New Treatment for Fibromyalgia?

From the University of Michigan Health Service

Fibromyalgia syndrome (FMS) is the most common cause of chronic widespread pain, affecting an estimated 2 percent of the population - or 5.6 million people - in the U.S. Characterized by widespread pain, exhaustion, and poor sleep, FMS can have a devastating impact on affected individuals. In fact, it has been shown to undercut health-related quality of life more so than rheumatoid arthritis and advanced cancer. FMS is frustrating to doctors and patients alike, because it is poorly understood and is frequently resistant to treatment. Basic questions about FMS are answered below.

What is FMS?

FMS is a chronic disorder in which muscles, tendons, and ligaments throughout the body ache, while small, specific areas ("tender points") are tender to the touch. The pain of FMS most often affects the neck, shoulders, upper back, lower back, and thighs. In addition to sleep disturbances and fatigue, people with FMS frequently suffer from depression, anxiety, tingling or numbness in the hands and feet, headache, and irritable bowel syndrome.

Who suffers from FMS?

Although FMS afflicts both sexes, women are approximately seven times more likely to suffer from FMS than men. The syndrome is most prevalent among women above the age of 50.

What are the burdens of FMS to patients and society?

FMS is not life-threatening, but it can be highly debilitating and highly distressing. FMS hampers patients' ability to work and engage in recreation, compromises personal relationships, and erodes mental well-being, since relief is often elusive and support from friends, family, and the healthcare system is often lacking. One study suggested that more than 38 percent of patients with FMS had contemplated suicide since the onset of their symptoms.

FMS imposes large economic burdens on affected individuals and society.

• Medical costs. Patients with FMS visit the doctor more frequently, are hospitalized more often, and take more medications than healthy persons. According to a 1996 study, the average annual healthcare cost per patient with FMS was $2,274.

• Lost income and disability. Sixteen percent of patients with FMS receive Social Security disability payments, compared with approximately 2 percent of adults in the U.S. without FMS Nearly one in five patients with FMS are unable to work more than 40 percent of the time.

The disability associated with FMS can be self-perpetuating, since patients who withdraw from usual activities such as work rarely improve.

What causes FMS?

The underlying cause of FMS is not known. In some patients, stress, poor sleep, rheumatic disorders (such as osteoarthritis), neuroendocrine dysfunction, or infections appear to initiate or aggravate symptoms of FMS. In other patients, no trigger can be identified.

Various physiological disturbances have been implicated in FMS. For example, several studies have suggested that hormonal systems involved in the body's response to stress (such as the adrenal glands) function differently in patients with FMS. In addition, a growing body of evidence suggests that pain is processed abnormally in patients with FMS, such that mildly painful stimuli - or even harmless stimuli - are perceived as very painful. The biochemical disturbances that contribute to this oversensitivity to pain may also play a role in other key symptoms associated with FMS, such as anxiety and depression.

How is FMS diagnosed?

FMS is challenging to diagnose because no abnormalities can be detected using standard means (such as a blood test), and because the syndrome shares many symptoms with other conditions, such as rheumatoid arthritis. According to the American College of Rheumatologists, widespread pain lasting at least three months and pain in 11 of 18 accepted tender points must be present to make a diagnosis of FMS.

How is FMS treated?

There is no cure for FMS. Comprehensive treatment strategies appear to be most effective, and may include education, aerobic exercise, stretching, massage, relaxation techniques, psychological consultation, and drug therapy. Even with comprehensive therapy, however, some symptoms tend to persist.

At this time, no drugs are officially approved for the treatment of FMS. However, a wide variety of agents, including antidepressants, muscle relaxants, sedatives, analgesics, opioids, anticonvulsants, and anti-anxiety medications, are used to manage various symptoms. Unfortunately, available medications are often poorly tolerated or ineffective for many patients.

Data suggest that pregabalin is an effective treatment for generalized anxiety disorder and neuropathic pain, an effective adjunctive therapy for epilepsy, and may also provide well tolerated relief from several core symptoms of FMS, including pain, sleep disturbance, and fatigue.