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Fibromyalgia

Fibromyalgia is a disorder that causes muscle pain and fatigue. People with fibromyalgia have “tender points” on the body. Tender points are specific places on the neck, shoulders, back, hips, arms, and legs. These points hurt when pressure is put on them.

fibromyalgia
fibromyalgia

Fibromyalgia, or fibromyalgia syndrome, is a condition that causes aches and pain all over the body. People with fibromyalgia often experience other symptoms, such as extreme tiredness or sleeping, mood, or memory problems.

Fibromyalgia affects more women than men. The pain, extreme tiredness, and lack of sleep that fibromyalgia causes can affect your ability to work or do daily activities. Treatment can help relieve
pain and help prevent flare-ups of symptoms.

Fibromyalgia is a long-lasting or chronic disorder that causes muscle pain and fatigue (feeling tired). If you have fibromyalgia, you have pain and tenderness throughout your body. Sometimes you may have two or more chronic pain conditions at the same time, such as:

People with fibromyalgia may also have other symptoms, such as

  • Trouble sleeping
  • Morning stiffness
  • Headaches
  • Painful menstrual periods
  • Tingling or numbness in hands and feet
  • Problems with thinking and memory (sometimes called “fibro fog”)

Photograph of a woman sitting on a couch

No one knows what causes fibromyalgia. Anyone can get it, but it is most common in middle-aged women. People with rheumatoid arthritis and other autoimmune diseases are particularly likely to develop fibromyalgia. There is no cure for fibromyalgia, but medicine can help you manage your symptoms. Getting enough sleep, exercising, and eating well may also help.

What are the signs and symptoms of fibromyalgia?
What are the signs and symptoms of fibromyalgia?

What Are the Symptoms of Fibromyalgia?

Symptoms of fibromyalgia include:

  1. Widespread Pain: The hallmark symptom of fibromyalgia is chronic, widespread pain that affects multiple areas of the body. This pain is often described as a deep, persistent ache and can vary in intensity.
  2. Chronic muscle pain, muscle spasms, or tightness
  3.  Difficulty remembering, concentrating, and performing simple mental tasks (“fibro fog”)
  4. Tender Points: While less emphasized in recent diagnostic criteria, some individuals with fibromyalgia experience increased sensitivity and pain at specific tender points on the body, including the neck, shoulders, chest, lower back, hips, elbows, and knees.
  5. Fatigue: Moderate or severe fatigue and decreased energy. Persistent, unrelenting fatigue is a common symptom of fibromyalgia. This fatigue is often not relieved by rest and can be severe enough to interfere with daily activities.
  6. Sleep Disturbances: Sleep problems are a frequent component of fibromyalgia. Individuals may experience difficulties falling asleep, staying asleep, or experiencing restorative sleep. This can contribute to increased fatigue and worsen pain.
  7. Cognitive Issues: Many people with fibromyalgia report difficulties with memory, concentration, and clear thinking. This is often referred to as “fibro fog.”
  8. Stiffness: Morning stiffness and joint stiffness are common complaints in fibromyalgia. Stiffness upon waking or after staying in one position for too long
  9. Headaches: Frequent tension-type headaches and migraines are often associated with fibromyalgia.
  10. Irritable Bowel Syndrome (IBS): Gastrointestinal symptoms like abdominal pain, bloating, diarrhea, and constipation can co-occur with fibromyalgia.
  11. Depression and Anxiety: Emotional symptoms, such as depression and anxiety, are often linked to fibromyalgia. The chronic pain and limitations it imposes can take a toll on mental health.
  12. Numbness and Tingling: Some individuals may experience sensations of numbness or tingling in their extremities.
  13. Sensitivity to Temperature and Noise: Increased sensitivity to temperature changes and noise can be experienced by people with fibromyalgia.
  14. Muscle Weakness: Some individuals may feel weakness in their muscles, particularly after physical activity or during periods of fatigue.
  15. Sensitivity: Heightened skin sensitivity, where even light pressure or touch can cause discomfort, is sometimes reported. Sensitivity to one or more of the following: odors, noise, bright lights, medications, certain foods, and cold
  16.  Abdominal pain, bloating, nausea, and constipation alternating with diarrhea (irritable bowel syndrome)
  17.  Numbness or tingling in the face, arms, hands, legs, or feet
  18. Increase in urinary urgency or frequency (irritable bladder)
  19. Reduced tolerance for exercise and muscle pain after exercise
  20. A feeling of swelling (without actual swelling) in the hands and feet

Fibromyalgia symptoms may intensify depending on the time of day — morning, late afternoon, and evening tend to be the worst times. Symptoms may also get worse with fatigue, tension, inactivity, changes in the weather, cold or drafty conditions, overexertion, hormonal fluctuations (such as just before your period or during menopause), stress, depression, or other emotional factors.

