Fibromyalgia
Justin Hogge
Definition of Fibromyalgia
 A common clinical syndrome of generalized musculoskeletal
pain, stiffness, and chronic aching characterized by
reproducible tenderness or palpation of specific anatomical
sites, generally referred to as tender points.
 Dr. Joe M. Elrod
Tender Points
 Tender Point Count and Intensity Can vary from day to day
 The degree of tender points tends to predict functional
limitation. But, the correlation is very far from perfect.
 Individuals with less than 11 of 18 of these tender points may
still have severe functional limitations. (Chronic Pain
Syndrome.)
 The cut-off between “fibromyalgia” and “chronic pain
syndrome” is somewhat arbitrary
Epidemiology
 An estimated 5 to 10 million people in the United States are
diagnosed with Fibromyalgia.
 80-90 percent of diagnosed fibromyalgics are said to be
women between 20 and 55 years of age but the number of
younger people with fibromyalgia is growing.
Symptoms
 Anxiety and/or panic attacks
 Cardiovascular problems (dizziness, palpitations)
 Chronic fatigue and low energy
 Chronic widespread aches and pains
 Depression
 Gastrointestinal disturbances/irritable bowl syndrome
 Intolerance to cold temperatures
 Irritable bladder syndrome
 Memory and concentration problems “Fibro Fog”
 Neck and back pain
Symptoms continued
 Pelvic pain in women (painful menstruation)
 Poor circulation (cold hands and feet)
 Sleep disturbances and/or restless leg syndrome
 Stiffness (especially in the morning)/muscle twitching
 Subjective soft tissue swelling or paresthesia in hands, arms, feet
or legs
 Tension headaches and/or migrains
What causes Fibromyalgia?
 Cause is unknown
 Abnormally high levels of Substance P in spinal fluid in some
patients
 Substance P important in transmission and amplification of
pain signals to and from brain
 “Volume control” is turned up too high in brain’s pain centers
What causes Fibromyalgia (cont)
 Familial tendency to develop FMS suggests genetic role
 Can be triggered by physical, emotional or environmental
stressors such as car accidents, repetitive injuries and certain
diseases
 Patients with Rheumatoid arthritis and SLE (Lupus) are more
likely to develop FMS
How is Fibromyalgia diagnosed?
 A diagnosis is made by evaluation of symptoms and presence
of tender points
 American College of Rheumatology Classification Criteria
for Fibromyalgia (1990)…….widespread pain for at least
3 months and
pain in 11 out of 18 tender point sites on digital palpation
How is Fibromyalgia diagnosed (cont)
 X-rays, blood tests, specialized scans such as nuclear
medicine and CT, muscle biopsies are all normal procedures.
 Objective “markers of inflammation” such as ESR
(erythrocyte sedimentation rate) are normal procedures.
 Must be distinguished from other common diffuse pain
conditions
How is Fibromyalgia treated?
 Fibromyalgia is a chronic condition managed with
medications, and physical and nutritional modalities
 Medication therapy is largely symptomatic, as there is no
definitive treatment cure for fibromyalgia
How is Fibromyalgia treated?
(Medications)
 Current studies suggest that the best pharmacologic
treatment for treating pain and improving sleep disturbance
includes:
 Antidepressants
- Tricyclic compounds such as cyclobenzaprine (FLEXERIL)
and amitriptyline (ELAVIL)
- Dual reuptake inhibitors such as venlafaxine (EFFEXOR),
duloxetine (CYMBALTA) and tramadol (ULTRAM) effect
norepinephrine & serotonin
How is Fibromyalgia treated?
(Medications)
SSRIs/ antidepressants such as fluoxetine (PROZAC),
paroxetine (PAXIL) and sertraline (ZOLOFT) for depression
and pain
- Recent studies have shown that the anti-epileptics (seizure
meds) gabapentin (NEURONTIN) and pregabalin (LYRICA)
have been effective
Other Therapies for Fibromyalgia
 Acupressure/Acupuncture
 Balneotherapy (Therapeutic baths)
 Biofeedback (Power of the mind)
 Collagen Hydrolysat (Food supplement)
 Magnet therapy
 Meditation/visual imaging
 Therapeutic massage
 Prolotherapy (injection of dextrose & Sarapin into joints or
trigger points)
Effects of Fibromyalgia on Exercise
 Pain associated with basic activities of daily living, general
fatigue, and altered perception of exertion make it hard for
individuals with FM to stay physically active.
 Morning stiffness, exaggerated delayed-onset muscle soreness
(DOMS) and difficulty with use of the arms in elevated
positions associated with FM limit the type of activities that
can be done.
Exercise with Fibromyalgia
 The irony here is that even though exercise can make you feel
worse short term, the lack of it can make your symptoms
more severe long term, as well as inviting more health
problems. The key is moderation and pacing. Numerous
studies demonstrate that even small amounts of exercise, as
little as 6 minutes per day, can lessen pain and fatigue.
Effects of medications on Exercise
 Lyrica (antiepileptics)
 Has been known to cause clumsiness, but other than that has no
significant effects on exercise.
 Neurontin (antiepileptics)
 Can cause dizziness and blurred vision so not recommended if
doing activities requiring quick reaction time, but most exercise
is ok.
 Antidepressants
 No significant effects on exercise.
Effects (acute) of exercise on patient
 Exercise causes acute pain and exhaustion with patients
diagnosed with fibromyalgia (more so than individuals
without fibromyalgia)
Effects (chronic) of exercise on patient
 Exercise has been shown to decrease symptoms including,
pain, stiffness, fatigue, depression, and insomnia with
fibromyalgia patients long term.
Exercise Testing
 Functional
 Lifting-specific activities
 Flexibility
 Sit and reach Goniometry
 Endurance
 6 and 12 min walk
 Strength
 Handgrip
 Isotonic
 Aerobic
 Cycle
Fibromyalgia Video
Summary
 Fibromyalgia is a chronic condition that affects 5 – 10 million
Americans.
 Doctors diagnose fibromyalgia based on a patient's symptoms
and physical exam.
 Patients experience pain and stiffness in the muscles, but
there are no measurable findings on X-rays or lab tests.
 While fibromyalgia does not damage the joints or organs, the
constant aches and fatigue can have a significant impact on
daily life.
References
 http://arthritis.about.com/od/fibromyalgia/a/fibro_facts.htm
 Clark, S.R. et al. “Exercise for patients with fibromyalgia: risks versus benefits.”
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Curr Rheumatol Rep. 3 no. 2 (April 2001): 135-140
Wolfe F. et al. “The American College of Rheumatology 1990 criteria for the
classification of fibromyalgia: report of the multicenter criteria committee.”
Arthritis Rheumatology. (1990)
www.Fibrocenter.com
Dunne, F.J. and C.A. Dunne “Fibromyalgia syndrome and psychiatric disorder.”
British Jounal of Hospital Medicine. (1995)
Webmd.com/fibromyalgia
Medline
Dr. Joe M. Elrod “Reversing Fibromyalgia” Woodland Publishing. 2nd ed. 2002