Fibromyalgia is a common but poorly understood syndrome that affects muscles, tendons, and ligaments, and results in significant pain throughout the body.

Although the cause of the disorder remains unclear, some studies suggest that many cases begin after a trauma or illness. The condition may be related to an abnormality in pain perception.

Symptoms

• Pain is the most common symptom and usually affects both sides of the body. There are specific tender points throughout the body, often on the back and neck.
• Nearly every fibromyalgia patient has fatigue, and many have chronic fatigue syndrome. Poor sleep quality is also common, and sleep apnea may occur.
• Other common concurrent illnesses include irritable bowel syndrome, depression or anxiety, and headache.
• Many other vague symptoms may occur, including tingling, allergies, and difficulty concentrating.

Risk Factors

• Gender: The condition is 10 times more common in women than in men.
• Increasing age
• Genetic factors: Specific genes that are associated with variations in function of the brain chemical serotonin have been identified in some fibromyalgia patients.

Fibromyalgia: Diagnosis and Treatment

Diagnosis

There are no tests for fibromyalgia. The diagnosis is based on history and physical examination, particularly the identification of specific tender points throughout the body.

In some cases, blood tests may be used to rule out other disease, such as rheumatoid arthritis, thyroid disease, and Lyme disease.

Treatment

The optimal treatment is a multidisciplinary approach, which includes exercise, physical therapy, good sleep hygiene, and mental health specialists.

• Low-impact aerobic exercise has been shown to be effective at decreasing symptoms. Muscle strengthening and flexibility programs, such as yoga, can also be helpful. Exercising three times a week is optimal.
• Mind-body treatments have been successful in some patients, including hypnotherapy, cognitive behavioral feedback, electromyography (EMG) biofeedback, and meditation programs.
• Acupuncture is currently under investigation as a potential treatment.

Many medications have been tried, but few have a significant effect on symptoms. Nonsteroidal anti-inflammatory drugs (e.g., ibuprofen) and acetaminophen (Tylenol) may be helpful in some patients. Antidepressant medications, including tricyclic antidepressants (e.g., desipramine) and selective serotonin reuptake inhibitors (e.g., Prozac), are effective in some patients.  

Fibromyalgia: Nutritional Considerations

• There is limited evidence that a low-fat, vegan diet may improve the symptoms of fibromyalgia. However, controlled clinical trials are necessary to test this hypothesis.

• Fibromyalgia patients with disturbed sleep may benefit from melatonin supplements at bedtime