Fibromyalgia

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Fibromyalgia (FM/FMS) is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. Pain is widespread, on both sides of the body, and above and below the waist.

Sufferers are fatigued and tired even when sleeping for long periods of time, and sleep is often disrupted by pain. Many FM sufferers have sleep disorders like sleep apnea and Restless leg syndrome. Cognitive impairment, when one cannot focus or pay attention and the patient has difficulty concentrating on mental tasks, is known by FM sufferers as "fibro fog". Some experience depression, headaches, and lower abdominal pain or cramping. Other symptoms include tingling or numbness in hands and feet, pain in jaw and disorders of the jaw such as temporomandibular joint disorder (TMJ), menstrual cycle cramps, and digestive problems like irritable bowel syndrome (IBS).[1][2]

1990 ACR Diagnostic Criteria: 18 Tender Points
2010 ACR Preliminatry Diagnostic Criteria: Wisedpread Pain Index (WPI), 19 Tender Point Areas

Prevelance[edit | edit source]

FM is the second most common rheumatic disorder behind osteoarthritis and is "now considered to be a lifelong Central nervous system disorder."[3] An estimated 10 million people in the US and 3-6% of the world population have fibromyalgia. It is seen in women, men, children, and all ethnic groups. It is often seen in families and diagnosed between the ages of 20 to 50 years; incidence increases with age.[4]

FM has a female:male 7:1 ratio under the American College of Rheumatology (ACR) 1990 Diagnostic Criteria and 2:1 when the ACR 2010 Preliminary Diagnostic Criteria is used.[5] See: Fibromyalgia (American College of Rheumatology (ACR) Criteria section).

Fibromyalgia in ME/CFS[edit | edit source]

Dr. Jarred Younger has said that many patients that meet the criteria for FM also meet criteria for Chronic Fatigue Syndrome (CFS) but the reverse is not necessarily true as a lot of people with CFS do not have chronic pain.[6] However, the Canadian Consensus Criteria (CCC) requires the symptom of pain to diagnose ME/CFS. It is the pattern and significant degree of chronic pain in FM that sets it apart from other diseases that have pain.

Health complications[edit | edit source]

FM is not a progressive disease but according to Dr. Dan Clauw the "slow gradual worsening of chronic pain patients over time is due to downstream consequences of poorly controlled pain and other symptoms, wherein individuals then progressively get less active, sleep worse, are under more stress and unknowingly develop bad habits which worsen pain and other symptoms."[7]

Fibromyalgia complications

People who have fibromyalgia frequently complain of a variety of symptoms that affect other parts of the body. Many people complain of gastrointestinal issues and restless legs syndrome (RLS). Additionally, the chronic pain and discomfort of fibromyalgia may lead to depression.[8]

Can fibromyalgia cause other medical conditions?

Fibromyalgia is not known to cause other medical conditions. However, people who have fibromyalgia seem to be at high risk for developing other painful conditions, including osteoarthritis (the common type of arthritis caused by wear and tear on the joints) as well as other related conditions, such as rheumatoid arthritis, lupus, and ankylosing spondylitis. Also, people with fibromyalgia are frequently diagnosed with chronic fatigue syndrome, irritable bowel syndrome (IBS), and temporomandibular joint (TMJ) disorder.[9]

Risk factors[edit | edit source]

Lupus and Rheumatoid arthritis (RA) are risk factors in developing FM. Car accidents, Post-traumatic stress disorder (PTSD), repetitive injuries, illness such as a viral infection, family history, and obesity have all been linked to FM.[10][11][12]

Diagnosis[edit | edit source]

Tender points, not trigger points, are used to diagnose Fibromyalgia.[13] Tender points will be above and below the waist and on both sides of the body. (See: Illustrations of the 1990 and 2010 American College of Rheumatology (ACR) Criteria depicting tender points near the top of this page.)

