by Hope Starkman, MD

Fibromyalgia is a very common pain syndrome which can occur in any age group or either sex. Fibromyalgia is most common, however, in women between the ages of 20-50. Fibromyalgia can occur alone or secondary to or in combination with other inflammatory or autoimmune disorders, like rheumatoid arthritis or systemic lupus erythematosus. It is associated with the presence of multiple specific tender/trigger points. Fibromyalgia is associated with poor or nonrestorative sleep, fatigue, burning or tingling sensation in the extremities, generalized stiffness, anxiety and depression as well as memory problems and cognitive dysfunction.

Many patients with fibromyalgia also experience headaches which vary in quality, bladder irritability and irritable bowels syndrome (alternating periods of diarrhea and constipation).

The exact cause of fibromyalgia is unknown. It is unclear as to whether or not genetics plays a role in the causation of fibromyalgia. One theory is that patients with fibromyalgia have an abnormal pain response threshold.

There is no diagnostic laboratory test available to support the diagnosis of fibromyalgia, and in fact, in the absence of other inflammatory or autoimmune disorders, all lab tests, muscle tests, electrodiagnostic tests are within normal limits. Sleep studies may demonstrate abnormal sleep patterns and obstructive sleep apnea should be excluded and treated if identified.

The diagnosis of fibromyalgia is made when a patient presents with at least 11 out of 18 classic tender points for at least 3 months. Despite this criteria, in my clinical experience many patients do not present with 11 out of 18 trigger points always at the same time and tender or trigger points often change over time. There is also the associated nonrestorative sleep. The diagnosis should not be made until other conditions like occult malignancies, autoimmune disorders, thyroid disorders are ruled out and treated if identified.

The treatments of fibromyalgia include the use of antidepressants, anti-inflammatory agents, analgesics, muscle relaxants and drugs like Lyrica. Many drugs are used off label, in other words without specific FDA approval to treat the signs and symptoms of fibromyalgia. Some of these agents work well in specific patients but patients should be aware of their off label use. Additional modalities such as physical therapy, psychotherapy, biofeedback, acupuncture and regular exercise regimens can also help to alleviate the symptoms of fibromyalgia. My practice includes the use of Acupuncture in the treatment of fibromyalgia which helps to lessen the need for higher dose or multiple medications and in some cases helps limit the use of medications, completely.