The Bipartisan Budget Act of 2015 (Public Law 114-74; November 2, 2015), made some changes to Social Security’s laws about claiming retirement and spousal benefits. Section 831 of the law (entitled “Closure of Unintended Loopholes”) made several changes to the Social Security Act and closed two complex loopholes that were used primarily by married couples. This fact sheet explains what is changing and how it might affect you.
Determining when to start your Social Security benefits is a complex and personal decision. We encourage you to research your options before you apply for benefits. You may also contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to speak with a representative about your retirement options.
What was the loophole? The law provides incentives to delay claiming retirement benefits: monthly benefits grow larger for each month you delay receiving retirement benefits between full retirement age (currently 66) and 70. The loophole allowed some married individuals to start receiving spousal benefits at full retirement age, while letting their own retirement benefit grow by delaying it.
How is the law changing? Under existing law, if you are eligible for benefits both as a retired worker and as a spouse (or divorced spouse) in the first month you want your benefits to begin and are not yet full retirement age, you must apply for both benefits. You will receive the higher of the two benefits. This requirement is called “deemed filing” because when you apply for one benefit you are “deemed” to have also applied for the other.
Under the new law deemed filing is extended to apply to those at full retirement age and beyond. In addition, deemed filing may occur in any month after becoming entitled to retirement benefits. For example, if you begin receiving your retirement benefit and only later become eligible for a spousal benefit (or vice versa), you will be “deemed” to have applied for the second benefit as soon as you are eligible for it. Your monthly payment will be the higher of the two benefit amounts.
What is the rationale for this change? Historically, spousal benefits were designed to be paid only to the extent they exceeded any benefit the spouse earned based on his or her own work record. This change in the law preserves the fairness of the incentives to delay, but it means that you cannot receive one type of benefit while at the same time earning a bonus for delaying the other benefit.
Who will be affected? If you turn 62 on or after January 2, 2016, and will be eligible for benefits both as a retired worker and as a spouse (or divorced spouse), then the new law applies to you. Deemed filing applies to retirement benefits, not to survivor’s benefits. So, if you are a widow or widower, you may start your survivor benefit independently of your retirement benefit if you restrict the scope of your application. There are also some exceptions to deemed filing. For example, deemed filing does not apply if you receive spouse's benefits and are also entitled to disability, or if you are receiving spousal benefits because you are caring for the retired worker’s child. If you have questions about your specific situation, contact Social Security.
How and when is Social Security implementing this change? We have already implemented this change with specific instructions to our field office employees because the law applies to those who attain age 62 on January 2, 2016 or later. We are continuing to update our website and materials.
Example 1: Maria turns age 62 after January 1, 2016 and her husband, Joe, is 65. They have each worked enough years to earn a retirement benefit. In March of 2020, Maria has reached her full retirement age and files for benefits. Maria is eligible for a spousal benefit on Joe’s record. Maria must file for both benefits. She can no longer file only for the spousal benefit and delay filing for her own retirement. She will receive a combination of the two benefits that equals the higher amount.
Example 2: Jennie is a 62-year-old widow. She is eligible for retirement benefits based on her work history, and she is also eligible for survivor benefits based on her deceased husband’s record. She starts her survivor benefit this year, restricts the scope of her application to widow’s benefits, and does not start her own retirement benefit, allowing it to grow. At age 70, she starts her own increased retirement benefit, which she will receive for the rest of her life. The new law does not affect her because deemed filing does not apply to widow(er)s. Jennie will receive the higher of the two benefits.
What was the loophole? As described above, retirement benefits grow for each month you delay claiming, between full retirement age (currently 66) and 70. A loophole allowed a worker at full retirement age or older to apply for retirement benefits and then voluntarily suspend payment of those retirement benefits, which allowed a spousal benefit to be paid to his or her spouse while the worker was not collecting retirement benefits. The worker would then restart his or her retirement benefits later, for example at age 70, with an increase for every month retirement benefits were suspended.
How is the law changing? Under the new law, you can still voluntarily suspend benefit payments at your full retirement age (currently 66) in order to earn higher benefits for delaying. But during a voluntary suspension, other benefits payable on your record, such as benefits to your spouse, are also suspended. And, if you have suspended your benefits, you cannot continue receiving other benefits (such as spousal benefits) on another person’s record.
There are some exceptions. If you are a divorced spouse, you can continue receiving a divorced spousal benefit even if your ex-spouse voluntarily suspends his or her retirement benefit.
What is the rationale for this change? There is less rationale for paying dependents if the primary worker has not retired or is not receiving payment from Social Security. It also preserves the fairness of the incentives to delay, so that couples cannot simultaneously receive a benefit and get a bonus for delaying.
Who will be affected? The new law applies to individuals who request a suspension on or after April 30, 2016, which is 180 days after the new law was enacted. Remember, you must have reached your full retirement age (currently 66) in order to request a suspension.
In some situations, we will honor requests received before April 30, 2016, that we are unable to process until after April 30, 2016. For example, there could be a situation where you are already full retirement age, and you contact us to apply for benefits before April 30, 2016, expressing your intent to apply for, and suspend, your benefits. If we cannot take your application until June 2016, we will honor the request for voluntary suspension that we received before April 30, 2016.
If you voluntarily suspended benefits prior to April 30, 2016, you may remain in voluntary suspense status, and the new law will not affect you. Also, if you submit your request before April 30, 2016 and your spouse or children become entitled to benefits either before or after that date, they will not be affected by the new rules and will continue to receive payment.
How and when is Social Security implementing this change? We have developed instructions for our field office employees so they can answer questions before this change takes effect for suspension requests that are submitted on or after April 30, 2016.
Example: Thomas will turn 66 in 2016, and Maria will turn 62. Thomas starts his retirement benefit at his full retirement age, 66, in June 2016, and Maria starts her spousal benefit based on his record. Thomas immediately suspends his benefit. In past years, that would have meant that Maria could continue receiving spousal benefits while Thomas could restart his own benefit at age 70 and receive an increase for each month he waited. Now, because Thomas reached his full retirement age and requested the suspension after April 30, 2016, he is subject to the new law. He can still choose to voluntarily suspend his benefit after his full retirement age, but if he does suspend his benefits, Maria’s spousal benefit will also be suspended.
For more information about these changes, contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778).
Imagine pain in an arm or leg so intense that the sufferer would rather undergo an amputation than put up with it any longer. For those with complex regional pain syndrome (CRPS), this is not just a hypothetical nightmare—it is reality. According to the National Institute of Neurological Disorders and Stroke (NINDS), CRPS is a chronic condition most often affecting one limb (arm, leg, hand or foot), usually after an injury or trauma to that limb. The main complaint is pain that is way out of proportion to the severity of the initial injury. The cause of the condition isn't clearly understood, according to NINDS. It can manifest as visual swelling, redness and other abnormalities in a limb.