United States[edit | edit source]

American College of Rheumatology (ACR) Criteria[edit | edit source]

Men do not seem to form the tender points needed for diagnosis under the 1990 criteria,[19] the 2010 proposed criteria diagnoses more men with a F/M ratio of 2:1.[20]
Tender points were used to diagnose with the 1990 criteria, however "considerable skill is needed to correctly check for a patient’s tender points (i.e., digital palpation that is done with certain amount of applied pressure), yet this technique is not typically taught at most medical schools."[21]
The new standards were designed to:
  • eliminate the use of a tender point examination
  • include a severity scale by which to identify and measure characteristic FM symptoms
  • utilize an index by which to rate pain[22]
  • There are 19 tender point areas in the widespread pain index (WPI), whereas the 1990 criteria had 18 tender points.[23]

The Social Security Administration for SSD/SSI filings relies on the 1990 or 2010 ACR criteria to diagnose fibromyalgia.[24]

Sleep study[edit | edit source]

Sleep dysfunction is often involved in fibromyalgia. Treating a sleep disorder can help with fibromyalgia symptoms. A diagnosed sleep disorder is also helpful if one needs to file for disability.

ICD Diagnostic code[edit | edit source]

World Health Organization[edit | edit source]

ICD-10

The World Health Organization (WHO) International Classification of Diseases (ICD) lists fibromyalgia as a "disease of the musculoskeletal system and connective tissue", under the code M79.7 (WHO ICD-10 Version: 016).[25]

  • M79.7 Fibromyalgia
Fibromyositis
Fibrositis
Myofibrositis[26]

In 2015, the United States finally adopted ICD-10 and Fibromyalgia as a diagnosis.[27] [28]

ICD-11 (2019)

ICD-11 (2019) has diagnostic code MG30.1 Chronic widespread pain.[29]

  • MG30.01 Chronic widespread pain

Parent

MG30.0 Chronic primary pain

Description

"Chronic widespread pain (CWP) is diffuse pain in at least 4 of 5 body regions and is associated with significant emotional distress (anxiety, anger/frustration or depressed mood) or functional disability (interference in daily life activities and reduced participation in social roles) [1]. CWP is multifactorial: biological, psychological and social factors contribute to the pain syndrome. The diagnosis is appropriate when the pain is not directly attributable to a nociceptive process in these regions and there are features consistent with nociplastic pain [2] and identified psychological and social contributors."[30]

Inclusions

  • Fibromyalgia

Exclusions

  • Acute pain (MG31)[31]

Pathophysiology[edit | edit source]

"Fibromyalgia (FM) is a chronic pain disorder with unknown etiology and unclear pathophysiology. There is no evidence that a single event “causes” FM. Rather, many physical and/or emotional stressors may trigger or aggravate symptoms. These have included certain infections, such as a viral illness or Lyme disease, as well as emotional or physical trauma."[32] The widespread pain is severe, debilitating, and abnormal in processing its pain. There is also sleep disturbance and fatigue. Cause or causes are unproven.[33]

Pathophysiology: Although the etiology remains unclear, characteristic alterations in the pattern of sleep and changes in neuroendocrine transmitters such as serotonin, substance P, growth hormone and cortisol suggest that regulation of the autonomic and neuro-endocrine system appears to be the basis of the syndrome. Fibromyalgia is not a life-threatening, deforming, or progressive disease. Anxiety and depression are the most common association. Aberrant pain processing, which can result in chronic pain, may be the result of several interplaying mechanisms. Central sensitization, blunting of inhibitory pain pathways and alterations in neurotransmitters lead to aberrant neuro-chemical processing of sensory signals in the CNS, thus lowering the threshold of pain and amplification of normal sensory signals causing constant pain.
The frequent co-morbidity of fibromyalgia with mood disorders suggests a major role for the stress response and for neuroendocrine abnormalities. The hypothalamic pituitary axis (HPA) is a critical component of the stress-adaptation response. In FMS, stress adaptation response is disturbed leading to stress induce symptoms. Psychiatric co-morbidity has been associated with FMS and needs to be identified during the consultation process, as this requires special consideration during treatment.

