Fibromyalgia

Topic Overview

What is fibromyalgia?

Fibromyalgia is widespread pain in the muscles and soft tissues above and below the waist and on both sides of the body. Fibromyalgia is a syndrome—a set of symptoms that happen together but do not have a known cause. In this syndrome, the nervous system (nerves, spinal cord, and brain) is not able to control what it feels, so ordinary feelings from your muscles, joints, and soft tissues are experienced as pain. People with fibromyalgia feel pain and/or tenderness even when there is no injury or inflammation.

Fibromyalgia does not harm your muscles, joints, or organs. And there are many things you can do to control it. When it is not controlled, you may not have any energy. Or you may feel depressed or have trouble sleeping. These and other symptoms can be bad enough to cause problems with your work and home life. With treatment, most people with fibromyalgia are able to continue working and participating in daily activities. Some people change their work duties and lifestyle if their symptoms are severe.

What causes fibromyalgia?

Experts have theories about what may cause fibromyalgia. But there is not enough evidence to support any single cause. Some think that people with fibromyalgia may have nerve cells that are too sensitive. Others think that chemicals in the brain (neurotransmitters) may be out of balance. Or it may be related to problems with the deep phase of sleep.

What are the symptoms?

The main symptom of fibromyalgia is pain in the muscles, soft tissues, back, or neck. Also certain spots on the body hurt when you press directly on them. Experts call these tender points. But you may also hear them called trigger points.

Fibromyalgia also causes sleep problems and tiredness.

Less common symptoms include headaches, morning stiffness, trouble concentrating, and irritable bowel syndrome. As with many conditions that cause chronic pain, it is common for people with fibromyalgia to have anxiety and depression. These can make you feel worse.

Fibromyalgia is a long-lasting (chronic) condition with no cure. Symptoms tend to come and go. You may have times when you hurt more, followed by times when symptoms happen less often, hurt less, or are absent (remissions).

Some people find that their symptoms are worse in cold and damp weather, during times of stress, or when they try to do too much.

How is fibromyalgia diagnosed?

Doctors can find out if you have fibromyalgia based on two things. One is widespread pain, which means the pain is on both sides of your body above and below the waist. The other is tenderness in at least 11 of 18 points when they are pressed. Your doctor will also take steps to be sure you don't have other conditions that cause pain, such as rheumatoid arthritis, polymyalgia rheumatica, systemic lupus erythematosus, or other autoimmune diseases.

How is it treated?

You may be able to control your symptoms with regular exercise and by finding better ways to handle stress. Good sleep habits are very important too. If you have trouble sleeping, changes to your routine, schedule, and sleep surroundings can help. Counseling can help you cope with long-term (chronic) pain.

If your symptoms are troublesome, your doctor can prescribe medicines that help you feel better.

Symptoms of depression, such as a loss of interest in things you usually enjoy or changes in eating and sleeping habits, can often be successfully treated if you tell your doctor about them.

Some people with fibromyalgia also find complementary therapies helpful. These include acupuncture, massage, behavioral therapy, and relaxation techniques.

Frequently Asked Questions

Learning about fibromyalgia:

Being diagnosed:

Getting treatment:

Living with fibromyalgia:

Cause

Fibromyalgia is considered to be a syndrome—a set of symptoms that occur together but do not have a known cause. There are theories as to what may cause it, but there is not enough evidence to support any single theory. People—especially women—who have a family member with fibromyalgia are more likely to develop it themselves. It has been recognized as a medical disorder only since the 1980s.

Some theories suggest that fibromyalgia may be linked to:

  • Oversensitive nerve cells in the spinal cord and brain. Oversensitivity may be due to changes in chemicals in the brain or spinal cord that regulate pain. As a result, the person senses pain more easily, and widespread muscle pain occurs.
  • An imbalance in the brain chemicals that control mood, which results in a lowered tolerance for pain and may also cause an unrestful sleep cycle and fatigue. When this happens, a person becomes less physically active, and the muscles and tissues become more sensitive and painful and more easily irritated.
  • An imbalance of hormones such as cortisol and growth hormone. Their release is controlled by the pituitary gland and the hypothalamus. Imbalances of these hormones can result in fatigue, mood changes, concentration and memory difficulties, a lowered tolerance for pain, and other symptoms.
  • A disturbance in the deep phase of sleep. Some chemicals, such as growth hormone, are secreted by the body during this phase of sleep. If sleep is disrupted, the body produces less of the hormone. Disturbed sleep may be both a cause and an effect of the pain of fibromyalgia.

