Health State Descriptions for Canadians
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Musculoskeletal diseases

Context

Introduction

Summary table

Back pain

Repetitive strain injury

Osteoarthritis

Rheumatoid arthritis

Systematic lupus erythematosus

Fibromyalgia

References

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Fibromyalgia

Fibromyalgia is a condition involving chronic musculoskeletal pain accompanied by excessive fatigue and exhaustion. Typically, the pain is located in the muscles and soft tissues surrounding the joints and in skin and organs throughout the body. Often onset is subtle, possibly affecting only one area, but over time, multiple sites are affected. The most common sites of pain include the neck, back, shoulders, arms, and legs, but any body part can be involved. Although symptoms vary in intensity and pain can be very severe, fibromyalgia is not life-threatening, nor does it lead to muscle or joint damage.

Fibromyalgia can develop in children; however, onset typically occurs during early to middle adulthood, and incidence increases with age. It is estimated that fibromyalgia affects 900,000 Canadians,⁶ or approximately 3% of the population.^4,5 Women are estimated to be four to nine times more likely to develop the disease than men.^6,41-44

Generally, symptoms of fibromyalgia follow a chronic, waxing and waning pattern (i.e., symptoms increase and decrease over time). Although they may never disappear completely, symptoms are not progressive; most individuals tend to improve with time. Pain and tenderness are the defining symptoms. Most individuals with fibromyalgia also experience sleep problems; often they can fall asleep but wake up repeatedly throughout the night, thereby preventing a deep, restorative sleep. This causes them to wake up tired; daytime fatigue is a prominent symptom. A neurological symptom (referred to as restless leg syndrome) is also common, which causes the limbs to move periodically during sleep. Additional symptoms include exhaustion, anxiety, depression, numbness, morning stiffness, irritable bowel symptoms (constipation alternating with diarrhea), temporomandibular joint disorder (TMJ, which affects the jaw joints and surrounding muscles resulting in facial pain), headaches and migraines, and impaired memory and cognitive functioning. Symptoms often vary depending on weather, stress, time of day, and physical activity level. Intensity of the symptoms is extremely variable from person to person; some individuals are almost completely incapacitated, while others are only mildly so. The health state described in this section represents the average (typical) case of fibromyalgia.

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The causes of fibromyalgia are unknown, but several contributing factors, such as an infectious illness or trauma, have been hypothesized. Exposure to a physical, emotional, or environmental stressor may act as a trigger in predisposed individuals (genetic factors appear to play a role) and also tend to cause exacerbation of the symptoms. Chemical abnormalities in the brain may result in pain amplification (due to abnormal sensory processing). It has also been suggested that sleep disturbances are not only symptoms, but a potential cause of fibromyalgia.^42,45

Although there is currently no laboratory or diagnostic test for fibromyalgia, the American College of Rheumatology has developed a set of criteria, based on patient symptoms, to be used in clinical practice. These criteria include the presence of widespread pain (pain in all four quadrants of the body: the left side, right side, below the waist, above the waist) for a duration of at least three months and pain in response to low levels of pressure (less than 4 kg) in 11 of 18 tender point sites on the body.⁴⁶ (Tender points are located in precise areas of the body, particularly in the neck, shoulder, spine, and hips.)

Fibromyalgia has no known cure, and therefore must be managed as a chronic condition. Treatment is aimed at easing pain and improving sleep, and includes medication, physical therapy, and self-management. Pharmacological treatments are typically not very effective at relieving pain. NSAIDs can provide some pain relief; antidepressants are more useful to help reduce pain, relax muscles and promote sleep. SSRIs (Selective Serotonin Reuptake Inhibiters) may also be prescribed to patients who are suffering from both fibromyalgia and depression (which commonly accompanies fibromyalgia and aggravates the symptoms). Acupuncture or therapeutic massage may help to alleviate pain by breaking up the trigger points and muscle spasms. Most importantly, self-management is an integral part of improving symptoms and managing the condition. Stretching and exercising daily help to reduce pain (although the exact mechanism is not understood), to maintain muscle strength and physical function and reduce muscle stiffness. Regular exercise also improves sleep. Relaxation exercises reduce stress that may potentially bring on symptoms. Furthermore, avoiding daytime napping and caffeine intake, and practicing effective sleep management (going to bed and getting up at the same time every day) may help to improve sleep. In general, little treatment is required for individuals with mild symptoms (especially once they understand how to avoid actions that trigger/worsen their symptoms), whereas a comprehensive treatment regimen is necessary for individuals with more severe symptoms.

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