Immune system research[edit | edit source]

Dr. Jarred Younger believes an overactive immune system is the cause and will be conducting a study to test this hypothesis.[34][35]

Dr. William Pridgen's research of HSV-1 (cold sore virus) as being involved in FM has conducted a successful Phase III clinical trial, which had been fast-tracked by the Food and Drug Administration (FDA), of a combination drug that suppresses this virus and also helps with pain. See: Fibromyalgia (Drugs: Trials: IMC-1 section).

ProHealth reports that an old Tuberculosis vaccine, Bacille Calmette-Guerin (BCG), may be researched for treatment of Fibromyalgia spearheaded by EpicGenetics and Massachusetts General Hospital.[36]

EpicGenetics has a blood test that is identifying the presence of specific white blood cell abnormalities of patients diagnosed with FM and has partnered with two universities to offer whole exome sequencing free of charge to those who test positive with their FM/a® test.[37] Concerns have been raised in regards to the FM/a EpicGenetics Blood Test, however.[38]

Comorbidities[edit | edit source]

  • Allodynia
    • Allodynia "Allodynia is pain, generally on the skin, caused by something that wouldn't normally cause pain." [39]
    • Painful to Touch: Fibromyalgia & Tactile Allodynia - Does Your Skin Hurt? Here's Why! "It's another one of those fibromyalgia symptoms that just doesn't make sense -- pain, sometimes severe pain, from a simple touch. The closest thing it compares to is having a sunburn all the time. A lot of people don't understand this symptom, including those who have it, because while it's common in fibromyalgia, it's rare in the general population."[40]
  • Body temperature
    • Temperature Sensitivity in Fibromyalgia & Chronic Fatigue Syndrome "When you're exposed to heat, does it feel like you're burning up? Does it seem impossible for you to cool off? Or maybe it's cold that bothers you, chilling you to the bone, leaving you unable to warm up.
    • Or are you one of those people with fibromyalgia (FMS) and chronic fatigue syndrome (ME/CFS) who is cold all the time, or hot all the time, or alternately hot or cold while out of sync with the environment?"[41]

Treatment[edit | edit source]

United States[edit | edit source]

Rheumatology and primary care providers: Diagnosing and treatment




Drugs[edit | edit source]

There are approved and off-label drugs for treating FM. Please Note: The information under "Drugs" is not meant to promote any Rx drug for Fibromyalgia or its comorbidities but to inform you of these drugs both approved and off-label. Always consult your doctor for guidance on Rx drug use for any illness or disease. Always check with your doctor and pharmacist for drug interactions.

Always review a drug company's prescription drug's side effects and possible drug interactions with your doctor and pharmacist.

Pregnant women must always consult with their doctor and pharmacist when taking any prescription drug, over-the-counter drug, supplement, or herbal remedy for side effects, drug interactions, and possible miscarriage, injury, birth defect, addiction, or death to the embryo, fetus, or baby. Breastfeeding women should always talk to their doctor and pharmacist for information about breast milk being laced with the drug she has taken causing side effects, injury, addiction, or death, and drug interactions to the baby consuming her breast milk.

Check with your doctor and pharmacist before using any prescription or over-the-counter drug, supplement, or herbal remedy being administered to a child. Check with your doctor for children's side effects or drug interactions that may not be listed.

FDA approved[edit | edit source]

FDA approved Side effects[edit | edit source]

Not all side effects or possible drug interactions of brand name or generic name drugs are listed or linked, review EACH brand name and EACH generic name medication's side effects and possible drug interactions with your doctor and pharmacist.



Off-label[edit | edit source]

  • Zanaflex (Generic name Tizanidine): Muscle relaxer for pain, sleep.

Off-label Side effects[edit | edit source]

Not all side effects or possible drug interactions of brand name or generic name drugs are listed or linked, review EACH brand name and EACH generic name medication's side effects and possible drug interactions with your doctor and pharmacist.




