonin is a powerful brain chemical, and serotonin levels play a significant role in Fibromyalgia (FM) pain. Serotonin levels are also associated with depression and sleep regulation.

For those with FM, 5-HTP may help to increase deep sleep and reduce pain. In one study published in the Alternative Medicine Review, researchers reported that supplementation with 5-HTP may improve symptoms of depression, anxiety, insomnia, and FM pains. Yet, there are some contradictory studies that show no benefit with 5-HTP.

5-HTP is usually well tolerated. But in the late 1980s, the supplement was associated with a serious condition called eosinophilia-myalgia syndrome. It's thought that a contaminant in 5-HTP led to the condition, which causes flu-like symptoms, severe muscle pain, and burning rashes. Be sure to speak to your health care provider before taking any new medication or supplement.

There's no specific evidence that St. John's Wort is helpful in treating FM. However, this herb is often used in treating depression, and depression is commonly associated with FM.

St. John's wort is usually well tolerated. The most common side effects are stomach upset, skin reactions, and fatigue. St. John's wort should not be mixed with antidepressants and can cause interactions with many types of drugs. If you're on medication, check with your doctor before taking St. John's wort or any supplement. In addition, watch taking St. John's wort with other medications, including antidepressants, as it could make you ill. Be sure to speak to your health care provider before taking any new medication or supplement.

There is no well-accepted effect of fibromyalgia on pregnancy. For example, no reliable improvement or worsening of pain is expected when a woman with fibromyalgia becomes pregnant, and there are no known health effects of fibromyalgia on the baby. One small study in 1997 did find that symptoms worsened during pregnancy, especially during the last trimester, and even after delivery; there was no effect on the babies' health. However, the relationship between fibromyalgia and pregnancy has not been thoroughly studied, and individual patients with the condition vary widely in how they feel while pregnant. Future research is necessary to identify whether there is a predictable effect of pregnancy on fibromyalgia or of fibromyalgia on the health of mother and fetus.

Medications used to treat fibromyalgia may not be safe for a developing fetus or during breast-feeding. If you have fibromyalgia (or any condition for which you take medications) and you plan to become pregnant, talk with your health-care providers about whether you should continue taking your medications.

To date, there is no evidence that FM is contagious or transmissible from person to person.

People with FM may improve after a few months, or after many years, or never at all. They may reach a plateau at some constant level of health, or may progressively decline. Often, the symptoms change over time, or cycle irregularly. Relapses are common, especially after stressful life events or additional illness. Exertion can cause not merely a relapse, but a worsening of overall health. Undiagnosed cases of FM often worsen as the sufferer attempts to return to a "normal" level of activity, only to make their condition worse through exertion.

Of those FM patients moderately to severely affected, many may expect to remain so for an indeterminate period, even for the duration of their life. It is not known whether any patients truly "recover" entirely from the illness, or merely recuperate enough to regain previous levels of activity.

Although it was once thought that FM might be a form of arthritis, research over the past 10 plus years has proven that to be false. Arthritis is defined as an inflammation of the joints, but there is no inflammation with FM, nor is there any damage to the joints. A Fibromyalgia patient may have a type of arthritis (like osteoarthritis or rheumatoid arthritis) in addition to FM, but it is a completely separate disorder. On the FM research front, new brain-imaging techniques and scientific studies are revealing that Fibromyalgia is better defined as a central nervous system disorder that results in abnormal pain processing.

For many years FM was described as a musculoskeletal disorder because much of the pain people experience with FM feels like it is coming from the muscles, joints and connective tissues. However, years of testing failed to reveal any actual damage to the musculoskeletal system.

What research has discovered is that a malfunction in the central nervous system of FM patients causes disordered sensory processing which leads to pain amplification. In other words, a stimulus that would not even be noticed by most people can be extremely painful to someone with Fibromyalgia.

