What is fibromyalgia?
Fibromyalgia is a condition that is characterized by widespread pain and discomfort that is part of a spectrum of syndromes whose common feature is somatization, the expression of psychological distress as physical symptoms. The symptoms are not specific and can include headaches and pain in the muscles, genitals, and jaw (temporomandibular joint), irritable bowel syndrome (diarrhea, constipation, bloating, unexplained abdominal pain), pain or pressure in the bladder, restless leg syndrome, sleep disturbances, non-restful sleep, fatigue, depression, anxiety, difficulty concentrating in other words, all symptoms that can be a part of other medical conditions. Some cases of fibromyalgia have known medical or psychiatric causes, whereas other cases do not.
How common is fibromyalgia during pregnancy?
Controversy surrounding the question of whether fibromyalgia should be classified as a particular medical condition is substantial and often emotional, casting a certain amount of doubt on how well the number of cases reported correlates with the presence of the condition (if it is a condition) in society. However, based strictly on data reported to the US Center for Disease Control and Prevention, fibromyalgia may affect up to 4 million adults in the US, or more than 1 out of 100 people. Since chronic pain syndromes like fibromyalgia are more common in younger adults than older people, and more common in women than men, it is fairly common for the condition to coincide with pregnancy.
How is fibromyalgia diagnosed?
The clinical picture of fibromyalgia overlaps with the picture of other pain syndromes, such as chronic fatigue syndrome. This, plus the fact that the patients symptoms or complaints in fibromyalgia do not come with any apparent pathology (disorder), and the fact that there is a psychological component to the condition, make fibromyalgia very difficult to diagnose. However, doctors often use patient self-reporting tools, such as the widespread pain index, which enable long-term pain throughout the body to be given a score from 0-19 points. Additionally, doctors utilize another tool called the symptom severity score, which scores 0-12 points and accounts for fatigue, how refreshed you feel upon awakening, and cognition (how well the patient thinks and concentrates). To be diagnosed with fibromyalgia, you must receive a widespread pain index score of 7, or higher and a symptom severity score of 5 or higher. Alternatively, you can be diagnosed if the widespread pain index is from 3-6 and the symptom severity score is at least 9.
In the course of working you up, doctors will want to rule out other conditions that are easier to define that can give you symptoms that often are associated with fibromyalgia. They will check your thyroid, for instance by measuring levels of thyroid-stimulating hormone (TSH) and thyroid hormones in your blood. They would order tests for various types of antibodies to reveal multiple sclerosis or rheumatoid arthritis, and also may order imaging tests, such as magnetic resonance imaging to look for these conditions. Many doctors will ask you questions and have you fill out other questionnaires designed to reveal mood disorders, such as major depressive disorder, which is very common during and after pregnancy (peripartum depression) and seasonal affective disorder, which is very common in people who live at high latitudes during the late fall and winter.
Does fibromyalgia cause problems during pregnancy?
Fibromyalgia may provide you with pain stress beyond what you would otherwise experience during pregnancy.
Does fibromyalgia during pregnancy cause problems for the baby?
There is no substantive evidence that fibromyalgia causes any direct harm to the developing baby. However, fibromyalgia increases your risk of developing major depressive disorder, and there is some concern that depression during pregnancy can cause problems for the baby, such as hyperactivity during childhood, and irregular heart rate while in the womb. During infancy, the child of a mother depressed during pregnancy may be at increased risk for disruption of the balance between various hormones and neurotransmitters (chemicals in the brain) and changes in brain electrical patterns. Such infants are more likely than other neonates to require admission into the neonatal intensive care unit, and there is increased risk of premature deaths. As older children, there may be an increased risk of obesity, and by adolescence, there may be an increased risk of developing a mood disorder and engaging in criminal behavior.
What to consider about taking medications when you are pregnant:
- The risks to yourself and your baby if you do not treat the fibromyalgia
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat fibromyalgia during pregnancy?
Medications that are used in managing patients with fibromyalgia include antidepressants, such as selective serotonin reuptake inhibitors (SSRIs). Among SSRIs, sertraline and citalopram are considered quite safe for the developing baby, but citalopram is not particularly effective for pain. Fibromyalgia also is treated with medication specific for pain, a commonly used pain drug being tramadol, but there is some concern that tramadol should be avoided during early pregnancy as it may possibly cause birth defects. Additionally, cyclobenzaprine, which is both an anti-depressant and a muscle relaxant is often given to improve sleep in people with fibromyalgia and is not thought to be dangerous to the developing baby.
Who should NOT stop taking medication for fibromyalgia during pregnancy?
Non-medication approaches are an important component of fibromyalgia treatment, so some women may be able to stop their medication for a period.
What should I know about choosing a medication for my fibromyalgia during pregnancy?
You may find Pregistrys expert reports about the individual medications to treat fibromyalgia here. Additional information can also be found in the sources listed at the end of this report.
What should I know about taking a medication for my fibromyalgia when I am breastfeeding?
SSRI medications given to the mother are considered fairly safe for a nursing infant, as there is very little absorption into breastmilk. Breastfeeding is not recommended for mothers who are taking tramadol. It is not yet clear whether a mother taking cyclobenzaprine presents any risk to her nursing infant.
What alternative therapies besides medications can I use to treat my fi
bromyalgia during pregnancy?
Cognitive-behavioral therapy, and other psychotherapies can be effective, either alone, or in combination with medications to improve your mood, your tolerance of pain, and your overall function. Regular exercise also has been shown to improve the condition. Consider finding a pain specialty team that can help treat your fibromyalgia – this team would include a doctor, a psychiatrist, a pharmacist, a physical therapist, and possibly other health professionals who can help you manage your pain.
What can I do for myself and my baby when I have fibromyalgia during pregnancy?
Follow your doctors recommendations, including getting on an exercise program thats appropriate for pregnancy, and considering behavioral treatments.
Resources for fibromyalgia in pregnancy:
For more information about fibromyalgia during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles:
- Mayo Clinic: Fibromyalgia
- Cleveland Clinic: Understanding Fibromyalgia