Sleep medications[edit | edit source]

Not all side effects or possible drug interactions of brand name or generic name drugs are listed or linked, review EACH brand name and EACH generic name medication's side effects and possible drug interactions with your doctor and pharmacist.

Disordered sleep is a prominent symptom in FM. There are four types of sleep medications used in FM; antihistamines, benzodiazepines, nonbenzodiazepines, sedating antidepressants.[57]

Low dose naltrexone and low dose seroquel (see under the heading: Drugs) can also help with sleep when taken at bedtime.

Articles and blogs on drugs[edit | edit source]

Drug trials[edit | edit source]

  • IMC-1
2016, The Pridgen Revolution? Dr. Pridgen on Bringing His Antiviral Approach to Fibromyalgia To Market "Almost three years ago, Dr. Pridgen threatened to turn the world of fibromyalgia treatment on its head. Few had connected fibromyalgia with viruses or even immune problems when Pridgen announced that a) FM is caused herpes simplex virus reactivation and b) that it could be treated with antivirals."[58]
2016, Novel Fibromyalgia Treatment Granted FDA Fast Track Designation "In the successful Phase II trial in fibromyalgia, IMC-1 was studied to confirm the hypothesis that chronic tissue-resident herpes simplex virus type 1 (HSV-1) may be one of the underlying causes of fibromyalgia and causally related to fibromyalgia symptoms or recurrence. IMC-1 is a novel fixed-dose oral combination antiviral medication designed to suppress this suspected virus and thus alleviate fibromyalgia symptoms."[59]
2017, Through the “Valley of Death”: Dr. Pridgen, Fibromyalgia and the Looming Trials "First there were the anecdotal reports – FM patients were not just getting better but some, and not just a few, were getting well using something entirely new – an antiviral protocol, of all things, created not by a pain specialist or rheumatologist but by a surgeon."[60]
2017, A famciclovir + celecoxib combination treatment is safe and efficacious in the treatment of fibromyalgia "IMC-1 was efficacious and safe in treating symptoms of fibromyalgia, supporting the hypothesis that herpes virus infections may contribute to this syndrome. Improved retention rates, decreased adverse event rates, and evidence of efficacy on a broad spectrum of outcome measures are suggestive that IMC-1 may represent an effective, novel treatment for fibromyalgia."[61]
  • Bacille Calmette-Guerin (BCG) vaccine
2017, Century-old vaccine gives new hope to fibromyalgia community

Drug trials failed[edit | edit source]

  • TNX-102
2016, The drug failed in its primary goal in providing pain relief and Tonix Pharmaceuticals will not be moving forward in developing a Ffbromyalgia drug.[62]
DS-5565
2016, Three New Fibromyalgia Drugs Could Be On The Way "Japanese drugmaker Daiichi Sankyo is now testing what could be Lyrica 2.0."[63]
Phase III clinical trial of DS-5565 found ineffective
2017, The Big Hurt: Second Major Fibromyalgia Drug in a Year Fails "In the three 13-week, double-blind, global, phase 3 ALDAY clinical trials evaluating Mirogabalin for the treatment of pain associated with fibromyalgia, Mirogabalin did not meet the primary efficacy endpoint to demonstrate a statistically significant reduction in the weekly average of worst daily pain score from baseline to Week 13."[64]

Therapies[edit | edit source]

Exercise[edit | edit source]

Please Note: These recommendations are for fibromyalgia patients and not ME/CFS sufferers.

  • Moderate aerobic exercise and weights with as fewer reps possible with a day or two of rest in between. Do not start a program if you are in a flare.[67]
  • Fibromyalgia Myth vs. Fact Heading: Myth #3: People With Fibromyalgia Need More Exercise. Appropriate exercise, which each patient needs to gauge for themselves.

