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August 6, 2010 | Comments: 1

Fibromyalgia: A Mystery Story

Fibromyalgia is a puzzling syndrome characterized by chronic pain in muscles and joints. It affects an estimated six million Americans, mostly women.

Fibromyalgia is sometimes accompanied by other symptoms such as stiffness, sleep problems, and fatigue. Further complicating the picture, people with fibromyalgia often also have additional conditions, such as irritable bowel syndrome, chronic fatigue, temporomandibular disorder (jaw pain), restless legs syndrome, migraines, and depression. Some medical experts still question whether fibromyalgia is physiological or psychological. Either way, it has been the focus of serious research.

Doctors don’t know what causes fibromyalgia, but it’s likely several factors are involved. Before 1990 it was viewed primarily as a muscle disorder. It’s now thought to involve the central nervous system. People with fibromyalgia may respond more to painful stimuli—but may also experience pain from stimuli that are not normally painful, possibly due to reduced levels of the brain chemicals serotonin and norepinephrine. There’s some evidence of an imbalance of cortisol and other hormones as well. Chronic psychological or physical stress may initiate fibromyalgia by increasing inflammatory substances, which set off a cascade of effects on the immune and nervous system.

Fibromyalgia does not damage or deform muscles or joints. But most people find it hard to deal with a condition that some health-care providers and others regard with skepticism.

If you think you may have fibromyalgia

• See your doctor (or a rheumatologist) who will evaluate your medical history and test for “tender points.” A physical exam and various tests can help rule out other conditions. There is no gold-standard method to diagnose fibromyalgia.

• A few drugs, including Lyrica and Cymbalta, are now approved by the FDA to treat fibromyalgia. How they work is unknown, but they may affect the release of neurotransmitters in the brain. These drugs won't help everyone with fibromyalgia--and, like all drugs, they have side effects. 

• Low- to moderate-intensity aerobic exercise (such as brisk walking, cycling, or swimming) may help reduce pain and improve sleep and overall psychological well-being, though you may experience more pain initially.

• Cognitive behavioral therapy may help in coping with pain, fatigue, and negative thoughts.

• Some people think certain foods and additives—commonly wheat, dairy, citrus, sweets, alcohol, coffee, or MSG—exacerbate their symptoms. You can try eliminating suspect foods to see if that helps, and then reintroduce them after two weeks to see if symptoms worsen. In small studies, vegetarian diets helped some people with fibromyalgia.

• Acupuncture, massage, hypnosis, and various other alter­native therapies may help fibromyalgia, but the evidence is not consistent. Such treatments should complement, not replace, standard medical care. 

• None of the many supplements touted for fibromyalgia—including magnesium, zinc, ginkgo biloba, coenzyme Q-10, and kava—are proven to work, and some may pose a risk. If you take any supplements, be sure to tell your doctor.

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