Who Gets Fibromyalgia?

Anyone can get this disorder, though it occurs most often in women and often starts in middle age. If you have certain other diseases, you may be more likely to have fibromyalgia. These diseases include:

If you have a family member with fibromyalgia, you may be more likely to get the disorder.

What Causes Fibromyalgia?

The exact cause of fibromyalgia is not well understood, and it is believed to be a complex interplay of multiple factors. Several theories and contributing factors have been proposed, but the condition’s origin remains elusive. Some factors that may play a role in the development of fibromyalgia include:

  1. Genetics: There appears to be a genetic component to fibromyalgia, as it can run in families. Certain genetic variations may predispose individuals to be more susceptible to the condition.
  2. Abnormal Pain Processing: Fibromyalgia is thought to be related to how the brain and nervous system process pain signals. People with fibromyalgia may have heightened sensitivity to pain and an abnormal response to painful stimuli.
  3. Neurochemical Imbalances: There may be imbalances in neurotransmitters, such as serotonin, norepinephrine, and dopamine, which play a role in mood regulation and pain perception. These imbalances could contribute to the symptoms of fibromyalgia.
  4. Physical or Emotional Trauma: Physical trauma, such as car accidents or injuries, and emotional trauma, such as post-traumatic stress disorder (PTSD), may trigger or exacerbate fibromyalgia symptoms in some individuals.
  5. Infections: Some infections, like the Epstein-Barr virus and Lyme disease, have been associated with the onset of fibromyalgia symptoms in some cases. It’s unclear whether these infections directly cause fibromyalgia or if they trigger it in susceptible individuals.
  6. Autoimmune Factors: While fibromyalgia is not classified as an autoimmune disease, some individuals with the condition may have abnormal immune responses that contribute to their symptoms.
  7. Hormonal Factors: Hormonal changes, particularly in women, have been linked to the development or exacerbation of fibromyalgia symptoms. This may explain why the condition is more common in women.
  8. Lifestyle and Environmental Factors: Poor sleep, stress, physical inactivity, and an unhealthy diet can contribute to the development and worsening of fibromyalgia symptoms.

It’s important to note that fibromyalgia is a complex and multifaceted condition, and it may not have a single, specific cause. Instead, it likely results from a combination of genetic predisposition, environmental factors, and individual vulnerabilities.

Sometimes, fibromyalgia can develop on its own. Fibromyalgia tends to run in families, and some scientists think that a gene or genes could make you more likely to develop fibromyalgia. The genes could make you react strongly to things that other people would not find painful.

How is Fibromyalgia Diagnosed?

Diagnosing fibromyalgia can be challenging because there are no specific laboratory tests or imaging studies that can definitively confirm the condition. Instead, the diagnosis of fibromyalgia is typically made based on a combination of clinical evaluation, medical history, and the presence of specific symptoms. Here is how fibromyalgia is generally diagnosed:

  1. Medical History: The process often begins with a thorough medical history. Your healthcare provider will ask about your symptoms, their duration, and their impact on your daily life. They may inquire about family history, previous medical conditions, and any trauma or stressors that might have triggered or worsened your symptoms.
  2. Physical Examination: A physical examination is a crucial part of the diagnostic process. Your healthcare provider will typically check for the presence of tender points on your body. These tender points are specific areas where pain is often more pronounced in fibromyalgia patients. While the concept of tender points has been somewhat de-emphasized in more recent diagnostic criteria, they are still sometimes used to help confirm the diagnosis.
  3. Symptom Assessment: Fibromyalgia is characterized by a range of symptoms, including widespread pain, fatigue, sleep disturbances, and cognitive difficulties (often referred to as “fibro fog”). Your healthcare provider will assess the presence and severity of these symptoms.
  4. Exclusion of Other Conditions: Since fibromyalgia symptoms can overlap with other medical conditions, your healthcare provider will typically perform tests to rule out other conditions that could be causing your symptoms. These conditions may include rheumatoid arthritis, lupus, multiple sclerosis, and thyroid disorders, among others.
  5. Diagnostic Criteria: The diagnosis of fibromyalgia may be based on widely accepted criteria, such as those established by the American College of Rheumatology (ACR). The 1990 ACR criteria required the presence of tender points, but the 2010 ACR criteria placed greater emphasis on assessing widespread pain and other associated symptoms. According to the 2010 criteria, fibromyalgia can be diagnosed if the following conditions are met:
    • Widespread pain lasting at least three months.
    • Tender points are no longer required for diagnosis.
    • The absence of another underlying medical condition that could explain the symptoms.
  6. Patient Questionnaires: Your healthcare provider may ask you to complete questionnaires that assess your pain, fatigue, and other symptoms. These questionnaires can help in evaluating the severity and impact of fibromyalgia on your life.
  7. Laboratory Tests: Although there are no specific blood tests to diagnose fibromyalgia, your healthcare provider may order blood tests to rule out other conditions or to assess factors such as inflammation or thyroid function.

