Fibromyalgia

Anna Sonnerup was a champion biathlete, a star of the demanding sport that combines cross-country skiing and target shooting. She was considered a shoo-in for the Olympics, but shortly before the trials she began to experience inexplicable periods of fatigue and weakness. They seemed to come and go. Then shockingly, at the preliminary trials she failed to qualify. What kept her from reaching the Olympics? It turned out that she had fibromyalgia, a disease predominated by muscle pain.

Next to osteoarthritis, fibromyalgia is probably the most common rheumatic problem. Found in women more often than men, it usually occurs between the ages of 20 and 50 and may affect as many as 2 percent of Americans. Fibromyalgia triggers pain in muscles, tendons, and ligaments rather than in the joints. Though it doesn’t deform joints or limbs, it does cause pain and fatigue. Often, it causes depression, particularly because of the frustrating symptoms, but also because the condition is difficult to diagnose and poorly understood. Some researchers think it’s caused by small traumas to the muscles which may occur after flu or extreme physical or emotional stress that decrease the blood flow. Others believe that the root of the disease is a sleep disorder that often occurs simultaneously. For some reason, in people with fibromyalgia, the deepest and most restful cycle of sleep is interrupted, although they may not be aware of it. Significantly, even healthy people showed symptoms of fibromyalgia when they were deprived of this type of sleep.

Symptoms. These include pain and stiffness, often in the whole body, but particularly in the neck, shoulders, hips, and lower back. People with fibromyalgia often complain of severe fatigue and feeling tired even after sleeping and may report other problems as well. Here’s a breakdown of symptoms and how many people feel them:

  • Temporary numbness or tingling (called paresthesia) 60 percent .
  • Headaches-50 percent .
  • Irritable bowel syndrome or abdominal pain, constipation, or diarrhea-30 to 50 percent .
  • Sleep disorders, including apnea (when you stop breathing during sleep), and restless leg movements-75 percent .
  • Among women, pain during menstruation-40 percent .
  • Depression-20 to 30 percent.
  • Anxiety-50 percent

Diagnosis. This can be difficult. Your doctor will consider your symptoms and may run lab tests to check for conditions such as thyroid disease, rheumatoid arthritis, lupus, and polymyalgia rheumatica. Some people may have more than one condition: One in 10 people with rheumatoid arthritis, for example, also has fibromyalgia. And there’s no simple blood test or X-ray evidence to confirm the disease. Since 1990, however, two specific guidelines for diagnosing this disorder have been used:

  • Pain on both sides of the body for at least three months .
  • Pressure applied to at least 11 of 18 trigger points all over the body produces pain, often severe .

Treatment. In treating fibromyalgia, your doctor has two primary goals: to ease your pain and help you sleep better. Here’s how to achieve them.

Exercise. When you’re suffering from fibromyalgia, you’re tired and achy, and the last thing in the world you want to do is zip around the block. Crawling into bed feels more like it. But this lack of activity actually makes things worse, because muscles that aren’t in shape feel pain more sharply. If you’ve been inactive, you need to start exercising again slowly, with as little as 10 minutes of daily walking. Every week, increase your time by 5 minutes until you’re up to 30 to 40 minutes of exercise daily. If walking is too painful, try a non-weight-bearing activity such as swimming or bike riding. And remember that although it may be hard to believe right now, soon your workouts will make you feel better. Studies confirm that exercise can ease the pain and fatigue of fibromyalgia.

Change your sleep patterns. Generally, people with fibromyalgia don’t have trouble falling asleep they just don’t rest well while they’re sleeping. To help improve the quality of your sleep, go to bed and get up at the same time every day, even if it means getting up early on weekends. Forgo daytime naps, and avoid alcohol or caffeine in the evenings. (Drinks containing caffeine include cola drinks and other sodas such as Mountain Dew. Check the label if you’re not sure if a beverage contains caffeine.) And sleeping pills are not a good idea. They may make things worse by interfering with the deep stages of sleep you need.

Start physical therapy. Your doctor may refer you to a physical therapist when you have painful flare ups or when you need to build up an exercise program. A physical therapist can gently stretch your muscles after spraying the area with a solution that deadens the pain.

Learn proper body mechanics. Sometimes your job or a sport involves repetitive motions, and limiting or eliminating certain movements can reduce flare ups. You can also work on your posture and learn to do certain tasks in a more mechanically “correct” fashion, such as changing how you grip your tennis racket or sitting in a different position at your computer. An occupational or physical therapist may offer valuable suggestions.

Consider medication. Fibromyalgia doesn’t involve inflammation or swelling, so corticosteroids or high dose NSAIDs won’t help. You may, however, use acetaminophen (Tylenol) or over-the-counter low-dose NSAIDs such as aspirin, ibuprofen, or naproxen. Your doctor may prescribe low doses of antidepressants such as amitriptyline (Elavil) or nortriptyline (Pamelor), plus the muscle relaxant cyclobenzaprine, to help you sleep. Another helpful option is antidepressants such as fluoxetine (Prozac) or sertraline (Zoloft), which help block pain and restore normal sleep. One study found that people who took the antidepressant fluoxetine or amitriptyline slept better and felt less pain after taking the drug for six weeks. The two antidepressants together were twice as effective. Finding the right dose may take some time, however, and the effect is not immediate, so don’t give up.