Many people connect the beginning of their fibromyalgia symptoms to a certain event. These events can include an illness such as the flu, an injury or surgery, or emotional trauma and stress.1 An event of this type combined with other factors, such as increased sensitivity to pain and an ongoing sleep disturbance, may lead to fibromyalgia syndrome in some people.

Symptoms

The range and severity of symptoms caused by fibromyalgia vary from person to person. Widespread, chronic pain—often described as deep or burning—is the most common symptom. Pain is considered to be widespread if it is above and below your waist and on the right and left sides of your body. Fibromyalgia pain is more common in the trunk, neck, low back, hips, and shoulders. And it is rare in the hands and feet. It usually develops gradually and can interfere with even simple daily activities.

Other symptoms that can occur along with pain include:1

  • Fatigue that interferes with work and daily activities.
  • Sleep problems (difficulty falling or staying asleep, waking up feeling tired).
  • Morning stiffness lasting less than an hour.
  • Headaches.
  • Constipation or diarrhea related to irritable bowel syndrome.
  • Memory problems and difficulty concentrating.
  • Anxiety or depression.

Fibromyalgia can sometimes feel like the flu. You may experience body aches, tiredness, and intestinal problems. The pain in your joints and muscles may be especially bothersome at night, waking you from sleep, or in the morning, when you may feel very stiff and sore. You may have trouble concentrating because of fatigue. Symptoms can last from days to months or years.

People with fibromyalgia have periods when their symptoms become worse and periods when they have milder or no symptoms. Flare-ups of fatigue and muscle and joint aches are common, especially following physical or emotional stress. Many people with fibromyalgia report that cold or damp weather, poor sleep, fatigue, stress, or overexertion makes their pain worse.

Because symptoms of fibromyalgia are similar to so many other disorders, your doctor may try to rule out other conditions with similar symptoms before he or she can properly diagnose fibromyalgia. In some cases, you may have another condition in addition to fibromyalgia.

What Happens

For most people, fibromyalgia seems to involve a cycle of muscle pain, increased sensitivity to pain, and inactivity that may be made worse by sleep problems and fatigue.

  • Increasing pain causes a person to be less physically active.
  • Muscles that are not exercised regularly are more likely to be irritated during activity. It is also possible that people with fibromyalgia are more sensitive to pain or have muscles that are more easily irritated.
  • The irritated muscles are painful. Some doctors think that the muscles of people with fibromyalgia remain sore because they do not repair themselves as well as the muscles of people who do not have this condition.
  • Muscle pain, sometimes occurring together with disrupted sleep and daytime fatigue, leads to less and less activity.

Although fibromyalgia is a long-lasting (chronic) condition with no cure, it can be controlled and does not damage the muscles, joints, or internal organs. People usually can manage symptoms with home treatment, especially exercise. Treatment with medicines may be helpful when sleep problems, severe pain, or depression develop. Unfortunately, a few people may not respond to any treatment measures.

Most people with fibromyalgia adjust to their symptoms and are able to continue working and participating in daily activities. But some may have to change their work duties and lifestyle if their symptoms are severe.

What Increases Your Risk

Certain factors may increase your risk for developing fibromyalgia. Being female greatly increases your chance of developing this syndrome. It is possible that having a rheumatic disorder (such as rheumatoid arthritis), an infectious disease (such as Lyme disease or mononucleosis), a psychiatric condition (such as major depression), or a traumatic event (such as a car accident) may increase your chance of developing fibromyalgia. There is some evidence that having a family history of fibromyalgia may increase your risk.

If you already have fibromyalgia, you may be more likely to have recurring symptoms or persistent pain if you are a woman and you have:2

  • Frequent episodes of emotional or physical stress.
  • Had symptoms for many years.
  • Insomnia or a sleep disorder.
  • Depression or an anxiety disorder.
  • Belly pain, headaches, or problems with urination.

When To Call a Doctor

Call your doctor if you have had the following symptoms for more than 6 weeks without an obvious cause. They may be signs of fibromyalgia, especially if they have developed gradually.

