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Fibromyalgia

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of fibromyalgia.

Risk Factors

An estimated ten million Americans have fibromyalgia, and up to 20% of people who seek help from a rheumatologist suffer from this disorder. Some evidence suggests that a number of factors may predispose people to fibromyalgia, including being female, having had difficult experiences in childhood, having a psychological vulnerability to stress, and coming from a very stressful culture or environment.

Women

Nine out of 10 fibromyalgia patients are women, and an estimated 3.4% of American women have fibromyalgia. Women's symptoms also tend to be more severe than men's. Women may be more prone to develop fibromyalgia during menopause.

Age

The disorder usually occurs in people between 20 to 60 years of age, though it can occur at any time. Some studies have noted peaks around age 35; others note it is most common in middle-aged women. In one trial, fibromyalgia increased with age and had a prevalence of over 7% among people in their 60s and 70s.

Juvenile Primary Fibromyalgia. This variant of fibromyalgia appears in adolescents, typically after 13 with a peak incidence at age 14. It is uncommon, but studies indicate that its incidence may be increasing. One study found that 1.2% of school children, all girls, met the criteria for fibromyalgia. Other studies have found an even higher prevalence of fibromyalgia in children. Symptoms are similar to adult fibromyalgia but outcomes appear to be better in young people.

Family Factors

Studies report a higher incidence of fibromyalgia among family members. It is not clear if genetic or psychological factors, or both, are involved.

  • One study reported that 28% of the children of mothers with fibromyalgia also develop the disorder. Offspring who developed fibromyalgia were no more likely to have psychological disorders than those who did not.
  • Another study noted that 66% of parents of children with fibromyalgia reported some sort of chronic pain, and about 10% had fibromyalgia itself. Close-knit families, oddly enough, were more likely to have a child with a severe case of fibromyalgia.

Conditions That Commonly Occur in Fibromyalgia Patients

A number of conditions overlap or often co-exist with fibromyalgia that have similar symptoms. It is not clear if these conditions or others are risk factors for fibromyalgia, are direct causes, have common causes, or have no relationship at all with CFS.

Chronic Fatigue Syndrome. There is a significant overlap between fibromyalgia and chronic fatigue syndrome (CFS). In a 2003 study, for example, 43% of CFS patients also were diagnosed with fibromyalgia. As with fibromyalgia, the cause of CFS is unknown and its course is chronic. Both disorders can be diagnosed by a physician only on the basis of symptoms reported by the patient and cannot be confirmed by laboratory tests or other objective measures. The two disorders share most of the same symptoms. They are even treated almost identically. The differences are primarily the following:

  • Fatigue is the dominant symptom in CFS. It is severe and not relieved by rest or sleep and not the result of excessive work or exercise.
  • Pain with tender points is the primary symptom in fibromyalgia. (Some patients with CFS exhibit similar tender pressure points. However, muscle pain is less prominent in patients with CFS.)

Some physicians believe that fibromyalgia is simply an extreme variant of chronic fatigue syndrome. There is some physical evidence, however, that the two disorders are distinct, with treatments that are specific to each.

Myofascial Pain Syndrome. Myofascial pain syndrome can be confused with fibromyalgia and may also accompany it. Unlike fibromyalgia, myofascial pain tends to occur in trigger points, as opposed to tender points, and typically there is no widespread, generalized pain. Trigger-point pain occurs in taut muscles, and when the doctor presses on these points, the patient may experience a muscle twitch. And unlike tender points, trigger points are often small lumps, about the size of a pencil eraser.

Major Depression. The link between psychological disorders and fibromyalgia is very strong and problematic. Certain studies report that between 50% and 70% of fibromyalgia patients have a lifetime history of depression. Only between 18% and 36% of fibromyalgia patients, however, have concurrent major depression, a severe form of depression. It should be noted that some researchers have observed that people who have both psychological disorders and fibromyalgia are more likely to seek medical help than patients who simply have symptoms of fibromyalgia. Such findings may bias study results and favor a higher-than-actual association between depression and fibromyalgia.

Depression most likely does not cause fibromyalgia, in any case, but it may increase susceptibility to it. Depressed feelings in people with fibromyalgia can certainly be normal responses to the pain and fatigue caused by this syndrome. Such emotions, however, are situational and temporary, and are not considered to be a depression disorder. Unlike ordinary periods of sadness, an episode of major depression disorder can last many months. Symptoms of major depression include the following:

  • A depressed mood every day.
  • Significant weight gain or loss (of 10% or more of an individual's typical body weight).
  • Insomnia or excessive sleeping.
  • Restlessness or a sense of being slowed down.
  • Low energy every day.
  • Worthless or inappropriately guilty feelings.
  • An inability to concentrate or to make decisions.
  • Suicidal thoughts.

Major depression is likely to be the responsible condition in the presence of several of these symptoms plus the absence of physical symptoms (particularly the tender points typical of fibromyalgia).

Chronic Headache. Chronic primary headaches, including tension-type or migraines, are common in fibromyalgia patients. Some experts believe that migraine headaches and fibromyalgia may even share common defects in the systems that regulate certain neurotransmitters (chemical messengers in the brain), including serotonin and epinephrine (commonly called adrenaline). Low levels of magnesium have also been noted in both fibromyalgia and migraine sufferers. In fact, chronic migraine sufferers who fail to benefit from usual therapies may also have fibromyalgia.

Migraine headache
The term "migraine" refers to a syndrome of vascular spasms of the cranial blood vessels. Symptoms of a migraine attack may include heightened sensitivity to light and sound, nausea, auras (loss of vision in one eye or tunnel vision), difficulty of speech and intense pain predominating on one side of the head.

Multiple Chemical Sensitivity. Multiple chemical sensitivity (MCS) is a term now used to describe conditions in which certain chemicals can cause symptoms similar to CFS or fibromyalgia in some people. It has also been observed in people with fibromyalgia. Experts have come up with criteria to help recognize people with MCS.

  • The symptoms are reproducible with repeated exposure to a chemical. (These are often common chemicals found in popular products, such as perfumes, fabric softeners, and air fresheners.)
  • The condition is chronic.
  • Symptoms can be produced by exposure to the chemical at levels lower than previously or commonly tolerated.
  • The symptoms improve when the chemical is removed.
  • Symptoms can be triggered by multiple substances that are chemically unrelated.
  • Symptoms involve multiple organ systems.

Still, as with CFS and fibromyalgia, some experts are uncertain whether MCS is an actually medical condition or if it is psychologically based. In one study, for example, CFS patients who believed their problem was chemically triggered were exposed to either an active chemical or a placebo (an inactive substance). Both groups reported symptoms, including those exposed only to the placebo. It should be noted that everyone is exposed to many chemicals on a daily basis, and it is very difficult to determine if chemicals are responsible for specific symptoms.

Restless Legs Syndrome (RLS). About 15% of people with fibromyalgia have restless legs syndrome. RLS is an unsettling and poorly understood movement disorder sometimes described as a sense of unease and weariness in the lower leg that is aggravated by rest and relieved by movement.

Disorders Affected by the Sympathetic (also called Autonomic) Nervous System. Other conditions that commonly accompany fibromyalgia include chest pain and heart palpitations, mitral valve prolapse, and a sudden drop in blood pressure.

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