FIBROMYALGIA

ICD-9: 729.1

Description

Fibromyalgia is a chronic condition characterized by pain in the muscles, ligaments, and tendons; constant fatigue; and muscle tenderness. Women are 80% more likely than men to develop this condition. It is most common in those of middle age, affecting 2% of the adult population in the United States.

Etiology

The exact cause of fibromyalgia is unknown, but a variety of factors seem to be involved. Genetics may be a key factor, as clients with the condition tend to have family members with fibromyalgia. Clients with fibromyalgia may have a lower pain threshold because of increased pain signals to the brain. Nerve stimulation causes an increase in neurotransmitters, and because the pain receptors are more sensitive, they become overreactive to the neurotransmitters. Other factors, such as emotional distress, trauma, and illness, may trigger or exacerbate the condition.

Signs and Symptoms

Pain begins as a constant, dull muscle ache. Additionally, pain comes from tender points or sites where firm pressure causes an increase in pain. These spots include the back of the head, tops of shoulders, outer elbows, upper hips, and inner knees. Exhaustion is also common because of the inability to enter into the restorative phase of sleep. Coexisting conditions with fibromyalgia include chronic fatigue syndrome, SLE, osteoarthritis, posttraumatic stress disorder, restless leg syndrome, and depression.

Diagnostic Procedures

A physical examination showing widespread pain (both sides of the body and above and below the waist) lasting at least 3 months and 11 out of 18 possible tender points is sufficient for diagnosis. Blood work that includes a CBC, an ESR, and thyroid function may be ordered to rule out other conditions.

Treatment

Reduction of pain is the first goal of treatment; the second is to improve sleep. Several different medications can be prescribed: analgesics, antidepressants such as duloxetine HCl, and antiseizure drugs can reduce pain and improve sleep. Recently, the drug milnacipran has been approved specifically for the treatment of fibromyalgia. Stress management and physical therapy are also recommended.

Complementary Therapy

Massage, acupuncture, and chiropractic care can help alleviate pain. Low-impact exercise, yoga, and meditation can reduce stress and alleviate symptoms. Therapy in a warm-water pool is beneficial.

CLIENT COMMUNICATION

Clients must understand that reduction of stress and adequate sleep along with exercise and a healthy diet can help alleviate symptoms and exacerbation of the condition.

Prognosis

Fibromyalgia is a chronic condition, so prognosis depends on how the client responds to treatment. Even with treatment, symptoms may worsen and last for months or years.

Prevention

There is no known prevention for fibromyalgia.