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Diagnosis and Management of Fibromyalgia

Natan Rosenfeld Natan Rosenfeld April 26, 2021
Medically reviewed by Susan Kerrigan, MD and Marianne Madsen

Fibromyalgia is a chronic disease that causes widespread musculoskeletal pain associated with severe fatigue, unrefreshing sleep, memory problems, depression, and anxiety. It is a disorder characterized by amplified pain signals in the brain and the spinal cord. The disorder usually begins after physical and/or mental trauma such as infection, significant psychological stress, or a significant physical trauma. In other cases, there may not be any identifiable cause. 

 

Women are affected more than men. In the US, around 4 million people suffer from this condition. It can affect the neck, shoulder, back, chest, hips, buttocks, arms, and legs. The cause of fibromyalgia is not known, but various factors can increase risk for it. It is associated with multiple other conditions including tension headache, temporomandibular joint (TMJ) pain, and irritable bowel disease (IBS). 

 

How do I know if I have fibromyalgia?

 

Fibromyalgia causes symptoms that may be similar to other conditions, so it can be difficult to diagnose. Some key symptoms of the disease include:

 

  • Widespread pain
  • Fatigue
  • Non-refreshing sleep
  • Depression and/or anxiety
  • Problems with memory
  • Inability to concentrate or pay attention
  • Headaches or migraines

 

Other symptoms, which are less common, can include:

 

  • A tingling sensation or numbness in the hands and feet
  • Symptoms of irritable bowel syndrome (diarrhea and constipation) 

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Fibromyalgia - Symptoms

Fibromyalgia - Symptoms

Causes and Risk Factors for Fibromyalgia

 

The cause of fibromyalgia has not been clearly identified. It is believed that repeated nerve stimulation could increase the chemicals that cause pain signals in the brain and the spinal cord. This leads to amplification of the pain signals.These are some of the suspected risk factors

 

  • Genetics: It tends to run in families, increasing the likelihood that there could be a genetic risk. This has not been yet identified. 
  • Physical and/or emotional trauma
  • Infections: Certain illnesses could trigger the disease.
  • Female gender

Diagnosing fibromyalgia

 

There is no laboratory test to diagnose fibromyalgia. The most important aspect in its diagnosis is to exclude other causes for pain, including many auto-immune diseases and endocrine abnormalities. 

 

The main symptom for the disease is widespread pain throughout your body lasting for more than 3 months, but there are multiple other symptoms.  When your doctor examines you, he or she could find multiple soft tissue tenderness at various parts of your body. 

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Fibromyalgia - Testing and Diagnosis

Fibromyalgia - Testing and Diagnosis

Managing fibromyalgia

 

The treatment of fibromyalgia includes non-pharmacological therapies and pharmacological options. 

 

Non-pharmacological therapies play a vital role in managing the fibromyalgia symptoms. These include:

 

  • Adequate treatment of anxiety and/or depression
  • Stress management (deep breathing exercises, psychological support, counseling) 
  • Stretching and aerobic exercise
  • Adequate sleep 

 

Pharmacological therapies are also available. FDA-approved medications for the management of some of the symptoms of fibromyalgia include:

 

  • Pregabalin
  • Duloxetine
  • Milnacipran

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Fibromyalgia - Treatment

Fibromyalgia - Treatment

These medications have some role in management of the symptoms but are beneficial only to a few patients. These medications must be used in combination with the non-pharmacological options discussed above to have the best outcomes. Other non-opioid medications  (acetaminophen, NSAIDs) could be of help to relieve some of the pain. Opioids are frequently used in fibromyalgia treatment, but the available evidence suggests that the opioids medications are not effective–they have negative effects with poor long-term outcomes. Use of opioids is not recommended to treat the pain symptoms of fibromyalgia. 

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