CRPS is widely considered to be the single worst source of pain—ranking higher on pain scales than childbirth, cancer and amputation. Yet the condition is rare and can be difficult to recognize. As a result, patients with CRPS—predominantly women, with an average age of 40, according to the National Institutes of Health—can search for an average of approximately four years before being properly diagnosed with the condition, according to a study published in the Scandinavian Journal of Pain. This long wait, compounded by the pain, can severely impact their daily living and quality of life. Although reports of those experiencing the symptoms of this condition have existed as long ago as the Civil War, according to a study published in The BMJ, no medication has yet been approved.
Randall Kaye, M.D. is the Chief Medical Officer at Axsome Therapeutics, Inc., a clinical-stage biopharmaceutical company currently enrolling patients at sites across the U.S., Canada, the U.K. and Australia in a clinical study, called CREATE-1, to evaluate its experimental medication AXS-02 for the treatment of chronic pain caused by CRPS. In this quest, Axsome is motivated by the many stories from CRPS patients, describing how difficult it can be to live with CRPS. Thought not yet approved, AXS-02 has been granted Fast Track and Orphan Drug Designation by the U.S. Food and Drug Administration and Orphan Medicinal Product Designation.
AXS-02 (disodium zoledronate tetrahydrate) is an oral, non-opioid, potentially first-in-class pain therapeutic being developed for the treatment of chronic pain caused by CRPS. The compound has multiple mechanisms of action to address chronic pain: it inhibits bone-resorbing osteoclasts, downregulates acid-sensing ion channels, reduces pro-inflammatory cytokine production and is anti-angiogenic.
As a result of his efforts at Axsome Therapeutics, Dr. Kaye is especially able to appreciate the need for novel approaches to CRPS and to oversee efforts to advance the state of care.
National Institute of Neurological Disorders and Stroke
The Centers for Disease Control and Prevention, in long-awaited guidelines on prescribing opioid medications for pain, gives tepid endorsement for the use of urine testing before and during opioid therapy for pain, despite its statements that, “Urine drug tests do not provide accurate information about how much or what dose of opioids or other drugs a patient took,” and "The clinical evidence review did not find studies evaluating the effectiveness of urine drug screening for risk mitigation during opioid prescribing for pain.”
"Urine drug testing results can be subject to misinterpretation and might sometimes be associated with practices that might harm patients (e.g., stigmatization, inappropriate termination from care),” the guidelines state. Indeed, Cal NORML regularly hears from patientswho are terminated from pain management medications because of their use of medical marijuana.
"Clinicians should not test for substances for which results would not affect patient management or for which implications for patient management are unclear,” the CDC states. "For example, experts noted that there might be uncertainty about the clinical implications of a positive urine drug test for tetrahyrdocannabinol (THC)”...Clinicians should not dismiss patients from care based on a urine drug test result because this could constitute patient abandonment and could have adverse consequences for patient safety."
"We applaud the CDC's reasoned approach to the use of urine testing and its drawbacks when used on pain patients," said Ellen Komp, Deputy Director of California NORML. "Considering that opioid overdose deaths are significantly lower in states with medical marijuana programs,we are sorry the agency apparently didn't read the letter Elizabeth Warren recently sent to its chief calling for marijuana legalization as a means of dealing with the problem of opiate overdose."
Also from the guidelines:
"Experts agreed that prior to starting opioids for chronic pain and periodically during opioid therapy, clinicians should use urine drug testing to assess for prescribed opioids as well as other controlled substances and illicit drugs that increase risk for overdose when combined with opioids, including nonprescribed opioids, benzodiazepines, and heroin [notice THC is not included.]” The use of "a relatively inexpensive immunoassay panel for commonly prescribed opioids and illicit drugs” was acknowledged but its drawbacks were noted (does not detect synthetic opioids (e.g., fentanyl or methadone) and might not detect semisynthetic opioids (e.g., oxycodone). These panels are often where THC is detected.
"Most experts agreed that urine drug testing at least annually for all patients was reasonable. Some experts noted that this interval might be too long in some cases and too short in others, and that the follow-up interval should be left to the discretion of the clinician. Previous guidelines have recommended more frequent urine drug testing in patients thought to be at higher risk for substance use disorder. However, experts thought that predicting risk prior to urine drug testing is challenging and that currently available tools do not allow clinicians to reliably identify patients who are at low risk for substance use disorder."
"Some clinics obtain a urine specimen at every visit, but only send it for testing on a random schedule. Experts noted that in addition to direct costs of urine drug testing, which often are not covered fully by insurance and can be a burden for patients, clinician time is needed to interpret, confirm, and communicate results.”
Called "the nation's top federal health agency," CDC sought the input of experts to assist in reviewing the evidence and providing perspective on how CDC used the evidence to develop the draft recommendations.
UPDATE 2/26 PM: This response was received from CDC spokesperson Courtney Lenard:
It is prudent for clinicians to restrict use of any medical test to situations when results of the test would be helpful in decisions about patient management. This is particularly important when testing or test results might have unintended negative consequences for patients. Some experts noted that in some cases, positive THC results might have legal or other consequences for patients but might not inform patient care decisions. While CDC is not stating that urine tests for THC should never be used, the guideline recommends that clinicians should only test for substances (including THC) if the clinician knows how he or she would use the results to inform patient management.
Regarding the statement “However, experts thought that predicting risk prior to urine drug testing is challenging and that currently available tools do not allow clinicians to reliably identify patients who are at low risk for substance use disorder.”: this statement refers to the difficulty in risk-stratifying patients for urine drug testing, given that most other available tools would not allow clinicians to accurately predict which patients are at low enough risk for substance use disorder that urine drug testing would not be needed.
The first thing to realize with Social Security Disability (SSD) benefits and retirement is that “full retirement age” is not always 65. In fact, 65 is only considered the age of retirement for those born in 1937 or earlier, so chances are that you will be among those who hit full retirement age at a later date. In any event, you will still want to know how your SSD benefits will be affected by hitting what is considered retirement age by the Social Security Administration (SSA) for someone in your age demographic.
Over the years, the SSA has periodically adjusted the age of full retirement. There are several designations of full retirement age according to the SSA and each is defined by your date of birth. The breakdown is as follows:
|Date of Birth||Full Retirement Age|
|1937 or before||65|
|1938||65 +2 months|
|1939||65 +4 months|
|1940||65 +6 months|
|1941||65 +8 months|
|1942||65 +10 months|
|1943 to 1954||66|
|1955||66 +2 months|
|1956||66 +4 months|
|1957||66 +6 months|
|1958||66 +8 months|
|1959||66 +10 months|
|1960 or after||67|
For the majority of current SSD beneficiaries, the age of full retirement is 67, which means you may have at least a couple more years before you need to be concerned with how hitting retirement age will affect your benefits; however, it’s good to understand the process in advance so there are no surprises when you do reach 67.
