Rheumatic Diseases

A list of the most common we treat.

Fibromyalgia

Condition & Description

Fibromyalgia is a chronic nervous system condition that causes widespread pain and tenderness, affects 2-4% of people, and usually affects women more often than men. People who have other rheumatic diseases are at higher risk of having fibromyalgia.

Fibromyalgia is not an inflammatory or autoimmune disease. Research suggests that the nervous system is involved. Brain chemicals, like serotonin and norepinephrine, may be off balance, changing reactions to painful stimuli. Fibromyalgia may cause fatigue, poor sleep, and mood problems, like anxiety or stress. It does not cause any signs on x-rays or blood tests.

There is currently no cure for fibromyalgia. Medications may relieve symptoms for some people. The treatment plan includes exercise, diet, a good sleep routine and cognitive behavioral therapy.

Signs/Symptoms

Fibromyalgia symptoms are different for each person. The most common symptoms are widespread pain and tender places around the body. People may feel tenderness to even slight pressure on muscles or around joints. Severe fatigue and sleep problems are also common. Someone with fibromyalgia may not feel refreshed after sleeping all night.

Other fibromyalgia signs and symptoms include:

• Problems with memory or clear thinking, known as “fibro fog”

• Depression or anxiety

• Migraines or tension headaches

• Digestion problems like IBS or heartburn

• Irritable or overactive bladder

• Pelvic pain

• Temporomandibular disorder (TMJ), or jaw pain or popping

Other diseases may cause widespread pain or fatigue. Doctors may ask patients to describe their digestive, sleep or memory problems. Blood tests and x-rays may be used to rule out other causes, like thyroid problems or polymyalgia rheumatica.

Common Treatments

Fibromyalgia is treated with both nondrug therapies and medications. Exercise is the most effective treatment, including low-impact aerobic activity and body-based therapies like tai chi or yoga.

Cognitive behavioral therapy and mindfulness training can help people with fibromyalgia learn skills to help manage or reduce their symptoms. Complementary therapies like acupuncture, chiropractic and massage may help ease symptoms, but there is little evidence to support effectiveness. Psychotherapy may help patients manage stress and anxiety. A sleep medicine specialist may help patients address sleep disorders.

Three drugs are FDA-approved for fibromyalgia: duloxetine (Cymbalta) and milnacipran (Savella) adjust brain chemicals to ease widespread pain, and pregabalin (Lyrica), which blocks overactive nerve cells involved in pain. Older drugs, such as amitryptiline (Elavil), cyclobenzaprine (Flexeril) and other antidepressants may be used too. Opioids, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) and sleep medicines like zolpidem (Ambien) are not recommended for use in treating fibromyalgia symptoms.

Care/Management Tips

Self-care is important to manage fibromyalgia symptoms and have good quality of life. This A healthy lifestyle, along with medications, can be effective at reducing pain, improving sleep, easing fatigue and stress, and helping patients cope with fibromyalgia.

Exercise as often as possible. Start slowly and do more over time. Walking, swimming, stretching and yoga are good activities for people with fibromyalgia. Add more movement to daily routines, like taking a flight of stairs instead of the elevator. Medications may help ease pain and make it easier to be more active.

Rest and relaxation are helpful too. Make time to relax each day. Deep breathing or medication can ease stress. Set regular sleep habits, like going to bed at the same time each night. Don’t take naps or drink coffee to ease afternoon fatigue. Nicotine is a stimulant, but it makes fibromyalgia sleep problems worse. Quit smoking or using tobacco products.