Posted by Brigham and Women's Hospital November 19, 2013
Today’s post is written by Dr. Edgar Ross, Director of the Pain Management Center at Brigham and Women’s Hospital (BWH). The post was adapted from an article that appeared in the September issue of the newsletter published by the Osher Center for Integrative Medicine at BWH.
Fibromyalgia is a poorly understood syndrome that is quite common but can be difficult to diagnose and treat. The symptoms of fibromyalgia include widespread soft tissue pain, disturbed sleep, fatigue, and characteristic tender points that are multiple and diffuse. Conditions such as migraine headaches, chronic fatigue syndrome, depression, irritable bowel syndrome, restless legs syndrome, and temporal mandibular joint dysfunction are often associated with fibromyalgia. Fibromyalgia patients usually experience widespread pain and discomfort.
The processes within our bodies that can produce symptoms of fibromyalgia are not well understood. The leading theory suggests that the origins of fibromyalgia may relate to an over-reaction of the central nervous system to all types of sensation. These disturbances can have an impact on sleep. Sleep studies of patients with fibromyalgia frequently identify a lack of restful sleep.
Fibromyalgia can be difficult to diagnose because the signs and symptoms in patients can vary from visit to visit. In 1990, the American College of Rheumatology published a list of tender points that can be used to establish the diagnosis. Though laboratory testing is not useful for making a diagnosis of fibromyalgia, it can help rule out other conditions that mimic this condition.
Many patients who have been diagnosed with fibromyalgia actually have myofascial pain (discomfort or pain in the muscles that control jaw function and the neck and shoulder muscles). The diagnosis of myofascial pain is made by the observation that the patient consistently has musculoskeletal pain in a localized area over time. Fibromyalgia and myofascial pain have different pathophysiologies (functional changes) underlying their pain and require different treatment approaches.
Fibromyalgia patients require treatment for their pain, depression, sleep deprivation, and rehabilitation focusing on physical activation and learning energy conservation. The guiding principle of treatment for fibromyalgia is a multidisciplinary approach. Therapies include:
- Medication: There are a number prescription medications that can be helpful in treating fibromyalgia, but medications alone usually are not effective enough.
- Exercise: An exercise program that emphasizes both aerobic conditioning and strengthening has been shown to be the most effective approach to improve both function and sleep patterns. Exercise has additional benefits, including antidepressant effects and improvement in a feeling of well-being. Because of the pain that is involved, starting an active regimen can be difficult. Combining social activities with an exercise program also may be helpful.
- Alternative therapies: Other therapies, such as acupuncture, nutritional counseling, movement therapy, massage, mindfulness-based stress reduction, and others, have been shown in clinical trials to be effective additions to exercise programs.
Other common treatment approaches for fibromyalgia consist of muscle reeducation (the use of physical therapeutic exercises to restore muscle tone and strength), energy conservation training, non-opioid pain medications, and psychological counseling.
With commitment and understanding on the part of health care providers, most patients with fibromyalgia can improve and return to more productive lives.
- Video – Integrative Medicine: The Osher Center Approach
- Mindfulness Meditation Helps Fibromyalgia Patients