Fibromyalgia is a baffling illness. No one is sure what causes it. Some doctors even question whether it’s real. But fibromyalgia is distressingly real to the estimated 4 million Americans who suffer it.

Overwhelmingly, this condition affects adult women. Frederick Wolfe, M.D., and colleagues at the University of Kansas School of Medicine in Wichita, surveyed 3,000 residents of that city, and discovered that 3.4 percent of the women had fibromyalgia, while the condition affected only 0.5 percent of the men. Contrary to the conventional wisdom that fibromyalgia is a young women’s ailment, Dr. Wolfe’s group also found that fibromyalgia becomes more common with age. Women from 50 to 80 are at greatest risk. Other risk factors include divorce and having a high school education, but no college.

Doctors first identified fibromyalgia in 1843, and thought it involved muscle inflammation, hence it’s original name, fibrositis—”itis” for inflammation. But over time, doctors realized that there’s no inflammation, just pain, and they changed the name to fibromyalgia—”my” means muscles, “algia” pain.

According to the American College of Rheumatology, fibromyalgia involves at least three months of widespread flu-like muscle and body aches with pain affecting at least 11 of 18 specific points around your body, plus sleep problems, and often fatigue, chronic headaches, numbing or tingling sensations, irritable bowel syndrome, mental fuzziness, and symptom changes in response to activity, stress, or changing weather. Fibromyalgia is often debilitating, but rarely disabling. Most employed people who have it continue to work full-time.

Rheumatologist Stuart Silverman, M.D., medical director of the Fibromyalgia Rehabilitation Program at Cedars Sinai Medical Center in Los Angeles, speculates that the condition develops in response to some stress—an injury, infection, or possibly some environmental chemical exposure—that somehow alters your brain chemistry in ways that amplify your perception of pain, and disrupt your muscle metabolism and ability to enjoy restful sleep.

Some experts believe that fibromyalgia, chronic fatigue syndrome (CFS), and multiple chemical sensitivities are closely related. In one study of 30 people with each of these conditions, researchers at Harborview Medical Center in Seattle, found that all three caused “remarkably similar symptoms.” Some experts even speculate that fibromyalgia and chronic fatigue are the same illness with different symptoms predominating—pain in fibromyalgia, fatigue in CFS.

While fibromyalgia is chronic and painful, it is not life-threatening, and usually does not get worse over time.

Because of the dozens of possible symptom permutations, fibromyalgia can be mistaken for an enormous number of more serious diseases, including: systemic lupus erythematosus (SLE), osteo- or rheumatoid arthritis, and underactive thyroid gland (hypothyroidism), among others. It’s important to get professionally diagnosed. Your family doctor may be able to do it, or you might need to consult a rheumatologist.

The key to curing fibromyalgia is to re-normalize your brain chemistry. Drugs can help, Dr. Silverman says, but for permanent relief, he recommends a combination of four approaches: good nutrition, regular exercise, stress management, and sleep retraining to increase the restfulness of your sleep.

Fibromyalgia remains mysterious. But at the Cedars Sinai program, most people reduce their symptom scores by about half in six weeks, and those who continue to follow the program’s recommendations improve an average of another 30 percent by three months later.

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