It’s important to note that fibromyalgia is a diagnosis of exclusion, meaning that other potential causes of your symptoms must be ruled out before a fibromyalgia diagnosis can be made. The process can take time, and it often involves multiple healthcare visits and assessments. A rheumatologist or a healthcare provider experienced in diagnosing and managing fibromyalgia is typically best equipped to make an accurate diagnosis and develop a treatment plan tailored to your needs.

You may see many doctors before receiving the diagnosis. This can happen because the main symptoms of fibromyalgia, pain and fatigue, are similar to many other conditions. Doctors often have to rule out other causes of these symptoms before making a diagnosis of fibromyalgia.

Doctors use guidelines to help diagnose fibromyalgia, which can include:

  • A history of widespread pain lasting more than 3 months.
  • Physical symptoms including fatigue, waking unrefreshed, and cognitive (memory or thought) problems.
  • The number of areas throughout the body in which you had pain in the past week.

How is Fibromyalgia Treated?

The treatment of fibromyalgia typically involves a multi-faceted approach that combines medication, lifestyle changes, and self-care strategies to manage the symptoms and improve the overall quality of life for individuals with the condition. Here are some common treatments and strategies for fibromyalgia:

  1. Medications:
    • Pain Relievers: Over-the-counter pain relievers like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) may provide some relief, although they are often less effective in managing fibromyalgia pain.
    • Antidepressants: Certain antidepressant medications, such as tricyclic antidepressants (TCAs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), can help reduce pain and improve sleep. Duloxetine (Cymbalta) and amitriptyline (Elavil) are examples.
    • Antiseizure Medications: Medications like pregabalin (Lyrica) and gabapentin (Neurontin) may be prescribed to manage pain and improve sleep.
    • Muscle Relaxants: Medications like cyclobenzaprine (Flexeril) may help relieve muscle spasms.
    • Pain Medications: In some cases, opioid medications may be prescribed for severe pain, but these are typically considered a last resort due to the risk of dependence and addiction.
  2. Physical Therapy: Physical therapy can be beneficial in improving strength, flexibility, and mobility. Therapists can design exercise programs tailored to the individual’s needs and teach techniques for managing pain.
  3. Exercise: Regular, low-impact exercise, such as walking, swimming, or gentle yoga, can help reduce pain, improve fitness, and enhance overall well-being. It’s important to start slowly and gradually increase the intensity of exercise.
  4. Cognitive Behavioral Therapy (CBT): CBT is a type of counseling that can help individuals with fibromyalgia manage pain, cope with stress, and improve sleep. It can be particularly effective in addressing the emotional aspects of living with chronic pain.
  5. Stress Management: Learning stress-reduction techniques, such as relaxation exercises, deep breathing, and mindfulness meditation, can help manage the emotional impact of fibromyalgia and reduce symptom severity.
  6. Sleep Management: Improving sleep quality is crucial in fibromyalgia management. Establishing a consistent sleep routine, creating a comfortable sleep environment, and avoiding caffeine and electronic devices before bedtime can be helpful.
  7. Diet and Nutrition: Maintaining a balanced diet, staying hydrated, and reducing the consumption of caffeine and alcohol can contribute to symptom management. Some individuals find relief by identifying and eliminating specific dietary triggers.
  8. Alternative Therapies: Complementary and alternative therapies like acupuncture, chiropractic care, and massage therapy may provide relief for some individuals.
  9. Support Groups: Joining a support group for fibromyalgia can offer emotional support and practical advice. It can be reassuring to connect with others who understand what you’re going through.
  10. Medication Management: Regularly reviewing and adjusting medications with a healthcare provider is important to ensure the most effective treatment plan.

It’s essential to work closely with a healthcare provider to develop an individualized treatment plan tailored to your specific needs and symptoms.

Only three medications, duloxetine, milnacipran, and pregabalin are approved by the U.S. Food and Drug Administration (FDA) for the treatment of fibromyalgia. Duloxetine was originally developed for and is still used to treat depression. Milnacipran is similar to a drug used to treat depression but is FDA approved only for fibromyalgia. Pregaballin is a medication developed to treat neuropathic pain (chronic pain caused by damage to the nervous system).

