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FIBROMYALGIA (FM) RESEARCH FM Research

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) sponsors research that will improve scientists' understanding of the specific problems that cause or accompany Fibromyalgia (FM), in turn helping them to develop better ways to diagnose, treat, and prevent this medical condition.

The research on FM supported by NIAMS covers a broad spectrum, ranging from basic laboratory research to studies of medications and interventions designed to encourage behaviors that reduce pain and change behaviors that worsen or perpetuate pain.

The following are descriptions of some of the promising research now being conducted:


Understanding Pain

Research suggests that fibromyalgia is caused by a problem in how the body processes pain, or more precisely, a hypersensitivity to stimuli that normally are not painful. Therefore, several NIH-supported researchers are focusing on ways the body processes pain to better understand why people with fibromyalgia have increased pain sensitivity. These studies include:

  • An investigation into the relationship between variations in a gene called ADRA1A and risk factors for chronic pain conditions.

  • The establishment of a tissue bank of brain and spinal cord tissue to study fibromyalgia and to determine the extent to which chronic pain in fibromyalgia patients is associated with the activation of cells in the nervous system and the production of chemical messengers, called cytokines, that promote inflammation.

  • The use of imaging methods to evaluate the status of central nervous system responses in patients diagnosed with fibromyalgia compared with those diagnosed with another chronic pain disorder and pain-free controls.

  • An investigation to understand how the activation of immune cells from peripheral and central nervous system sources trigger a cascade of events leading to the activation of nerve cells, chronic pain, and the dysregulation of the effects of analgesic drugs against pain.

  • An intensive evaluation of twins in which one of the pair has chronic widespread pain and the other does not, along with twins in which neither of the pair has chronic pain, to help researchers assess physiological similarities and differences in those with and without chronic pain and whether those differences are caused by genetics or environment.

  • A study examining the use of cognitive behavioral therapy in pain patients, which researchers hope will advance their knowledge of the role of psychological factors in chronic pain as well as a new treatment option for fibromyalgia.

  • The Patient-Reported Outcomes Measurement Information System (PROMIS) initiative. The PROMIS initiative is researching and developing new ways to measure patient-reported outcomes (PROs), such as pain, fatigue, physical functioning, emotional distress, and social role participation that have a major impact on quality-of-life across a variety of chronic diseases. The goal of this initiative is to improve the reporting and quantification of changes in PROs. NIAMS supports an effort to develop PROMIS specifically for use in patients with fibromyalgia.


Improving Symptoms

A better understanding of fibromyalgia and the mechanisms involved in chronic pain are enabling researchers to find effective treatments for it. Some of the most promising lines of research in this area include the following:

  • Increasing Exercise

    Although fibromyalgia is often associated with fatigue that makes exercise difficult, regular exercise has been shown to be one of the most beneficial treatments for the condition. A new NIAMS-supported study is trying to determine whether increasing lifestyle physical activity (that is, adding more exercise such as walking up stairs instead of taking the elevator) throughout the day produces similar benefits to exercise for fibromyalgia, improving symptoms such as pain, fatigue, and tenderness. The study is also examining the potential mechanisms by which lifestyle physical activity might influence symptoms. Other research supported by NIAMS is examining the effectiveness of a 16-week program of a simplified form of Tai Chi on pain and other measures such as sleep quality, fatigue, anxiety, and depression.

    NIAMS-supported research is also examining ways to help people maintain helpful exercise programs. Because many people with fibromyalgia associate increased exercise with increased pain, doctors and therapists often have a difficult time getting patients to stick with their exercise program. The new research is examining patients' fears that cause them to avoid exercise as well as behavioral therapies to reduce fears and help them maintain exercise.


  • Improving Sleep

    Researchers supported by NIAMS are investigating ways to improve sleep for people with fibromyalgia whose sleep problems persist despite treatment with medications. One team has observed that fibromyalgia patients with persistent sleep problems share characteristics with people who have sleep-disordered breathing—a group of disorders, the most common of which is the obstructive sleep apnea, characterized by pauses in breathing during sleep. These researchers are studying whether continuous positive airway pressure (CPAP, a therapy administered by a machine that increases air pressure in the throat to hold it open during sleep) might improve the symptoms of fibromyalgia.

    Other groups of researchers are examining the link between sleep disturbance and chronic pain in fibromyalgia and are studying whether behavioral therapy for insomnia might improve fibromyalgia symptoms.


Studying and Targeting Treatments

In addition to exercise and improving sleep, NIAMS-supported researchers are looking at different ways to reduce pain and other symptoms of fibromyalgia. Potential therapies under study include transcranial magnetic stimulation (TMS) and vagus nerve stimulation.

TMS is a therapy in which an electrical current is passed through an electromagnetic coil placed on the scalp, inducing a small electrical current within the underlying cortex. Recent research shows that the therapy not only decreases depressive symptoms in depressed patients, but also is effective in reducing pain. The new study will examine whether TMS is effective in improving pain in people with widespread chronic pain disorder, including fibromyalgia.

Vagus nerve stimulation is a treatment that uses a device similar to a pacemaker to administer regular, mild pulses of electrical energy to the brain by way of the vagus nerve. The vagus nerve runs from the brain stem to the lower abdomen and controls body functions, including heart rate, that are not under voluntary control.

