Fibromyalgia

toc = Fibromyalgia = Fibromyositis; Fibrositis Last reviewed: February 14, 2011. Fibromyalgia is a common syndrome in which a person has long-term, body-wide pain and tenderness in the joints, muscles, tendons, and other soft tissues. Fibromyalgia has also been linked to fatigue, sleep problems, headaches, depression, and anxiety.

Causes, incidence, and risk factors
The cause is unknown. Possible causes or triggers of fibromyalgia include: Fibromyalgia is most common among women aged 20 to 50. The following conditions may be seen with fibromyalgia or mimic its symptoms:
 * Physical or emotional trauma
 * Abnormal pain response - areas in the brain that are responsible for pain may react differently in fibromyalgia patients
 * Sleep disturbances
 * Infection, such as a virus, although none has been identified
 * Chronic neck or back pain
 * Chronic fatigue syndrome
 * Depression
 * Hypothyroidism (underactive thyroid)
 * Lyme disease
 * Sleep disorders

Symptoms
Pain in the main symptom of fibromyalgia. It may be mild to severe. People with fibromyalgia tend to wake up with body aches and stiffness. For some patients, pain improves during the day and gets worse at night. Some patients have pain all day long. Pain may get worse with activity, cold or damp weather, anxiety, and stress. Fatigue, depressed mood, and sleep problems are seen in almost all patients with fibromyalgia. Many say that they can't get to sleep or stay asleep, and they feel tired when they wake up. Other symptoms of fibromyalgia may include:
 * Painful areas are called tender points. Tender points are found in the soft tissue on the back of the neck, shoulders, chest, lower back, hips, shins, elbows, and knees. The pain then spreads out from these areas.
 * The pain may feel like a deep ache, or a shooting, burning pain.
 * The joints are not affected, although the pain may feel like it is coming from the joints.
 * Irritable bowel syndrome (IBS)
 * Memory and concentration problems
 * Numbness and tingling in hands and feet
 * Palpitations
 * Reduced ability to exercise
 * Tension or migraine headaches

Signs and tests
To be diagnosed with fibromyalgia, you must have had at least 3 months of widespread pain, and pain and tenderness in at least 11 of 18 areas, including Blood and urine tests are usually normal. However, tests may be done to rule out other conditions that may have similar symptoms.
 * Arms (elbows)
 * Buttocks
 * Chest
 * Knees
 * Lower back
 * Neck
 * Rib cage
 * Shoulders
 * Thighs

Treatment
The goal of treatment is to help relieve pain and other symptoms, and to help a person cope with the symptoms. The first type of treatment may involve: If these treatments do not work, your doctor may prescribe an antidepressant or muscle relaxant. The goal of medication is to improve sleep and pain tolerance. Medicine should be used along with exercise and behavior therapy. Duloxetine (Cymbalta), pregabalin (Lyrica), and milnacipran (Savella) are medications that are approved specifically for treating fibromyalgia. However, many other drugs are also used to treat the condition, including: Cognitive-behavioral therapy is an important part of treatment. This therapy helps you learn how to: Support groups may also be helpful. Other recommendations include: Severe cases of fibromyalgia may require a referral to a pain clinic.
 * Physical therapy
 * Exercise and fitness program
 * Stress-relief methods, including light massage and relaxation techniques
 * Anti-seizure drugs
 * Other antidepressants
 * Muscle relaxants
 * Pain relievers
 * Sleeping aids
 * Deal with negative thoughts
 * Keep a diary of pain and symptoms
 * Recognize what makes your symptoms worse
 * Seek out enjoyable activities
 * Set limits
 * Eat a well-balanced diet
 * Avoid caffeine
 * Practice good sleep routines to improve quality of sleep (See: Sleeping difficulty)
 * Acupressure and acunpuncture

Expectations (prognosis)
Fibromyalgia is a long-term disorder. Sometimes, the symptoms improve. Other times, the pain may get worse and continue for months or years.