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What is fibromyalgia and what causes it?

Asked by Alicia C., COLUMBUS, Ohio

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What is fibromyalgia? What causes fibromyalgia? Can it effectively be treated without prescription drugs? What is the difference between gabapentin and Cymbalta?

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Conditions Expert Dr. Otis Brawley Chief Medical Officer,
American Cancer Society

Expert answer

Dear Alicia:

Fibromyalgia is a rheumatologic disorder sometimes called fibrositis. It is a common cause of chronic pain in the muscles, tendons, and ligaments. The cause of fibromyalgia is unknown. It is six times more common in women than men. There are no laboratory tests to diagnose it. It is really a clinical diagnosis after other causes of pain have been excluded. Patients look fine, with no obvious abnormalities on physical examination, laboratory and radiologic studies. Many people who have it may not be taken seriously and may be thought of as faking their symptoms or having a mental illness. Fibromyalgia is a real disease.

Patients with fibromyalgia typically complain of fatigue and pain in the neck, middle, and lower back, and pain in the chest wall, arms, and legs. The pain is chronic and persistent, although it usually varies in intensity. Patients may have a sensation of joint swelling although the joints are not swollen or inflamed. Pain is often caused by exertion, stress, lack of sleep and weather changes. Sensations of numbness, tingling, burning, or a crawling sensation on the skin are often described. Some patients have a variety of gastric and bowel symptoms, pelvic pain and bladder symptoms of frequency and urgency suggestive of the interstitial cystitis.

The musculoskeletal problems associated with mild fibromyalgia can sometimes be treated with stretching exercises and pain medicines such as acetaminophen and tramadol. Nonsteroidal anti-inflammatory drugs such as ibuprofen are generally not helpful as this disease does not have an inflammatory component. Patients with moderate to severe fibromyalgia have reported relief with a number of drugs. These drugs are often developed and FDA approved for other diseases and later found to have activity in fibromyalgia meaning they provide pain relief and increased physical functioning. These include the tri-cyclic antidepressants such as amitriptyline or desipramine, the selective serotonin reuptake inhibitors, anti-depressants such as paroxetine (trade name Paxil) and fluoxetine (trade name Prozac), and the anti-seizure medicines gabapentin and clonazepam. Muscle relaxants such as cyclobenzaprine are also sometimes useful. Cymbalta is the trade name for the drug duloxetine, a serotonin-norepinephrine reuptake inhibitor, originally developed for the treatment of depression. It has been reported as useful in the treatment of fibromyalgia. These are the most commonly used drugs, but not the only drugs found useful in treating this disease. Some patients find one drug very useful and others useless.

Patients with this disease really do benefit from a good relationship with an understanding health care provider. Few will be able to have reasonable quality of life with over-the-counter drugs alone.

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