Fibromyalgia is a syndrome. A syndrome is a disease state that has several co-existing signs and symptoms. Although many patients who have been labeled with fibromyalgia syndrome come to our practice because of chronic diffuse body pain, fibromyalgia syndrome is more than a musculoskeletal problem as it also includes many other symptoms that coexist with the pain. Most patients with fibromyalgia syndrome have pain that is located in several typical tender spots.
Fibromyalgia is characterized by general soft tissue and muscle tenderness. There is a heightened pain response to pressure or touch. Sometimes a hug or a massage can seem very uncomfortable. The pain is usually chronic; most people have achy symptoms for many years before seeking evaluation and treatment. The pain usually begins in one or two areas of the body that become more tender over time.
The heightened pain response can vary over time. Fibromyalgia patients can have good days and bad days. Many patients complain of flare-ups after a period of relatively tolerable symptoms.
These hormonal imbalances may have predisposed the patient to develop fibromyalgia syndrome, with its widespread symptoms.
Fibromyalgia can be categorized as primary or secondary. The causes of primary fibromyalgia are generally unknown, although stress and hereditary factors seem to play a role. These hereditary conditions, such as adult-onset diabetes (diabetes type 2), rheumatoid arthritis, thyroid disease, mood disorders (bipolar disorder and major depression), and anxiety disorders can cause other types of painful conditions. Thus, pain caused by these conditions should include treatment of the primary condition, and the other types of pains should be identified and treated before someone is labeled with fibromyalgia.
Patients who are double-jointed or have abnormal posture because of different leg lengths or scoliosis (abnormal curvature of the spine) can be predisposed to fibromyalgia. These conditions can be hereditary. We may find that most fibromyalgia patients actually develop the syndrome secondary to other medical conditions.
Secondary fibromyalgia is caused by injury, surgery, or acquired (developed later in life and not hereditary) musculoskeletal or neuromuscular conditions.
After taking a comprehensive medical and personal history, your Pain Specialists of America physician will conduct a thorough medical examination. He or she will look for the presence of specific areas on the neck, collarbone, chest, upper back, sides of the spine, inside of either arm at the elbow, low back, kneecaps, buttocks, and feet that are intensely painful when pressed.
Other medical conditions that can cause similar pains and symptoms such as myofascial pain syndrome should be excluded or treated first. Fibromyalgia syndrome is a label for several co-existing symptoms without an obvious identifiable cause and is a “diagnosis of exclusion.” The label does not tell us why a person has pain, but it is sometimes comforting for a patient to know that there is a name for the condition and that the condition has physical signs that can be identified by a medical professional.
Your Pain Specialists of America physicians will recommend a multi-faceted approach to treat the condition. Steps known to be beneficial are:
We often offer specialized physical therapy that takes into account the patient’s tolerance for exercise, soft tissue and manual treatments, and variability of the symptoms. Aquatic therapy is commonly offered. Treating the condition through exercise often takes several months and may become a lifetime process. Small gains in pain reduction and improved energy will accumulate over time. Improvements in the other symptoms are celebrated as well. Although there is no cure for fibromyalgia, there can be relative remission in the symptoms.
We can also offer several medications to help with different symptoms. Some medications treat more than one symptom. For example, medications commonly used for seizures and bipolar disorders are often used to reduce nerve and muscle pain and help with sleep. Anti-depressants can help reduce the pain of fibromyalgia and depression as well as help alleviate nerve pain, low energy, and poor sleep. There are also different choices in each medication category. You and your physician will discuss the options and choose the ones that will work for you.
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