There are two major changes that take affect when you reach full retirement age. The first is that your benefits will no longer be paid through SSD. Instead, you will transition to the SSA’s “Old Age” or retirement program instead. Your benefits will not be interrupted with this transition and the benefit payment will be processed as usual. It will simply come in from a different Social Security fund rather than SSD, but you won’t even notice the difference.
The second change that comes with reaching full retirement age is that your benefits are no longer subject earning limits that were in place with your SSD benefits. In other words, you can increase your earnings from a part time job or other income source without losing dollars in your monthly benefit check.
Standard full retirement benefits from the SSA are calculated on what a worker contributed to the Social Security system over the course of their employment. Disability benefits are as well, so the amount of your monthly benefit payment is not affected by the transition from SSD to retirement benefits.
SSD beneficiaries don’t have to do anything when they hit the age of full retirement. The SSA automatically transitions your benefits to the retirement fund without requiring you to complete new applications or other forms.
The SSA does currently allow people to apply for and begin receiving early retirement benefits at the age of 62; however, if you are disabled and have been receiving SSD benefits, then hitting early retirement age is not applicable for you. Instead, you would simply continue to receive SSD benefit until you reach the age of full retirement, at which time you would be transitioned from SSD to retirement benefits automatically by the SSA.
The Social Security Disability Insurance program dodged a bullet late last year when Congress approved a temporary patch to keep the program from running low on cash.
With as many as 11 million Americans facing a 19 percent reduction in their disability insurance benefits, Congress and the White House agreed to shift funding from the much larger Social Security retirement account to keep the program going with full benefits through 2022.
However, the long-term prognosis for the $150 billion annual disability insurance trust fund is cloudy for now. And before lawmakers agree to extend it again, there is likely to be a tough reexamination of the program to find ways to reduce costs, crack down on fraud and move more people off the roles and back to work.
“I think with any program like this there are always going to be challenges to it in terms of people questioning whether it should exist at all,” Jonathan Schwabish, a senior research associate with the Urban Institute and an expert on disability insurance, said in an interview Thursday. “On the other side there are people questioning whether it provides the support that people who are disabled need.”
The program was designed to assist the physically and mentally disabled and their families, although over the years it has been expanded to provide assistance to more people with physical problems, especially women. While the program frequently has come under criticism for being overly generous, benefits average $1,165 per month, or roughly $14,000 a year.
Both the Social Security retirement trust fund and the companion disability insurance program are on shaky financial ground in the long term and their funding will have to be addressed by Congress in the coming years to avert a crisis. The retirement fund itself is anticipated to run out of cash by 2035, according to a trustees’ report. And there may be increased pressure on the retirement program as a result of Congress shifting funds from it to the disability program.
However, in many ways, the disability insurance program will be much harder to fix, according to Schwabish, because of the wide range of disabilities that are covered and the types of judgments that are made to allow people into the program or to remove them. Congress ordered a number of pilot projects to experiment with ways to wean more beneficiaries off the program, but past efforts at this have been generally unsuccessful.
The percentage of disabled workers as a share of all workers has more than tripled since 1970, according to Schwabish. The disability insurance program provided benefits to nearly 9 million disabled workers in 2013, nearly six times the 1.5 million disabled workers who received benefits in 1970.
Schwabish and the Urban Institute this week published an important primer on the disability insurance program, including how it operates and who it benefits. Here are some of the highlights:
By Guest Blogger Marsha V. Robinson-Vaden, Office of Research, Demonstration, and Employment Support, Social Security Administration
If you are getting disability benefits and want to work, we have good news for you! Social Security’s work incentives and Ticket to Work programs can help you get started.
Special rules make it possible for people receiving Social Security disability benefits (SSDI) or Supplemental Security Income (SSI) to work and still receive monthly payments. And, if you cannot continue to work because of your medical condition, your benefits can start again – you may not even have to file a new application.
Work incentives include:
The rules for Social Security disability and SSI are different. However, we describe the rules under each program in ourRed Book (Publication No. 64-030) – A Guide to Work Incentives. Also, Social Security recognizes the importance of supporting youth in their efforts to navigate the path toward adult life. In this year’s edition of the Red Book, we included resources to assist youth with this transition. We provide general information to assist youth and the parents, providers, or representatives of a youth receiving SSI or Social Security disability to locate national and community supports and resources.
Whether you are receiving Social Security disability or SSI benefits, it is important to let the Social Security Administration know promptly when you start or stop working, or if any other change occurs that could affect your benefits.
The Ticket to Work program may also be able to help you. You can receive vocational rehabilitation, training, job referrals and other employment support services free of charge. You will not undergo medical reviews while you are using the Ticket and making timely progress pursuing your return to work plan. Find help in your are by visiting the Ticket to Work website athttp://www.chooseworkttw.net/resource/jsp/searchByState.jsp.
When you are ready to explore your work options, we have a national call center where you can talk directly with us about work, benefits or our work incentive programs. Just call 1-866-968-7842, Monday through Friday, between 8 a.m. and 8 p.m. EST. If you are deaf or hard of hearing, you may call our TTY number, 1-866-833-2967. Or you can call our toll-free number and ask for a free copy of the publication, Your Ticket to Work(Publication No. 05-10061).
For more information about the ways we can help you return to work and our work incentives programs, please read the Red Book
Fibromyalgia is a syndrome of unknown causes that results in lasting, sometimes debilitating, muscle pain and fatigue. Fibromyalgia is also known as fibrositis or fibromyositis.
Pain. The primary symptom of fibromyalgia is pain. The pain can be in one place or all over the body. The exact locations of the pain are called tender points. Fibromyalgia pain is often described as:
Fatigue and Sleep Disturbances. Another major fibromyalgia complaint is fatigue. Some patients report that their fatigue is more distressing than their pain. Sleep disturbances, particularly restless legs syndrome, are also very common. Fatigue and sleep disturbances are almost universal in patients with fibromyalgia. Some experts believe that if these symptoms are not present, the condition may not be fibromyalgia.
Depression and Mood. Up to a third of fibromyalgia patients have depression. Disturbances in mood and concentration are also very common. These conditions often go undiagnosed.
Other Symptoms. The following symptoms may also be present:
Symptoms in Children. In general, children with fibromyalgia most often have sleep disorders and widespread pain.
In the most common type of fibromyalgia, the causes are not known. Physical injuries, emotional trauma, or viral infections such as Epstein-Barr may trigger the disorder, but no one trigger has proven to be a cause of primary fibromyalgia.
