What is Fibromyalgia?

Fibromyalgia is a term used to describe a condition causing chronic intractable widespread or whole body pain, more so in joints and muscles, fatigue, insomnia, forgetfulness, and many other symptoms of unknown cause.

How common is Fibromyalgia?

It is not clear, and estimates vary from 2-8% of the population. It affects women more than men, and its incidence increases with aging. It probably affects Caucasians more than other races, but exact studies to determine racial differences are not available.

 

What is the problem causing Fibromyalgia?

Its exact cause in the body is not known. There is not enough evidence to suggest that it is an inflammatory disorder. Patients with this condition have altered perception of pain, i.e., non-painful stimuli can be painful for them. But altered pain perception is not the only issue, and does not explain all the symptoms. It seems that the defect is more central (brain and spinal cord) than peripheral (nerves and muscles.)

 

Do patients with Fibromyalgia have brain lesions?

Studies have shown multiple types of brain abnormalities in patients with this condition. These abnormalities are mostly microscopic, or degenerative in nature, resulting in problem with circuitry of brain. These findings are determined in research setting with sophisticated scans, which are usually not available in day-to-day clinical settings. Regular MRI or CT scan may not provide any significant abnormality, and are not used for its diagnosis. Sometimes MRI scan is done to rule out some other conditions that can cause similar symptoms, like MS.

 

Is Fibromyalgia a hereditary condition?

Not necessarily, but family history does significantly increases its chances.

 

What are the risk factors for Fibromyalgia?

Following are some of the risk factors. Patients with Fibromyalgia probably have underlying genetic tendency for this condition, and exposure to certain risk factors may lead to this condition.  

. Female gender

. Aging

. Emotional trauma, including emotional abuse

. Physical trauma, including auto accident

. Chronic physical diseases, like cancer

. Chronic psychological diseases, like depression

. Infections like Lyme, HIV, Hepatitis C, EBV, parvovirus, or any severe infection

. Rheumatologic diseases like SLE, rheumatoid arthritis

. Family history

 

What are the symptoms of Fibromyalgia?

Following are its main symptoms:

. Generalized muscle and joint pain on both sides of body

. Difficulty sleeping

. Fatigue

. Fogginess of mind, forgetfulness, and other cognitive difficulties

. Headaches and neck pain

 

Do patients with Fibromyalgia have cognitive difficulties?

Patients with fibromyalgia can have multiple types of cognitive difficulties, including forgetfulness, difficulty processing information, and difficulty with organization. These symptoms can be compounded by associated depression and anxiety, or drug use if present. No formal treatment is known for this condition.

 

How is Fibromyalgia diagnosed?

There is no physical test for its diagnosis. It is diagnosed based upon its presenting symptoms, and findings (or lack of them) on physical examination. Testing is done to rule out some other similar conditions.

 

What conditions may co-exist with Fibromyalgia?

Following conditions are more commonly noted in patients with Fibromyalgia:

. Irritable Bowel Syndrome

. Depression and anxiety disorder

. Restless Leg Syndrome

. Severe allergies

. Rheumatologic diseases, like SLE

 

How is Fibromyalgia treated?

There is no specific treatment known for this condition, which is partly due to lack of knowledge about its exact cause. Following measures can be helpful:

A: Reassurance and Education: It is important to inform the patient about the nature of this diagnosis, and its details. Awareness about this condition within general public, and the medical community, has been improving. For a patient, a proper diagnosis helps to alleviate further anxiety, depression, and the burden of sometimes a never-ending investigative process.

B: Non-pharmacological measures: Regular physical activity such as walking, swimming, or any other aerobic, and muscle strengthening exercise can help. Walking outside has better value, for mind and body, then inside.

C: Acupuncture: Multiple adequate trials have shown its benefit, with no serious side effects.  

D: Massage therapy: It can help in many painful conditions, but it is not clear if it can help in Fibromyalgia.

E: Tai Chi: It was also noted to be beneficial in Fibromyalgia.

F: Yoga: It can help to reduce suffering from pain, and increase functionality, with no significant side effects.

G: Cognitive Behavior Therapy: This is when a patient is educated and guided, with regular counseling by his/her doctor or a trained therapist, to better self-manage this condition. Part of this process involves an understanding of what may or may not work, or can or cannot be done.

H: Natural supplements: One can find numerous companies selling a variety of products for chronic pain. In most of these cases, formal comparative studies are not available. Evidence quoted is almost always anecdotal or based upon presumed mechanism of action. Also, in most cases, it is not clear what the right dose of a natural supplement is as they have not been tested in scientific manner. This is because the FDA has limited oversight and control over natural products, compared to pharmacological products. This is the main reason that these products are sold without appropriate scientific evidence. Also, the nature and type of natural products vary in different societies, due to their historical experiences, preferences, and biases. This does not mean that herbal medicine is ineffective; in most cases, it is not possible to tell if an herb is effective or ineffective.

 

Following is an overview of scientific studies. Scientific studies can be tricky to interpret, even for many doctors. In general, in terms of their quality, I divide them in four types, as follows:

Poor: This type of study has a fundamental flaw and its conclusion is not valid. For example, let’s imagine a disease affected 2 out of 100 people living in cities, but it affected mostly the homeless. Let’s say another person, examines a sample of 100 random city people, but does not include homeless, and concludes that the disease does not exist in the city. In reality, the disease is there, it is not found because the study is of poor quality.

