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What is fibromyalgia?

Fibromyalgia (pronounced fy-bro-my-al-ja) is widespread pain in the muscles, ligaments and tendons. Ligaments and tendons connect muscles to bones.
Fibromyalgia also causes people to have trouble sleeping and feel very tired all the time.

Although fibromyalgia is a relatively recent term, this syndrome has been known by several other names over the past years, including soft tissue rheumatism, fibrositis and non-articular rheumatism.

How common is fibromyalgia?

It affects 900,000 (3 in 100) Canadians.
Women are at least four times more likely than men to develop fibromyalgia.
It usually occurs in people over age 50.

Fibromyalgia is a common disease, affecting from 2% to almost 6% of all people. Women are much more likely to develop fibromyalgia than men (by a ratio of 4 to 1). The incidence of it increases with age, and it is most common in women 50 years of age or older.

What are the warning signs of fibromyalgia?

Stiffness, especially in the morning, and pain in muscles and joints all over the body.
Trouble sleeping at night and a feeling of being very tired all the time.
Numbness in muscles and joints.
Poor memory and concentration.
Other warning signs may include depression, tension and migraine (pronounced my-grane) headaches, and pain in the jaw.

If you have fibromyalgia you may experience a number of symptoms. Common symptoms include pain and swelling in many joints or soft tissues. As a result of the pain you may have trouble sleeping, and be very fatigued and feel weak throughout the day. Your memory may be poor and you could have trouble concentrating. You might also feel stiff, particularly in the morning. Some people also experience numbness in joints or muscles.

In addition, your eyes may be dry. You may feel unable to stand the cold and might develop sensitivities to certain foods, medications and/or allergens. Some people with fibromyalgia also experience depression, tension and migraine headaches, irritable bowel and bladder (characterized by pain in the abdomen and frequent need to go to the bathroom, or difficulty in doing so), chronic fatigue syndrome and temperomandibular joint (TMJ) dysfunction (characterized by pain in the jaw).

The heightened experience of pain of people with fibromyalgia often causes them to become less active in order to avoid pain. Decreased activity then causes the muscles to weaken, making future activity more difficult. Many people with fibromyalgia feel like they are on a downward cycle. If you are in pain and not sleeping well, it makes sense that you are going to be very tired or fatigued during the day. Being in pain and having no energy makes it difficult to manage normal activities such as maintaining a job and housekeeping, as well as recreational and other leisure pursuits. This can lead to stress and anxiety. Depression is also common in people with fibromyalgia. These stresses are made worse by the fact that people with fibromyalgia look “fine” to others. Thus, it is often hard for them to get understanding and support from family, friends and employers.

What causes fibromyalgia?

The exact cause of fibromyalgia is not known.
A number of factors might be involved with causing fibromyalgia. These include accidents and injuries, surgery, other illnesses or infections, emotional trauma and stress.

Researchers are not sure of the cause of fibromyalgia, however a number of potentially responsible factors have been suggested. For many people fibromyalgia develops gradually without any known cause. Others attribute its onset to a variety of triggers including problems with the joints in the neck and low back, motor vehicle accidents, work-related injuries, viral illnesses, surgery, infections, emotional trauma, or physical or emotional stress.

What can you do about fibromyalgia?

If your doctor thinks you have fibromyalgia, he or she may refer you to a rheumatologist (room-a-tol-o-jist). A rheumatologist is a doctor who has received special training in the diagnosis and treatment of problems with muscles, joints and bones.
Your doctor may perform a physical examination. He or she will ask if you have had pain throughout your body for more than three months. Your doctor will also check if certain spots on your body are tender when pressed on.
There is no cure for fibromyalgia but there are things you can do to manage the disease.
Learn as much as you can about this disease. Speaking with people who are specialists in arthritis care can provide you with the information you need.

There is no cure for fibromyalgia. The goal of treatment is to help in the management of pain and other symptoms. Establishing the correct diagnosis is important because something can be done to manage most forms of arthritis.

If your doctor thinks you have fibromyalgia, he or she will probably perform a physical examination. To be diagnosed with fibromyalgia, you must have experienced widespread pain for a period of three months or longer. The pain must be above and below the waist, and on both the left and right sides of the body. Another characteristic feature of fibromyalgia is the existence of at least 11 (of a possible 18) distinct sites of deep muscle tenderness that hurt when touched firmly; these include the side of the neck, the top of the shoulder blade, the outside of the upper buttock and hip joint, and the inside of the knee. Your doctor will test this by either pressing on these spots with his or her thumb.

In addition to widespread pain and specific tenderness in 11 of the 18 points, many people with fibromyalgia experience a wide variety of other symptoms. Because some of these symptoms are also common in other types of arthritis, your doctor may order blood tests, X-rays and other laboratory tests. These tests are done to find out if other diseases are present, and they do not specifically diagnose fibromyalgia.

