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Fibromyalgia is most commonly seen in women ages 30 to 50, however can be experienced by anyone. It is associated
with anxiety, depression, and sleep disorders. Constipation, diarrhea, and abdominal pain associated with Irritable Bowel
Syndrome (IBS) are typical in people with Fibromyalgia. People generally experience pain in specific locations of the body
when pressure is applied. These locations are commonly the back of the head (occiput), upper back, neck, elbows, hips
and knees. The pain generally persists for weeks to months and is often accompanied by stiffness. Signs of inflammation
are particularly absent.
Another frequently reported complaint of patients with Fibromyalgia is headaches with associated facial pain that may be
related to the tenderness they are experiencing in their neck and shoulders. Fibromyalgia can also predispose to an
increased sensitivity to noises, bright lights, odors, and touch, similar to what are experiences during a severe migraine
headache.
A common complication of chronic pain, particularly Fibromyalgia, is Central Sensitization. This is a development involving
both the peripheral nervous system (PNS) and the central nervous system (CNS). Local tissue injury and inflammation
activate the PNS, which sends signals through the spinal cord to the brain. Central sensitization occurs when there is an
increase in the excitability of neurons within the CNS, so that normal inputs from the PNS begin to produce abnormal
responses. Low-threshold sensory fibers activated by very light touch of the skin activate neurons in the spinal cord that
normally only respond to noxious, or more severe, stimuli. As a result, an input that would normally produce a harmless
sensation now produces significant pain.
Although many complaints are common and reported among people with Fibromyalgia, the diagnostic criteria are less
extensive. The American College of Rheumatology has established general classification guidelines for the diagnosis of
Fibromyalgia. According to these guidelines the diagnosis is made clinically by the physician based upon a history of
multiple areas of aches or pain for at least three months and have a minimum of 11 of 18 locations on the body that are
abnormally tender under relatively mild pressure. The physician is able to make the diagnosis of Fibromyalgia in a patient
based upon the history of symptoms and by eliciting the specific tender points on physical exam. If the patient has a
history associated with Fibromyalgia but has less than the 11 tender spots, or are tender in non-fibromyalgia locations,
then this is considered “Myofascial Pain Syndrome” and is managed and treated the similar to Fibromyalgia.
Treatment
Although the intensity and frequency of the symptoms may vary, they probably never disappear completely on their own. It
may be encouraging to know, however, that Fibromyalgia is not a progressive or life-threatening condition and certain
treatments can significantly improve the symptoms. People may experience a remission period, where they are free from
symptoms without treatment are have much lower levels of pain. Most commonly, the symptoms return and treatment is
needed to alleviate the physical and emotional complaints. One of the most difficult aspects seen in treating patients with
Fibromyalgia is that they experience both physical discomfort and psychological/emotional hardships. Both the body and
the mind need to be addressed for successful treatment.
Pharmacologic treatments typically used in patients with Fibromyalgia include:
• Antidepressant
• Analgesics (NSAIDs)
• Muscle relaxants
• Acetaminophen
• Membrane Stabilizing Drugs
• Sleeping aids
Mixed outcomes are seen with drug treatments alone and emerging data favors pharmacological treatments with other
modalities. Treatment goals of patients with Fibromyalgia include the improvement of physical pain, increasing daily
activities, and restoration of normal sleep cycles. A combination of treatments including pharmacotherapy with alternative
therapies such as acupuncture, physical therapy, and activities increasing physical movement (Rooks 2007) is increasing
in popularity.
Therapies for pain and stress management are not new. Some alternative therapies have been practiced for thousands
of years but their use has become more popular in recent years, especially with people who have chronic illnesses, such
as Fibromyalgia, arthritis, headaches, chronic back pain, among many other conditions.
These therapies can be especially beneficial for those with Fibromyalgia:
• Physical Therapy
• Acupuncture
• Yoga
• Massage therapy
• Meditation
• Prayer
• Cognitive Behavioral Therapy
• Infusions of Membrane Stabilizing Drugs
• Yoga
• Exercise Therapy
• Aquatic Therapy
• TENS Unit
• Trigger Point Injections
Several of these treatments do safely and effectively reduce pain and the associated complaints, and are quickly gaining
acceptance in the practice of medicine. Acupuncture, massage therapy (Tsao 2007), cognitive behavioral therapy,
transcutaneous electrical nerve stimulation (TENS), and heat application have all been shown to decrease some of the
symptoms associated with Fibromyalgia as well as alleviate some of the mental strains experienced by these patients.
