Fibromyalgia was once often dismissed by physicians and the public as a psychological
disorder or "waste basket" diagnosis because of an absence of objective findings
on physical examination and usual laboratory and imaging evaluations. Many physicians
still do not accept FM as a distinct illness. However, recent basic and clinical
investigation has rapidly clarified the neurophysiologic bases for FM and has led to
its new classification as a central sensitivity syndrome (CSS). Fibromyalgia can now
be considered a neurosensory disorder characterized, in part, by abnormalities in CNS
pain processing. Increased understanding of the biological bases underlying FM is
rapidly leading to a new era of specific medications for the condition.
At a clinical level, FM is much more than widespread pain. It overlaps substantially
with the following:
The diagnostic label attached to a patient may be determined largely by the
first specialist that he or she sees. For example, a rheumatologist might
diagnosis FM, whereas a gastroenterologist may diagnose irritable bowel syndrome (IBS).
In addition, FM coexists in unusually high frequency with certain illnesses
characterized by systemic inflammation, such as
rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and
chronic hepatitis C infection, among others. In such cases, both disorders must be
recognized and treated for optimum therapeutic outcome.
The pain of FM is present in the soft tissues throughout the body. Pain and
stiffness concentrate in spots such as the neck and lower back. The
don't seem to be inflamed, nor do they display the typical signs of discomfort, such as
heat, redness, or swelling. Most tests show nothing out of the ordinary in the anatomy
of people with FM. The figure above and to your right indicates the tender points in
red. In the image above, the left is the front view, while the image on the right is the
The word Fibromyalgia (FM) comes from the Latin term for fibrous tissue (fibro) and the
Greek ones for muscle (myo) and pain (algia). Tender points are specific places on the
body, neck, shoulders, back, hips, and upper and lower extremities where people with FM
feel pain in response to slight pressure.
Although FM is often considered an arthritis-related condition, it is not truly a form
of arthritis (a disease of the joints) because it does not cause inflammation or damage
to the joints, muscles, or other tissues. Like arthritis, however, FM can cause
significant pain and fatigue, and it can interfere with a person's ability to carry on
daily activities. Also like arthritis, FM is considered a rheumatic condition.
What Exactly Does Rheumatic Mean?
Even physicians do not always agree on whether a disease is considered rheumatic. If you
look up the word in the dictionary, you'll find it comes from the Greek word rheum,
which means flux, not an explanation that gives you a better understanding. In
medicine, however, the term rheumatic means a medical condition that impairs the joints
and/or soft tissues and causes chronic pain.
While FM is one of the most common diseases affecting the muscles, its cause is
currently unknown. The painful tissues involved are not accompanied by tissue
inflammation. Therefore, despite potentially disabling body pain, patients with FM do
not develop body damage or deformity. FM also does not cause damage to internal body
organs. Therefore, FM is different from many other rheumatic conditions (such as
rheumatoid arthritis, systemic lupus, and polymyositis). In those diseases,
tissue inflammation is the major cause of pain, stiffness and tenderness of the
joints, tendons and muscles, and it can lead to joint deformity and damage to the
internal organs or muscles.
FM as defined by the ACR criteria is more common in females than in males, with
a female-to-male ratio of approximately 9:1. Males with FM tend to have lower
health perception and more physical limitations than females. Females with FM have
greater pain sensitivity and may exhibit greater life interference
due to pain.
Some of the mechanisms that may contribute to increased pain sensitivity in women
1. Differences in primary afferent input to the CNS, with developmental and
menstrual cycle–dependent enhancement.
2. Developmental and phasic gonadal-hormonal modulation of pain regulatory
systems, stress-induced analgesia, and opioid receptors.
3. Higher levels of trait and state anxiety.
4. Increased prevalence of depression.
5. Use of maladaptive coping strategies.
6. Increased behavioral activity in response to pain.
Although usually considered a disorder of women aged 20-50 years, FM is observed
in pediatric populations, especially in adolescents, and in older persons. FM in
children responds to a combination of psychotherapy, exercise, relaxation techniques,
and education. Pharmacotherapy is generally not indicated.
