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 Fibromyalgia 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 Fibromyalgia 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.
Who Gets Fibromyalgia
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 Fibromyalgia. The disease is estimated to affect 1 in 100 people.
Pain and Stiffness
Everyone with Fibromyalgia 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.
The pain with Fibromyalgiacan be quite variable. It can fluctuate and people with Fibromyalgia can have good days and bad days. It can also be aggravated by stress, lack of sleep, physical activity, and occasionally even the weather. Pain is usually worse after physical activity and can last for several days.
While pain from Fibromyalgia can be severe, with this disease there is nothing actually wrong with the muscles or joints, so there is no tissue damage.
One of the worst symptoms of Fibromyalgia is when extreme fatigue is associated with the pain and stiffness. This can be very debilitating.
Other associated symptoms of Fibromyalgia include difficulty concentrating, difficulty remembering, trouble sleeping, emotional changes, migraines, headaches, depression, anxiety, restless legs syndrome, irritable bowel and an irritable bladder.
Fibromyalgia is diagnosed by physicians through the process of elimination to rule out other diseases with similar symptoms. It can be confusing to diagnose the disease because it does not cause obvious damage to tissues.
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 Fibromyalgia 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 Fibromyalgia 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 is thought to happen because the nerves and brain amplify pain signals. People with Fibromyalgia 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 Fibromyalgia are entirely normal.
Researchers believe that Fibromyalgia 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 Fibromyalgia 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 Fibromyalgia isn’t visually apparent or obvious, others might not understand or believe what you are going through. This can be frustrating.
The majority of cases of Fibromyalgia occur after a stressful incident, such as an emotional or physical injury. For instance, a car accident or another medical illness could trigger Fibromyalgia.
There is no simple cure for Fibromyalgia. Most treatments are aimed at specific symptoms of Fibromyalgia, such as pain and fatigue.
One of the most powerful tools against Fibromyalgia is education: the more you know about it, the better off you will be.
Cognitive Behavioural Therapy
Cognitive Behavioural Therapy can be helpful for people with Fibromyalgia. This type of talk therapy involves teaching patients how to deal with the pain and fatigue of Fibromyalgia. They learn practical tips on how to ease pain symptoms and fatigue.
Cognitive Behavioural Therpay 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 Fibromyalgia to take care of.
A regular exercise routine is very important for patients with Fibromyalgia. At first the exercise may feel very painful but starting slowly and regularly can improve symptoms.
Good exercises for Fibromyalgia include walking, biking, swimming, and water aerobics.
Tai Chi has also been found to improve the symptoms of Fibromyalgia.
An exercise program can be developed with the guidance of an experienced physiotherapist.
There are days when people with Fibromyalgia feel better. On those days many people tend to “over do it” and this results in a flare of their Fibromyalgia 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 Fibromyalgia 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 Fibromyalgia 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 Fibromyalgia 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 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 Fibromyalgia. 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.
Serotonin-Norepinephrine Reuptake Inhibitors and Selective Serotonin Reuptake Inhibitors
Drugs called Serotonin-norepinephrine reuptake inhibitors can be used to reduce pain caused by Fibromyalgia. A well known example is Cymbalta (duloxetine). Occasionally Selective serotonin reuptake inhibitors, can be effective. A well known example is Prozac (fluoxetine).
Lyrica (Pregabalin) 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 Fibromyalgia.