Massage[edit | edit source]

Acupuncture[edit | edit source]

Disability[edit | edit source]

United States[edit | edit source]

Please Note: The following is NOT legal advice and it should not be relied upon in taking steps for a disability case. Only Social Security and a Disability Lawyer practicing Disability Law can provide the most up to date and the correct legal avenue for bringing a disability case.

In theUnited States, Social Security Insurance and Social Security Disability (SSI) and (SSD) benefits are available for Fibromyalgia. Generally for SSI/SSD, notes and tests from a Primary Provider may be allowed for submission but Specialists such as a rheumatologist, neurologist, rpychiatrist, etc. are required for diagnosis, ongoing treatment and completing SSI/SSD paperwork.

The Social Security Administration for SSD/SSI filings relies on the 1990 or 2010 ACR criteria to diagnose Fibromyalgia. (See: "Policy Interpretation" for the POLICY INTERPRETATION RULING.)[71]

  • Applying for Disability With Fibromyalgia One patient's success of applying, denial, successful appeal, and a breakdown of what SSI/SSD requires for the medical determination of a favorable decision of disability.

Examinations and Tests[edit | edit source]

For documentation of symptoms and providing proof of a fibromyalgia (FM) diagnosis, you and your doctor should consider the following examinations and tests:

Fibromyaglia Diagnostic Examination
Rheumatologist examination and diagnosis of FM. (Consider having a rheumatologist order tests and coordinate and order other specialists' tests and complete the paperwork for Social Security. A primary doctor cannot complete disability paperwork but may be able to forward test results.)
Arthritis
Whole body bone scan to rule out treatable arthritis.
Blood Tests
Routine blood tests for diabetes (fasting sugar, A1C) and a full Thyroid disease panel (TSH, T3, Free T3, T4 and Free T4).
Rule out Rheumatoid arthritis, lupus, Lyme disease and other diseases that can share some of the same symptoms of fibromyalgia and may be treatable.
Vitamin and mineral deficiencies such as B12 and Vitamin D which are treatable with over the counter supplements and prescription treatments improving fatigue and pain.
Irritable bowel syndrome diagnosis which may require blood, upper endoscopy to rule out celiac disease and fecal tests to check for bacteria (SIBO) and intestinal parasites.
Mental Health and Cognition
An ear, nose, and throat specialist (ENT) (Otorhinolaryngology) examination and imaging may be ordered for Temporomandibular joint disorder (TMJ). (Ear, sinus, throat/lymph infections, and tinnitus can also be documented.)

Of course, one can have arthritis, sleep apnea, chronic Lyme disease or other diseases and still have FM, but there may be a treatable condition where a patient's overall health, including their FM, improves.[72][73][74]

There have been cases of Vitamin D deficiency being misdiagnosed as fibromyalgia as a D deficiency can cause pain. Supplementation or prescribed D treatments may alleviate this pain. However, it is possible to have both a D deficiency and fibromyalgia and correcting the deficiency will only resolve the pain stemming from it.[75][76]

Blogs about navigating SSD process[edit | edit source]

Notable studies[edit | edit source]

Awards and current research[edit | edit source]

Psychiatric paradigm[edit | edit source]

Hyperbaric oxygen therapy[edit | edit source]

Noted in this News Medical article about the research all the women had concussions.

Controversies[edit | edit source]

Dr. Frederick Wolfe, the director of the National Databank for Rheumatic Diseases and the lead author of the 1990 paper that first defined the diagnostic guidelines for fibromyalgia, says he has become cynical and discouraged about the diagnosis. He now considers the condition a physical response to stress, depression, and economic and social anxiety.[77]

Learn more[edit | edit source]

Ongoing process of diagnosing and categorizing[edit | edit source]

  • 2012, Personality and Fibromyalgia Syndrome Conclusion: "No specific fibromyalgia personality is defined but it is proposed that personality is an important filter that modulates a person’s response to psychological stressors. Certain personalities may facilitate translation of these stressors to physiological responses driving the fibromyalgia mechanism."[78]