Many experts believe that fibromyalgia is not a disease, but is rather a chronic pain condition brought on by several abnormal body responses to stress. Areas in the brain that are responsible for the sensation of pain react differently in fibromyalgia patients than the same areas in healthy people.
People with fibromyalgia have been found to have decreased activity in opioid receptors in parts of the brain that affect mood and the emotional aspect of pain. This reduced response might explain why fibromyalgia patients are likely to have depression, and are less responsive to opioid painkillers, researchers say.
Sleep disturbances are common in fibromyalgia. Patients with the condition have a higher-than-average rate of a sleep disorder called periodic limb movement disorder (PLMD). Patients with PLMD involuntarily contract their leg muscles every 20 - 40 seconds during sleep, which may occasionally wake them up.
Some researchers believe that fibromyalgia does not lead to poor sleeping patterns, but that sleep disturbances come first. Researchers continue to investigate the link between fibromyalgia and sleep.
Many abnormalities of hormonal, metabolic, and brain chemical activity have been described in studies of fibromyalgia patients. Changes appear to occur in several brain chemicals, although no regular pattern has emerged that fits most patients. Since there has been no clear cause-and-effect relationship established, it may be that fibromyalgia is a result of the effects of pain and stress on the central nervous system, which lead to changes in brain circuitry, rather than a brain disorder itself.
Serotonin. Of particular interest to researchers is serotonin, an important nervous system chemical messenger found in the brain, gut, and other areas of the body. Serotonin plays important roles in creating feelings of well-being, adjusting pain levels, and promoting deep sleep. Serotonin abnormalities have been linked to many disorders, including depression, migraines, and irritable bowel syndrome. Lower serotonin levels have also been noted in some patients with fibromyalgia.
Stress Hormones. Researchers have also found abnormalities in the hormone system known as the hypothalamus-pituitary-adrenal gland (HAP) axis. The HAP axis controls important functions, including sleep, stress response, and depression. Changes in the HAP axis appear to produce lower levels of the stress hormones norepinephrine and cortisol. (By contrast, levels of stress hormones in depression are higher than normal.) Lower levels of stress hormones lead to impaired responses to psychological or physical stresses. (Examples of physical stress include infection or exercise.)
Low IGF-1 Levels. Some studies have reported low levels of insulin-like growth factor-1 (IGF-1) in about a third of fibromyalgia patients. IGF-1 is a hormone that promotes bone and muscle growth. Low levels of growth hormone may lead to impaired thinking, lack of energy, muscle weakness, and intolerance to cold. Studies suggest that changes in growth hormone likely stem from the hypothalamus in the brain. While researchers have not found a link between IGF-1 levels and fibromyalgia, growth hormone levels in the blood may be a marker of the disorder.
Abnormal Pain Perception and Substance P. Some studies have suggested that people with fibromyalgia may perceive pain differently than healthy people. Fibromyalgia may involve too much activity in the parts of the central nervous system that process pain (the nociceptive system). Brain scans of fibromyalgia patients have found abnormalities in pain processing centers. For example, researchers have detected up to three times the normal level of substance P (a chemical messenger associated with increased pain perception) in the cerebrospinal fluid of fibromyalgia patients.
Using brain scans, researchers have also discovered an abnormal increase in blood flow (called "brain perfusion") in an area of the brain that discriminates the intensity of pain, and a decrease in blood flow in areas thought to be involved in the emotional response to pain. These abnormalities were unrelated to the patients' depression and anxiety levels, further reinforcing the idea that fibromyalgia is a real disorder, rather than just a side effect of depression.
Some fibromyalgia patients may be oversensitive to external stimulation, and overly anxious about the sensation of pain. This increase in awareness is called generalized hypervigilance.
A conflict between sensory perception and nervous system processing might occur in people with fibromyalgia. Fibromyalgia patients have been found to have greater awareness of, or less tolerance for, movement problems (such as tremor) that don't match with their expected sensory feedback. This mismatch in sensory signals might enhance the perception of pain. Fibromyalgia patients also seem to be more sensitive to sounds.
Fibromyalgia has symptoms that resemble those of some rheumatic illnesses, including rheumatoid arthritis and lupus (systemic lupus erythematosus). These are autoimmune diseases in which a defective immune system mistakenly attacks the body's own healthy tissue, producing inflammation and damage. The pain in fibromyalgia, however, does not appear to be due to autoimmune factors, and there is little evidence to support a role for an inflammatory response in fibromyalgia.
Although not primary causes, psychological and social factors may contribute to fibromyalgia in three ways:
Studies have reported higher numbers of severe emotional and physical abuse in patients with fibromyalgia compared with the general population. Most often, the abusers are family members or partners. This suggests that post-traumatic stress disorder (PTSD) or chronic stress may play a strong role in the development of fibromyalgia in some patients. PTSD, an anxiety disorder, is a reaction to a specific traumatic event. Some evidence indicates that PTSD actually results in changes to the brain, possibly from long-term overexposure to stress hormones.
Some research has found muscle abnormalities in fibromyalgia patients. These problems can be classified as the following:
To date, none of these abnormalities has a clearly defined relationship with fibromyalgia.
About 5 million Americans have fibromyalgia. The condition affects women more often than men.
Some evidence suggests that several factors may make people more susceptible to fibromyalgia. These risk factors include:
Nine out of 10 fibromyalgia patients are women. Women may be more prone to develop fibromyalgia during menopause.
The disorder usually occurs in people ages 20 - 60 years, though it can occur at any time. Some studies have noted peaks at around age 35. Others note that fibromyalgia is most common in middle-aged women. In one study, cases of fibromyalgia increased with age, and reached a frequency of more than 7% among people in their 60s and 70s.
Juvenile Primary Fibromyalgia. This type of fibromyalgia appears in adolescents, typically after age 13, with a peak incidence at age 14. It is uncommon, but studies indicate that its incidence may be increasing. Symptoms are similar to adult fibromyalgia, but outcomes may be better in young people.
Studies report a higher incidence of fibromyalgia among family members. It is not clear whether genetic or psychological factors, or both, are involved. Studies have found that:
There is no obvious, objective method for diagnosing fibromyalgia. The criteria used for studying fibromyalgia are very helpful, particularly if the patient does not have an accompanying disorder, such as depression or arthritis, that could complicate the diagnosis. Failure to meet the criteria, however, does not rule out fibromyalgia. Fibromyalgia should be suspected in any person who has muscle and joint pain with no identifiable cause.
