Ask the Doctor: Fibromyalgia
By Scott Fishman, MD
I feel achy all the time and my doctor just diagnosed me with
fibromyalgia. I have looked this up on the internet and see
a lot of confusing information, and it sounds like this may
be a life sentence of pain and suffering. What is this and
what can I do about it?
Fibromyalgia is a mysterious disorder and it afflicts a lot
of people. In addition, fibromyalgia is a perplexing disorder,
as it does not have a clear cause or a clear type of person
that it affects. It does predominantly occur in younger women,
but is also seen in both men and women of all ages.
We do know that fibromyalgia is a disorder of the connective
tissue, that is to say, a disorder of the fibers that connect
the muscles in our body as well as the muscles themselves.
Many patients with fibromyalgia have tenderness throughout
their bodies. Thus, if I have a patient with fibromyalgia,
and I press on their muscles, I will be able to find tender
areas, if not trigger points, meaning tender areas that radiate
pain away from the site that I am pushing on. Patients with
true fibromyalgia have these kinds of points all over their
Other patients, who may have a disorder that is very similar
to fibromyalgia, may have this type of tenderness, but with
just tender points locally or in a specific region. We consider
these problems under the heading of what is called "myofascial
pain." Myofascial is simply another term that relates
to the connective tissues and muscles. Patients also may have
other problems that occur secondary to fibromyalgia, such
as depression or anxiety, which we know can worsen the sensation
of pain and perpetuate the cycle of aching muscles.
The treatment options for fibromyalgia patients include sometimes
injecting either a local anesthetic or anti-inflammatory medicines,
such as corticosteroids into the muscle. Sometimes, just needling
the muscle itself, without injecting any medication (such
as might be done with an acupuncture needle) can be of benefit
to patients with myofascial pain or fibromyalgia. Other times,
however, these injections are not of benefit and other treatment
options need to be considered.
Physical therapy remains a mainstay of treatment for this
disorder. Because these people typically have impaired physical
disability, rigorous physical therapy conditioning programs
are usually employed. Other therapies that have been known
to be helpful include medications that help regulate sleep
because patients with fibromyalgia often have problems sleeping,
particularly a part of sleep that is called "delta sleep."
For this reason, medications in the family of drugs called
"tricylic antidepressants" are often used. These
medicines are not used as antidepressants, as their names
might suggest, but are typically used because they have pain
relieving and sedating properties that help patients with
pain and sleep.
Other medications include drugs that treat nerve-type pain,
in order to calm down overactive nerves. These medications
include Neurontin®, and other anticonvulsants. Anti-inflammatory
drugs are also used with some success. Unfortunately, there
is no one class of drugs that has been uniformly successful
in patients with fibromyalgia.
Scott Fishman, MD, author of The War on Pain, has
given permission to use this information, which originally
appeared on Discovery Health.
July 19, 2005