Fibromyalgia appears to have real underlying causes

Q: My sister was just diagnosed with fibromyalgia. Can you tell me more about this condition?

A: Fibromyalgia is a somewhat controversial condition, although less so than it was 20 years ago. It causes pain, aches and stiffness in muscles and joints throughout the body. Patients also feel unusually tired. The results of common blood tests, X-rays and other tests are usually normal for people with fibromyalgia, but depression and anxiety are also more common.

Some doctors believe that the symptoms of fibromyalgia are explained by these psychological conditions. I think the evidence increasingly indicates that fibromyalgia is an illness with real underlying physical causes.

A characteristic feature of fibromyalgia is pain and stiffness that occur in specific spots along the body, called "tender points." The area between the shoulder blades and the bottom of the neck tends to be the most painful. In people with fibromyalgia, only certain spots are tender; pushing on other parts of the body does not cause pain. (I've put an illustration of tender points along the body on my website, AskDoctorK.com.)

When we feel pain - any type of pain - it is because certain nerve endings are stimulated. Those nerves send chemical signals to a part of the brain where pain is "felt." Doctors and scientists are beginning to unravel the chemistry of pain. People with fibromyalgia have different levels of pain-sensing chemicals in the brain and spinal cord than healthy people do, so they are likely more sensitive to pain.

To manage the pain, doctors often recommend over-the-counter pain relievers. Examples include acetaminophen (Tylenol), ibuprofen (Motrin, Advil) and naproxen (Aleve). A doctor may also prescribe a muscle relaxant or antidepressant to relieve pain. Doctors also often treat the condition with these drugs: cyclobenzaprine, amitriptyline and gabapentin.

In recent years, the FDA has approved three drugs to treat fibromyalgia. One is pregabalin (Lyrica), an anticonvulsant drug. The other two are antidepressant drugs, duloxetine (Cymbalta) and milnacipran (Savella).

But medications are often ineffective. Non-drug treatments are more likely to help. Heat and massage, for example, can provide short-term pain relief.

Regular light-to-moderate aerobic exercise can also relieve muscle pain and tenderness. Good options for your sister might include swimming, walking and biking. She should start slowly and build up gradually.

Twice-weekly strengthening and stretching exercises can help build muscle and improve flexibility. Tai chi and yoga, both mind-body exercises, are also excellent options.

Finally, better sleep quality may relieve symptoms. To sleep better, she should avoid (or cut down on) caffeine, not exercise late in the day, and avoid fluids late in the evening.

If her symptoms still do not improve, she might consider acupuncture, massage therapy, biofeedback, group therapy or stress management.

We still do not know the underlying cause of fibromyalgia, but we are discovering underlying changes in body chemistry that are related to the symptoms. As that knowledge advances, so will the treatment.

• Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.