Fibromyalgia is a syndrome characterised by fatigue and diffuse muscular pain. Many patients with fibromyalgia describe the symptoms as 'feeling as though they were run over by a truck'. While sleep disturbances are common among sufferers, it is not always clear whether the sleep problems are a symptom of the syndrome or one of its causes.

Fibromyalgia is a relatively common condition, and estimated to affect around 2.5 million people in the United States alone.

Diagnosis

The condition is often diagnosed by a medical specialist known as a rheumatologist. As these doctors specialise in arthritic and autoimmune conditions, they can rule out other conditions that might have similar symptoms. There are no blood tests or x-rays that can tell if a person has fibromyalgia, but a doctor might use these as part of the diagnostic process.

The main diagnostic test involves 'pressure points'. These are certain points along the body that tend to be extremely sensitive to gentle pressure among people with fibromyalgia. If a number of these pressure points are sensitive, and other conditions have been ruled out, a doctor might diagnose fibromyalgia.

Possible Causes

Doctors, researchers, and patients all have many theories as to what causes the condition. A common theme, however, is that of sleep. Most patients with fibromyalgia have disrupted sleep. Among the chronic illnesses that are commonly associated with fibromyalgia, most also have a negative impact on the quality of sleep. An interesting study found that when healthy college students had their sleep disrupted on a regular basis for several weeks, many of them developed the symptoms of fibromyalgia. When they were allowed to return to their previous sleeping habits, the symptoms disappeared.

Many people have undiagnosed sleep disorders, such as sleep apnea. It is possible that such 'hidden' disorders may be associated with the development of fibromyalgia in some people - hopefully future research will have the answer.

The neurotransmitters¹ that determine how our bodies perceive pain may also play a role in fibromyalgia, as might hormone levels. It is possible that the impact of sleep disruption on the development of fibromyalgia is mediated by altered neurotransmitter and/or hormone levels.

Several other causes have also been postulated, including both chronic and acute infections², injuries, emotional trauma, and muscle abnormalities. It's unlikely that there is only one, simple pathway involved - the development of fibromyalgia may involve the interaction of several of these factors, and these may well vary from person to person.

Treatment

There are several important parts to treatment. Pain management is likely to be one of the first things the patient will be interested in, however.

Medications

Several different medications have been used for pain control in patients with fibromyalgia. Some of the most effective have been antidepressants, including tricyclics such as nortriptylline and SSRIs - selective serotonin reuptake inhibitors, such as fluoxetine³. Some patients or family members see the prescription of antidepressants as 'proof' that the doctors don't really believe in the patient's condition, or that it is an emotional problem. Considerable research has shown that these medications help block the perception of pain, and are used in the treatment of many other types of chronic pain. These medications can also help people with fibromyalgia enjoy a better quality of sleep, which can in turn alleviate symptoms.

While these medications can be useful, in many cases some of the other treatment modalities can help reduce the need for them.

'Sleep Hygiene'

As disrupted sleep has been observed as both a cause and a symptom of fibromyalgia, it is not unsurprising that many treatments focus upon restoring sleep quality. An important component here is keeping to a regular schedule - the grogginess that the average person feels after staying out late or sleeping in is greatly exacerbated by fibromyalgia. Good 'sleep hygiene' is key, which means trying to go to bed and wake at the same times each day. Some of the medications used for pain control in fibromyalgia can also help with sleep; daily exercise suggested below can also help establish more regular and restorative sleeping patterns.

Exercise

While many people with fibromyalgia feel that their pain is simply too severe to allow exercising, repeated studies have shown that regular exercise is the most effective treatment for fibromyalgia. It is possible that it has an impact on abnormal neurotransmitter or hormone levels, or helps to alleviate muscular abnormalities. Exercising at roughly the same time each day is also helpful in achieving restorative sleep. If people with fibromyalgia have a difficult time finding ways to exercise without severe pain, a physical therapist can be extremely helpful.

Relaxation, Biofeedback, and Other Sources of Help

Relaxation training and biofeedback can both help patients find better ways of coping with pain. Others report benefits from massage therapy or accupuncture. Some have found that counselling and support groups have helped them cope with the impact that the condition has had upon their lives and relationships.

The Ugly Spiral

Without treatment, fibromyalgia can take a downward spiral. The chronic pain further disrupts sleep and prevents people from exercising. These changes in sleep and exercise patterns make the symptoms of fibromyalgia worse. Between the chronic pain and the isolation resulting from fewer activities, depression can often occur. The depression can then, in turn, worsen the fibromyalgia.

Myths and Misconceptions

• It's all in your head. You're just depressed.

  Depression can cause fibromyalgia, and the chronic pain of fibromyalgia can lead to depression. This does not, however, mean that they are the same thing. They have different diagnostic criteria, and many people with fibromyalgia do not meet the criteria for any psychiatric or emotional disorders. Because fibromyalgia occurs predominantly in women, it has often been disregarded as a type of PMS or 'female hysteria'. While diseases that can't be easily 'seen' can be harder to understand, people with fibromyalgia are experiencing real pain and real fatigue.

• Or maybe you're just faking it.

  While there are undoubtedly some people who might be faking symptoms of fibromyalgia, they are likely a small minority. One study even found that rheumatologists could dependendably tell the difference between people who truly had fibromyalgia and those who were given an incentive to fake the symptoms. Furthermore, the benefits of faking the symptoms of fibromyalgia would be incredibly small - sadly, the condition tends to elicit more discrimination than sympathy.

• Fibromyalgia is an early warning sign of life-threatening illness.

  People who are chronically ill with conditions such as lupus, rheumatoid arthritis, or migraines are more likely than healthy people to develop fibromyalgia. However, there's absolutely no evidence that fibromyalgia in of itself has any long-term effects on a person's life expectancy.