What is it?

• Fibromyalgia (fi-bro-my-al-jee-ah) is chronic (long-term) pain in your muscles, bones, ligaments, and tendons. The ligaments and tendons are the tissues that connect muscles and bones together. You may also have fatigue (feeling very tired), sleeping problems, numbness and tingling, and headaches. Fibromyalgia may feel like a joint disease, such as arthritis, but does not cause joint deformities. A joint deformity is swelling and inflammation of a joint like the knuckles, wrist, or knees.
• People of all ages, from children to the elderly, can get fibromyalgia but the average age is 50. Fibromyalgia is more common in women than men. There is no cure for fibromyalgia but you cannot die from fibromyalgia. There are no tests or x-rays to tell caregivers that you have fibromyalgia. It is often hard for caregivers to decide that you have fibromyalgia because the symptoms happen with other diseases as well. But fibromyalgia is a real illness, not "all in your mind."

Causes:

The following things may cause symptoms of fibromyalgia to start or get worse but the actual cause of fibromyalgia is not known.

• An illness.
• Emotional trauma (such as the death of a family member or close friend).
• Hormone changes (such as menopause or "the change of life").
• Lack of exercise.
• Physical trauma (an injury, such as a car accident).
• Stress.

Signs and Symptoms:

Fibromyalgia causes a group of signs and symptoms. Signs are what your caregiver sees when you are examined (tested). Symptoms are things you tell your doctor about how you feel.

Pain is the main symptom and is usually all over your body. The pain may start in one area like your neck and shoulders and with time spread to other areas. You may feel like you have the "flu." The pain may feel burning, sore, stiff, or aching, or it may feel like numbness and tingling in your hands, arms, feet, or face. The amount of pain changes at different times during the day. Some of the following things can make the pain worse.

• Weather.
• How active you are.
• How much sleep you get.
• How much stress you have.

You may have "trigger points" which are areas that are very sore when touched, like in the neck and shoulder. These tender points may be on both sides of the body, like the hips, knees, and elbows.

Caregivers will ask you the following questions to help them understand your pain:

• Where does it hurt? Where does it not hurt? Does the pain move from one area to another?
• How would you rate the pain on a scale of 0 to 10 (0 is no pain and 10 is the worst pain you ever had.)?
• How does the pain feel? Try to choose words that tell caregivers what type of pain you have. Is the pain sharp, cramping, twisting, squeezing, or crushing? Or is the pain stabbing, burning, dull, numb, or "pins-and-needles" feeling?
• When did the pain start? Did it begin quickly or slowly? Is the pain steady or does it come and go?
• How often does the pain bother you and how long does it last?
• Does the pain affect your daily life? Can you still work in spite of the pain?
• Does the pain wake you from sleep?
• Do certain things or activities cause the pain to start or get worse, like coughing or touching the area?
• Does the pain come before, during, or after meals?
• Does anything lessen the pain like changing positions, resting, medicine, or changing what you eat?
• Women: does your pain change during your menstrual cycle?

Fatigue: You may feel exhausted (very tired) or like you do not have any energy a lot of the time. Being so tired may even be more of a problem for you than the pain. You may also have sleeping problems. You may wake up feeling as though you are not rested. This is because your deep sleep stage may have been interrupted. You may fall asleep easily, but sleep lightly and wake up often during the night. These sleeping problems make your problems with fatigue even worse.

Feeling Depressed: You may feel "blue" or "down" because your mood changes often. You may feel depressed (sad), anxious, and have trouble focusing on small tasks.

Other symptoms: You may have migraine headaches, dry eyes and mouth, abdominal (belly) pain, bloating, bowel problems, and weight gain. You may also be very sensitive to the cold and have no energy to exercise. Or you may be able to exercise for only a short time before you get very tired.

Wellness Recommendations:

Regular, low intensity aerobic exercise and stretching is good and can improve sleep and decrease symptoms of fibromyalgia.

Medical Care:

Medicines (sleeping pills, muscle relaxants, or antidepressants) may help you sleep better. Ibuprofen or acetaminophen, over-the-counter medicine, may help your pain. Other medicines may also be used to help the pain of fibromyalgia.