Autoimmune disease is the result of a body's overactive immune response. In a sense, the body's immune system begins to attack it's own cells and tissues. There is no evidence that FM is an autoimmune disease. In fact, years of research have not turned up any virus, bacteria or immune disorder.

It's not unusual, however, for someone with FM to also have one or more autoimmune diseases, such as: Celiac Disease, Crohn's Disease, Lupus, Multiple Sclerosis, Rheumatoid Arthritis, Sjögren's Syndrome, or some types of thyroid disease. Other illnesses that are suspected to have an autoimmune link and may occur with FM include: Chronic Fatigue Syndrome, Endometriosis, Interstitial Cystitis, and Lyme disease.

This myth probably causes the most frustration to FM patients. After years of being told "It's all in your head," patients finally have proof that FM is a very real, physical illness. Research studies have revealed a number of biological abnormalities, including:

• Decreased blood flow to specific areas of the brain, particularly the thalamus region, which may help explain the pain sensitivity and cognitive functioning problems experienced by FM patients.


• High levels of substance P, a central nervous system neurotransmitter involved in pain processing.


• Low levels of nerve growth factor.


• Low levels of somatomedin C, a hormone that promotes bone and muscle growth.


• Low levels of several neurochemicals: serotonin, norepinephrine, dopamine and cortisol.

Despite the scientific evidence, some medical professionals continue to dismiss FM as a psychological problem, insisting that the symptoms are caused by depression. The fact is that the percentage of FM patients who suffer with depression is no higher than for any other chronic illness. Unfortunately, since it takes an average of 17 years for new research to become part of mainstream medicine, we're probably going to be fighting this myth for several more years.

Lifestyle modifications may help you conserve energy and minimize pain. Learn what factors aggravate your symptoms and avoid them when possible. Many patients find warm water (hot tub or shower) to be soothing. Hot wraps for particularly painful areas are also beneficial. Maintaining a rigid sleep schedule (e.g., ensuring that you receive at least eight hours of sleep per night and that you have a routine for easing you into sleep) is one method endorsed by patients to help minimize daytime fatigue and reduce nighttime sleep difficulties. Gentle movement and stretching exercises will help you maintain your function, which is essential when the body is tired and the muscles hurt.

Changes in weather, cold or drafty environments, hormonal fluctuations (premenstrual and menopausal states), stress, depression, anxiety, infections (flu or a cold), and over-exertion can all contribute to symptom flare-ups. Repetitive use of the same muscle group can strain the muscles and lead to more pain.

No. However, a diet full of fruits and vegetables may supply your body with additional antioxidants like malic acid found in apples, and calcium found in deep green vegetables. Antioxidants are considered to be beneficial for minimizing oxidative stress that can occur in tissues when the body generates certain reactive chemicals, called free radicals. An excess of free radicals is harmful to the tissues, which is likely why researchers have discovered that an antioxidant/oxidant imbalance corresponds with lower pain thresholds, higher muscle pain levels, and greater fatigue levels.

Doctors recommend that you try to minimize the amounts of preservatives or chemicals that you consume in your diet because your body will require more antioxidants to clear them from your system, and many patients are chemically sensitive. Moreover, there are certain chemicals in foods that tend to cause more problems or magnify FM symptoms, such as aspartame, commonly known on the supermarket shelf as Equal or NutraSweet.

In addition to a healthy diet, several vitamins and nutritional supplements have been determined to be beneficial for a variety of chemical imbalances to help you improve the quality of your life. For example, melatonin is known to increase brain serotonin levels and has hypnotic effects that may aid sleep as well. Vinpocetine, a substance extracted from the periwinkle plant, has been known for years to improve brain function. Supplements also can help with gastrointestinal distress, muscle function, fibro-fog, and fatigue.

Depression or anxiety may occur as a result of your constant pain and fatigue, or the frustration you feel with the condition. It is also possible that the same chemical imbalances in the brain that cause FM also cause depression and anxiety.

