The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) sponsors research that will improve scientists' understanding of the specific problems that cause or accompany Fibromyalgia (FM), in turn helping them to develop better ways to diagnose, treat, and prevent this medical condition.

The research on FM 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 FM 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 NIAMS-supported researchers are focusing on ways the body processes pain to better understand why people with FM have increased pain sensitivity.

Previous research has shown that people with FM have reduced blood flow to parts of the brain that normally help the body deal with pain. In one new NIAMS-funded study, researchers will be using imaging technology called positron emission tomography (PET) to compare blood flow in the brains of women who have FM with those who do not. In both groups, researchers will study changes in blood flow that occur in response to painful stimuli.

Researchers speculate that female reproductive hormones may be involved in the increased sensitivity to pain characteristic of FM. New research will examine the role of sex hormones in pain sensitivity, in reaction to stress, and in symptom perception at various points in the menstrual cycles of women with FM and of women without it. The results from studying these groups of women will be compared with results from studies of the same factors in men without FM over an equivalent period of time.

Another line of NIAMS-funded research involves developing a rodent model of FM pain. Rodent models, which use mice or rats that researchers cause to develop symptoms similar to FM in humans, could provide the basis for future research into this complex condition.

Understanding Stress

Medical evidence suggests that a problem or problems in the way the body responds to physical or emotional stress may trigger or worsen the symptoms of any illness, including FM. Researchers funded by NIAMS are trying to uncover and understand these problems by examining chemical interactions between the nervous system and the endocrine (hormonal) system. Scientists know that people whose bodies make inadequate amounts of the hormone cortisol experience many of the same symptoms as people with FM, so they also are exploring whether there is a link between the regulation of the adrenal glands, which produce cortisol, and FM.

Another NIAMS-funded study suggests that exercise improves the body's response to stress by enhancing the function of the pituitary and adrenal glands. The hormones produced by these two endocrine glands are essential to regulating sleep and emotions as well as processing pain.

Improving Sleep

Researchers supported by NIAMS are investigating ways to improve sleep for people with FM whose sleep problems persist despite treatment with medications. One team has observed that FM patients with persistent sleep problems share characteristics with people who have insomnia, such as having erratic sleep and wake schedules and spending too much time in bed. This team is testing whether strategies developed to help insomnia patients will also help people with FM achieve deep sleep, which eases pain and fatigue. Preliminary results show that sleep education, which teaches good sleep habits, and cognitive behavioral therapy, which includes sleep education and a regimen to correct poor habits and improper sleep schedules, both reduce insomnia.

Looking for the family connection, because FM appears to run in families, one group of NIAMS-supported researchers is working to identify whether a gene or genes predispose people to the condition.

Another team is trying to determine whether FM is more common in people with other conditions, such as serious mood disorders, that tend to run in families. Specifically, the group is studying the prevalence of psychiatric disorders and arthritis and related disorders in people with FM and their first-degree relatives (parents, children, sisters, and brothers) as compared to people with rheumatoid arthritis and their relatives. The group is exploring whether clusters of conditions exist in families, which might shed light on shared risk factors or disease processes.

Studying and Targeting Treatments

NIAMS recently funded its first study of a drug treatment for FM. The study will measure the effectiveness of gabapentin, an anticonvulsant medication, in reducing symptoms of FM. Gabapentin has been found to relieve chronic pain caused by nervous system disorders, and it was recently approved by FDA for the treatment of persistent, severe pain that can follow an episode of shingles.

Scientists recognize that people with FM often fall into distinct subgroups that adapt to and cope with their symptoms differently. They also realize that these subgroups may respond to treatments differently. One NIAMS-funded team of researchers has divided people with FM into three groups based on how they cope with the condition. Relative to other chronic pain patients, those in the first group have higher levels of pain and report more interference in their life due to pain. They also have higher levels of emotional distress, feel less control over their lives, and are less active.

The second group reports receiving less support from others, higher levels of negative responses from significant others, and lower levels of supportive responses from significant others. Those in the third group are considered adaptive copers; they have less pain, report less interference in their lives due to pain, and have less emotional distress. Members of this last group feel more control over their lives and are more active. On the premise that the better you understand the subgroups, the better you can tailor treatments to fit them, the researchers now are trying to design and test different programs for each group, combining physical therapy, interpersonal skills training, and supportive counseling.

Research on Complementary and Alternative Medicine (CAM)

According to reviewers who have assessed the research on CAM and Fibromyalgia (FM), much of the research is still preliminary, and evidence of effectiveness for the various therapies used is limited.

Research on Acupuncture

Stimulation of anatomical points with thin metallic needles—for FM has produced mixed results. One review article notes that three studies found some evidence to support the use of electroacupuncture (in which the needles are pulsed with electric current). However, the effects of electroacupuncture in these studies were mostly short lived, and two studies of traditional acupuncture had negative results.

Some researchers believe that low levels of magnesium may contribute to FM. However, there is no conclusive scientific evidence that magnesium supplements relieve FM symptoms. Two small studies had conflicting results.

A review of the research on massage therapy for FM notes only modest, preliminary support. Two studies had some positive findings, but two others found either no benefits or only short-term improvements.

Supplements containing the amino acid derivative SAMe are used for a variety of conditions. Although several small studies of SAMe for FM have had mixed results, there is some evidence of a benefit. Reviewers conclude that more research is needed.

Finally, according to reviewers, research evidence is insufficient to draw conclusions about the effectiveness of other CAM treatments—biofeedback, chiropractic care, hypnosis, and magnet therapy—used for FM.

NCCAM Research on Fibromyalgia

The National Center for Complementary and Alternative Medicine (NCCAM) funds clinical trials that look at CAM for FM. Recent projects include studies of:

• The effects of tai chi on FM patients' musculoskeletal pain, fatigue, sleep quality, psychological distress, physical performance, and health status.


• Brain-imaging techniques for determining whether acupuncture relieves pain due to FM.


• The effectiveness of a form of electroencephalograph (EEG) biofeedback in treating FM.