Home > Encyclopedia of Nursing & Allied Health > Fibromyalgia

Definition

Fibromyalgia (formerly known as fibrositis) is an inflammation of the fibrous or connective tissue (muscles, joints, ligaments, and tendons) of the body. Widespread pain, fatigue, and multiple tender points characterize this condition. Other symptoms may include sleep disturbance, headache, and bowel disturbances.

Description

Fibromyalgia is more common than previously thought, with as many as 3–6% of the population affected by the disorder. Fibromyalgia is more prevalent in adults than children, with more women affected than men—particularly women aged 35 to 55. Fibromyalgia symptoms have often been characterized as psychosomatic in origin. Recent research has proved that belief false, and fibromyalgia is now regarded as a disorder that can be diagnosed and treated effectively with ongoing care and follow-up.

Causes and symptoms

The exact cause of fibromyalgia is not known. There are events that can precipitate the symptoms of fibromyalgia, including sports injuries, car accidents, falls, or other trauma to the body. Sometimes it occurs in several members of a family, suggesting that there may be an inherited tendency for the disorder. People with fibromyalgia are most likely to complain of three primary symptoms: pain in muscles, joints, and ligaments; stiffness; and excessive fatigue. Widespread, ongoing pain is characteristic of fibromyalgia. A careful history and physical examination may uncover additional areas of pain when the chief complaint lies in only one area of the body. The most significant area of pain may shift over time, and the pain can be intermittent.

Pain is the major symptom of fibromyalgia, with aches, tenderness, and stiffness of multiple muscles, joints, and soft tissues. The pain may also tend to move from one part of the body to another. It is most common in the neck, shoulders, chest, arms, legs, hips, and back. Although the pain is present most of the time and may last for years, the severity of the pain is variable and dependent on individual patient perception.

Symptoms of sleeplessness and overall fatigue may result from the individual's chronic pain, coupled with anxiety about the problem and how to find relief. The body's inflammatory response also produces chemicals in the brain that are known to contribute to fatigue. Other common symptoms are tension headaches, difficulty swallowing, recurrent abdominal pain, diarrhea (irritable bowel syndrome), and numbness or tingling of the extremities. Stress, anxiety, depression, lack of dietary control, or lack of sleep can increase symptoms. Intensity of symptoms varies. Some patients gradually improve, while others have recurrent episodes of their symptoms.

Diagnosis

Diagnosis is difficult, and the disease may be overlooked because symptoms of fibromyalgia are vague and general. In addition, fibromyalgia may mimic symptoms of other diseases and conditions. Support staff should question the patient regarding sleep and exercise patterns, diet, and emotional conditions. Coexisting nerve and muscle disorders, such as rheumatoid arthritis, spinal arthritis, or Lyme disease, may further complicate the diagnostic process. Presently, there are no tests available to specifically diagnose fibromyalgia. The final diagnosis is frequently made after a period of time in which the physician observes the patient and rules out other medical conditions with similar symptoms.

Because of the emotional distress experienced by people with this condition and the influence of stress on the symptoms themselves, fibromyalgia has often been labeled a psychosomatic condition. Recognition of the underlying inflammatory process involved in fibromyalgia has helped promote the validity of this disease. Nurses, nurse practitioners or physician's assistants should inquire into the emotional state of the patient, and be prepared to note it in the chart. Mental health consultation may be necessary due to depression or anxiety, and emphasis on the importance of a support group for fibromyalgia patients should be given.

In 1990, the America College of Rheumatology developed standards for fibromyalgia that health care practitioners can use to diagnose this condition. According to these standards, a person is thought to have fibromyalgia if he or she has widespread pain in combination with tenderness for at least three months in at least 11 of the 18 sites known as trigger points. Trigger point sites include the neck, spine, hip, elbow, knee, and shoulder.

Treatment

There is no known cure for fibromyalgia. Therefore, the goal of treatment is successful symptom management. Treatment usually requires a combination of therapies, including exercise, proper rest, and diet, and pharmacologic treatment. Patient education by the health care team is imperative so that the patient has a clear understanding of his or her role in the recovery process and the successful management of this condition.

