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1. What are the symptoms of fibromyalgia?

   The classic symptoms of fibromyalgia are widespread pain, tenderness, fatigue and problems sleeping. Other symptoms include (but are not limited to) cognitive dysfunction, stiffness, irritable bowel syndrome, depression, and anxiety.

2. What causes the disease?

   No one knows exactly what causes fibromyalgia, but current thinking centers on a theory called "central sensitization," which means that people with fibromyalgia have increased sensitivity to pain signals in their brains, resulting in a lower threshold for pain. Women are six times more likely than men to develop the disorder. The most common time for women to develop fibromyalgia is between ages 30 and 55.

3. I think I may have fibromyalgia, but my doctor doesn't know much about the disease. What should I do?

   Ask for a referral to a rheumatologist or physiatrist who is knowledgeable about the disease. A rheumatologist is a doctor who specializes in disorders that affect the joints, muscles, tendons, ligaments and bones. A physiatrist specializes in diagnosing and treating injuries and diseases causing pain, loss of function and disability.

4. I have heard that aerobic exercise is good for fibromyalgia, but how can I possibly exercise when I'm in such pain?

   If you've been sedentary awhile, you should start out with stretching exercises for several weeks. Therapy in warm water is easier than therapy on land. Heat, massage, hydrotherapy (exercising in a pool or using a whirlpool) and relaxation therapy are among the strategies that can help. Discuss any exercise plan with a health care professional before you start.

5. What medications are available to treat fibromyalgia pain?

   The U.S. Food and Drug Administration approved Lyrica (pregabalin) for the treatment of fibromyalgia in 2007. It is the first drug specifically indicated for the condition. Other medications commonly used include antidepressants and anti-seizure drugs.

6. What medications are available to treat the sleeping problems associated with fibromyalgia?

   Antidepressants are sometimes effective, and occasionally a doctor may prescribe a short-term course of sleeping pills. A muscle relaxant called cyclobenzaprine (Flexeril) may temporarily help to improve sleep and reduce pain. The drug zolpidem (Ambien) is sometimes prescribed for short intervals to persons having severe sleep problems. Pregabalin (Lyrica) and gabapentin (Neurontin) have been shown to improve sleep in patients with fibromyalgia. If you're having trouble sleeping, you may also want to employ standard nonmedical remedies, such as avoiding caffeine, forgoing naps, avoiding alcohol and consistently going to bed at the same time every night.

7. What is the relationship between fibromyalgia and depression?

   An estimated 50 percent of those with fibromyalgia experience depression or anxiety at some point in their lives. What causes the correlation between fibromyalgia and depression is unclear, but it may be related to shared abnormalities in serotonin and norepinephrine—mediated pathways in the central nervous system.

8. Why has the diagnosis of fibromyalgia been so controversial?

   Because up until the late 1990s, no pathological origin for the chronic, persistent pain could be found. Now multiple studies link the condition to abnormal pain processing in the central nervous system. Because women who presented with the syndrome often had depression and anxiety along with their condition, some doctors thought fibromyalgia was primarily caused by psychological factors. In recent years, skepticism has largely given way to interest in more fully characterizing symptoms and finding effective treatments.

9. What are some nonmedical approaches to treating the disease?

   Medications may be necessary, but there are a number of day-to-day strategies for coping with the disease. A fibromyalgia support group can help provide insight, advice and support. You can improve sleep by avoiding naps and caffeine and by going to bed at a consistent time. You should also monitor your pain and adjust your activities accordingly. To manage pain, you can try massage, heat and cold packs, relaxation therapy, water therapy (such as whirlpools), biofeedback and acupuncture/acupressure.