Fibromyalgia (FM) is a long-term (chronic) pain syndrome characterized by symptoms of widespread body pain, stiffness, and fatigue. It is a disorder of pain regulation where pain sensations are amplified and where sensations that are not normally painful can hurt.
The pain and stiffness of FM are usually worse in the morning and it can take hours before the body loosens up. Fibromyalgia pain can be quite variable and can be aggravated by stress, lack of sleep, physical activity, and even the weather.
The exact causes of FM are not fully understood and there may be multiple triggers involved. Researchers believe that it is a neurologic (brain) problem related to how the body transmits and interprets pain signals.
Fibromyalgia predominantly affects women. Men can also be affected but cases are much less common. The disease affects mostly young to middle-aged people. The majority of cases occur after a stressful incident, such as an emotional or physical injury. For example, a car accident or another medical illness could trigger FM. The disease is estimated to affect 1 in 100 people.
Everyone with fibromyalgia (FM) will experience its symptoms differently. The most common symptom is pain and stiffness throughout the entire body.
In most cases pain and stiffness is worse in the morning, slowly loosening up during the day. It can fluctuate and people with FM can have good days and bad days. The pain with FM can be quite variable. It can be aggravated by stress, lack of sleep, physical activity, and occasionally even the weather. After physical activity, pain is usually worse and can then last for several days.
One of the worst symptoms of FM is when extreme fatigue is associated with the pain and stiffness. This can be very debilitating.
Other associated symptoms of FM include difficulty concentrating, difficulty remembering, trouble sleeping, emotional changes, migraines, headaches, depression, anxiety, restless legs syndrome, irritable bowel and an irritable bladder.
While pain from FM can be severe, with this disease there is nothing actually wrong with the muscles or joints, so there is no tissue damage.
Fibromyalgia is diagnosed by physicians through the process of elimination to rule out other diseases with similar symptoms. Since the disease does not cause obvious damage to tissues, it can be confusing to diagnose.
Physicians will conduct a thorough physical exam, and thoroughly review their patient’s medical history. A thorough series of blood tests helps to rule out other conditions with similar symptoms. When all other illnesses with similar symptoms are ruled out, a diagnosis of FM can be made.
It can be very tiring for patients to be subjected to many tests that do not provide answers. Despite the fact that FM cannot be diagnosed by a scan or blood test, it is a very real disease.
A diagnosis can only be made by a health care provider.
Fibromyalgia (FM) is thought to happen because the nerves and brain amplify pain signals. People with FM feel muscle and joint pain when there actually is no tissue damage causing the pain.
It is important to understand that the joints and muscles in people with FM are entirely normal.
Researchers believe that FM is a neurologic (brain) problem. They believe the body has a problem in transmitting pain signals, and that the nerves and brain are not able to turn off painful stimuli as they normally would.
When the brain is bombarded with pain signals over a long period of time, nerves that normally shut off pain signals, called descending inhibitors die off. This means that pain signals can reach the brain in an uninhibited (limitless) way. Over time the brain becomes sensitized to pain so things that aren’t usually perceived as being painful, such as lightful touching of an arm, can feel very painful.
The exact cause of FM is not fully understood. The abnormal processing of pain signals may be triggered by a prior injury, viral illness or other autoimmune illness. Because the cause of FM isn’t visually apparent or obvious, others might not understand or believe what you are going through. This can be frustrating.
Fibromyalgia predominantly affects women. Men can also be affected but cases are much less common. This disease affects mostly young to middle-aged people. The majority of cases of FM occur after a stressful incident, such as an emotional or physical injury. For instance, a car accident or another medical illness could trigger FM.
There is no simple cure for FM. Most treatments are aimed at specific symptoms of FM, such as pain and fatigue. One of the most powerful tools against FM is education: the more you know about it, the better off you will be.
Cognitive Behavioural Therapy (CBT)
CBT can be helpful for people with fibromyalgia. This type of talk therapy involves teaching patients how to deal with the pain and fatigue of FM. They learn practical tips on how to ease pain symptoms and fatigue. CBT can help people with the disease take control of the extent to which symptoms of fibromyalgia bother them and interferes with their everyday activities.
Better Sleep Hygiene
Practicing proper sleep hygiene and getting plenty of sleep can significantly improve pain and fatigue levels in people with fibromyalgia. Improving sleep habits is one of the most important things for people diagnosed with FM to take care of.
A regular exercise routine is very important for patients with FM. At first the exercise may feel very painful but starting slowly and regularly can improve symptoms. Good exercises for FM include walking, biking, swimming, and water aerobics. Tai Chi has also been found to improve the symptoms of FM. An exercise program can be developed with the guidance of an experienced physiotherapist.
There are days when people with FM feel better. On those days many people tend to “over do it” and this results in a flare of their FM for the next few days. Activity should be moderated to not “over do it” on good days and to not “do too little” on days you are feeling sore.
Many patients with FM derive significant benefit by focusing on improving their lifestyle. This includes reducing or eliminating sources of stress, losing weight or maintaining a healthy weight, and proper nutrition with healthy foods.
Medications for Fibromyalgia
No medication can cure FM but the right medications can help to decrease the amount of pain and other symptoms. It is important to understand that medications are not “the answer” to completely control symptoms.
Some medications are available over-the-counter at a pharmacy without a prescription, while others must be prescribed by a doctor. People with FM should consult their doctor before taking any type of medication for their symptoms, to help them choose which one(s) might be the best to control their specific symptoms, and to help them understand any possible side effects.
Analgesics (Pain Relievers)
Simple analgesics (pain relievers) such as acetaminophen (paracetamol, Tylenol) or other anti-inflammatory drugs may be sufficient for some people’s pain symptoms.