Physical regimens found to be helpful include a regular stretching program and low-impact aerobic activities that increase the heart rate. Exercise programs should be approved by a physician or physical therapist, and include both warm-up and cool-down sessions, with special attention given to avoiding exercises that cause joint pain. Adequate rest is essential in the treatment of fibromyalgia.

Nutrition is an important component in the management of this condition. The patient's diet should include a wide variety of fruits and vegetables to provide the body with trace elements and minerals that are necessary for healthy muscles. Avoidance of stimulating drinks (such as coffee, tea, or any drink containing caffeine), avoidance of alcohol (may lead to sleeplessness) and such medications as decongestants prior to bedtime is advised. If diet, exercise, and adequate rest do not relieve the symptoms of fibromyalgia, medication may be prescribed.

Medications that have been found to have some benefit include antidepressant drugs, muscle relaxants, and nonsteroidal anti-inflammatory drugs (NSAIDS).

People with fibromyalgia often need a rheumatology consultation (a meeting with a doctor who specializes in disorders of the joints, muscles, and soft tissue) to decide the cause of various rheumatic symptoms, to be educated about fibromyalgia and its treatment, and to exclude other rheumatic diseases. A physician must recommend a treatment program that is individualized to meet the patient's needs.

Alternative treatment

Massage therapy can be helpful, especially when a family member is instructed on specific massage techniques to manage episodes of increased symptoms. Specific attention to mental health, including behavior modification and psychological consultation, may also be important because depression and anxiety may precede or accompany an incident of fibromyalgia. Other alternative therapies, including homeopathic medicine, Chinese traditional medicine (both acupuncture and herbs), polarity therapy, and Western botanical medicine, can assist the person with fibromyalgia in day-to-day functioning and contribute to alleviation of symptoms.

Prognosis

Fibromyalgia is a chronic condition, but causes no body damage or deformity. It does not cause damage to internal organs, as opposed to conditions such as rheumatoid arthritis, which leads to joint deformity. Treatment is based on the relief of symptoms, so a cure is not a realistic goal. Management of the condition may allow patients to return to a higher level of function at work, play, and home.

Health care team roles

Fibromyalgia can be a stressful and frustrating condition for a majority of patients. Successful treatment often requires a period of trial and error to pinpoint which agents and activities work best for the individual patient. Patience while waiting for diagnosis and treatment should be stressed by support staff, along with reassurance that the physician is working to find a treatment regimen that will provide relief. However, there is no set treatment that works for every patient. Even the process of diagnosing fibromyalgia can take time, which also leads to patient frustration. Therefore, support from the health care team and coordination of care through followup calls to outside health care providers is needed to avoid actually worsening the patient's condition due to undue stress. Nursing parameters are pain management, improved sleep management, introduction of relaxation techniques (including massage and biofeedback if needed), and monitoring alternative treatments and medication. There could be a wide variety of health care providers on a patient's health care team: nurses, physicians, a rheumatologist or other subspecialist, nutritionist, physical therapist, alternative medicine caregiver, or mental health care providers. This requires that the health care providers who most frequently see the patient coordinate and record in the patient's medical chart all treatments being undertaken at any given time. Coordination of care increases patient compliance, and may boost the patient's perception of his or her level of function. Patient education is an integral part of the treatment and management of fibromyalgia and its symptoms. Patients should be supported both physically and emotionally. Chronic pain may make it more difficult to communicate with a patient in a manner that promotes professionalism and optimal care. Constant cognizance of the treatment goals (to control pain and increase level of function) is needed as and well as positive reinforcement of compliance with treatment suggestions and monitoring of patient milestones.

Prevention

There is currently no way to specifically prevent fibromyalgia. However, adequate sleep and nutrition, stress management, safe levels of exercise, and annual check-ups are important in the avoidance of this condition.

Michele R. Webb