  • Widespread muscle tenderness and pain, particularly on both sides of the body and both above and below the waist
  • Disturbed sleep (tossing, turning, waking up frequently during the night) and waking up feeling tired and unrested
  • Muscle and joint stiffness that doesn't get better when you move around

If you have fibromyalgia, be alert to symptoms of depression, such as a loss of interest in things you usually enjoy or changes in eating and sleeping habits. These can often be successfully treated if you tell your doctor about them.

Watchful Waiting

Watchful waiting means taking a wait-and-see approach. It is normal to have sore muscles when you overexert yourself. This pain usually will go away after a few days. If you think you are injured and the muscle or joint pain does not go away in a few days (no more than a week), talk with your doctor.

Who To See

Not every doctor will be comfortable diagnosing or treating the symptoms of fibromyalgia, because it still is not a well-defined disorder. Be sure to seek a doctor who is sensitive to your chronic pain, fatigue, and other symptoms associated with fibromyalgia. Health professionals with the most experience with fibromyalgia include:

Other health professionals who may be able to help you manage your fibromyalgia include:

Pain management programs can be helpful, too. These typically include a team of doctors, counselors, nurses, and pharmacists who can help you develop a strategy for pain management. Your personal program may include medicines, complementary therapies, diet, exercise, and counseling.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

There are no specific tests that can confirm a diagnosis of fibromyalgia. It often is diagnosed when other disorders with similar symptoms of chronic pain have been ruled out with lab tests. Your doctor will also ask questions about your medical history and do a physical exam.

The formal criteria used to diagnose fibromyalgia include:

  • Widespread pain that has been present for at least 3 months. Pain is considered to be widespread if it is above and below your waist and on the right and left sides of your body.
  • Pain and tenderness at 11 or more of 18 specific spots, usually occurring only when the areas are pressed. Experts call these tender points. But you may also hear them called trigger points. (Some people may have fewer than 11 tender points but still may have fibromyalgia.)

Other symptoms typical of fibromyalgia include stiffness, fatigue, headaches, painful menstrual periods, and sleep difficulties. These may get worse with increased stress, anxiety, or exertion or with changes in the weather.

A person may not meet these criteria but may still have fibromyalgia. That is why diagnosis can be so difficult.

Treatment Overview

Currently, there is no cure for fibromyalgia. But there are many steps you can take to understand your condition and manage your symptoms. Treatment is focused on managing pain, fatigue, depression, and other symptoms common in fibromyalgia in an attempt to break the cycle of increased sensitivity to pain and decreased physical activity. Every person may respond to a different combination of treatments.

Treatment may include:

Home treatment is also a vital part of managing fibromyalgia. Your efforts to get regular exercise, improve your sleep habits, and reduce stress are as important to your treatment as any medicine your doctor may prescribe.

Initial treatment

If you have just been diagnosed with fibromyalgia, your initial treatment goals might include:

  • Starting a program of regular physical exercise. Getting consistent exercise, especially cardiovascular exercise, is one of the best ways to manage fibromyalgia. Pool exercise has been found to be particularly effective for many people.3 It's important to progress your exercise program slowly so you don't get sore muscles that cause you to want to stop exercising. Working with a physical therapist familiar with fibromyalgia may be helpful.1
  • Identifying sleep problems, if you have them, and learning about ways to get more restful sleep.
  • Relieving pain and stiffness with medicines and heat.
  • Identifying "triggers" that seem to make your symptoms worse and learning to avoid or manage them. A trigger can be anything you've noticed that increases your symptoms. Triggers may relate to the weather, particular activities, stressful events, or lack of sleep.
  • Starting a program of cognitive-behavioral therapy to help you learn to relax, reduce stress, and manage your pain. This can help decrease pain and fatigue. And it can improve your mood and help you function.3

With some guidance and instruction, you will be able to start working on most of these goals at home. You may have a team of health professionals to help you. The team may include your family medicine doctor, a rheumatologist or endocrinologist, a physical therapist, and a psychologist.

Ongoing treatment

Exercise, sleep, and stress reduction can be extremely helpful in controlling your symptoms. Symptoms of fibromyalgia come and go repeatedly, so it is important to keep doing home treatment over the long term.

Prescription medicines can help certain symptoms, including pain and sleep problems. Talk with your doctor if you think the medicines you are taking do not help. There may be other choices. Remember that your need for medicine may change over time.