For temporary pain relief when it is really necessary, short acting opiates such as Tylenol 3 or codeine may be used. These are medications that must be taken in small quantities and very carefully as it is easy to become dependent (addicted) on them. Patients taking narcotics should keep their doctor in the loop about how much and how frequently they take this type of pain medication.
It is wise to steer clear of longer-acting narcotic (opiate) medications such as Oxycontin because they are potentially addictive and are not helpful in the long run.
Amitriptyline is one of the most commonly used and oldest drugs that has been shown to help with FM. The medication belongs to a family called tricyclic antidepressants. It is taken in low doses right before bedtime to improve sleep and reduce chronic pain. The downside of this medication is that it can leave people feeling groggy in the morning. It is important to take the smallest dose possible to reduce symptoms and minimize the side effects.
SNRIs and SSRIs
Drugs called SNRIs (serotonin-norepinephrine reuptake inhibitors) can be used to reduce pain caused by fibromyalgia. A well known example is Cymbalta (duloxetine). Occasionally SSRIs (selective serotonin reuptake inhibitors), can be effective. A well known example is Prozac (fluoxetine).
Lyrica (Pragabalin) and Gabapentin
Lyrica (pregabalin) and gabapentin are effective medications for pain symptoms that work by blunting pain signals in the spinal cord. For some people with fibromyalgia, this is one of their most effective treatments.
Depending on specific symptoms, muscle relaxants such as cyclobenzaprine can be an effective way of reducing muscle stiffness and pain caused by FM.
Living with FM
The pain and stiffness caused by FM can sometimes limit people’s normal activities, including work. There are many things people can do to lessen the impact of FM on their work and daily routine.
We recommend adjusting features of the workplace to help make working with FM easier. For example, people that sit for much of the day can adjust the position of chairs and desks for proper posture. Vehicle seats can be adjusted to make driving more comfortable and reduce stress on joints and affected tissues.
Those who find out they have FM while they’re still young can consider choosing work that isn’t physically demanding on their joints and back.
Exercise is important to overall health. It also helps keep the joints moving properly, and helps protect them by strengthening the muscles around them.
The level and amount of exercise people with FM can do depends on the activity of their disease.
A trained arthritis physiotherapist is the best person to help design an exercise program tailored to the needs of patients with FM.
The following are some useful articles on exercising with arthritis:
Exercise and Arthritis: An article by arthritis physiotherapist Marlene Thompson
Exercising in a Flare: Another excellent article by Marlene Thompson on how to cope with flares through your exercise routine.
Alcoholic beverages are not an effective treatment for FM, and they can interact with many medications.
People with FM that plan on drinking should ask their doctor about possible negative interactions with the medications they take.
Some examples of medication that mixes poorly with alcohol includes, and is not limited to: the DMARDs methotrexate, Arava (leflunomide), and Imuran (azathioprine).
Smoking is not healthy for people with FM. It can make symptoms worse and harder to treat.
Research has shown that some arthritis medications do not work as well in people who smoke.
We recommend that smokers quit immediately to reduce the impact of their symptoms, improve the effectiveness of their medications, and improve their overall health.
Smoking significantly increases the risk of cardiovascular disease. The chronic (long-term) inflammation caused by rheumatic diseases like FM already increases this risk without a big extra boost from smoking.
Travel is still possible when you have FM.
It is best for people with this disease to get organized well in advance of a trip to ensure a smooth, comfortable, and enjoyable time.
Check out our Travel Checklist page.
Though FM does not particularly cause a loss of sex drive, it can cause pain, fatigue and emotional hardships. These hardships risk creating barriers to sexual needs, ability, and satisfaction.
People with FM can take comfort knowing that sex and intimacy can be maintained. In many cases, it can help draw partners closer together, especially through improved communication.
For more information on intimacy and arthritis, a great book is: Rheumatoid Arthritis: Plan to Win by Cheryl Koehn, Taysha Palmer and John Esdaile.
Fibromyalgia (FM) has no effect on fertility. The chances of getting pregnant for people with FM are the same as with people that don’t have it. FM also has no known effects on the developing fetus or the newborn.
The two main issues doctors worry about with FM and pregnancy are:
Patients with FM might be treated with a number of medications that can affect pregancies including NSAIDs, anti-TNF biologics, and occasionally DMARDs. It is important for people with FM who want to become pregnant to discuss their medications with their doctor and create a pre-pregnancy plan. A plan is important for a number of reasons. For example, discontinuing a particular medication for safety of the newborn might cause FM to flare, so its wise to have a plan in place to handle these possibilities.
Any type of arthritis that affects the pelvis or the hips can make vaginal delivery difficult. It is important for those planning pregnancy to discuss delivery options with an obstetrician.
Following the basics of healthy eating can help improve health and well-being in everyone, including those with FM. Keeping a healthy weight helps reduce the load on weight-bearing joints including the spine, hips, and knees, making it easier to live with the disease.
Unfortuantely, no special diet has ever been proven to significantly alter the course of FM or any other types of arthritis.
In addition, no known natural remedies or complementary therapies have been proven to help FM in any significant way.
People with FM should consult with their doctor to make sure that any supplements or alternative therapies they consume will not negatively interact with their medications.
Its very important for people with FM to attend regularly scheduled appointments with their rheumatologist, and promptly get any tests that are ordered by their doctors.
It is often very important that medications are taken exactly as prescribed. Patients should always talk to their doctor about any issues they experience, or if they would like to change anything.
Fibromyalgia is a chronic disease and a rheumatologist is the best partner in helping patients achieve the best quality of life possible.