By Nicole Berardoni M.D, Paul Lynch M.D, and Tory McJunkin M.D
Fibromyalgia is most commonly seen in women ages 30 to 50; however, it can be experienced by anyone. It is associated with anxiety, depression, and sleep disorders. Constipation, diarrhea, and abdominal pain associated with irritable bowel syndrome (IBS) are also typical in people with fibromyalgia. People generally experience pain in specific locations of the body when pressure is applied. These locations are commonly the back of the head (occiput), upper back, neck, elbows, hips, and knees. The pain generally persists for weeks to months and is often accompanied by stiffness. Signs of inflammation are particularly absent.
Another frequently reported complaint of patients with fibromyalgia is headaches with associated facial pain that may be related to the tenderness they are experiencing in their neck and shoulders. Fibromyalgia can also predispose someone to an increased sensitivity to noises, bright lights, odors, and touch, similar to experiences during a severe migraine headache.
A common complication of chronic pain, particularly fibromyalgia, is central sensitization. This is a development involving both the peripheral nervous system (PNS) and the central nervous system (CNS). Local tissue injury and inflammation activate the PNS, which sends signals through the spinal cord to the brain. Central sensitization occurs when there is an increase in the excitability of neurons within the CNS, so that normal inputs from the PNS begin to produce abnormal responses. Low-threshold sensory fibers activated by very light touch of the skin activate neurons in the spinal cord that normally only respond to noxious, or more severe, stimuli.
As a result, an input that would normally produce a harmless sensation now produces significant pain. Although many complaints are common and reported among people with fibromyalgia, the diagnostic criteria are less extensive. The American College of Rheumatology has established general classification guidelines for the diagnosis of fibromyalgia.
According to these guidelines, the diagnosis is made clinically by the physician based upon a history of multiple areas of aches or pain for at least three months and patients who have a minimum of 11 of 18 locations on the body that are abnormally tender under relatively mild pressure. The fibromyalgia specialist is able to make the diagnosis of fibromyalgia in a patient based upon the history of symptoms and by eliciting the specific tender points on physical exam. If the patient has a history associated with fibromyalgia, but has less than the 11 tender spots, or are tender in non-fibromyalgia locations, then this is considered “myofascial pain syndrome” and is managed and treated similar to fibromyalgia.
Treatment of Fibromyalgia Symptoms
Although the intensity and frequency of the symptoms may vary, they probably never disappear completely on their own. It may be encouraging to know, however, that this is not a progressive or life-threatening condition and certain fibromyalgia treatments can significantly improve symptoms. People may experience a remission period, where they are free from symptoms without treatment or have much lower levels of pain.
Most commonly, the symptoms return and treatment is needed to alleviate the physical and emotional complaints.
One of the most difficult aspects for fibromyalgia specialists in treating patients is that they experience both physical discomfort and psychological/emotional hardships. Both the body and the mind need to be addressed for successful treatment. This may include:
- Analgesics (NSAIDs)
- Muscle relaxants
- Membrane-stabilizing drugs
- Sleeping aids
Mixed outcomes are seen with drug treatments alone and emerging data favors pharmacological treatments with other modalities. Treatment goals of patients with fibromyalgia include the improvement of physical pain, increasing daily activities, and restoration of normal sleep cycles. A combination of treatments including pharmacotherapy with alternative therapies such as acupuncture, physical therapy, and activities increasing physical movement (Rooks 2007) is increasing in popularity.
Fibromyalgia treatments for pain and stress management are not new. Some alternative therapies have been practiced for thousands of years, but their use has become more popular in recent years, especially with people who have chronic illnesses, such as fibromyalgia, arthritis, headaches, and chronic back pain, among many other conditions.
These therapies can be especially beneficial for those with fibromyalgia:
- Physical therapy
- Massage therapy
- Cognitive behavioral therapy
- Infusions of membrane stabilizing drugs
- Exercise therapy
- Aquatic therapy
- Tens UNIT
- Trigger point injections
Several of these therapies do safely and effectively reduce pain and the associated complaints, and are quickly gaining acceptance in the practice of medicine. Acupuncture, massage therapy (Tsao 2007), cognitive behavioral therapy, transcutaneous electrical nerve stimulation (TENS), and heat application have all been shown to decrease some of the symptoms associated with fibromyalgia as well as alleviate some of the mental strains experienced by these patients. Ginkgo biloba, which has been used as a sleep aid, has also been known to improve sleep and some of the associated complaints of fibromyalgia (Lister 2002).
Possible Future Fibromyalgia Treatments
Recently the effect of Botox (botulinum toxin A) as a treatment for fibromyalgia has been studied. Thus far, a trial from South Africa has been done that reported 16 people with fibromyalgia were treated with multiple injections of Botox. Several participants had an increased level of pain in areas of the body that didn’t receive injections. Other participants reported improvement without the increase in pain. The Food and Drug Administration has not yet approved Botox for the treatment of fibromyalgia so more clinical trials are needed to determine the safety and potential benefits of this as a treatment.
The common over-the-counter cough suppressant dextromethorphan is also currently being investigated, along with other studies looking at lidocaine and ketamine infusions, but no significant data has been published on their potential benefits as of yet.
If you have fibromyalgia, call us today to schedule an appointment with a fibromyalgia specialist. We are happy to offer these treatment options for fibromyalgia to the Phoenix area.
- Fibromyalgia Treatment Update. PMID: 17278924. Curr Opin Rheumatol. 2007 Rooks DS. Mar;19(2):111-7. Study finds acupuncture improves fibromyalgia symptoms. PMID: 17102788.
- Mayo Clin Womens Healthsource. 2006 Dec;10(12):3. Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial. PMID: 16770975 Mayo Clin Proc. 2006 Jun;81(6):749-57.
- Effectiveness of Massage Therapy for Chronic, Non-malignant Pain: A Review. PMID: 17549233 Evid Based Complement Alternat Med. 2007 Jun;4(2):165-79. Epub 2007 Feb 5 Tsao 2007
- Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment. PMID: 16078356 J Rheumatol Suppl. 2005 Aug;75:6-21. Mease 2005
- An open, pilot study to evaluate the potential benefits of coenzyme Q10 combined with Ginkgo biloba extract in fibromyalgia syndrome. J Int Med Res. 2002 Mar-Apr;30(2):195-9 Lister 2002