Blood tests[edit | edit source]

Brain scans[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. Fibromyalgia Symptoms - Web MD
  2. Fibromyalgia - Mayo Clinic
  3. Fibromyalgia now considered as a lifelong central nervous system disorder NAIDW.org
  4. Prevalance - National Fibromyalgia Association
  5. Fibromyalgia:Epidemiology - Medscape
  6. Webinar with Jarred Younger, Ph.D.
  7. Ask the Doctors: Is Fibromyalgia Progressive?
  8. Fibromyalgia Complications - Share Care
  9. Can fibromyalgia cause other medical conditions? - Honor Society of Nursing (STTI) - Share Care
  10. Fibromyalgia Fact Sheet - CDC
  11. Fibromyalgia - Questions and Answers about Fibromyalgia - NIH
  12. When Fibromyalgia Is More than Pain - ProHealth By Celeste Cooper
  13. The Difference Between Fibromyalgia Tender Points and Myofascial Trigger Points
  14. 18 Points Used to Diagnose Fibromyalgia - Health.com
  15. Tender Points might no longer be used for diagnosis of Fibromyalgia - Massachusettes CFIDS/ME FM Association
  16. 2011 Modification of 2010 ACR Fibromyalgia Criteria - CelesteCooper.com
  17. Criteria for the diagnosis of fibromyalgia: validation of the modified 2010 preliminary American College of Rheumatology criteria and the development of alternative criteria. - PubMed
  18. 2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria
  19. How Fibromyalgia Affects Men - WebMD
  20. Fibromyalgia - Epidemiology - Sex-related differences in incidence - Medscape
  21. Tender Points might no longer be used for diagnosis of Fibromyalgia - Tender Points might no longer be used for diagnosis of Fibromyalgia - Massachusettes CFIDS/ME FM Association
  22. Tender Points might no longer be used for diagnosis of Fibromyalgia - The new criteria for FM diagnosis - Massachusettes CFIDS/ME FM Association
  23. Tender Points might no longer be used for diagnosis of Fibromyalgia - Tender Points might no longer be used for diagnosis of Fibromyalgia - Massachusettes CFIDS/ME FM Association
  24. SSR 12-2p: Titles II and XVI: Evaluation of Fibromyalgia
  25. World Health Organization, International Classification of Diseases - Fibromyalgia M79.7, ICD-10, 2016
  26. M79.7 Fibromyalgia - ICD-10 Version:2016
  27. 2015/16 ICD-10-CM Diagnosis Code M79.7
  28. The Health Care Industry Finally Recognizes Fibromyalgia
  29. Fibromyalgia - ICD-11 (Working Status)
  30. Fibromyalgia - ICD-11 (Working Status)
  31. Fibromyalgia - ICD-11 (Working Status)
  32. Pathogenesis of fibromyalgia - UpToDate
  33. Fibromyalgia - Open Medicine Foundation
  34. New UAB Study Could Radically Change Fibromyalgia Treatment As We Know It - National Pain Report By Donna Gregory Burch
  35. Testing the fibromyalgia immune system with lipopolysaccharide (LPS) - YouTube - May 24, 2017
  36. Century-old vaccine gives new hope to fibromyalgia community - ProHealth
  37. EpicGenetics, with the Assistance of Leading Medical Centers, Expands Clinical Study of FM/a® Test to Diagnose Fibromyalgia, Identify Genetic Markers Unique to the Disorder and Explore Direct Treatment Approaches - Business Wire
  38. Junk Ethics - The Fibromyalgia Perplex by Fred Wolfe
  39. Allodynia - about.com definition article
  40. Painful to Touch: Fibromyalgia & Tactile Allodynia - Does Your Skin Hurt? Here's Why!
  41. Temperature Sensitivity in Fibromyalgia & Chronic Fatigue Syndrome - Very Well By Adrienne Dellwo
