What Are Researchers Learning About Fibromyalgia?

NIAMS sponsors research that will improve scientists’ understanding of the specific problems that cause or accompany fibromyalgia, in turn helping them develop better ways to diagnose, treat, and prevent this syndrome.
The research on fibromyalgia supported by NIAMS covers a broad spectrum, ranging from basic laboratory research to studies of medications and interventions designed to encourage behaviors that reduce pain and change behaviors that worsen or perpetuate pain.
Following are descriptions of some of the promising research now being conducted:
Understanding pain. Research suggests that fibromyalgia is caused by a problem in how the body processes pain, or more precisely, a hypersensitivity to stimuli that normally are not painful. Therefore, several NIH-supported researchers are focusing on ways the body processes pain to better understand why people with fibromyalgia have increased pain sensitivity. These studies include:

• An investigation into the relationship between variations in a gene called ADRA1A and risk factors for chronic pain conditions.
• The establishment of a tissue bank of brain and spinal cord tissue to study fibromyalgia and to determine the extent to which chronic pain in fibromyalgia patients is associated with the activation of cells in the nervous system and the production of chemical messengers, called cytokines, that promote inflammation.
• The use of imaging methods to evaluate the status of central nervous system responses in patients diagnosed with fibromyalgia compared with those diagnosed with another chronic pain disorder and pain-free controls.
• An investigation to understand how the activation of immune cells from peripheral and central nervous system sources trigger a cascade of events leading to the activation of nerve cells, chronic pain, and the dysregulation of the effects of analgesic drugs against pain.
• An intensive evaluation of twins in which one of the pair has chronic widespread pain and the other does not, along with twins in which neither of the pair has chronic pain, to help researchers assess physiological similarities and differences in those with and without chronic pain and whether those differences are caused by genetics or environment.
• A study examining the use of cognitive behavioral therapy in pain patients, which researchers hope will advance their knowledge of the role of psychological factors in chronic pain as well as a new treatment option for fibromyalgia.
• The Patient-Reported Outcomes Measurement Information System (PROMIS) initiative. The PROMIS initiative is researching and developing new ways to measure patient-reported outcomes (PROs), such as pain, fatigue, physical functioning, emotional distress, and social role participation that have a major impact on quality-of-life across a variety of chronic diseases. The goal of this initiative is to improve the reporting and quantification of changes in PROs. NIAMS supports an effort to develop PROMIS specifically for use in patients with fibromyalgia.

Improving Symptoms. A better understanding of fibromyalgia and the mechanisms involved in chronic pain are enabling researchers to find effective treatments for it. Some of the most promising lines of research in this area include the following:

• Increasing exercise. Although fibromyalgia is often associated with fatigue that makes exercise difficult, regular exercise has been shown to be one of the most beneficial treatments for the condition. A new NIAMS-supported study is trying to determine whether increasing lifestyle physical activity (that is, adding more exercise such as walking up stairs instead of taking the elevator) throughout the day produces similar benefits to exercise for fibromyalgia, improving symptoms such as pain, fatigue, and tenderness. The study is also examining the potential mechanisms by which lifestyle physical activity might influence symptoms. Other research supported by NIAMS is examining the effectiveness of a 16-week program of a simplified form of Tai Chi on pain and other measures such as sleep quality, fatigue, anxiety, and depression.
  NIAMS-supported research is also examining ways to help people maintain helpful exercise programs. Because many people with fibromyalgia associate increased exercise with increased pain, doctors and therapists often have a difficult time getting patients to stick with their exercise program. The new research is examining patients’ fears that cause them to avoid exercise as well as behavioral therapies to reduce fears and help them maintain exercise.
• Improving sleep. Researchers supported by NIAMS are investigating ways to improve sleep for people with fibromyalgia whose sleep problems persist despite treatment with medications. One team has observed that fibromyalgia patients with persistent sleep problems share characteristics with people who have sleep-disordered breathing—a group of disorders, the most common of which is the obstructive sleep apnea, characterized by pauses in breathing during sleep. These researchers are studying whether continuous positive airway pressure (CPAP, a therapy administered by a machine that increases air pressure in the throat to hold it open during sleep) might improve the symptoms of fibromyalgia.
  Other groups of researchers are examining the link between sleep disturbance and chronic pain in fibromyalgia and are studying whether behavioral therapy for insomnia might improve fibromyalgia symptoms.
• Studying new treatments. In addition to exercise and improving sleep, NIAMS-supported researchers are looking at different ways to reduce pain and other symptoms of fibromyalgia. Potential therapies under study include transcranial magnetic stimulation (TMS) and vagus nerve stimulation.
  TMS is a therapy in which an electrical current is passed through an electromagnetic coil placed on the scalp, inducing a small electrical current within the underlying cortex. Recent research shows that the therapy not only decreases depressive symptoms in depressed patients, but also is effective in reducing pain. The new study will examine whether TMS is effective in improving pain in people with widespread chronic pain disorder, including fibromyalgia.
  Vagus nerve stimulation is a treatment that uses a device similar to a pacemaker to administer regular, mild pulses of electrical energy to the brain by way of the vagus nerve. The vagus nerve runs from the brain stem to the lower abdomen and controls body functions, including heart rate, that are not under voluntary control.

Where Can People Get More Information About Fibromyalgia?

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse National Institutes of Health

1 AMS Circle Bethesda,  MD 20892-3675 Phone: 301-495-4484 Toll Free: 877-22-NIAMS (877-226-4267) TTY: 301-565-2966 Fax: 301-718-6366 Email: NIAMSinfo@mail.nih.gov Website: http://www.niams.nih.gov