Johns Hopkins Health Alert
Fibromyalgia Syndrome -- Common and Difficult to Diagnose
If you suffer from aches, stiffness, increased sensitivity to pain or other arthritis-like symptoms, it could be fibromyalgia.Fibromyalgia is a common rheumatic condition. It is not a form of arthritis as it does not cause inflammation to the joints, muscles or other tissues. Instead, fibromyalgia causes pain and stiffness in tissues around the joints.
The exact cause of fibromyalgia is unknown, but there are several theories under study, including abnormalities of the central nervous system, sleep disturbances and the possibility that it is triggered by a viral infection or an injury.
Symptoms of fibromyalgia include pain, aches and stiffness that may occur all over the body, moderate to severe fatigue, trouble sleeping, depression and anxiety, difficulty thinking and concentrating and increased sensitivity to pain.
Because symptoms of fibromyalgia are similar to those of many other disorders, it is difficult to diagnose. You may see several doctors before getting a correct diagnosis. No x-ray, biopsy, or blood test can identify fibromyalgia. However, the American College of Rheumatology has developed a set of criteria to diagnose fibromyalgia, including widespread pain, present for at least three months; pain located on both sides of the body, above and below the waist; and pain in at least 11 of 18 tender points.
Once you are diagnosed with fibromyalgia, your doctor will work with you to develop a multifaceted treatment approach that may include pain medications, improving sleep patterns, exercise, psychological counseling and complementary therapies. You may also need to work on your day-to-day activities to avoid repetitive motions that cause fatigue and increase pain. Treatments that are not recommended include excessive rest and avoidance of activities, botox injections and herbs or supplements that claim to cure fibromyalgia.
If you are living with fibromyalgia, working with your doctor and sticking to your treatment plan can do a lot towards relieving your symptoms. Also, medications are under study that may soon yield new treatments.
Fibromyalgia Trigger Points
Tender points—specific spots that are quite painful when pressure is applied to them—are typical in fibromyalgia. Tender points usually are present on both sides of the body. To test for pain at the tender points, your physician will apply about nine pounds of pressure per square inch (equivalent to pressing your thumb on a hard surface until the tip of your thumbnail begins to turn white). The pressure may be applied with one or two fingers, or with a special device called a dolorimeter. Fibromyalgia is easily overlooked or misdiagnosed. It is important that you seek medical attention from a rheumatologist or a physician who is experienced in diagnosing and treating fibromyalgia.
Posted in Arthritis on July 20, 2006
Reviewed June 2011
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My wife and I both have osteo arthritis in multiple areas. Prior to the diagnosis of arthritis, we both had some degree of fibromyalgia. Any information on these areas is read with interest. John E. Speck
Posted by: johnspeck | September 18, 2006 7:14 PM
Hi, 39 year old female who has extreme back pain for years. I've had 2 disc fusions in 01 successful and 3 disc fusion c4-c7 rejected. Assumed all pain from fusion gone bad. Now diagnosed sleep apnea using CPAP still wake with severe numbness and with pins and needle pain in the morning. Legs like I've run a marathon when nothing done. Hurt enough I think I won't be able to take a step but easeses as I move. My knees thighs buttocks back delts elbows wrists and hands all feel fat and hurt terribly. With time eases. I'm on a morphin patch due to the bad disc fusion pain in the neck excruciating and now told to fix properly I will need to be fused from c3-t2. Opted not to operate. Now one last thing to the mix I sleep (for no known reason) for 4 and 5 days at a time. Never know when the sleep spells occur it just happens. I wake to go to the bathroom and eat but remember nothing. I also have sleep paralyses, asleep but can hear conversations going on and want to be a part (my congestive heart failure mother telling my husband to take the fat from the meat and use that to make gravy and to give her the burned fat off the roast because that's the best part) ... "no no no Mom no you can't cook like that anymore. Please Mom no no no we're going to cook the roast a better healthier way....." I was screaming these words but only I could hear my screams. The time I've described I slept for 4 days and did not go back down for 2 weeks. I've found info on Klein Levin's Disease and the sleep patterns described sound just like KLD. I can't seem to find any doctors that can tell me what is wrong. I went from playing professional volleyball 5 nights a week and was a work-aholic as a robotics space engineer to being 65lbs over weight and barely able to walk with a walker and sleeping my life away. Anyone have any thoughts?
Posted by: dbuzzelli | September 30, 2006 5:49 PM
I was diagnosed with fibromyalgia in 1994 but believe I've had it from a very young age. I worked from age 5 to 18 on the family farm. I attributed my aches and pains to the hard work I was doing. Then I went to work for the U.S. government. I spent 33 years working at a desk with a typewriter and then computers as they came into the office. I attributed the burning/aching/wrenching shoulder/back pain (which I always had on the farm) to 8 hours a day at a desk typing/answering phones/interviewing people/and other normal office duties.
Currently I take 3 pain meds and a muscle relaxer. Two years ago I was offered an early retirement and took it. The last year that I worked, I only worked one complete week.
I am willing to be a "guinea pig" but have had no luck in finding any trials/testing/etc near where I live. I am in upstate NY near the PA border.
Any information would be appreciated.