NIAMS recently funded its first study of a drug treatment for FM. The study will measure the effectiveness of gabapentin, an anticonvulsant medication, in reducing symptoms of FM. Gabapentin has been found to relieve chronic pain caused by nervous system disorders, and it was recently approved by FDA for the treatment of persistent, severe pain that can follow an episode of shingles.

Scientists recognize that people with FM often fall into distinct subgroups that adapt to and cope with their symptoms differently. They also realize that these subgroups may respond to treatments differently. One NIAMS-funded team of researchers has divided people with FM into three groups based on how they cope with the condition. Relative to other chronic pain patients, those in the first group have higher levels of pain and report more interference in their life due to pain. They also have higher levels of emotional distress, feel less control over their lives, and are less active.

The second group reports receiving less support from others, higher levels of negative responses from significant others, and lower levels of supportive responses from significant others. Those in the third group are considered adaptive copers; they have less pain, report less interference in their lives due to pain, and have less emotional distress. Members of this last group feel more control over their lives and are more active. On the premise that the better you understand the subgroups, the better you can tailor treatments to fit them, the researchers now are trying to design and test different programs for each group, combining physical therapy, interpersonal skills training, and supportive counseling.


Research on Complementary and Alternative Medicine (CAM)

According to reviewers who have assessed the research on CAM and Fibromyalgia (FM), much of the research is still preliminary, and evidence of effectiveness for the various therapies used is limited.


Research on Acupuncture

Stimulation of anatomical points with thin metallic needles—for FM has produced mixed results. One review article notes that three studies found some evidence to support the use of electroacupuncture (in which the needles are pulsed with electric current). However, the effects of electroacupuncture in these studies were mostly short lived, and two studies of traditional acupuncture had negative results.

Some researchers believe that low levels of magnesium may contribute to FM. However, there is no conclusive scientific evidence that magnesium supplements relieve FM symptoms. Two small studies had conflicting results.

A review of the research on massage therapy for FM notes only modest, preliminary support. Two studies had some positive findings, but two others found either no benefits or only short-term improvements.

Supplements containing the amino acid derivative SAMe are used for a variety of conditions. Although several small studies of SAMe for FM have had mixed results, there is some evidence of a benefit. Reviewers conclude that more research is needed.

Finally, according to reviewers, research evidence is insufficient to draw conclusions about the effectiveness of other CAM treatments—biofeedback, chiropractic care, hypnosis, and magnet therapy—used for FM.


NCCAM Research on Fibromyalgia

The National Center for Complementary and Alternative Medicine (NCCAM) funds clinical trials that look at CAM for FM. Recent projects include studies of:

  • The effects of tai chi on FM patients' musculoskeletal pain, fatigue, sleep quality, psychological distress, physical performance, and health status.

  • Brain-imaging techniques for determining whether acupuncture relieves pain due to FM.

  • The effectiveness of a form of electroencephalograph (EEG) biofeedback in treating FM.


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Sources:

  • Questions and Answers about Fibromyalgia, Health Information, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), NIH Publication No. 04-5326.

  • Arnold LM. Biology and therapy of fibromyalgia: new therapies in fibromyalgia. Arthritis Research and Therapy. 2006;8(4):212.

  • Clauw DJ, Crofford LJ. Chronic widespread pain and fibromyalgia: what we know, and what we need to know. Best Practice and Research Clinical Rheumatology. 2003;17(4):685–701.

  • Fibromyalgia and related conditions: levels of scientific evidence for specific therapies. Natural Standard Database Web site. Accessed on December 17, 2007.

  • Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. Journal of the American Medical Association. 2004;292(19):2388–2395.

  • Harris RE, Clauw DJ. How do we know that the pain in fibromyalgia is "real"? Current Pain and Headache Reports. 2006;10(6):403–407.

  • Holdcraft LC, Assefi N, Buchwald D. Complementary and alternative medicine in fibromyalgia and related syndromes. Best Practice and Research Clinical Rheumatology. 2003;17(4):667–683.

  • Mayhew E, Ernst E. Acupuncture for fibromyalgia: a systematic review of randomized clinical trials. Rheumatology. 2007;46:801–804.

  • National Institute of Arthritis and Musculoskeletal and Skin Diseases. Questions and Answers About Fibromyalgia. National Institute of Arthritis and Musculoskeletal and Skin Diseases Web site. Accessed on March 14, 2008.

  • Natural medicines in clinical management of fibromyalgia: clinical management series. Natural Medicines Comprehensive Database Web site. Accessed on December 13, 2007.

  • Sarac AJ, Gur A. Complementary and alternative medical therapies in fibromyalgia. Current Pharmaceutical Design. 2006;12(1):47–57.

  • Sim J, Adams N. Systematic review of randomized controlled trials of nonpharmacological interventions in fibromyalgia. The Clinical Journal of Pain. 2002;18(5):324–336.

  • Tsao JC. Effectiveness of massage therapy for chronic, non-malignant pain: a review. Evidence-Based Complementary and Alternative Medicine. 2007;4(2):165–179.

  • Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis and Rheumatism. 1990;33(2):160–172.
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