Another important part of ongoing treatment for fibromyalgia is, when possible, avoiding or limiting your exposure to "triggers" or "stressors" that make your symptoms worse. Cold or damp weather, poor sleep, fatigue, physical or emotional stress, and overexertion seem to be common stressors for people with fibromyalgia. It may not be possible to avoid these things completely. But you can learn ways to reduce stress, practice better sleep habits, and avoid overexerting yourself.

Watch for signs of depression or anxiety. They are common in people with fibromyalgia and can make problems with sleep and feelings of pain even worse. These can often be successfully treated as long as you recognize them and discuss them with your doctor.

Many people with fibromyalgia have other joint or muscle diseases (such as rheumatoid arthritis or lupus) that need to be treated too. Make sure you tell your doctor about new symptoms or problems that get worse.

Treatment if the condition gets worse

Fibromyalgia is not a progressive disease and causes no permanent physical damage. But the symptoms can be debilitating. And there may be periods of time when you feel worse than usual.

If new symptoms develop or if existing symptoms get worse, talk to your doctor. He or she may need to reassess your treatment. Your doctor may need to adjust your medicines or prescribe different ones. Or perhaps you are exercising too much or not enough.

It's also possible that new symptoms or symptoms that are worse could be related to something other than fibromyalgia. Your doctor can evaluate this possibility if you let him or her know that you are having problems.

What To Think About

Exercise seems to help most people with fibromyalgia, but no one particular treatment stands out as the most effective. The kind of treatment you need or want may be based on:

  • How bad your symptoms are.
  • Whether the condition is disrupting your daily life.
  • What kinds of changes in your life you are willing and able to make.

Because the symptoms of fibromyalgia can come and go, you may find it difficult to judge whether a particular treatment is really working. Different people may respond differently to each type of treatment. It can take time. And you may have to try several different treatments to find an approach that works for you.

Prevention

Currently, fibromyalgia can be neither prevented nor cured. But prompt treatment of your symptoms may help reduce the length of a flare-up.

Home Treatment

Although fibromyalgia is a chronic condition, there is much you can do to relieve and control your symptoms. Home treatment is the most important part of treating fibromyalgia. There are many things you can do:

  • Exercise regularly. Of all the treatments for fibromyalgia, cardiovascular (aerobic) exercise may have the most benefit in reducing pain and other symptoms and in improving your overall condition. Work with a physical therapist or other professional who has expertise with fibromyalgia to build an exercise program that works for you. And then stay with it.
  • Improve sleep. Sleep disturbances seem to both cause and result from some of the other symptoms of fibromyalgia, such as pain. Learn good sleep habits. And try to get enough sleep each night.
  • Relieve pain. Heat therapy, massage, gentle exercise, and short-term use of nonprescription pain relievers may be helpful.
  • Reduce stress.
  • Learn about fibromyalgia. The more you know about fibromyalgia, the more control you will have over your symptoms. People who feel more in control also tend to be more active and report less pain and other symptoms.4
  • Learn ways to manage your memory problems. Feeling as though you are not thinking clearly—sometimes called "fibro fog"—increases stress and can make memory problems worse. Simple things like writing yourself notes can help you feel more in control.5
  • Adopt a good-health attitude, along with these other healthy habits. It's hard to stay positive when you don't feel well. But a good attitude helps you focus less on your challenges and feel more healthy.

The best results occur when you take an active, committed role in your own treatment. You may need to adjust your lifestyle to fit home treatment, especially regular exercise, into your daily routine. It may take time to find an approach that works for you. Try to be patient. And keep in mind that consistent home treatment usually can help relieve or control symptoms of fibromyalgia.

Medications

Medicines do not cure fibromyalgia. But some medicines may help improve fibromyalgia symptoms, especially muscle pain and frequent waking during the night. Not all people with fibromyalgia will need, want, or benefit from medicines. But people with more severe pain, sleep problems, or depression that disturbs their daily life may find medicines helpful.

Antidepressants are often used to treat symptoms of fibromyalgia. This does not mean that the condition is "all in your head." Antidepressants may help by improving sleep and mood or by blocking pain signals. Many people with fibromyalgia seem to benefit from the use of these medicines.

