Fibromyalgia is a condition characterized by widespread pain and tenderness in the muscles and associated soft tissues. It may be accompanied by sleep disturbances, fatigue, and memory and mood issues.
More than five million Americans over the age of 18 have been diagnosed with the condition. Fibromyalgia, which represents abnormal pain perception processing, is the second most common disorder that rheumatologists (specialists in diseases that affect your joints tendons, ligaments, bones, and muscles) encounter.
Although fibromyalgia can affect patients of either sex and at any age, it most commonly presents itself in young or middle-aged women.
Signs and Symptoms
Fibromyalgia is a syndrome that consists of many signs and symptoms.
- Persistent (happening consistently for three months or more) widespread pain, which must occur on both sides of your body and above and below your waist;
- Stiffness all over the body;
- Fatigue since sleep is often disrupted by pain;
- Impairment of your ability to focus, pay attention, and concentrate on mental tasks, which is sometimes referred to as “fibro fog”;
- Headaches and migraines;
- Tingling or numbness in the hands and/or feet;
- Pain in the face or jaw, including disorders of the jaw referable to temporomandibular joint syndrome (TMJ);
- Digestive problems, such as abdominal pain, bloating, constipation, and even irritable bowel syndrome (IBS), and;
- Multiple other unexplained symptoms, such as anxiety and/or depression, and functional impairment of activities of daily living.
Symptoms of fibromyalgia are commonly confused with those of arthritis. However, unlike arthritis, it causes muscle and soft tissue pain and has not been found to cause muscle or joint inflammation and damage.
In some cases, symptoms may begin after a physical trauma, surgery, infection, or significant psychological stress. In other cases, there is no single triggering event, so symptoms will gradually accumulate over time.
The cause of fibromyalgia is unknown. However, according to Mayo Clinic, experts “believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals.”
The most common risk factors for fibromyalgia include:
- Gender: Women are twice as likely to have fibromyalgia as men. In fact, 80 to 90 percent of people diagnosed with the condition are female.
- Age: Most people that are diagnosed are middle-aged. Additionally, you are more likely to develop the disease as you get older.
- Family History: You may be more likely to develop fibromyalgia if a relative — especially parents or siblings — also has the condition.
- Certain Medical Conditions: If you have osteoarthritis, rheumatoid arthritis, or lupus, you may be more likely to develop fibromyalgia.
Other potential risk factors have weak associations with the development of fibromyalgia. These include:
- Stressful or traumatic events, such as car accidents or post-traumatic stress disorder;
- Traumatic injuries;
- Illnesses, such as bacterial or viral infections, and;
Unfortunately, more research is needed to see if these possible risk factors for fibromyalgia are indeed real.
Screening and Prevention
Screening allows for identification of unrecognized disease or risk factor. At this moment, there are no recommendations regarding the efficacy of screening for fibromyalgia.
However, there are many unsettled questions concerning the concept of primary prevention (actions aimed at avoiding the manifestations of a disease) for fibromyalgia. In the case of fibromyalgia, primary prevention may consist of the immediate care of acute pain or treatment for mood disturbances, as there are no specific laboratory or instrumental tests to determine risk factors for the disease.
The goal of secondary prevention (actions aimed to reduce the impact of a disease or injury that has already occurred) is early detection of the disease when patients have no symptoms and interventions improve their outcomes. In addition, diagnostic or classification criteria are not universally accepted, depending on the medical specialty.
When to See a Doctor
If you suspect that you may have fibromyalgia, you should make an appointment with your doctor.
Before the said appointment, it would be best to write a list that includes:
- Detailed descriptions of your symptoms;
- Information about your past medical history;
- Information about the medical problems of your parents and/or siblings;
- All the medications and dietary supplements you take, and;
- Questions you want to ask your doctor.
Because many of the signs and symptoms of fibromyalgia can mimic other medical disorders, like arthritis or lupus, you may see several doctors before receiving a definitive diagnosis. As a result, an accurate diagnosis, along with early treatment, is paramount in the case of fibromyalgia. As such, you may receive a referral to a rheumatologist, a doctor who specializes in the treatment of arthritis and other similar conditions.
Fibromyalgia is a diagnosis of exclusion. As such, a thorough evaluation for the presence of other medical disorders is required before making a definitive diagnosis.
In the case of suspected fibromyalgia, your doctor will ask about your medical history and give you a thorough physical examination. If necessary, they may order certain tests such as X-rays and blood work. These measures allow them to rule out other possible diseases or illnesses.
There is no single blood test to confirm the diagnosis of fibromyalgia. So, doctors may use a combination of the following blood tests:
- Complete blood count;
- Erythrocyte sedimentation rate;
- Cyclic citrullinated peptide test;
- Rheumatoid factor;
- Thyroid function tests, and;
- Vitamin D levels.
In addition to X-rays, medical imaging tests such as full-body magnetic resonance imaging and brain computed tomography can be utilized to rule out most of the common causes of chronic pain and point to fibromyalgia. Originally, doctors would check 18 specific points (“trigger points”) on a person’s body to see how many of them were painful when pressed firmly. Revised guidelines no longer require such an examination. Lastly, your doctor may perform an evaluation to calculate your widespread pain index and symptom severity scores.
Fibromyalgia can cause chronic pain, disability, and decreased quality of life. Many people who have fibromyalgia also have other painful medical conditions, such as tension or migraine headaches, TMJ disorders, IBS, interstitial cystitis, anxiety, and depression.
Those with fibromyalgia may have complications such as:
- Higher Rates of Hospitalization: Those with fibromyalgia are twice as likely to be hospitalized.
