"I have pain all over. Advil and Tylenol don't help very much. This has been going on for months and I'm getting really tired, doctor!" These are the statements I commonly hear from my patients with fibromyalgia. It is not known what causes fibromyalgia, but it does occur much more commonly in women up to ten times more often than men. Most sufferers are between the ages of 20 and 50.

It can begin during times of psychological distress and is often associated with lower education level and economic status. It is found in all populations around the country.

Often there are associated symptoms of anxiety, difficulty concentrating, fatigue, headaches, transient numbness in different areas of the body and problems sleeping. In order to be diagnosed with fibromyalgia, the patient must have chronic, widespread pain for at least three months. Also needed is what doctors call a "trigger point" pain in at least 11 of 18 different areas of the body. This tender, very focal pain is, by definition, found in patients suffering from fibromyalgia. These points are in the front chest and neck, the back of the head and neck, the outer elbow, the upper and lower sides of the hips and the inner area of the knee.

Other interesting conditions associated with fibromyalgia are irritable bowel and irritable bladder symptoms. Patients can often have pain in the abdomen associated with either constipation or diarrhea which is relieved by having a bowel movement. Also, TMJ (temporomandibular joint/jaw pain), night time restless leg symptoms, premenstrual mood disorder and painful menstrual cramps have been associated with fibromyalgia.

The diagnosis of fibromyalgia should be confirmed by a primary care physician or rheumatologist because it can easily mimic many other conditions. A careful examination and lab tests to evaluate thyroid function, presence of other rheumatologic disease and other bone and joint disorders is very important.

There are some therapies which have shown good evidence for effectively treating fibromyalgia. The drugs amitryptyline (Elavil) and cyclobenzaprine (Flexeril) have both been shown to have positive effect on symptoms. More importantly, cardiovascular exercise, group therapy and cognitive behavioral therapy have been shown to improve symptoms.

Some treatments have shown to have variable levels of effectiveness in treating fibromyalgia. Examples of this include drugs in the antidepressant category, such as duloxetine (Cymbalta), venlafaxine (Effexor), escitalopram (Lexapro) and fluoxetine (Prozac), which have been shown to help symptoms but without as much consistent improvement. Hypnosis, acupuncture, and biofeedback have also shown equivocal improvement of symptoms.

The important therapies which have been found to be of no value are narcotics such as codeine or hydrocodone, steroids, non-steroidal anti-inflammatory drugs, melatonin and thyroid hormone. Guiafenescin at higher than normal doses was in favor five to ten years ago as an alternative therapy, but has since fallen out of favor because of minimal effectiveness.

Newer drugs such as pregalbin (Lyrica) and tramadol (Ultram) have shown some improvement of symptoms in this condition.

The treatment of fibromyalgia must be tailored to fit the individual patient. Often a multidimensional approach using drug therapy and behavioral therapy and exercise produces the best results. Be sure to see your doctor for further information about fibromyalgia.

Learn more about this author, Erich Rosenberger M.D..
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