Fibromyalgia symptoms in different people respond to different medicines. Your doctor may try more than one medicine before finding one that works best for you. You may also find that a medicine that has been helping your symptoms seems to become less effective over time. Talk with your doctor if you are not getting relief. He or she may try a different medicine or make suggestions for helping find new ways to modify your activity, sleep, and stress.

Medication Choices

Often medicines may be combined (such as fluoxetine and amitriptyline) for the most effective treatment of symptoms of pain and sleep disruptions.

Certain types of antidepressants may be used to improve sleep, relieve pain and fatigue, and, in some cases, treat depression. These improvements in symptoms may allow you to feel better and to be more active. Antidepressants used for fibromyalgia include:6

  • Tricyclic antidepressants, such as amitriptyline or cyclobenzaprine (Flexeril). Cyclobenzaprine is usually thought of as a muscle relaxant, rather than an antidepressant, but it is the same type of drug as a tricyclic antidepressant.
  • Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) or paroxetine (Paxil).
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)—also called mixed (or dual) reuptake inhibitors—such as duloxetine (Cymbalta), milnacipran (Savella), or venlafaxine (Effexor).
  • Atypical antidepressants, meaning drugs that don't fit well into the general categories of antidepressant medicines. Bupropion (Wellbutrin) is an example of an atypical antidepressant that is used for fibromyalgia.

A seizure medicine (anticonvulsant) called pregabalin (Lyrica) is used to treat fibromyalgia. Pregabalin may help reduce pain, sleep problems, and fatigue.7

Other medicines are being studied and used for treating fibromyalgia, including:

  • Another seizure medicine (anticonvulsant) called gabapentin (Neurontin).8
  • Pain medicines such as tramadol (Ultram), sometimes combined with acetaminophen.3, 9
  • A medicine called sodium oxylate (Xyrem) that is used for sleep disorders such as narcolepsy.10

Nonprescription pain relievers, such as acetaminophen (for example, Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDS, such as ibuprofen or aspirin) usually are not very helpful in treating day-to-day symptoms of fibromyalgia. But they may be useful in reducing severe pain caused by a flare-up of symptoms. You should check with your doctor if you need to keep taking these medicines, because they may harm your stomach, kidneys, or in rare cases, your liver. Your doctor may want to monitor you if you take acetaminophen or NSAIDs daily.

What To Think About

In general, medicines are only a part of the long-term treatment of fibromyalgia. They may help break the cycle of pain and sleep problems when symptoms flare up. But medicines usually are part of a larger treatment plan that focuses on exercise and other types of treatment.

Narcotic pain relievers and sleep aids that can lead to addiction are rarely used to treat fibromyalgia. They can be helpful to some people who have severe symptoms. But you can become dependent on them over time, and the treatment can become worse than the fibromyalgia symptoms.

Surgery

There is no surgical treatment for fibromyalgia.

Other Treatment

A variety of other treatments have been used for conditions that cause chronic pain. Most of these complementary or alternative therapies are not proven treatments for fibromyalgia. But they may be helpful when symptoms flare up, and they may improve quality of life. Safe complementary therapies such as acupuncture or massage, for instance, may help relieve stress, ease muscle tension, and help you feel better and healthier.

Other Treatment Choices

Most people with fibromyalgia try some type of alternative therapy.11 Some of these have been shown to be effective for many people. But for other therapies, such as tender point injections, there is no evidence that they help. Treatments that have been shown to help people who have fibromyalgia include:3

Other treatments that have been used to treat fibromyalgia include:

What To Think About

You may find one or more complementary or alternative therapies to be helpful in relieving some of your symptoms. Keep in mind that there is only limited information about the effectiveness of these treatments (and others you may have heard about) for treating fibromyalgia.

If you have fibromyalgia and are thinking about trying a complementary therapy, get the facts before you begin. Consider these questions with your doctor:

  • Is it safe? Talk with your doctor about the safety and potential side effects of the treatment. Remember that fibromyalgia does not physically harm you or damage your body. A treatment that could be harmful may not be worth the risk, especially when its benefits are unproved. Avoid treatments that may be harmful, such as unusual diets or excessive vitamin or mineral supplements. (A daily multiple vitamin-mineral supplement is okay. Try to avoid taking more than 100% of the recommended daily allowance for any vitamin or mineral unless your doctor prescribes a special supplement.)
  • Does it work? Because the symptoms of fibromyalgia can come and go, you may find it hard to judge whether a certain treatment is really working. Symptoms of fibromyalgia often improve on their own. Or the treatment may be causing a placebo effect that is making you feel better. Keep in mind that when you get better after treatment, the treatment may not be the reason for the improvement. Also remember that a treatment that works for one person may not work for you. It may take time. And you may have to try several different treatments to find an approach that works for you.
  • Will it improve my general health? Even if complementary therapies are not effective in treating fibromyalgia, many of them are safe and healthy habits that may improve your general well-being and may be worth trying.