Posted by: Rhea | October 28, 2006 12:45 AM
I was dx. almost 1 year ago with ra & fibro. I have been treated with meds for the ra. but I am having trouble telling if the pain is coming from the ra or the fibro. Is there a way to tell the difference? I was told the treatments I am using won't help the fibro. Only the ra. so I am not sure if the meds are working since I can't tell which pain is which. Any help would be GREAT. thanks Alex
Posted by: Alex | January 27, 2007 12:33 AM
I have had fibromyalgia, RA, Sjogrens, psorias athritis and a few other kinds of athritis. I can now tell when one or the other of these hurts, there are various levels of pain and types. When my RA is bothering me, the pain is distinctively my joints. When the fibromyalgia is hurting, which is most of the time, the pain is in between the joints on either side. At least for me, everybody is different. Like for about a 2 months my wrists and elbows just throb like a dull toothache, but it is the tissues and musles that run between the wrist and elbow. I can feel my wrists all over and the pain isn't there, it is in the (meat) meaning everything even my skin will be so sore to the touch of your arm. My RA is a totally different level of pain and gets really sharp pain to even worse pain. Fibro I think is more painful and can go to extremes. My body feels like a big toothache that never quits hurting. Well I hope this my help someone out there. Thanks Teresa
Posted by: Teresa Bouck | March 18, 2007 11:08 AM
I have had fibro for 6 yrs and have been on many different meds which all seem to have some kind of intolerable side effect. Vicodin 7.5mg is the only thing that has worked for me and I take one every 4 hrs while awake for the past 5 yrs. I never take less then 4 a day and try to keep it under 6 tabs. I would like to be off Vicodin as a regular drug and take only occasionally. The problem is that it is the only drug that makes a difference. I can't stand the sweating of SSRI or SSNRI and Lyrica sent me to the ER with extreme anxiety and I felt like I couldn't sit still. I do take Ambien CR every night and I know I wouldn't sleep without it. Trazadone made me hungover and fatigued. Flexeril gave me heart palpatations. I need a muscle relaxant, but had my B/P fall extremely low. I swim in warm water, work part-time and keep my house for me and my husband. I have 2 wonderful adult children and enjoy my life, but I feel like I have hit a wall. Do I start over again and reevaluate the side effects, or stay on the opiates. I have had minimal, short term relief with bio-feedback. I have tried accupuncture and massage both with negative results. Does anyone have any suggestions? I'm desperate.
Posted by: lslipke | October 22, 2007 9:59 PM
I am interested to know if Bikram yoga (hot yoga) would be of benefit for a person suffering from fibromyalgia pain.
Posted by: pamelagoldberg | October 17, 2008 3:42 PM
I have fibro. Does anyone know if I can take BOTH 5-HTP & SAMe? My e-mail is janeles50@aol.com. THANK YOU IN ADVANCE, JANE
Posted by: janeles50 | May 17, 2009 11:56 PM
I am currently seeing an Internal Medicine doctor for every symptom described on the Fibromyalgia symptom list. I have had bloodwork that rules out RA, Lupus and any other autoimmune problem. I did have 1 slightly low thyroid test, I am taking a very low dose of Levothyroxin (25mcg) with no change in my symptoms with normal thyroid levels upon repeat testing. My doctor says I don't have Fibromyalgia because my blood tests were negative for inflammation and has not given me a referral to a Rhuematologist. He has perscribed some of the medicines used to treat Fibromyalgia (Gabapentin, Setraline and just this week Cymbalta). The Gabapentin and Setraline only gave minor relief to some symptoms...to early to tell on the Cymbalta as I have only taken it twice. From the information I have read here, my doctor is incorrect about the blood test (I think he is talking about the Red Blood Cell Sedimentation Rate). Does anyone have any information in regards to blood test results?
Posted by: lyndahughes | June 10, 2010 10:22 AM
There are no blood tests that can tell you if you have fibromyalgia. The only way to be diagnosed is with the testing of the "tender points". One must test positive 11 out of 18. There is a blood test however, to test for RA which is called a sed rate. If the Levothyroxin isn't working talk to your doctor about adding the T3 to your regiment. I cannot take Trazadone either it causes me to have restless leg syndrome. Have you tried ALL SSRI's? The one that I find works for me is Lexapro, I did not like how the others made me feel either. I have only been diagnosed with fibromyalgia for 2 years. I had been going to an accupunctureist and some of the needle placements where in the "tender points" for fibromyalgia. I had told the doctor that they hurt and where painful which he dismissed. Up until that point I had been driving an hour and a half to work each way and working without any problems until I was sent to the rheumatologist by my dermatologist to check me out for RA. Once the rheumatologist started pushing on the "tender points" I about came off the table and wanting to hit him. Every since that day Sept 10, 2008 I have been in pain. I was in so much pain that I was on 600 mg of Lyrica (which is the max), Cymbalta 90 mg (again the max) and then they add 600 mg Neurontin. With all of these meds I gained about a total of 50 lbs. And after that day in September, I was only able to work for another month. Maybe you can try a chiropractor, it works for me. Does anyone have any thoughts on the accupuncture or the rheumatologist?
Posted by: island_girl.98 | August 30, 2010 2:37 AM
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Thank you for the information on fibromyalgia
Posted by: johnspeck | September 18, 2006 7:10 PM