In 1990, the American College of Rheumatology (ACR) set the following criteria for classifying fibromyalgia:
A. Widespread pain must be present for at least 3 months. This pain must appear in all of the following locations:
B. Pain in at least 11 of 18 specific areas called tender points on the body. The pain experienced when pressing on a tender point is very localized and intensely painful (not just tender). Tender points are located in the following areas:
Other Factors. The ACR classification provides a guideline, but doctors will also use a patient's medical history and other symptoms to reach a diagnosis. Fibromyalgia is often diagnosed when other diseases have been excluded. Long-term symptoms that may indicate fibromyalgia include:
A doctor should always take a careful personal and family medical history, which includes a psychological profile and history of any factors that might indicate other conditions, such as:
Patients should report any drugs they take, including vitamins and over-the-counter or herbal medications.
Pressure on Tender Spots. Any physical examination for fibromyalgia requires that the doctor press firmly on all potential tender spots. These spots must be painful when pressed, not simply tender. In addition, for a doctor to reach a diagnosis of fibromyalgia, these tender sites should normally not show signs of inflammation (redness, swelling, or heat in the joints and soft tissue). The tender points may also change in location and sensitivity over time. A doctor may then recheck tender points that do not respond the first time in patients who have other significant symptoms.
Detection of Other Causes of Symptoms. A health care provider will also examine the nails, skin, mucus membranes, joints, spine, muscles, and bones to help rule out arthritis, thyroid disease, and other disorders.
No blood, urine, or other laboratory tests can definitively diagnose fibromyalgia. If such tests show abnormal results, the doctor should look for other disorders. Tests for specific diseases depend on family histories and other symptoms, and may include:
The doctor may suggest follow-up psychological profile testing, if laboratory results do not indicate a specific disease.
Between 10% and 30% of all doctor's office visits are due to symptoms that resemble those of fibromyalgia, including fatigue, malaise, and widespread muscle pain. Because no laboratory test can confirm fibromyalgia, doctors will usually first test for similar conditions. A diagnosis of many of the disorders below may not always rule out fibromyalgia, because it can accompany other common conditions.
Several conditions may overlap or coexist with fibromyalgia, and have similar symptoms. It is not clear whether these conditions cause fibromyalgia, are risk factors for the disorder, have causes in common with fibromyalgia, or have no relationship at all with it.
Chronic Fatigue Syndrome. There is a significant overlap between fibromyalgia and chronic fatigue syndrome (CFS). As with fibromyalgia, the cause of CFS is unknown. A doctor can diagnose either disorder based only on symptoms reported by the patient. The two disorders share most of the same symptoms. They are also treated almost identically. The main differences are:
Some doctors believe that fibromyalgia is simply an extreme type of chronic fatigue syndrome. Physical evidence, however, indicates that the two disorders are distinct, and each has its own treatments.
Myofascial Pain Syndrome. Myofascial pain syndrome can be confused with fibromyalgia and may also accompany it. Unlike fibromyalgia, myofascial pain tends to occur in trigger points, as opposed to tender points, and typically there is no widespread, generalized pain. Trigger-point pain occurs in tight muscles, and when the doctor presses on these points, the patient may experience a muscle twitch. Unlike tender points, trigger points are often small lumps, about the size of a pencil eraser.
Major Depression. The link between psychological disorders and fibromyalgia is very strong. Studies report that 50 - 70% of fibromyalgia patients have a lifetime history of depression. However, only 18 - 36% of fibromyalgia patients have major depression.
Some studies have found that people who have both psychological disorders and fibromyalgia are more likely to seek medical help, compared with patients who simply have symptoms of fibromyalgia. If this is the case, study results may be biased, finding a higher-than-actual association between depression and fibromyalgia.
Depressed feelings in people with fibromyalgia can be normal responses to the pain and fatigue caused by this syndrome. Such emotions, however, are temporary and related to the condition. They are not considered to be a depression disorder. Unlike ordinary periods of sadness, an episode of major depression can last many months.
Symptoms of major depression include the following:
If several of the above symptoms are present, and none of the physical symptoms (particularly the tender points) of fibromyalgia exist, the condition is most likely major depression.
Chronic Headache. Chronic primary headaches, such as migraines, are common in fibromyalgia patients. Some experts believe that migraine headaches and fibromyalgia may even share common defects in the systems that regulate certain chemical messengers in the brain, including serotonin and epinephrine (adrenaline). Low levels of magnesium have also been noted in patients with both fibromyalgia and migraines. Chronic migraine sufferers who do not benefit from usual therapies may also have fibromyalgia.
Multiple Chemical Sensitivity. Multiple chemical sensitivity (MCS) is a term that describes conditions in which certain chemicals cause symptoms similar to CFS or fibromyalgia. As with CFS and fibromyalgia, some experts are uncertain whether MCS is a medical problem or psychologically based condition. Because everyone is exposed to many chemicals on a daily basis, it is very difficult to determine whether chemicals are responsible for specific symptoms.
Experts have come up with criteria to help recognize MCS:
Restless Legs Syndrome. About 15% of people with fibromyalgia have restless legs syndrome. Restless legs syndrome is an unsettling and poorly understood movement disorder that is sometimes described as a sense of unease and weariness in the lower leg that is aggravated by rest and relieved by movement.
Disorders Affected by the Sympathetic (also called Autonomic) Nervous System. Other conditions that commonly accompany fibromyalgia include:
Certain stress-related disorders commonly occur with fibromyalgia, and have overlapping symptoms. In fact, some experts believe these disorders so often interact that they may all be part of one general condition.
Some tests may be positive for one or more of these diseases. However, fibromyalgia should not be ruled out if the results are uncertain, these conditions have already been treated successfully, or the patient meets the criteria for fibromyalgia.
Multiple sclerosis. This condition may have symptoms similar to those of fibromyalgia. Magnetic resonance imaging (MRI) scans often detect patches of tissue in the brain that confirm multiple sclerosis (MS). MRI findings combined with other tests and clinical findings usually make this diagnosis fairly certain. However, some patients may have symptoms that suggest MS, but tests cannot confirm the diagnosis. Some of these patients may have symptoms similar to those of fibromyalgia.
Autoimmune diseases. Rheumatoid arthritis, systemic lupus erythrematosis, and Sjogren syndrome are usually easy to diagnose, but they may develop slowly and be difficult to diagnose at first. Even if a doctor determines that a patient is most likely to have fibromyalgia, the doctor should keep track of any changes in symptoms over time in case the patient actually has one of these other illnesses.
Lyme Disease. Lyme disease is a bacterial disease transmitted by ticks. Health care providers can usually diagnose early Lyme disease correctly, but a delayed response or recurrence of this disorder may be mistaken for fibromyalgia. Some experts believe that 15 - 50% of patients referred to clinics for Lyme disease actually have fibromyalgia. Late Lyme disease can usually (but not always) be ruled out using blood tests that identify the organism that causes this disease. If fibromyalgia patients are incorrectly diagnosed and treated for Lyme disease with prolonged courses of antibiotics, the drugs may have serious side effects.
