A Staff Report from the Straight Dope Science Advisory Board

Is fibromyalgia a real disease?

October 14, 2008

Dear Cecil,

My mother has been diagnosed with fibromyalgia. All the information I can find suggests this is a blanket term for a lot of separate conditions. The straight dope, please. Is my mother really sick, or is it just all in her doctor's head?

Guest contributor Matt Craver replies:

I’m not a doctor, much less your mother’s doctor, so I can’t say for certain how sick she is. However, I can tell you fibromyalgia (a/k/a fibromyalgia syndrome, or FMS) is a real, serious, painful disorder. At one point some thought it was a psychosomatic illness, and a few doctors may still treat it as such, but FMS experts say telling a fibromyalgia patient “it’s all in your head” can make the condition worse.

Fibromyalgia is often linked to clinical depression, but most studies say depression, hypochondria, and other psychological issues are an effect of the chronic pain or are otherwise tangled up in the syndrome — they don't cause it. Fibromyalgia produces physical changes such as damage to muscle and nerve fibers, and is also associated with changes in the way pain signals are transmitted by the central nervous system and processed in the brain. We know fibromyalgia-like syndromes can be induced in psychologically healthy volunteers through sleep deprivation or disruption, and that sleep disorders are a feature of fibromyalgia.

Your confusion about “a lot of separate conditions” is understandable. First of all, our understanding of what happens in fibromyalgia is incomplete. Second, while fibromyalgia has been a recognized diagnosis for some time, a good definition of the condition was only recently developed. If you were looking at information based on older sources, it may not reflect this new research.

Fibromyalgia is a syndrome — a specific collection of symptoms presumed to have a common cause. The name means “pain in muscles and fibrous tissues.” The first doctor to recognize fibromyalgia was the British rheumatologist W. R. Gower in 1904. Other names for fibromyalgia are fibrositis, myofascial pain syndrome, and fibromyositis. Fibromyalgia causes soft-tissue pain and inflammation, mostly in the muscles and associated tissues. Patients also often suffer muscle spasms, joint stiffness and swelling, and mood swings or depression. The most characteristic symptom is something called tender points — spots such as the base of the neck where mild pressure causes sharp pain.

Diagnosing fibromyalgia isn't easy. There's no definitive laboratory test, and other conditions can be confused with it, including chronic fatigue syndrome (CFS), polymyalgia rheumatica, myalgic encephalomyelitis (ME), hypothyroidism, hepatitis C, and some cancers. A combination of blood tests and clinical symptoms is used to differentiate between these conditions and fibromyalgia, usually by ruling out alternative diagnoses.

The scientific community is divided on whether to distinguish fibromyalgia, CFS, and ME. All involve pain and fatigue, and some researchers have suggested all three are different manifestations of the same condition.

We don't know what causes fibromyalgia. Stress and sleep disruption seem to play a part, as does genetics — the condition runs in families. Other contributing factors include psychological disturbances or poor coping mechanisms, hormone imbalances, and changes in the way the body responds to pain, inflammation or stress.

Many in the medical community consider fibromyalgia a “woman’s disease,” which may have contributed to the view it was psychosomatic. About 67 percent of fibromyalgia patients are women, a significant but not overwhelming proportion. Overall, an estimated 5 percent of adult women and 1.5 percent of adult men have fibromyalgia. Most of those affected are middle-aged.

In most people, fibromyalgia never goes away completely. However, it can be controlled through a comprehensive regimen including pain control, techniques to improve sleep, stretching, aerobic and resistance exercise, massage, and stress management. The goal is to restore quality of life as much as possible with minimal impact on daily activities.

Although your mother may be able to resume a close-to-normal life, treatment of fibromyalgia can be frustrating for both patient and doctor. Pain control is typically achieved through a combination of drugs, including anti-depressants and pain medications. Individuals vary in their response to these drugs and finding the right combination involves trial and error. Some good news: the FDA recently approved the first medication specifically for treating fibromyalgia, pregabalin (Lyrica). Whether it'll work for your mom I can't say, but be assured that what's she's been diagnosed with is a real condition, not just a random collection of symptoms to which doctors have attached a name.

Sources

Banic B., S. Petersen-Felix, O.K. Andersen, B.P. Radanov, P.M. Villiger, L. Arendt-Nielsen, M. Curatolo, "Evidence for spinal cord hypersensitivity in chronic pain after whiplash injury and in fibromyalgia," Pain, 107(1-2): 7-15 (2004)

Fibromyalgia Information Foundation, http://www.myalgia.com/

Merskey, H., "Social influences on the concept of fibromyalgia," CNS Spectrums, 13 (3 supp. 5): 18-21 (2008).

Porter, Robert S., Merck Manual Online, http://www.merck.com/mmpe/index.html

Sommer, C., W. Häuser, K. Gerhold, et al., "[Etiology and pathophysiology of fibromyalgia syndrome and chronic widespread pain]" (in German), Schmerz, e-pub ahead of print (2008)

White, K.P., M. Speechley, M. Harth, T. Ostbye, "The London Fibromyalgia Epidemiology Study: comparing the demographic and clinical characteristics in 100 random community cases of fibromyalgia versus controls," Journal of Rheumatology, 26(7): 1577-85 (1999)

White, K.P., M. Speechley, M. Harth, T. Ostbye, "The London Fibromyalgia Epidemiology Study: the prevalence of fibromyalgia syndrome in London, Ontario,"' Journal of Rheumatology, 26(7): 1570-6 (1999)

Yunus, M.B., U.P. Kalyan-Raman, K. Kalyan-Raman, A.T. Masi, "Pathologic changes in muscle in primary fibromyalgia syndrome," American Journal Of Medicine 81(3A): 38-42 (1986)

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