Limited: This type of study may provide suggestions for further exploration, and its conclusion may or may not be true. Doctors have learned that in clinical trials a placebo (no medicine) pill can help about 15-20% of people. If someone claims that a natural supplement works for pain without telling us what percentage of patients improved, the study may be called poor. The only way to know if the supplement works is if we compare it to placebo. In addition, let’s say a study is done when half of the patients receive the supplement and the other half a placebo, but each group knows what it is getting. This type of study is also limited, as it creates bias in reporting and documenting. A limited study can help to get some ideas for research but is not enough to make clinical recommendations.

Adequate: This is an average placebo-controlled (half of patients getting the test medicine and the other half a similar looking placebo), double-blinded (both the patient and the doctor are unaware of what a patient is taking, a placebo or the test medicine) study. Many times, due to ethical reasons, instead of a placebo an alternate medicine is used for comparison. Most clinical trials for pain are of this type. This type of trial may still have some deficiencies, such as not including enough females, or children, or excluding a certain race. Pain medicines sold by pharmaceutical companies are tested in this manner. These kinds of studies are expensive to perform and take a lot of time and effort.

Excellent: This type of study tries to do a better job than an adequate study. On the other hand, it may require an even bigger patient population, longer duration, and larger resources to accomplish.

It is important to note that for FDA to approve a drug or a treatment, at least two trials of adequate or excellent quality are required. No natural supplement treatment for Fibromyalgia fulfills this requirement. The evidence provided to us is mostly from either poor or limited studies. 

 

Following is a brief overview on some of the natural products:

Vitamin D: There is some evidence that patients with Fibromyalgia seem to have less than normal levels of Vitamin D. Some limited studies have suggested benefit of taking it as a supplement, but the evidence is not conclusive. Larger or better studies are needed to answer this question. Until then, if it is low, it may be reasonable to take a vitamin D supplement.

Turmeric: There is some evidence that it has anti-inflammatory properties. Based upon that, some studies suggested its benefit in arthritis. There is no evidence that it works in Fibromyalgia. Its proper dose is unclear, and it is probably better to take a small amount as a spice in food instead of tablets and capsules.

Sam E: A limited trial provided suggestion that there might be some benefit of this product for pain.

Willow tree bark: Willow tea can be helpful for pain, as it has aspirin like chemicals.

Caffeine:  A cup of tea or coffee can also help, especially for mild headaches or mild body aches. Too much caffeine (probably more than 160 mg in a day) can also have paradoxical or opposite effects.

Arnica: It is a flowering herb, usually used in topical creams for pain. It is not clear how it works, and formal studies are not available. It should be used with caution as it can thin blood, especially in patients taking any type of blood thinner. It is best not to ingest it or to put it on a wound.

Avocado and soy oils: No formal evidence exists for their benefit.

Aquamin: It is derived from red algae, and there is suggestion that in vitro (in a test tube) it has some anti-inflammatory properties. There is no similar evidence that it has this effect in humans.

Boswellia: It is derived from gum resin of a tree. It is sold as an anti-inflammatory product. There is no formal evidence of its benefit.

Cat’s claw: It is derived from a tropical vine, claimed to help in many conditions, but without any formal evidence.

Capsaicin: It can help in painful local conditions from inflammation like arthritis, not much for a generalized pain condition like Fibromyalgia. It is used as a local application, creating a burning sensation, which helps to mask an underlying joint pain.

Cloves: No formal evidence of efficacy in Fibromyalgia. Its oil may be helpful in certain local pain condition, like a toothache.

Comfrey: Similar to capsaicin, it can be used locally. Ingestion can be poisonous. No adequate study available.

Devil’s Claw: May be useful in arthritis, formal studies are not available.

Feverfew: Generally considered a treatment for migraine, for which it is only marginally effective.

Ginger: It has anti-inflammatory properties. Exact dose is unclear; too much ginger can cause stomach irritation. It may be better to use it as a spice instead of a capsule.

Glucosamine: Sold as anti-inflammatory agent for arthritis. Evidence for its effectiveness is limited or lacking.

Magnesium: Considered a treatment for migraine. Formal evidence is lacking, may be marginally effective.

Valerian Root: May be a mild sleep aid, with no formal evidence for pain.  

Cannabis products: There is anecdotal or limited evidence of their benefit for pain in Fibromyalgia. Formal research is lacking, mostly due to its controlled status. Cannabis is a complicated product with thousands of chemicals. Further research may reveal benefit of some of its byproduct.

I: Pharmacological treatment: Any medicine approved for treatment of Fibromyalgia requires at least two adequate trials. Physicians also prescribe medicines without formal evidence of efficacy: Following meds can help in this condition:

. Antidepressants: Amitriptyline, nortryptyline, venlafaxine, duloxetine, milnacipran, or SSRIs.

. Anti-seizure meds: Pregabilin and gabapentin.

. Muscle relaxers: Cyclobenzaperine, carisoprodol

. Analgesics: NSAIDs, tramadol (low dose). Opioids are best avoided, unless nothing else works, and with appropriate caution and safeguards.

. Sedatives: Zolpidem to improve sleep.

. Trigger point injections

 

Where can I get more information about Fibromyalgia?

American Academy of Neurology

American Rheumatology Association