Ginkgo biloba, which has been used as a sleep aid, has also been known to improve sleep and some of the associated
complaints of Fibromyalgia (Lister 2002).
Possible future treatments
Recently the effect of Botox (Botulinum toxin A) as a treatment for Fibromyalgia has been studied. Thus far a trial from
South Africa has been done which reported 16 people with Fibromyalgia who were treated with multiple injections of
Botox. Several participants had an increase level of pain in areas of the body that didn't receive injections. Other
participants reported improvement without the increase in pain. The Food and Drug Administration has not yet approved
Botox for the treatment of Fibromyalgia so more clinical trials are needed to determine the safety and potential benefits
this as a treatment.
The common over the counter cough suppressant Dextromethorphan is currently being investigated, along with other
studies looking at Lidocaine and Ketamine infusions, but no significant data has been published on their potential benefits
as of yet. If you have fibromyalgia, call us today to schedule an appointment. We are happy to offer these treatment
options for fibromyalgia to the Phoenix area.
Journal Articles
Fibromyalgia Treatment Update. PMID: 17278924. Curr Opin Rheumatol. 2007 Rooks DS. Mar;19(2):
111-7.
Study finds acupuncture improves fibromyalgia symptoms. PMID: 17102788. Mayo Clin Womens
Healthsource. 2006 Dec;10(12):3.
Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial. PMID:
16770975 Mayo Clin Proc. 2006 Jun;81(6):749-57.
Effectiveness of Massage Therapy for Chronic, Non-malignant Pain: A Review. PMID: 17549233 Evid
Based Complement Alternat Med. 2007 Jun;4(2):165-79. Epub 2007 Feb 5 Tsao 2007
Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and
treatment. PMID: 16078356 J Rheumatol Suppl. 2005 Aug;75:6-21. Mease 2005
An open, pilot study to evaluate the potential benefits of coenzyme Q10 combined with Ginkgo biloba
extract in fibromyalgia syndrome. J Int Med Res. 2002 Mar-Apr;30(2):195-9 Lister 2002
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Fibromyalgia
by Nicole Berardoni M.D, Paul Lynch M.D, and Tory McJunkin M.D
Fibromyalgia is a chronic connective tissue disorder
characterized by widespread pain, fatigue, and weakness. The
disease is characterized by multiple tender points on the body.
The tender points are found in specific locations around the
neck, back, upper and lower extremities. Light pressure at these
points causes pain. Previously, Fibromyalgia was known by
other names such as chronic muscle pain syndrome,
psychogenic rheumatism, and fibrositis (Mease 2005).
by Nicole Berardoni M.D, Paul Lynch M.D, and Tory McJunkin M.D
Fibromyalgia is a chronic connective tissue disorder
characterized by widespread pain, fatigue, and weakness. The
disease is characterized by multiple tender points on the body.
The tender points are found in specific locations around the
neck, back, upper and lower extremities. Light pressure at these
points causes pain. Previously, Fibromyalgia was known by
other names such as chronic muscle pain syndrome,
psychogenic rheumatism, and fibrositis (Mease 2005).