Herbs and Supplements:

Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.

Herbs:

• Capsaicin creams (Capsicum frutescens) from the cayenne pepper, applied to the skin over the affected area, has been used for many years, but has not been studied in people who have fibromyalgia. Initial applications are irritating but after the first couple of weeks the irritation goes away. The hands should be washed after application of the cream, unless the hands are the treated areas, in which case, they should be washed 30 minutes after application.
• Eleuthero (Eleutherococcus senticosus) has been used for many years, but has not been studied in people who have fibromyalgia.
• Ginger (Zingiber officinale) has been used for many years, but has not been studied in people who have fibromyalgia.
• Kava kava (Piper methysticum) has been used for many years, but has not been studied in people who have fibromyalgia.
• Licorice (Glycyrrhiza glabra) has been used for many years, but has not been studied in people who have fibromyalgia.

Supplements:

• 5-HTP (5-hydroxytryptophan) may be helpful for fibromyalgia and has been studied in people.
• B vitamins have been used, but have not been studied in people who have fibromyalgia.
• Bromelain has been used, but has not been studied in people who have fibromyalgia.
• Magnesium may be helpful and has been studied in people who have fibromyalgia.
• Malic acid may be helpful and has been studied in people who have fibromyalgia.
• Melatonin has been used, but has not been studied in people who have fibromyalgia.
• SAMe (S-adenosylmethionine) is helpful for fibromyalgia and has been studied in people.

Complementary Therapies:

• Acupuncture may help fibromyalgia.
• Biofeedback can decrease fibromyalgia symptoms.
• Magnetic field therapy may help fibromyalgia.
• Meditation is helpful in fibromyalgia.
• TENS (transepidermal nerve stimulation) may help fibromyalgia.

Other ways of treating your symptoms : Other ways to treat your symptoms are available to you.

Talk to your caregiver if:

• You would like medicine to treat fibromyalgia.
• Your symptoms have not gone away or improved by these self-help measures.
• You have questions about what you have read in this document.

SEEK CARE IMMEDIATELY IF:

• You feel like doing harm to yourself or to others.

Care Agreement:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

References:

1. Berman BM, Ezzo J, Hadhazy V et al: Is acupuncture effective in the treatment of fibromyalgia? J Fam Pract 1999; 48(3):213-218.

2. Buckelew SP, Conway R, Parker J et al: Biofeedback/relaxation training and exercise interventions for fibromyalgia: a prospective trial. Arthritis Care Res 1998; 11(3):196-209.

3. Cheing GL& Hui-Chan CW: Transcutaneous electrical nerve stimulation: nonparallel antinociceptive effects on chronic clinical pain and acute experimental pain. Arch Phys Med Rehabil 1999; 80(3):305-312.

4. Di Massa A, Misuriello I, Olivieri MC et al: Pulsed magnetic fields. Observations in 353 patients suffering from chronic pain. Minerva Anestesiol 1989; 55(7-8):295-299.

5. Jacobsen S, Danneskiold-Samsoe B & Andersen RB: Oral S-adenosylmethionine in primary fibromyalgia: double-blind clinical evaluation. Scand J Rheumatol 1991; 20(4):294-302.

6. Kaplan KH, Goldberg DL & Galvin-Naduea M. The impact of a meditation-based stress reduction program on fibromyalgia. Gen Hosp Psychiatry 1993; 15:284-289.

7. Mengshail AM, Komnaes HB & Forre O. The effects of 20 weeks of physical fitness training in female patients with fibromyalgia. Clin Exp Rheum 1992; 10:345-349.

8. Sarnoch H, Adler F & Scholz OB: Relevance of muscular sensitivity, muscular activity, and cognitive variables for pain reduction associated with EMG biofeedback in fibromyalgia. Percept Mot Skills 1997; 84(3 Pt 1):1043-1050.

9. Sarzi Puttini P & Caruso I: Primary fibromyalgia syndrome and 5-hydroxy-L-tryptophan: a 90 day open study. J Int Med Res 1992; 20(2):182-189.