Drugs and Alcohol. Fatigue is a side effect of many prescription and over-the-counter medications, such as antihistamines. Constant fatigue is also a symptom of drug and alcohol dependency or abuse. Health care providers should consider medications as a possible cause of fatigue if an individual has recently started, stopped, or changed medications. Withdrawal from caffeine can produce depression, fatigue, and headache.
Polymyalgia Rheumatica. Polymyalgia rheumatica is a condition that causes pain and stiffness. It generally occurs in older women. Tender points are also present with this disorder, although they almost always occur in the hip and shoulder area. Morning stiffness is common, and patients may also experience fever, weight loss, and fatigue. A higher-than-normal erythrocyte sedimentation rate (ESR) can help diagnose polymyalgia rheumatica. Elevated ESR, however, also occurs with other conditions. Polymyalgia rheumatica usually responds dramatically to low doses of a steroid medication such as prednisone. Because polymyalgia rheumatica is sometimes associated with a rare condition called temporal arteritis, which may cause blindness if not treated, an accurate diagnosis is important.
Fibromyalgia can be mild or disabling, and the emotional toll can be substantial. People with fibromyalgia experience greater psychological distress and a greater impact on quality of life than those with other conditions, such as chronic low back pain. About half of all patients have difficulty with routine daily activities, or are unable to perform them. An estimated 30 - 40% of patients have had to quit work or change jobs. Patients with either CFS or fibromyalgia are more likely to lose jobs, possessions, and support from friends and family than are people suffering from other conditions that cause fatigue.
The pain, emotional consequences, or sleep disturbances that come with fibromyalgia may lead to self-medication and overuse of sleeping pills, alcohol, drugs, or caffeine.
Outlook in Adults. Some studies show that fibromyalgia symptoms remain stable over the long term, while others report a better outlook, with 25 - 35% of patients reporting improvement in pain symptoms over time. Studies suggest that regular exercise improves the outlook. Those with a significant life crisis, or who are on disability, have a poorer outcome, as determined by improvements in the patients' ability to work, their own feelings about their condition, pain sensation, and levels of disturbed sleep, fatigue, and depression. Although the disease is lifelong, it does not get worse and is not fatal.
Outlook in Children. Children with fibromyalgia tend to have a better outlook than adults with the disorder. Several studies have reported that more than half of children with fibromyalgia recover in 2 - 3 years.
Fibromyalgia is a mysterious condition. Its causes are still largely unknown, as is how it inflicts damage. No strong evidence indicates that any single treatment (or combination of treatments) has any significant effect for most patients.
However, in 2007 the U.S. Food and Drug Administration approved pregabalin (Lyrica) as the first drug treatment for fibromyalgia after a study showed the medicine reduced fibromyalgia pain in 63% of patients. A year later, the FDA approved the drug duloxetine (Cymbalta) for fibromyalgia. Cymbalta has been shown to reduce fibromyalgia pain by more than 30%.
Many patients with fibromyalgia are treated first with medication; however, the American Pain Society Fibromyalgia Panel recommends a combined approach using cognitive-behavioral therapy, education, medication, and exercise. Treatment usually involves not only relieving symptoms, but also changing a patient's attitude about the disease. Treatment should also teach patients behaviors that help them cope.
Treatments usually involve trial and error:
A combination of non-drug therapies appears to work just as well as drug therapy in improving pain, depression, and disability. This combination includes exercise, stress management, massage, and diet.
Patients must have realistic expectations about the long-term outlook of their condition, and their own individual abilities. It is important to understand that fibromyalgia can be managed, and patients can live a full life. The following tips may be helpful when starting a treatment program for fibromyalgia:
The definition of improvement is personal. For example, some patients are pleased with only a 10% reduction in pain and other symptoms.
Many studies have shown that exercise is the most effective component in managing fibromyalgia, and patients must expect to take part in a long-term exercise program. Physical activity prevents muscle wasting, increases well-being, and, over time, reduces fatigue and pain. Many studies have also demonstrated that exercise can improve physical and emotional function, as well as reduce symptoms, including pain.
Programs often combine aerobic, strength-training, and flexibility exercises with self-management education. Some studies have shown improvements lasting for up to 9 months after the exercise program ends.
Graded Exercise. The basic approach used for fibromyalgia is called graded exercise. Graded exercise means you slowly increase the amount of your physical activity.
In general, graded exercise involves:
Patients who try difficult exercises too early actually experience an increase in pain, and are likely to become discouraged and quit.
Every patient must be prepared for relapses and setbacks, but they should not get discouraged. Patients who do not respond to one type of exercise might consider experimenting with another form.
Physical therapy can be very helpful. Studies suggest that physical therapy may reduce muscle overload, lessen fatigue from poor posture and positioning, and help condition weak muscles.
Sleep is essential, particularly because sleep disruptions worsen pain. Many patients with fibromyalgia have trouble getting a restful and healing night's sleep. Those who are unable to sleep consistently have little improvement in symptoms. Swing shift work, for example, is extremely hard on fibromyalgia patients. Poor sleep habits can add to sleep problems. Tips for good sleep habits include:
Fibromyalgia patients should maintain a healthy diet low in animal fat and high in fiber, with plenty of whole grains, fresh fruits, and vegetables. Although everyone should be careful about calories from fats, some are healthy.
Omega-3 Fatty Acids. Oils containing omega-3 fatty acids are of particular interest for arthritic pain. Such oils are found in cold-water fish. You can also purchase these oils as supplements called EPA-DHA or omega 3.
Vegetarian or Vegan Diet. A vegan diet has no meat, dairy, or eggs and includes uncooked fruits, vegetables, nuts, and germinated seeds. The actual benefit of various vegetarian diets remains unproven.
Relaxation and stress-reduction techniques are proving to be helpful in managing chronic pain. Evidence shows that people with fibromyalgia have a more stressful response to daily conflicts and encounters than those without the disorder. Several relaxation and stress-reduction techniques may be helpful in managing chronic pain, including:
Biofeedback. Evidence from controlled trials does not suggest that biofeedback techniques are very helpful for fibromyalgia patients. During a biofeedback session, electric leads are taped to a subject's head. The person is encouraged to relax using any method that works. Brain waves are measured and an audio signal sounds when alpha waves are detected. Alpha waves are brain waves that occur with a state of deep relaxation. By repeating the process, people using biofeedback connect the sound with the relaxed state, and learn to relax on their own.
Meditation. Meditation, used for many years in Eastern cultures, is now widely accepted in this country as an effective relaxation technique. A number of studies are reporting its benefits for fibromyalgia patients who practice on a continued and regular basis. The practiced meditator can achieve the following physical benefits:
An important goal for both religious and therapeutic meditation practices is to quiet the mind -- essentially to relax thought. This redirection of brain activity from thoughts and worries to the senses disrupts the stress response and prompts relaxation and renewed energy.