  42. What is Fibro Fog - Fibromyalgia and Cognitive Dysfunction - Medical.net
  43. Irritable Bowel Syndrome in Fibromyalgia & Chronic Fatigue Syndrome - Why Do They Go Together?
  44. Fibromyalgia, Chronic Fatigue Syndrome & Interstitial Cystitis by Adrienne Dellwo - VeryWell
  45. Impaired Language in Fibromyalgia & Chronic Fatigue Syndrome - Talking, Reading & Writing
  46. Aphasia - Mayo Clinic
  47. What is Dysphasia?-Ayushveda
  48. Fibromyalgia Tied to Hysterectomy, Gynecologic Disease
  49. Sleep is associated with task-negative brain activity in fibromyalgia participants with comorbid chronic insomnia
  50. Fibromyalgia and Sleep - ProHealth - By: Cort Johnson
  51. Chronic Fatigue Syndrome, Fibromyalgia, and Autoimmune Thyroid Disease
  52. Thyroid Disease in Fibromyalgia & Chronic Fatigue Syndrome
  53. Fibromyalgia Symptoms - The Monster List!
  54. Cymbalta Lawsuits - Drug Watch
  55. Eli Lilly Settles Cymbalta Withdrawal Lawsuits - Donna Gregory Burch - National Pain Report - October 6, 2016
  56. Court Blocks Sale of Generic Lyrica, Upholds Pfizer Patents by Karen Lee Richards - Health Central - July 25, 2012
  57. Sleep Medications For Fibromyalgia Fibrodaze.com
  58. The Pridgen Revolution? Dr. Pridgen on Bringing His Antiviral Approach to Fibromyalgia To Market
  59. Novel Fibromyalgia Treatment Granted FDA Fast Track Designation - Fibromyalgia News Today By Charles Moore
  60. Through the “Valley of Death”: Dr. Pridgen, Fibromyalgia and the Looming Trials - Simmaron Research By Cort Johnson
  61. A famciclovir + celecoxib combination treatment is safe and efficacious in the treatment of fibromyalgia - NCBI, Dovepress Journal of Pain - J Pain Res. 2017; 10: 451–460. Published online 2017 Feb 22. doi: 10.2147/JPR.S127288
  62. Potential Fibromyalgia Treatment is Put on Hold - National Pain Report - September 2016
  63. Three New Fibromyalgia Drugs Could Be On The Way By Donna Gregory Burch
  64. The Big Hurt: Second Major Fibromyalgia Drug in a Year Fails - Health Rising
  65. Warm-Water Exercise for Fibromyalgia - About.com Health FMS/ME/CFS
  66. Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia. - PubMED
  67. Exercising With Fibromyalgia - By Ronenn Roubenoff, MD
  68. CMS.gov Regulations and Guidance
  69. Acupuncture Good for Fibromyalgia? Acupuncture School Online
  70. Short-term complementary and alternative medicine on quality of life in women with fibromyalgia - JIM, Elsevier, Science Direct
  71. SSR 12-2p: Titles II and XVI: Evaluation of Fibromyalgia
  72. Common Misdiagnoses of Fibromyalgia - WebMD
  73. Overlapping and Related Conditions - CFIDS & Fibromyalgia
  74. When Fibromyalgia Is More than Pain - ProHealth By Celeste Cooper
  75. What Is Fibromyalgia? Medscape Readers Weigh In - Medscape By Bret Stetka, MD
  76. Chronic Pain: Does Vitamin D Help? - WebMD By Gina Shaw
  77. Drug Approved. Is Disease Real? - New York Times
  78. Personality and Fibromyalgia Syndrome
  79. Is Fibromyalgia a Psychosomatic Illness? Med Student Asks Celeste Cooper
  80. British Journal of Psychiatry Open Sep 2016, 2 (4) 275-279; DOI: 10.1192/bjpo.bp.115.002808 - Sarah Penfold, Emily St. Denis, Mir Nadeem Mazhar
  81. Neural signature for fibromyalgia may aid diagnosis, treatment


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From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history