Fibromyalgia (FMS) is a chronic pain syndrome that affects about 7% of the population, making it one of the most commonly seen conditions in a rheumatology practice. Much research is being done to explore FMS, but much is still unknown.

  1. What causes FMS?  Unknown.
  2. Is it hereditary?  Unknown.
  3. What is the cure?  Unknown.
  4. Is there a diagnostic test for FMS?  Not yet.

For a long time, FMS was felt to be a “waste-basket” diagnosis, or an “all-in-your-head” diagnosis. This was likely due to the fact that commonly ordered blood tests and xrays are normal in patients with FMS. However, there are sophisticated research tests (involving special brain scans or analysis of spinal fluid) that can detect abnormalities in fibromyalgia that are not seen in patients without this disorder. These tests, though, are NOT routinely available yet in the regular doctor’s office: these are research tests only. The family doctor or rheumatologist makes a diagnosis based on symptoms reported by the patient, physical exam findings, and blood work to help eliminate other illness that might mimic FMS.

Common characteristics that may be found in patients with FMS.

1.  Stress or mood disturbance. Stress can occur in many different forms: including problems in one’s family, work, living situation, finances, etc. Stress can also come about from prior trauma, including events from long ago. Mood disturbances include depression and anxiety. Not everyone with FMS has depression or anxiety, but many patients do.

2.  Deconditioning. Many patients with FMS report a lack of exercises at the time they come in for evaluation. Some patients used to be very physically active, but something happened in their life (perhaps a serious illness, or a move to a new location, or a new job taking more time) that resulted in a change or an end to their exercise routine. Other patients really have not been physically active for most of their lives. Regular aerobic physical exercise has proven benefits for FMS (and numerous other health conditions) and it is a necessary part of the treatment of FMS.

3.  Impaired sleep. Patients often describe trouble falling asleep, trouble staying asleep, and feeling like they didn’t get enough sleep when they wake up in the morning. Nonrestorative sleep also contributes to your brain not functioning at its best, so patients report “brain fog” with difficulty thinking clearly, trouble keeping up in normal conversation or forgetting where they put things. When the brain gets good quality sleep, the brain functions better, and the patient feels better.

4.  Widepsread pain. This is often the most troublesome complaint in FMS, pain “all over”. Typical over-the-counter analgesics only partially address the pain in FMS, and frequently prescription medications are needed for pain relief. Pain can flare at times, often triggered by stress or changes in the weather, or sometimes for no apparent reason.

The approach to FMS treatment involves addressing all these different problems (pain, sleep, deconditioning, mood disturbance), but with patience an d persistence on the part of the patient, the prognosis is good.