With a hard-to-treat condition like fibromyalgia, it can be tempting to jump at the promise of an effective treatment. Be careful. Avoid products that claim to have a secret ingredient or that claim to cure fibromyalgia. Avoid those that encourage unhelpful behaviors such as excessive resting or avoiding activity.

Also make sure you know how much a treatment is going to cost before you agree to it. An expensive, unproven treatment that may or may not help you may not be worth the high cost. Beware of treatment providers or products that require a large financial investment at the outset or a series of costly treatments.

Other Places To Get Help

Organizations

American College of Rheumatology
1800 Century Place
Suite 250
Atlanta, GA  30345
Phone: (404) 633-3777
Fax: (404) 633-1870
Web Address: www.rheumatology.org
 

The American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP, a division of ACR) are professional organizations of rheumatologists and associated health professionals who are dedicated to healing, preventing disability from, and curing the many types of arthritis and related disabling and sometimes fatal disorders of the joints, muscles, and bones. Members of the ACR are physicians; members of the ARHP include research scientists, nurses, physical and occupational therapists, psychologists, and social workers. Both the ACR and the ARHP provide professional education for their members.

The ACR Web site offers patient information fact sheets about rheumatic diseases, about medicines used to treat rheumatic diseases, and about care professionals.


Arthritis Foundation
1330 West Peachtree Street
Suite 100
Atlanta, GA  30309
Phone: 1-800-283-7800
Web Address: www.arthritis.org
 

The Arthritis Foundation provides grants to help find a cure, prevention methods, and better treatment options for arthritis. It also provides a large number of community-based services nationwide to make living with arthritis easier, including self-help courses; water- and land-based exercise classes; support groups; home study groups; instructional videotapes; public forums; free educational brochures and booklets; the national, bimonthly consumer magazine Arthritis Today; and continuing education courses and publications for health professionals.


National Center for Complementary and Alternative Medicine (NCCAM) Clearinghouse
P.O. Box 7923
Gaithersburg, MD  20898
Phone: 1-888-644-6226
(301) 519-3153 for international calls
Fax: 1-866-464-3616 toll-free
TDD: 1-866-464-3615 toll-free
E-mail: info@nccam.nih.gov
Web Address: www.nccam.nih.gov/health/clearinghouse (or www.nccaminfo.org/livehelp/ for live help online)
 

The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) explores complementary and alternative healing practices in the context of rigorous science, trains complementary and alternative medicine researchers, and gives out authoritative information. Send all requests for information and questions about NCCAM to the NCCAM Clearinghouse.


National Fibromyalgia Association
2121 South Towne Centre Place
Suite 300
Anaheim, CA 92806
Phone: (714) 921-0150
Fax: (714) 921-6920
TDD:  
E-mail:  
Web Address: www.fmaware.org
 

The National Fibromyalgia Association was founded to support people who have fibromyalgia and other chronic pain illnesses. The association has an educational Web site and publishes an international magazine called Fibromyalgia AWARE. The association also helps develop continuing medical education programs and provides a means for fibromyalgia experts to share their research and expertise with patients and health care professionals.


National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health
1 AMS Circle
Bethesda, MD  20892-3675
Phone: 1-877-22-NIAMS (1-877-226-4267) toll-free
(301) 495-4484
Fax: (301) 718-6366
TDD: (301) 565-2966
E-mail: niamsinfo@mail.nih.gov
Web Address: www.niams.nih.gov
 

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is a governmental institute that serves the public and health professionals by providing information, locating other information sources, and participating in a national federal database of health information. NIAMS supports research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases and supports the training of scientists to carry out this research.

The NIAMS Web site provides health information referrals to the NIAMS Clearinghouse, which has information packages about diseases.


