Fibromyalgia

I. Background

Fibromyalgia is a condition that causes widespread pain, sleep problems, fatigue, and
often psychological distress. People with fibromyalgia may also have other symptoms, such
as26
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Morning stiffness.

Tingling or numbness in hands and feet.

Headaches, including migraines.

Irritable bowel syndrome.

Sleep disturbances.

Cognitive problems with thinking and memory (sometimes called "fibro fog").

Painful menstrual periods and other pain syndromes.

The American College of Rheumatology (ACR) 2010 criteria is used for clinical
diagnosis and severity classification. Diagnosis is based on the following

Widespread Pain Index (WPI) >7 and a symptom severity scale (SS) >5 or
WPI 3-6 and SS >9.
Symptoms have been present at a similar level for at least 3 months.

The patient does not have a disorder that would otherwise explain the
pain. Full criteria [PDF - 130KB].

Fibromyalgia often co-occurs (up to 25-65%) with other rheumatic conditions such as
rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis.

NOTE: For the following sections, using data based on ICD9-CM codes, there is no specific
single code for fibromyalgia. According to coding rules, fibromyalgia is coded to 729.1 which is
labeled Myositis and Myalgia, unspecified and can include other conditions. Thus, numbers
using ICDM9-CM code 729.1 for mortality, ambulatory care, and hospitalizations may be
overestimates.
II. Prevalence

The prevalence of fibromyalgia is about 2%, affecting an estimated 5 million adults in

2005. Prevalence was much higher among women than men (3.4% versus 0.5%).1

Most people with fibromyalgia are women (Female: Male ratio 7:1). However, men and
children also can have the disorder.

Most people are diagnosed during middle age and prevalence increases with age.

III. Incidence

No incidence data found.

IV. Mortality

Approximately 23 deaths per year from 19791998. [Unpublished CDC data]

o

Crude numbers of deaths coded as underlying cause-of-death as 729.1 rose from 8

in 1979 to a high of 45 in 1997.

In 1998,Myositis and Myalgia, Unspecified accounted for only 0.45% (42/9,

367) of all deaths attributed to arthritis and other rheumatic conditions.

Mortality among adults with fibromyalgia is similar to the general population, although
death rates from suicide and injuries are higher among fibromyalgia patients.1

V. Hospitalizations

In 1997, about 7,440 hospitalizations listed ICD9-CM code 729.1 as the principal
diagnosis.5
People with fibromyalgia have approximately 1 hospitalization every 3 years.6
Women have higher hospitalization rates than men at all ages. People hospitalized with
primary cardiovascular conditions had a higher prevalence of reporting fibromyalgia as a
secondary condition.25

VI. Ambulatory Care

5.5 million ambulatory care visits on average per year.7

Medical and psychiatric comorbidity are stronger determinants of high physician use than
functional comorbidity among patients with fibromyalgia.8

VII. Costs

Average yearly direct medical costs per person range from $3,400 to $3,600.9

Total annual costs (direct and indirect) per person = $5,945.6

Office and emergency room visits, procedures and tests, and hospitalizations are the
largest components of direct medical costs among patients with fibromyalgia.9

VIII. Impact on Health-Related Quality of Life (HRQOL)

Fibromyalgia patients scored lowest on 7 of 8 subscales (except role-emotional) of the

SF-36 compared with patients that had other chronic diseases.10,11

Fibromyalgia patients scoring their perceived present quality of life averaged a score of
4.8 (1 = low to 10 = highest).12

Standard, generic HRQOL instruments may not be sensitive enough to capture quality-oflife issues for many people with fibromyalgia.

Adults with fibromyalgia are 3.4 times more likely to have major depression than peers
without fibromyalgia.13

IX. Unique Characteristics

Causes and risk factors for fibromyalgia are unknown, but some things have been weakly
associated with disease onset
o

Stressful or traumatic events, such as car accidents, post-traumatic stress disorder

(PTSD).14

Repetitive injuries.14

Illness (e.g., viral infections).14

Certain diseases (i.e., lupus, rheumatoid arthritis, chronic fatigue syndrome).14

Genetic predisposition.14,15

Obesity.16

People with fibromyalgia react strongly (abnormal pain perception processing) to things
that other people would not find painful.

Best outcomes are achieved by using multiple types of treatments. Screening and
treatment for depression is extremely important. 17 Scientific evidence for effective therapies
include
o

Medications.17,18

Aerobic exercise and muscle strengthening exercise.19-23

Education and relaxation therapy in a primary care setting.24

Cognitive behavioral therapy.28

How is fibromyalgia treated?

There is no cure for fibromyalgia. However, symptoms can be treated with both medication and
non-drug treatments. Many times the best outcomes are achieved by using multiple types of
treatments.
Medications: The U.S. Food and Drug Administration has approved three drugs for the treatment
of fibromyalgia. They include two drugs that change some of the brain chemicals (serotonin and
norepinephrine) that help control pain levels: duloxetine (Cymbalta) and milnacipran (Savella).
Older drugs that affect these same brain chemicals also may be used to treat fibromyalgia. These
include amitriptyline (Elavil) and cyclobenzaprine (Flexeril). Other antidepressant drugs can be
helpful in some patients. Side effects vary by the drug. Ask your doctor about the risks and
benefits of your medicine.
The other drug approved for fibromyalgia is pregabalin (Lyrica). Pregabalin and another drug,
gabapentin (Neurontin), work by blocking the over activity of nerve cells involved in pain
transmission. These medicines may cause dizziness, sleepiness, swelling and weight gain.
Doctors do not recommend opioid narcotics for treating fibromyalgia. The reason for this is that
research evidence suggests these drugs are not of great benefit to most people with fibromyalgia.
In fact, they may cause greater pain sensitivity or make pain persist. Tramadol (Ultram) may be
used to treat fibromyalgia pain if short-term use of an opioid narcotic is needed. Over-thecounter medicines such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs
(commonly called NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve, Anaprox) are not
effective for fibromyalgia pain. Yet, these drugs may be useful to treat the pain triggers of
fibromyalgia. Thus, they are most useful in people who have other causes for pain such as
arthritis in addition to fibromyalgia.
For sleep problems, some of the medicines that treat pain also improve sleep. These include
cyclobenzaprine (Flexeril), amitriptyline (Elavil), gabapentin (Neurontin) or pregabalin (Lyrica).
It is not recommended that patients with fibromyalgia take sleeping medicines like zolpidem
(Ambien) or benzodiazepine medications.

Other Therapies: People with fibromyalgia should use non-drug treatments as well as any
medicines their doctors suggest. Research shows that the most effective treatment for
fibromyalgia is physical exercise. Physical exercise should be used in addition to any drug
treatment. Patients benefit most from aerobic exercises. Other body-based therapies including Tai
Chi and yoga can ease fibromyalgia symptoms.
Cognitive behavioral therapy is a type of therapy focused on understanding how thoughts and
behaviors affect pain and other symptoms. CBT and related treatments such as mindfulness can
help patients learn symptom reduction skills that lessen pain.
Other complementary and alternative therapies (sometimes called CAM or integrative medicine),
such as acupuncture, chiropractic and massage therapy, can be useful to manage fibromyalgia
symptoms. Many of these treatments, though, have not been well tested in patients with
fibromyalgia.
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