Fibromyalgia Overview

By: Peter F. Ullrich, Jr., MD
March 26, 2008

Definition of fibromyalgia

The condition called “fibromyalgia” is a myofascial pain syndrome (a muscular pain syndrome) that can result in generalized back pain and muscle pain, a feeling of general fatigue, and specific tender areas. The patient will have a normal neurological exam, but may have multiple spots that are tender to palpation, called "tender points". These tender points are specific places on the neck, shoulders, back, hips, arms, and legs. These points hurt when pressure is put on them.

Fibromyalgia most commonly affects middle-age women who are otherwise healthy. However, the condition can affect women of all ages, as well as men and children.

While there is no known anatomical reason for the syndrome, it is suspected that there are underlying biochemical causes.

Fibromyalgia symptoms

• Difficulty sleeping

• Feeling tired after waking from sleep, instead of feeling refreshed

• Stiff joints in the morning that usually feel better as the day goes on

• Headaches

• Tingling or numbness in hands and feet

• Depression

Fibromyalgia treatment

Physicians who treat fibromyalgia typically include family physicians, general internists, or rheumatologists (who specialize in treating painful conditions that involve the joints, muscles, tendons and ligaments). Often a team of healthcare professionals is the best option to treat the diverse symptoms of fibromyalgia.

For example, treatment for fibromyalgia may include one or a combination of the following options:

• Massage or injections of lidocaine may be used to help relieve the pain in tender spots

• Non-narcotic pain medications (e.g. acetaminophen)

• Low-impact aerobic conditioning

• Antidepressants (e.g. Amytriptiline), both for help with sleeping and to alleviate the pain

On June 21, 2007, the FDA approved Lyrica (pregabalin) as the first medication specifically indicated to treat fibromyalgia pain. Lyrica is an analgesic (pain relief medication) and anticonvulsant medication that is also approved to treat neuropathic pain.

In the clinical trial submitted to the FDA, 30% to 60% of study participants with fibromyalgia experienced significant pain relief while taking Lyrica. The mechanism of action of how Lyrica works to reduce pain in patients with fibromyalgia is not exactly known; it is thought that the drug may impact how chemicals in the brain transmit signals to communicate between neurons.

There are a number of potential risks and side effects with Lyrica, including but not limited to:

• Weight gain

• Dizziness, sleepiness

• Blurry vision

• Impaired motor function

• Swelling of the hands and feet

Source: FDA website - lyrica approval [1]

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Peter F. Ullrich, Jr., MD [3]
March 26, 2008

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