 

How to Prevent Fibromyalgia ?

Preventing fibromyalgia is challenging because the exact cause of the condition is not well understood, and it likely involves a combination of genetic, environmental, and other factors. While there is no guaranteed way to prevent fibromyalgia, there are some strategies that may help reduce the risk of developing it or minimize its impact. Here are some steps you can consider:

  1. Maintain a Healthy Lifestyle:
    • Regular Exercise: Engaging in regular, low-impact exercise can help improve your overall health and well-being. Staying physically active may reduce the risk of developing fibromyalgia or help manage symptoms if you have the condition. Be sure to choose exercise that you enjoy and can sustain.
    • Balanced Diet: A healthy diet can contribute to your overall well-being. Consuming a diet rich in fruits, vegetables, lean proteins, and whole grains may support your immune system and help manage inflammation.
    • Stress Management: Chronic stress can exacerbate fibromyalgia symptoms. Learning and practicing stress management techniques, such as mindfulness, meditation, or relaxation exercises, can be beneficial.
  2. Quality Sleep: Good sleep hygiene is important in reducing the risk of developing fibromyalgia or managing its symptoms. Maintain a consistent sleep schedule, create a comfortable sleep environment, and avoid caffeine and electronic devices before bedtime.
  3. Avoid Trauma and Injuries: While you can’t always prevent accidents or injuries, taking safety precautions and using seatbelts and protective gear when necessary can help reduce the risk of physical trauma that could potentially trigger or worsen fibromyalgia symptoms.
  4. Address Infections Promptly: Some infections have been associated with the onset of fibromyalgia symptoms. Addressing infections promptly and following appropriate medical treatment may help reduce the risk of developing the condition.
  5. Maintain Emotional Well-being: Emotional well-being plays a role in the development and management of fibromyalgia. Seeking therapy or counseling for emotional challenges, managing mental health conditions like depression and anxiety, and building strong support networks can be important.
  6. Genetic Counseling: If you have a family history of fibromyalgia, consider genetic counseling to better understand your risk factors and potential prevention strategies.

Living With Fibromyalgia

There are many things you can do to while living with fibromyalgia, including:

  • Getting enough sleep.
  • Exercising.
  • Adjusting your work demands.
  • Eating well.

Getting Enough Sleep

Getting enough sleep and the right kind of sleep can help ease the pain and fatigue of fibromyalgia. You may have problems such as pain, restless legs syndrome, or brainwave changes that interfere with restful sleep. It is important to discuss any sleep problems with your doctor, who can prescribe or recommend treatment.

Tips for Good Sleep

  • Keep regular sleep habits. Try to get to bed and wake up at the same time every day.
  • Avoid caffeine and alcohol in the late afternoon and evening. Even though alcohol can make you feel sleepy, drinking any close to bedtime can disturb your sleep.
  • Time your exercise. Regular daytime exercise can help improve your nighttime sleep. However, exercise within 3 hours of bedtime can keep you awake.
  • Avoid daytime naps. Sleeping in the afternoon can interfere with nighttime sleep. If you feel like you cannot get by without a nap, set an alarm for 1 hour. When it goes off, get up and start moving.
  • Reserve your bed for sleeping. Watching TV, reading, or using a laptop or phone in bed can keep you awake.
  • Keep your bedroom comfortable. Try to keep your bedroom dark, quiet, and cool.
  • Avoid drinking liquids and eating spicy meals before bed. Heartburn and late-night trips to the bathroom can interfere with your sleep.
  • Wind down before bed. Avoid working right up to bedtime. Try some relaxing activities that get you ready for sleep, such as listening to soft music or taking a warm bath.

Exercising

Although pain and fatigue may make exercise and daily activities difficult, it is important for you to be as physically active as possible. Research shows that regular exercise is one of the most useful treatments for fibromyalgia. If you have too much pain or fatigue to do exercise, you should begin with walking or other gentle exercise. Over time you can build your strength.

Adjusting Your Work Life

You can continue to work when you have fibromyalgia, but may have to make some changes to do so. For example, you may need to cut down the number of hours they work, switch to a less demanding job, or adapt your current job. An occupational therapist can help you make changes at work. For example, they can help design a more comfortable workstation or find more efficient and less painful ways to lift.

Eating well

Although some people with fibromyalgia report feeling better when they eat or avoid certain foods, no specific diet has been proven to influence fibromyalgia. Of course, it is important to have a healthy, balanced diet. Not only will proper nutrition give you more energy and make you generally feel better, it will also help you avoid other health problems.

 

Fibromyalgia_11-08-2015

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