People who try meditation for the first time should understand that it can be difficult to quiet the mind, and they should not be discouraged by a lack of immediate results. Some experts recommend meditating for no longer than 20 minutes in the morning after awakening and then again in the early evening before dinner. Even once a day is helpful. Do not meditate before going to bed, because it causes some people to wake up in the middle of the night, alert and unable to return to sleep.
Hypnosis. In one small, short-term controlled study, hypnosis was more effective than physical therapy in improving function and reducing pain.
Massage Therapy. Massage therapy is thought to stimulate the parasympathetic nervous system, which slows the heart and relaxes the body. In one study, patients who were given 30-minute massage sessions twice a week experienced lower stress and anxiety and less pain after 5 weeks compared to a group receiving an alternative therapy called transcutaneous electrical stimulation (TENS).
Because of the difficulties in treating fibromyalgia, many patients seek alternative therapies. Although some studies have reported a benefit from these treatments, there is not enough evidence to recommend them. In one analysis, evidence was weakest on the advantages of so-called manipulative ("hands-on") approaches, such as chiropractic treatments.
Acupuncture. Studies continue to report conflicting results on acupuncture's ability to relieve pain. Several small studies suggest that it offers some benefit, especially to people who cannot take medicines because of their side effects. Acupuncture also seems to help relieve pain when added to treatment with tricyclic antidepressants and exercise, and the improvements last for a few months after treatment ends. Other studies have not found enough evidence to support the use of acupuncture for fibromyalgia.
Chiropractic or Osteopathic Manipulation. Chiropractic or osteopathic manipulation may also help some patients. While some studies have reported pain relief and improved sleep with osteopathic manipulation, larger controlled studies are needed to clearly identify whether manipulation is an effective treatment. Osteopathic techniques may include manipulation of the spine or muscle tissue release. There is always a very small risk for adverse effects from any of these techniques. For example, in rare cases manipulation of the neck has caused stroke or damage to the large blood vessels in the neck.
Hydrotherapy and Similar Treatments. Hydrotherapy, also called balneotherapy, involves soaking in water, such as hot tubs, pools, or baths, to help relieve pain. One study found that exercising in a warm swimming pool was a cost-effective therapy that improves quality of life in women with fibromyalgia.
Warmth itself might provide some relief. According to another small study, Waon therapy -- a type of treatment in which patients first sit in a dry sauna and then are placed in a warm room and wrapped in blankets -- significantly reduced pain in fibromyalgia patients.
Herbal or Natural Remedies. Some alternative remedies are being investigated for fibromyalgia:
It is extremely important for patients to realize that any herbal remedy or natural medicine that has positive effects most likely has negative side effects and toxic reactions, just as any conventional drug does. Consult a doctor before using any untested products or dietary supplements. Also discuss with your doctor the potential interactions between the supplements and any medications you take.
Generally, manufacturers of herbal remedies and dietary supplements do not need approval from the U.S. Food and Drug Administration to sell their products. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. There have been a number of reported cases of serious and even deadly side effects from herbal products. Always check with your doctor before using any herbal remedies or dietary supplements.
Studies show that fibromyalgia patients feel better when they deal with the consequences of their disorder on their lives. Cognitive-behavioral therapy (CBT) enhances a patient's belief in their own abilities and helps them develop methods for dealing with stressful situations. CBT, also called cognitive therapy, is known to be an effective method for dealing with chronic pain from arthritic conditions. Evidence also suggests that cognitive-behavioral therapy can help some patients with fibromyalgia.
Although the effects of CBT and other non-medication treatments for fibromyalgia do not always last over the long-term, they may help certain groups of people, particularly those with a high level of psychological stress.
CBT may be particularly useful for addressing insomnia, one of the hallmark symptoms of fibromyalgia. In studies, patients who received CBT for insomnia woke up 50% less often at night, and had fewer symptoms of insomnia and improved mood.
The Goals of CBT. The primary goals of CBT are to change any unclear or mistaken ideas and self-defeating behaviors. Using specific tasks and self-observation, patients learn to think of pain as something other than a negative factor that controls their life. Over time, the idea that they are helpless goes away and they learn that they can manage the pain.
Cognitive therapy is particularly helpful for defining and setting limits, which is extremely important for these patients. Many fibromyalgia patients live their lives in extremes. They first become heroes or martyrs, pushing themselves too far until they collapse. This collapse reverses the way they view themselves, and they then think of themselves as complete failures, unable to cope with the simplest task. One important aim of cognitive therapy is to help such patients discover a middle route. Patients learn to prioritize their responsibilities and drop some of the less important tasks or delegate them to others. Learning these coping skills can eventually lead to a more manageable life. Patients learn to view themselves and others with a more flexible attitude.
The Procedure. Cognitive therapy usually does not last long. It typically consists of 6 - 20 one-hour sessions. Patients also receive homework, which usually includes keeping a diary and trying tasks they have avoided in the past because of negative attitudes.
A typical cognitive therapy program may involve the following measures:
Patients should learn to accept that relapses occur, and that over-coping and accomplishing too much too soon can often cause a relapse. Patients should respect these relapses and back off. They should not consider them a sign of failure.
Research also shows that patient education can be effective in treating fibromyalgia, especially when combined with CBT, exercise, and other therapies. Educational programs can take the form of group discussions, lectures, or printed materials, although there isn't any clear evidence on which type of education works best.
Cognitive therapy may be expensive and not covered by insurance. Other effective approaches that are free or less costly include support groups or group psychotherapy. In one study, educational discussion groups were as effective, or even more so, than a cognitive therapy program. Such results are not typical in all centers. Therapeutic success varies widely depending on the skill of the therapist.
In 2007 the Food and Drug Administration approved Pregabalin (Lyrica) as the first drug specifically for the treatment of fibromyalgia. Other drugs used to treat fibromyalgia are antidepressants or muscle relaxants. The goal has been to improve sleep and pain tolerance. Medications from other drug classes (such as sleeping aids and pain relievers) may also be prescribed. Patients receive drug treatments in combination with exercise, patient education, and behavioral therapies.
Pregabalin is an anti-epileptic. Also called anti-seizure drugs and anti-convulsants, these medicines affect the chemical messenger gamma aminobutyric acid (GABA), which helps prevent nerve cells from over-firing.