Chronic pain and fatigue are extremely prevalent in the general population,
especially among women and persons of lower socioeconomic status. The
prevalence of regional pain is 20%; widespread pain, 11%; FM according to
the American College of Rheumatology (ACR) criteria,27 3-5% in females
and 0.5-1.6% in males; and chronic fatigue, approximately 20%. Because the ACR criteria
are relatively insensitive, the actual prevalence of FM is higher.
FM experts estimate that about 10 million Americans and approximately 3-6% of the
population worldwide suffer with FM. While it is most common in women, the illness
strikes men, women, and children of all ages and ethnic backgrounds. For those with
severe symptoms, FM can be extremely debilitating and interfere with even routine
FM is a chronic relapsing condition. In academic medical centers,
long-term follow-up care of patients with FM reportedly averages 10 outpatient visits
per year and 1 hospitalization every 3 years. Chronic pain and fatigue in FM increases
the risk for metabolic syndrome.
A subset of patients with FM consider themselves to be more ill and more
impaired, reporting markedly abnormal scores for pain, functional disability,
fatigue, sleep disturbance, and psychologic status. They have significantly higher
levels of comorbid illness and healthcare utilization and costs than matched controls.
The annual economic burden of FM in 2005 was $10,199 (US dollars) per patient per
year, nearly double that of matched controls.
Years Spent Searching For Help
If you've been from one doctor to another looking for a correct diagnosis, you're not
alone. It takes
many years for most FM patients to receive an accurate diagnosis. Many times this
is because FM mimics other illnesses. Often times it's because many physicians
don't understand FM, or don't believe it to be a real illness.
Fibromyalgia can be mild or disabling, and the emotional toll can be substantial. People
with fibromyalgia experience greater psychological distress and a greater impact on
quality of life than those with other conditions, such as chronic low back pain. About
half of all patients have difficulty with routine daily activities, or are unable to
perform them. An estimated 30 - 40% of patients have had to quit work or change jobs.
Patients with either CFS or fibromyalgia are more likely to lose jobs, possessions, and
support from friends and family than are people suffering from other conditions that cause
While there is currently no cure for fibromyalgia, better ways to diagnose and treat the
chronic pain disorder continue to be developed. Since June 2007, the U.S. Food and Drug
Administration has approved three medications for the treatment of fibromyalgia and other
FM medications are currently in development. Research efforts have expanded as well. In
1990 there were approximately 200 published research papers on fibromyalgia studies. Today
there are more than 4,000 published reports.
While many strides have been made in the last decade, fibromyalgia remains a challenging
condition. However, clinical studies have demonstrated that fibromyalgia patients can
reduce their symptoms through a variety of treatment options. Working in conjunction with
knowledgeable healthcare professions, motivated and informed patients can experience
significant improvement in their symptoms and quality of life. Developing an individualize
self-management plan, from identifying effective treatments approaches to making necessary
lifestyle changes, will further improve one's health.
Risk of Negative Behaviors
The pain, emotional consequences, or sleep disturbances that come with fibromyalgia may
lead to self-medication and overuse of sleeping pills, alcohol, drugs, or caffeine.
Outlook in Adults. Some studies show that fibromyalgia symptoms remain stable over the
long term, while others report a better outlook, with 25 - 35% of patients reporting
improvement in pain symptoms over time. Studies suggest that regular exercise improves the
outlook. Those with a significant life crisis, or who are on disability, have a poorer
outcome, as determined by improvements in the patients' ability to work, their own
feelings about their condition, pain sensation, and levels of disturbed sleep, fatigue,
and depression. Although the disease is lifelong, it is not fatal.
Outlook in Children. Children with fibromyalgia tend to have a better outlook than adults
with the disorder. Several studies have reported that more than half of children with
fibromyalgia recover in 2 - 3 years.