- Higher Rates of Major Depression: Those with fibromyalgia are more than three times more likely to suffer from major depression. This depression may be the result of the frustration of dealing with this often-misunderstood condition.
- Higher Death Rates from Suicide and Injuries: While overall mortality is similar to the general population, death rates from suicide and injuries are higher among those with fibromyalgia.
- Higher Rates of Other Medical Conditions: Other medical conditions, such as osteoarthritis, rheumatoid arthritis, and lupus, usually occur when suffering from fibromyalgia.
Additionally, one’s ability to function at home or on the job may be impeded by the chronic pain and lack of sleep that comes with fibromyalgia.
While there is no cure for fibromyalgia, a variety of treatments are able to help control its symptoms.
Using medications to deal with fibromyalgia can help to reduce the pain and improve sleep.
Your doctor may prescribe over the counter pain relievers to help cope with the pain associated with fibromyalgia. Pain relievers that are often prescribed include:
- Acetaminophen (Tylenol),
- Ibuprofen (Advil)
- Naproxen sodium (Aleve), and;
- Tramadol (Ultram).
Opioids are not recommended since they can lead to dependence/addiction and may even worsen the pain over time.
The antidepressants duloxetine (Cymbalta) and milnacipran (Savella), which are generally prescribed at lower doses to treat depression, are approved by the Food and Drug Administration (FDA) for the treatment of fibromyalgia. They help ease pain, fatigue, and sleep difficulties associated with fibromyalgia.
While anti-seizure medications are designed to treat epilepsy, they are often useful in reducing pain and improving sleep. Helpful anti-seizure medications include gabapentin (Neurontin) and pregabalin (Lyrica).
These medications are often used in combination with antidepressants and anti-seizure drugs. Common anti-anxiety medications include:
- Alprazolam (Xanax);
- Temazepam (Restoril);
- Clonazepam (Klonopin);
- Buspirone (BuSpar), and;
There are plenty of therapies that help reduce the symptoms of fibromyalgia. Some examples include:
- Physical Therapy: Physical therapy will help teach patients exercises that will improve your strength, flexibility, and stamina, such as water-based exercises.
- Occupational Therapy: The focus of occupational therapy is to adjust your environment and the way you perform certain tasks, so you will put less stress on your body.
- Counseling: Talking with a counselor can help you develop strategies for dealing with stressful situations.
Using alternative therapies for pain and stress management are not new developments. In fact, quite a few of them have been practiced for thousands of years. However, their popularity on the rise in recent years — especially among people who have chronic illnesses.
These alternative therapies include:
- Acupuncture: Restores the balance of life forces in the body by inserts needles into the skin. Its effectiveness in relieving the symptoms associated with fibromyalgia is highly debated.
- Massage Therapy: According to Mayo Clinic, massage “can reduce your heart rate, relax your muscles, improve the range of motion in your joints, and increase the production of your body’s natural painkillers [endorphins].” Additionally, it can relieve stress and anxiety.
- Yoga and Tai Chi: Both yoga and tai chi combines meditation, slow movements, deep breathing, and relaxation. Plus, they improve flexibility and the range of motion in your joints.
Living with Fibromyalgia
Self-care is a major component in the management of fibromyalgia. If you have been diagnosed with fibromyalgia, the following self-care tips can help:
- Reduce Stress: Allow yourself time each day to relax and try stress management techniques, such as deep-breathing exercises or meditation.
- Get Adequate Sleep: Sufficient sleep can help with fatigue. In order to get enough sleep, make sure to practice good sleep habits. This includes going to bed and waking up at the same time each day and limiting napping during the day.
- Exercise Regularly: Exercises such as walking, swimming, biking, and water aerobics can help decrease the symptoms of fibromyalgia. As such, make sure to exercise for at least 30 minutes for most days of the week.
- Pace Yourself: Moderation is key, so keep your activity on an even level.
- Maintain a Healthy Lifestyle: This can include eating heart-healthy foods, limiting how much caffeine you have, and participating in activities that are enjoyable and fulfilling.
Diet is an integral aspect of care for fibromyalgia. Therefore, the following may contribute to an improvement in the symptoms of the disease:
- High-Energy Foods That Are Low in Sugar: Almonds, beans, oatmeal, avocado, and tofu are a few examples of foods that contain plenty of fiber but no added sugar.
- Avoiding Foods That Have Gluten: A 2014 study suggests that gluten sensitivity can contribute to fibromyalgia. As such, subscribing to a gluten-free diet will help deal with symptoms.
- Avoiding Fermentable Oligo-Di-Mono-Saccharides and Polyols (FODMAP): According to a recent study, a diet low in FODMAP could lead to decreasing pain levels in people with fibromyalgia.
- Not Eating Additives and Excitotoxins: A recent report has shown that excluding additives from one’s diet can significantly reduce pain in patients with fibromyalgia.
- Eating More Seeds and Nuts: There’s not much evidence to support a direct link between the benefits of eating more seeds and nuts, and an improvement in fibromyalgia symptoms. Despite that, they contain powerful micronutrients and minerals, which may be helpful for those with the condition.
Fibromyalgia affects approximately two percent of the adult population in the U.S.
As fibromyalgia is thought to be mediated by an abnormal amplification of painful sensations, patients diagnosed with the disease tend to be more sensitive to pain than people without fibromyalgia. Although it is not a life-threatening, deforming, or progressive disease, fibromyalgia can significantly decrease functional status and quality of life without proper diagnosis and treatment.