Pregabalin was approved in 2004 to treat nerve pain and diabetic peripheral neuropathy. Research is indicating it may improve sleep quality, fatigue symptoms, and fibromyalgia pain. One study found that three different doses of pregabalin -- 300 mg, 450 mg, and 600 mg -- were all effective at improving pain and sleep, and all were well tolerated by patients. The most common side effects include mild-to-moderate dizziness and sleepiness. Pregabalin can impair motor function and cause problems with concentration and attention. Patients should talk to their doctor about whether pregabalin may affect their ability to drive.
Studies have shown that another anti-convulsant, gabapentin (Neurontin), which is approved for the treatment of postherpetic neuralgia, affects pain transmission pathways and may relieve pain associated with fibromyalgia. Patients who took gabapentin also reported that they slept better and were less tired.
The main classes of antidepressants used for treating fibromyalgia are tricyclics, selective serotonin-reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs). Although these drugs are antidepressants, doctors prescribe them to improve sleep and relieve pain in non-depressed patients with fibromyalgia. The dosages used for managing fibromyalgia are generally lower than dosages prescribed for treating depression. If a patient has depression in addition to fibromyalgia, higher doses may be required.
Tricyclics. Tricyclic antidepressants were the first drugs to be well-studied for fibromyalgia. They cause drowsiness and can be helpful for improving sleep. The tricyclic drug most commonly used for fibromyalgia is amitriptyline (Elavil, Endep), which produces modest benefits with pain, but can lose effectiveness over time. Other tricyclics include desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), amoxapine (Asendin), and nortriptyline (Pamelor, Aventyl).
Generally, only small doses of tricyclic antidepressants are needed to relieve fibromyalgia. Therefore, although tricyclics have several side effects, these side effects may be less frequent in fibromyalgia patients than in those taking tricyclics for depression. Side effects most often reported include:
As with all medications, tricyclic antidepressants must be taken as directed. An overdose can be life-threatening.
Unfortunately, not all patients respond to tricyclics, and their effects wear off in some patients, sometimes after only a month.
Selective Serotonin-Reuptake Inhibitors. Selective serotonin-reuptake inhibitors (SSRIs) increase serotonin levels in the brain, which may have specific benefits for fibromyalgia patients. Commonly prescribed SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and fluvoxamine (Luvox). Studies suggest they may improve sleep, fatigue, and well-being in many patients. Studies are mixed on whether they improve pain. SSRIs should be taken in the morning, since they may cause insomnia. Common side effects are agitation, nausea, and sexual dysfunction, including a delay or loss of orgasm and low sex drive.
Serotonin-Norepinephrine Reuptake Inhibitors. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are also known as dual inhibitors because they act directly on two chemical messengers in the brain -- norepinephrine and serotonin. These drugs appear to have more consistent benefits for fibromyalgia pain than SSRIs.
Cyclobenzaprine (Flexeril) relaxes muscle spasms in specific locations without affecting overall muscle function. It helps relieve fibromyalgia symptoms. Cyclobenzaprine is related to the tricyclic antidepressants and has similar side effects, including drowsiness, dry mouth, and dizziness.
Zolpidem (Ambien) or other newer sleep medications such as zaleplon (Sonata) and eszopiclone (Lunesta) may improve sleep in patients with insomnia.
Pain relief is of major concern for patients with fibromyalgia. Pain relievers for fibromyalgia include:
Tropisetron. Tropisetron (Navoban) is a drug used to reduce vomiting during chemotherapy. European studies suggest that it may also help patients with fibromyalgia by reducing pain, dizziness, and depression, and by improving sleep. Fatigue and dizziness are the most common side effects.
Nabilone. A synthetic drug derived from marijuana may be another effective addition to fibromyalgia treatment, according to early studies. In one study, nabilone (Cesamet), which is also used to treat severe nausea and vomiting in chemotherapy patients, significantly relieved fibromyalgia pain compared to placebo. There are some challenges to using nabilone for fibromyalgia, however. First, it is a controlled substance that can become addictive, and researchers say it is so expensive that it would be cost-prohibitive to use for a chronic disease such as fibromyalgia.
Abeles M, Solitar BM, Pillinger MH, Abeles AM. Update on fibromyalgia therapy. Am J Med. 2008;121:555-561.
Arnold LM, Goldenberg DL, Stanford SB, Lalonde JK, Sandhu HS, Keck PE, et al. Gabapentin in the treatment of fibromyalgia: a randomized, double-blind, placebo-controlled multicenter trial. Arthritis & Rheumatism. 2007;56:1336-1344.
Geisser ME, Glass JM, Rajcevska LD, Clauw DJ, Williams DA, Kileny PR. A psychophysical study of auditory and pressure sensitivity in patients with fibromyalgia and healthy controls. J Pain. 2008;9:417-422.
Guedj E, Cammilleri S, Niboyet J, Dupont P, Vidal E, Dropinski JP, Mundler O. Clinical correlate of brain SPECT perfusion abnormalities in fibromyalgia. J Nucl Med. 2008;49:1798-1803.
Gusi N, Tomas-Carus P. Cost-utility of an 8-month aquatic training for women with fibromyalgia: a randomized controlled trial. Arthritis Res Ther. 2008;10:R24.
Harris RE, Clauw DJ, Scott DJ, McLean SA, Gracely RH, Zubieta JK. Decreased central u-opioid receptor availability in fibromyalgia. J Neurosci. 2007;27:10000-10006.
Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58:26-35.
Mannerkorpi K, Henriksson C. Non-pharmacological treatment of chronic widespread musculoskeletal pain. Best Pract Res Clin Rheumatol. 2007;21:513-534.
Matsushita K, Masuda A, Tei C. Efficacy of Waon therapy for fibromyalgia. Intern Med. 2008;47:1473-1476.
McCabe CS, Cohen H, Blake DR. Somaesthetic disturbances in fibromyalgia are exaggerated by sensory-motor conflict: implications for chronicity of the disease? Rheumatology. 2007;46:1587-1592.
Rooks DS, Gautam S, Romeling M, Cross ML, Stratigakis D, Evans B, et al. Group exercise, education, and combination self-management in women with fibromyalgia. Arch Intern Med. 2007;167;2192-2200.
Schweinhardt P. Fibromyalgia: a disorder of the brain? Neuroscientist. 2008;14:415-421.
Targino RA, Imamura M, Kaziyama HH, Souza LP, Hsing WT, Furlan AD, et al. A randomized controlled trial of acupuncture added to usual treatment for fibromyalgia. J Rehabil Med. 2008;40:582-588.
Van Koulil S, Effting M, Kraaimaat FW, van Lankveld W, van Helmond T, Cats H, et al. Cognitive-behavioural therapies and exercise programmes for patients with fibromyalgia; state of the art and future directions. Ann Rheum Dis. 2007;66:571-581.
Verbunt JA, Pernot DH, Smeets RJ. Disability and quality of life in patients with fibromyalgia. Health Qual Life Outcomes. 2008;6:8.