Some people who experience widespread pain without having 11 of 18 tender points, or who have pain that is localized in a specific part of the body, may also have many of the same symptoms as a person with fibromyalgia. Although these people will not be formally diagnosed with fibromyalgia, they can also benefit from treatment.

If you have fibromyalgia, many different treatments are available to help you manage your pain and other symptoms. Your active involvement in developing your prescribed treatment plan is essential.

Medicine

Medicines called tricyclics and tetracyclics are often used to treat fibromyalgia. These medicines are also used to treat depression.

Low dose tricyclic and tetracyclic antidepressant medications are medications frequently used in treating fibromyalgia. Some are helpful and in only a minority of patients. They increase a person’s serotonin levels. Serotonin is a chemical that naturally occurs in the brain. Research has shown that low levels of serotonin are associated with depression and other symptoms of fibromyalgia, including bowel problems, migraine headaches and anxiety.

Non-steroidal anti-inflammatory drugs (NSAIDS – pronounced en-seds) and corticosteroids are two types of medications often used to treat many forms of arthritis. However, neither has been shown to be useful in treating fibromyalgia.

Exercise

Exercise may help reduce pain and will keep muscles from becoming weak.
If you have fibromyalgia you should start exercising slowly. The best time to exercise is when you feel you have energy.
The key is to strike a balance between too much activity (which can strain and tire muscles), and too little activity (which can increase pain and stiffness and lead to further weakness).
Endurance exercises can strengthen your body and give you energy. These exercises include walking, water exercises and cycling. Stretching exercises can help you warm up your muscles before doing other exercise.
Your doctor can help you find the exercise that best meets your needs.

If you have fibromyalgia you may benefit from participating in some type of exercise program. Because many people with fibromyalgia are not in optimum physical condition, it is important to gradually build up the amount of exercise. Common types of exercise that are helpful for fibromyalgia are walking, low impact aerobic programs designed for people with arthritis, water exercise programs (aquasize), and use of exercise equipment such as a stationary bike, treadmill or Stairmaster.

Whatever exercise you choose, remember to use stretching exercises to warm up prior to beginning that day's activity, and listen to your body to determine if you are exercising at the right level. It is not unusual to feel some soreness when you start exercising for the first time. If your exercise program is causing an extended increase in pain, then cut your program back accordingly. Always consult a doctor before beginning an exercise program.

Heat

Applying heat helps relax aching muscles, and reduces pain and soreness. For example, take a hot shower.

Applying heat may give you some temporary relief of pain. Many people with fibromyalgia ease their discomfort using a heating pad, a hot shower or a whirlpool. Heat helps to reduce pain and stiffness by relaxing aching muscles and increasing circulation to the area.

Lifestyle Management

If you have fibromyalgia you may need to change your activities to reduce your pain and fatigue.
You may find it helpful to keep a diary of your activities and how they affect you. Once you know the things that make your pain and fatigue worse you can make changes to them.
Your doctor may be able to help you come up with ways to change your lifestyle so you do not feel as tired or stressed.

Lifestyle management refers to the changes you need to make in how you approach life. People with fibromyalgia often find it is not possible to remain as active as they once were.

The first step in lifestyle management is listening to and respecting what your body is telling you. Keep a diary over a period of several weeks or longer, and record your pain and fatigue levels in relation to other things that are happening in your life, such as your mood, level of activity, stress and quality of sleep. Once you are aware of the factors that may be out of balance in your life there are a number of things that you can learn to do to improve your pain, fatigue, sleep, mood and stress. Your doctor may be able to help you develop strategies to manage your lifestyle, or may refer you to a therapist who can work with you to change your daily activities.

Outcomes

The outcomes of fibromyalgia vary. Many people manage to remain at work and to lead satisfying, fulfilling lives. Some people with fibromyalgia have trouble sustaining their previous level of work and recreational activity. One of the main factors that seems to affect outcomes is how quickly treatment begins following the onset of symptoms.

Additional Tips for Living Well

The Arthritis Society offers a variety of programs and services that can be helpful.
You can reach the Society at 1-800-321-1433 from anywhere in Canada.
You can also reach us through our Web site at www.arthritis.ca

Along with the physical symptoms of arthritis, many people experience feelings of helplessness and depression. Learning daily living strategies to manage your arthritis gives you a greater feeling of control and a more positive outlook. To get the best results, people affected by arthritis need to form close ties with their doctors and therapists, and become full partners in their treatment. From our perspective, it's all part of 'living well with arthritis.' There are several resources you can use in finding out how best to manage your own arthritis. Here are a few:

The Arthritis Self-Management Program (ASMP) is a unique self-help program offered by The Arthritis Society to help you better control and manage your arthritis.

Of course, there are many other valuable resources for people with arthritis. If you're unclear about where to look for help, be sure to call The Arthritis Society at 1-800-321-1433