Book I - Pain Syndromes
Chapter 1 Low Back Pain
Chapter 2 Neck Pain
Chapter 3 Cancer Pain
Chapter 4 Headaches
Chapter 5 Spinal Stenosis
Chapter 6 Sciatica
Chapter 7 Arthritis
Chapter 8 Fibromyalgia
Chapter 9 Motor Vehicle Injuries
Chapter 10 Complex Regional Pain
Syndrome
Chapter 11 Vertebral Body
Fractures
Chapter 12 Hip and Leg Pain
Chapter 13 Diabetic Peripheral
Neuropathy
Book II - Interventional Procedures
Chapter 14 Epidural Steroid
Injection
Chapter 15 Facet Injections/Medial
Branch Blocks
Chapter 16 Radiofrequency Ablation
Chapter 17 Spinal Cord Stimulator
Implants
Chapter 18 IntraDiscal
Electrothermal Therapy (IDET)
Chapter 19
Vertebroplasty/Kyphoplasty
Chapter 20 Discography
Chapter 21 Percutaneous
Discectomy
Chapter 22 Occipital Nerve Block
Chapter 23 Sympathetic Block
Chapter 24 Stellate Ganglion Block
Chapter 25 Intrathecal Pump
Implants
Chapter 26 Caudal Steroid Injection
Chapter 27 Adhesiolysis
Chapter 28 Cervical Steroid
Injection
Chapter 29 Sacroiliac Joint
Injections
Chapter 30 Celiac Plexus Block
Chapter 31 Head and Neck
Procedures
Chapter 32 Joint Injections
Chapter 33 Continuous Catheter
Nerve Blocks
Chapter 34 Peripheral Nerve
Stimulation/Field Stimulation
Chapter 35 Disc Denervation
Book III Other Treatments
Chapter 36 Medication Management
Chapter 37 Acupuncture
Chapter 38 Prolotherapy
Chapter 39 Botox
Chapter 40 Massage
Chapter 41 Alternative and
Complementary Medicines
Chapter 42 Exercise and Nutrition
Counseling
Chapter 43 Prayer
Chapter 44 Cognitive Behavioral
Therapy
Chapter 45 Group Therapy
Chapter 46 Biofeedback
Chapter 47 Chiropractic
Manipulations
Chapter 48 Vitamin Supplements
Chapter 49 Customized
Pharmaceutical Formulations
Chapter 50 Hormone Therapy
Frequently Asked Questions
Chapter 1 Low Back Pain
Chapter 2 Neck Pain
Chapter 3 Cancer Pain
Chapter 4 Headaches
Chapter 5 Spinal Stenosis
Chapter 6 Sciatica
Chapter 7 Arthritis
Chapter 8 Fibromyalgia
Chapter 9 Motor Vehicle Injuries
Chapter 10 Complex Regional Pain
Syndrome
Chapter 11 Vertebral Body
Fractures
Chapter 12 Hip and Leg Pain
Chapter 13 Diabetic Peripheral
Neuropathy
Book II - Interventional Procedures
Chapter 14 Epidural Steroid
Injection
Chapter 15 Facet Injections/Medial
Branch Blocks
Chapter 16 Radiofrequency Ablation
Chapter 17 Spinal Cord Stimulator
Implants
Chapter 18 IntraDiscal
Electrothermal Therapy (IDET)
Chapter 19
Vertebroplasty/Kyphoplasty
Chapter 20 Discography
Chapter 21 Percutaneous
Discectomy
Chapter 22 Occipital Nerve Block
Chapter 23 Sympathetic Block
Chapter 24 Stellate Ganglion Block
Chapter 25 Intrathecal Pump
Implants
Chapter 26 Caudal Steroid Injection
Chapter 27 Adhesiolysis
Chapter 28 Cervical Steroid
Injection
Chapter 29 Sacroiliac Joint
Injections
Chapter 30 Celiac Plexus Block
Chapter 31 Head and Neck
Procedures
Chapter 32 Joint Injections
Chapter 33 Continuous Catheter
Nerve Blocks
Chapter 34 Peripheral Nerve
Stimulation/Field Stimulation
Chapter 35 Disc Denervation
Book III Other Treatments
Chapter 36 Medication Management
Chapter 37 Acupuncture
Chapter 38 Prolotherapy
Chapter 39 Botox
Chapter 40 Massage
Chapter 41 Alternative and
Complementary Medicines
Chapter 42 Exercise and Nutrition
Counseling
Chapter 43 Prayer
Chapter 44 Cognitive Behavioral
Therapy
Chapter 45 Group Therapy
Chapter 46 Biofeedback
Chapter 47 Chiropractic
Manipulations
Chapter 48 Vitamin Supplements
Chapter 49 Customized
Pharmaceutical Formulations
Chapter 50 Hormone Therapy
Frequently Asked Questions