Fibromyalgia Research: Challenges and Opportunities, Page 1

If you suffer from fibromyalgia, sometimes called fibrositis, you may experience widespread musculoskeletal pain, fatigue, and tender points; also see the separate “Fibromyalgia Q&A”.

Background on Fibromyalgia

Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas of the neck, spine, shoulders, and hips called “tender points.” People with this syndrome may also experience sleep disturbances, morning stiffness, irritable bowel syndrome, anxiety, and other symptoms. Available data suggest that the number of persons aged 18 and older in the United States with fibromyalgia is approximately 3.7 million. It primarily occurs in women of childbearing age, but children, the elderly, and men may also be affected.

Although the cause of fibromyalgia is unknown, researchers have several theories about what triggers the disease. Some scientists believe that the syndrome may result from an injury or trauma. This injury may affect the central nervous system. Fibromyalgia may be associated with changes in muscle metabolism, such as decreased blood flow, causing fatigue and decreased strength. Others believe the syndrome may be triggered by an infectious agent such as a virus in susceptible people, but no such agent has been identified.

Fibromyalgia is difficult to diagnose because many of the symptoms mimic those of other diseases. The American College of Rheumatology (ACR) has developed criteria for fibromyalgia that physicians can use in diagnosing the disease. According to ACR criteria, a person is considered to have fibromyalgia if he or she has widespread pain for at least 3 months in combination with tenderness in at least 11 of 18 specific tender point sites.

Treatment of fibromyalgia requires a comprehensive approach. The physician, physical therapist, and others in the medical support system, as well as the patient, may all play an active role in the management of fibromyalgia. Studies have shown that aerobic exercise, such as swimming and walking, improves muscle fitness and reduces muscle pain and tenderness. Heat and massage may also give short-term relief. Antidepressant medications may help elevate mood, improve quality of sleep, and relax muscles. People with fibromyalgia may benefit from a combination of exercise, medication, physical therapy, and relaxation.

Research on Fibromyalgia

Support of fundamental research is extremely important in fibromyalgia as well as in many disorders characterized by pain and sleep abnormalities, and many disciplines of medical research contribute to the knowledge base in understanding these symptoms. Since it is impossible to know with certainty which area will produce the next important discovery, the community of science, of which the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is a part, has to be open to all ideas. Discoveries can come from research funded in a variety of areas. For example, the National Institutes of Health (NIH) supports pain research at different levels — from the gene, molecule, cell, and organ to the human organism itself. NIH spends more than $75 million on pain research, which is conducted and supported by 15 institutes, centers, and offices. While this figure would not be reported as funding for fibromyalgia research specifically, certain aspects of pain research are applicable to understanding fibromyalgia.

The research on fibromyalgia supported by NIAMS covers a broad spectrum from basic research to clinical studies to behavioral interventions. For example, NIAMS investigators are examining the interactions between the nervous system and the endocrine (hormonal) system and regulation of adrenal function in fibromyalgia patients. Studies have shown that abnormally low levels of the hormone cortisol may be associated with fibromyalgia. Researchers are studying regulation of the function of the adrenal glands (which make cortisol) in fibromyalgia. People whose bodies make inadequate amounts of cortisol experience many of the same symptoms as people with fibromyalgia. It is hoped that these studies will increase understanding about fibromyalgia and may suggest new ways to treat the disorder.

Basic research studies to advance our understanding of the molecular and genetic basis of sleep and sleep disorders are also included in the NIAMS research portfolio. One specific project on mice focuses on identifying genetic factors that underlie molecular events involved in the regulation of sleep. A wealth of information on the neuroanatomy, neurochemistry, and neurophysiology of sleep provides a firm foundation for a genetic approach to studies of sleep. This project will use genetics to screen for single gene mutations that affect sleep patterns in mice. Understanding this in mice will advance understanding of how this translates to humans. Other basic research studies using animal models are investigating the link between sleep and long-term memory.

Examples of NIAMS-supported clinical research in fibromyalgia include comparing pain mechanisms in this disorder and low back pain; determining if aerobic exercise benefits patients with fibromyalgia through the action of the hypothalamus and pituitary and adrenal glands; and studying neuroendocrine changes in fibromyalgia and irritable bowel syndrome. The Institute is also funding a new clinical trial to determine the effectiveness of combining two antidepressants in treating the disorder.

In addition, NIAMS is currently funding research projects related to the role of behavioral factors in fibromyalgia. Investigators are evaluating the effects of two of the most promising nonpharmacologic interventions for fibromyalgia: cognitive behavioral therapy for pain management and physical exercise training. This study is designed to test the hypothesis that combining cognitive behavioral therapy and physical training will be more effective than cognitive behavioral therapy or exercise alone. If the cognitive and exercise interventions have synergistic effects in fibromyalgia patients, future studies could evaluate this combination in patients with other rheumatic diseases, or in those with stroke or burn injuries who are experiencing pain during exercise/rehabilitation regimens.

Providing social support and education about one’s disease or disorder has been shown to be an effective means for improving the health care status of individuals with chronic diseases. Studies are currently underway focusing on patients with fibromyalgia to advance understanding of how social support and education interventions may be helpful to these patients as well.

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