Depression can leave you feeling alone, anxious, and extremely sad, and can make FM even more troublesome to deal with. You are not alone - help for depression is out there and can include support groups, prescription medications and botanical supplements.

It is important to describe your signs of depression as accurately as possible to your health care provider so he can try to find a cause for your depression. Additionally, medications can be prescribed to help ease your depression symptoms. Antidepressants commonly used to treat depression have also been shown to be helpful in easing some FM symptoms.

Melatonin is a natural hormone that's available as an over-the-counter supplement. It is sometimes used to induce drowsiness and improve sleep patterns. Some preliminary findings show that melatonin may be effective in treating Fibromyalgia (FM) pain. Most patients with FM have sleep problems and fatigue, and it's thought that melatonin may help relieve these symptoms.

Melatonin is generally regarded as safe with few to no side effects. Due to the risk of daytime sleepiness, though, anyone taking melatonin should use caution when driving until they know how it affects them. Be sure to speak to your health care provider before taking any new medication or supplement.

Supplements as Fibromyalgia & CFS/ME Treatments is an article that can help answer this question. Before taking any herb or supplement, talk to your health care provider or pharmacist about possible side effects or herb-drug interactions.

Herbal therapies are not recommended for pregnant women, children, the elderly, or those with weakened immune systems. In addition, some herbs have sedative or blood-thinning qualities, which may dangerously interact with anti-inflammatory painkillers or other pain medications. Others may cause stomach upset if taken in large doses.

Experts believe that exercising is essential for keeping muscles strong and flexible, controlling weight, and helping you stay active in other areas of life. In fact, exercise and activity allow patients to have some control over the disease and the amount of pain they feel.

It used to be that doctors thought that exercise might exacerbate FM symptoms or accelerate the disease. So doctors encouraged patients to seek rest, not activity. But recent scientific studies have shown that, for most patients, range of motion, strengthening, and aerobic conditioning exercises are safe and necessary.

Whether it's daily walks, stretching routines, swimming, yoga, tai chi, or Pilates, low-impact exercise programs can keep you fit in spite of your FM.

There are no particular exercises to avoid with FM. Aerobic exercise (running, jogging), weight training, water exercise, and flexibility exercises can all help.

Golf, tennis, hiking, and other recreational activities are also healthful. If you have other medical problems or if you're planning more than a moderate-intensity exercise program, discuss your plan with your doctor before you start.

The answer is yes — many women with FM notice a connection between their menstrual cycles and their symptoms.

There are several theories about why FM develops, including the notion that the primary problem is abnormal hormonal regulation; if true, that could link the symptoms to menstrual cycles. Your description of a "link" is probably the best way to think about the relationship between menstrual cycle and FM symptoms. Although it's not at all clear that having your period causes an increase in symptoms, doctors and patients alike have long noted an association in timing between an increase in pain and the time just before or during menstrual bleeding. However, not every woman with this condition notices this connection.

Other theories focus on heightened pain perception, abnormal regulation of growth hormone, stress hormones, or stages of sleep. For instance, sophisticated studies of brain function show that when compared with people who don't have FM, those with this syndrome demonstrate increased activity in the areas of the brain involved in pain perception following minor trauma.

Just as the cause of FM is unknown, the things that make it better or worse are variable as well. On average, cold or humid weather, mental or physical fatigue, excessive activity or inactivity, or anxiety tend to make symptoms worse - for many, having their period is on this list as well. Warm or dry weather, warm water, adequate sleep, and regular, moderate exercise tend to improve symptoms. A number of medicines have demonstrated modest benefit, including low doses of amitriptyline, cyclobenzaprine or fluoxetine. Alternative therapies may be more helpful (and better tolerated) than conventional therapies in this condition.

We need a better understanding of what causes this illness. Only then will the connection between menstrual cycles and symptoms of FM become clearer. Ongoing research may provide this information in the near future. See your health-care providers for evaluation so that appropriate treatment for FM can be offered and to rule out another cause of your symptoms.