National Pain Foundation
300 East Hampden Avenue
Suite 100
Englewood, CO  80113
Web Address: www.nationalpainfoundation.org
 

Through information, education, and support, the National Pain Foundation (NPF) promotes the recovery of persons in pain. The NPF Web site provides information and resources in an interactive way that encourages patients to take an active role in managing their chronic pain. The My Pain section of the Web site includes a Personal Inventory section to help pain patients identify the information they need to manage their pain. The NPF has information about pain conditions such as arthritis, back and neck pain, and cancer pain. The NPF addresses the many approaches to pain management, such as medicines, injections, surgery, acupuncture, biofeedback, chiropractic, and physical therapy. The NPF also provides support for the special needs of children in pain and information about psychological factors related to pain. The Web site also provides information on clinical trials that are studying pain management and treatment.


References

Citations

  1. Bradley LA, Alarcon GS (2005). Fibromyalgia section of Miscellaneous rheumatic diseases. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 2, pp. 1869–1910. Philadelphia: Lippincott Williams and Wilkins.
  2. Bennett RM (1999). Emerging concepts in the neurobiology of chronic pain: Evidence of abnormal sensory processing in fibromyalgia. Mayo Clinic Proceedings, 74(4): 385–398.
  3. Goldenberg DL, et al. (2004). Management of fibromyalgia syndrome. JAMA, 292(19): 2388–2395.
  4. Nielson WR, Jensen MP (2004). Relationship between changes in coping and treatment outcome in patients with fibromyalgia syndrome. Pain, 109(3): 233–41.
  5. Arthritis Foundation (2007). Clearing the Fog. Available online: http://ww2.arthritis.org/conditions/diseasecenter/fibromyalgia/fibro_fog.asp.
  6. Häuser W, et al. (2009). Treatment of fibromyalgia syndrome with antidepressants. JAMA, 301(2): 198–209.
  7. Crofford LJ, et al. (2005). Pregabalin for the treatment of fibromyalgia syndrome. Arthritis and Rheumatism, 52(4): 1264–1273.
  8. Arnold LM, et al. (2007). Gabapentin in the treatment of fibromyalgia. Arthritis and Rheumatism, 56(4): 1336–1344.
  9. Bennett RM, et al. (2002). Tramadol and acetaminophen combination tablets in the treatment of fibromyalgia pain: A double-blind, randomized, placebo-controlled study. American Journal of Medicine, 114(7): 537–545.
  10. Russell IJ, et al. (2009). Sodium oxybate relieves pain and improves function in fibromyalgia syndrome. Arthritis and Rheumatism, 60(1): 299–309.
  11. Wahner-Roedler DL, et al. (2004). Use of complementary and alternative medical therapies by patients referred to a fibromyalgia treatment program at a tertiary care center. Mayo Clinic Proceedings, 80(1): 55–60.

Other Works Consulted

  • Arnold LM, et al. (2008). Patient perspectives on the impact of fibromyalgia. Patient Education and Counseling, 73(1): 114–120.
  • Busch A, et al. (2007). Exercise for treating fibromyalgia syndrome. Cochrane Database of Systematic Reviews (4).
  • Carville SF, et al. (2007). EULAR evidence based recommendations for the management of fibromyalgia syndrome. Annals of the Rheumatic Diseases, 67(4): 536–541.
  • Crofford LJ, Appleton BE (2001). Complementary and alternative therapies for fibromyalgia. Current Rheumatology Reports, 3(2): 147–156.
  • Meisler JG (2000). Toward optimal health: The experts discuss fibromyalgia. Journal of Women's Health and Gender-Based Medicine, 9(10): 1055–1060.
  • Richards SCM, Scott DL (2002). Prescribed exercise in people with fibromyalgia: Parallel group randomised controlled trial. BMJ, 325(7357): 185.
  • Taylor AG, et al. (2003). Fibromyalgia section of Pain. In JW Spencer, JJ Jacobs, eds., Complementary and Alternative Medicine: An Evidence-Based Approach, pp. 384–395 . St. Louis: Mosby.
  • Wolfe F, Rasker JJ (2009). Fibromyalgia. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 8th ed., vol. 1, pp. 555–569. Philadelphia: Saunders Elsevier.

Credits

Author Shannon Erstad, MBA/MPH
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Richa Dhawan, MD - Rheumatology
Last Updated October 21, 2009

Last Updated: October 21, 2009

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Bon Secours International| Sisters of Bon Secours USA| Bon Secours Health System

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