E-Note for Adult Medicine
Stat | Lytes | Drugs |  ID  | Heart | Lungs | Kidneys |  GI  | Rheum | Heme-Onc | Endo | Neuro | Derm | Misc. | Resource | Home

 Fibromyalgia    DX |  RX                                  See Fibromyalgia 2007                                                                                

Fibromyalgia is a problem that many people, particularly women, have in which there is diffuse pain . The pain is worse with movement and to touch or pressure. There is also a feeling of stiffness. The pain leads the sufferer to becoming inactive , and creates a cycle of pain , less activity, then pain with less activity. Many people with Fibromyalgia have common local problems that seem to be part of their pain, such as lower back pain, neck pain, shoulder problems, epicondylitis (tennis elbow), or trochanteric bursitis. Many people who have fibromyalgia have a disturbance in their sleep pattern that can often be measured on EEG, and treating the sleep disturbance can be very helpful. They also often have irritable bowel, chronic fatigue and chronic headaches.

Cause of Fibromyalgia - Unknown !
But there are many things that seem to trigger fibromyalgia such as:

  1. Injuries.
  2. Disc problems in the neck and back
  3. Shoulder problems such as rotator cuff, impingement, tendonitis.
  4. Lifestyle changes and problems such as new job, weight gain, posture problems, stress, inactivity.
  5. Work related problems such as repetitive activity and posture problems
  6. Sleep disturbance - many things can lead to a disturbance of normal sleep pattern and this contributes to the cycle of poor sleep causing more sensitivity to pain which in turn causes poor sleep.
  7. Drugs - many drugs cause sleep disturbance and also chronic use of drugs can lead to stress. Some of the many drugs that have these effects are : Alcohol, Caffeine, Nicotine, Diuretics, Street drugs, Others
  8. Psychiatric problems - untreated depression affects sleep. Many people who suffer with fibromyalgia have been found to be victims of abuse. Dealing with these issues is very important in trying to get well.
  9. Undiscovered Elements - Research has focused on hormonal imbalances as a cause of fibromyalgia, but there is no conclusive evidence for this as yet. Other possible contributing factors such as allergy, infections or toxins in the environment have also been considered.


Diagnosis of Fibromyalgia                                                     
Fibromyalgia is diagnosed primarily from listening to the patient's history and examining the patient . The characteristic story is one of long-standing, nonfocal pain, sleep disturbance, often accompanied by frequent headaches and irritable bowel symptoms, as well as fatigue.

Examination reveals no signs of inflammation such as swollen joints, and many tender areas in characteristic locations: the base of the skull, the medial supraspinatus and scapular areas, the anterior neck, sternoclavicular areas, lateral epicondyles, sacral dimples, greater trochanters, and medial knees. Many other area are often tender, and not much pressure is required to produce pain. Sometimes there is muscle spasm detectable.

Laboratory testing should focus on ruling out specific entities:

Treatment of Fibromyalgia
The treatments of fibromyalgia are aimed at treating the factors that aggravate it. Local problems, problems with various parts of the body such as neck, back, shoulder, elbow, feet are treated with:

  1. Posture support - supportive pillows to maintain normal back curve and a supportive neck pillow at night. Proper, supportive footwear is beneficial. Tennis elbow bands prevent stretching or the ligaments that pull on this tender area.
  2. Exercises - shoulder, back, and neck exercises strengthen and stretch the muscles around the joints and improve range of motion, preventing muscle spasm.  A program of slowly progressive, regular , exercise is essential in order to get well from fibromyalgia.
  3. Ergonomics - proper organization of work area so that the normal back and neck curves are not upset. Maintain proper support for the back when sitting (lumbar pillow). If a computer is used be sure the screen is positioned properly. There are proper ways to stand and lift. Inactivity has to be avoided.
    Work Issues-  It is best to analyze your work situation and list the factors there that can be changed, such as your work station, noise, and cold, and to work with your employer in getting help in changing these factors.
  4. Tricyclic medications as Amitriptyline/Elavil  - can help pain , sleep disturbance & depression.  
  5. Pain medications - aspirin, acetaminophen/ Tylenol, non-steroid anti-inflammatory medications as: ibuprofen/Motrin & muscle relaxant if there is spasm .  Attempt to achieve pain relief with local measures such as massage (using baby oil or ointments such as Zostrix can make this more effective), application of heat/cold (a hot water bottle works best for this), support - pillows, good chairs, firm mattress & physical therapy.
  6. Lyrica (pregabalin) 300 mg or 450 mg PO daily
    The most common side effects of pregabalin include mild to moderate dizziness and sleepiness. Blurred vision, weight gain, dry mouth, and swelling of the hands and feet were also reported in clinical trials. The side effects appeared to be dose-related. Because pregabalin can impair motor function and cause problems with concentration and attention, the FDA advises that patients talk to their health care provider about whether use of pregabalin may impair their ability to drive. The manufacturer has agreed to perform a study of pregabalin in children with fibromyalgia and in breast-feeding women.
    FDA Approves First Drug for Treating Fibromyalgia. FDA News. U.S. Food and Drug Administration, June 21, 2007 (http://www.fda.gov/bbs/topics/NEWS/2007/NEW01656.html)
  7. Savella (Milnacipran) - a selective serotonin and norepinephrine reuptake inhibitor (SNRI). 100-200 mg /day


What to expect with the Fibromyalgia sufferer:

Most Rheumatologists experience fibromyalgia as a life long problem for most patients, but that the majority get better to the point that they can perform and enjoy most activities, but do have some pain. Through a program of regular exercise, a full life can be not only tolerable but enjoyable. There is a lot of research being done on fibromyalgia and new treatments may be available soon.

John Scavulli, MD  - REF: Kaiser Intranet

Patient Information Fact Sheet on Fibromyalgia from ARA