Patients with fibromyalgia do not appear ill to casual observers and, therefore, are often misunderstood and mislabeled. They wake up hurting and the pains get worse as the day progresses, forcing them to take frequent rest, and limiting their physical and intellectual activity to a mere few hours per day. The patients feel as if they were carrying a heavy weight, causing their bodies and minds to become exhausted, in spite of their willingness to go on.

Fibromyalgia, which affects between 2% to 8% of the world’s population, is equally prevalent in all countries and may develop at any time from childhood to adulthood to old age. Most patients report a lifelong history of pain and are prone to many other types of pain besides body aches. They often complain of headaches, painful menstruation, bowel and bladder pains, back and neck aches, chronic fatigue, constipation, diarrhea, anxiety, and depression.

The fibromyalgic pain is generated both peripherally and centrally. Recent, preliminary evidence suggests that the small, distant nerve endings suffer from what is medically known as a small-fiber peripheral neuropathy. More traditional evidence also suggests that the brain pain sensors are miscalibrated to feel more pain. This dysfunctional, central-pain-amplification, or allodynia, combined with hypersensitive peripheral nerve endings, are two cardinal features of the fibromyalgia syndrome. The word allodynia comes from Greek and means the other pain, i.e. the pain caused by things that should not cause pain, such as touch, slight pressure, or normal movement.

Family members of patients with fibromyalgia are eight to nine times more likely to complain about different types of chronic pains, thus suggesting a strong genetic predisposition. Twin studies suggest that genes and environment determine the risk of developing fibromyalgia and other functional pain disorders equally. Situational stressors, traumatic experiences, certain infections, arthritic disorders, and physical trauma can all trigger or worsen fibromyalgia. Unlike normal people, the brains of fibromyalgia patients show abnormally heightened activation of their pain centers in response to mild provocation with touch and pressure.

The diagnosis of fibromyalgia is clinical and based on having multiple body aches, a heightened sensitivity to applying physical pressure on muscles and soft tissues during the physical examination, experiencing inappropriate pain when the blood pressure cuff is inflated or when blood is drawn or when an injection is given, and finding that all appropriate laboratory and radiological investigations are essentially normal. Extensive testing may be harmful because incidental abnormalities may provoke more anxiety and lead to more invasive, potentially risky procedures.

The fibromyalgic aches involve different body sites at different times and wax and wane with rest, stress, sleep, activities, and work load. They commonly involve the soft tissues of arms, legs, shoulders, neck, back, hands, and feet. Pains in the joints may also occur, but the joints do not show signs of inflammation such as swelling, heat, or redness. Squeezing, pushing, or pressing on the skin, muscles, ligaments, or joints provokes more intense and longer lasting pain than anticipated by the examiner. A small, accidental bump incurred during normal activity may provoke a great amount of pain and the pain may last much longer than usual.

Therapy for fibromyalgia requires a team approach. A combination of appropriate medication by an experienced physician, cognitive behavior therapy, exercise therapy, family and social support, scheduled periods of rest, different types of physical therapy, trigger point injections, acupuncture, electric nerve stimulation, and patient education can all be utilized to optimize response. Commonly used pain medications such as arthritis or analgesic pills, narcotics, and steroids are usually ineffective. Narcotics may even worsen the pain and thus drugs commonly used to reverse narcotic effects such as naltrexone may actually help the pains, reinforcing the notion of a disturbed central-pain-processing system.

Patient education emphasizes that the symptoms of fibromyalgia are not due to inflammation and that the disease does not lead to muscle and joint damage. Empowering patients through education and self-help may do more good than medication. A University of Michigan fibromyalgia education and self-help site is highly informative and may be accessed at: https://fibroguide.med.umich.edu.

Patients who have other painful conditions such as arthritis, neuralgias, peripheral neuropathy, and degenerative disk disease, may also suffer from fibromyalgia, which can amplify and worsen their primary pains. In such cases, management of the primary disorders may not provide enough relief unless the patients’ fibromyalgia is addressed and treated separately.