Fibromyalgia

Musculoskeletal

Fibromyalgia (FM) is a neurosensory disorder that causes chronic fatigue, stiffness, tenderness, and pain in the muscles, joints, and tendons. This chronic pain disorder usually occurs between the ages of 25 and 60 years of age and is most common in women (a small percentage of men also suffer from it. Fibromyalgia can be debilitating, leading to depression, missed days at work and school, and, in the worst case, homebound. Symptoms of FM often arise after a stressful event, such as surgery, infection, and psychological or physical trauma. New developments in the treatment of fibromyalgia along with lifestyle changes can significantly improve how sufferers feel. This article will explain the disorder in detail and will give you helpful tips on living with and managing the disorder.

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Symptoms

The symptoms of fibromyalgia are different for each person. The primary symptom that urges people to visit their doctor is generalized pain and weakness that does not go away and extreme fatigue.

Pain. Patients diagnosed with fibromyalgia experience chronic and widespread pain in one or many areas of the muscles, tendons, and joints. People with FM may experience what is referred to as “pressure” or tender places on joints and in specific places or points on their bodies. Doctors also look at pain in one or more pressure points that are significant to FM sufferers to diagnose fibromyalgia.

Fatigue and sleep disturbance. FMS causes chronic and severe fatigue that can be disabling and leave you feeling like you cannot get out of bed or perform usual tasks. Each person with FM will have a different experience with fatigue. However, a common description of fatigue is a generalized heaviness in the body and a feeling of tiredness not relieved by rest or sleep. Another symptom that contributes to this extreme fatigue is a lack of restful sleep. FM patients often report restless sleeping patterns with frequent nighttime awakenings and difficulty in falling asleep.

Other related symptoms. Fibromyalgia symptoms tend to be worse in the late evening or first thing in the morning. You may also feel worse in extreme temperatures (very hot or very cold). Excessive activity may drain you of your energy stores and it will take longer to rest and recover (often days). You may also feel worse around the time of your period or during times of stress. You may notice increased symptoms with certain fragrances, chemical household cleaners, lights and noises, medications, and some foods. Symptoms tend to come in “flares” where they are very severe for a while, then may lessen or even disappear completely for months to years. These symptoms are:

  • Joint and muscle stiffness
  • Trouble focusing or concentrating
  • Memory issues (brain fog, trouble with word recall)
  • Abdominal pain or bloating
  • Constipation
  • Migraine headaches
  • Jaw pain
  • Anxiety
  • Depression
  • Irritated bladder
  • Inability to tolerate exercise
  • Feeling swollen or puffy

Risk Factors

The causes of fibromyalgia are not clear, but here are a few factors that may increase the chances of developing FM. These include:

Nervous system and psychological trauma. Patients with fibromyalgia have shown dysfunction in their autonomic nervous system which could be caused by excessive stress in early childhood. People with FM often have trouble with coping, depression, and anxiety especially related to childhood abuse and dysfunctional parents.

Genetic. Fibromyalgia is often seen in close family members with first-degree relatives of patients with FM being 8.5 times more likely to have the disorder as compared to the general population.

Infection. Research has shown that fibromyalgia patients test positive for several viruses including, rotavirus, herpes, and Epstein-Barr virus. Some patients who had been infected with Lyme disease also have developed symptoms of fibromyalgia several months after the infection.

Hormones and brain chemical disruption (serotonin, cortisol, thyroid hormones, and norepinephrine). Something happens that changes the way the brain perceives pain in fibromyalgia sufferers. There are higher levels of pain transmitters in the brain and people with the disorder have a lower pain tolerance than others.

Having one risk factor does not necessarily mean you are going to get fibromyalgia but having multiple risk factors may increase the chances. Also, if the doctor is unable to find a physical cause for your symptoms in tests, you may be diagnosed with fibromyalgia by a diagnosis of exclusion. Other risk factors for fibromyalgia include:

  • Female gender
  • History of rheumatic or autoimmune disease. Arthritis, lupus, MS, etc.
  • Family history of fibromyalgia or autoimmune Disease
  • History of physical or emotional trauma
  • Exposure to chemicals or other environmental factors

Diagnosis

Fibromyalgia can be hard to diagnose, and for some patients an accurate diagnosis may take years. If you have the symptoms of fibromyalgia, your doctor will test you for other causes first. These tests may include ruling out other conditions that can cause symptoms such as thyroid function, sedimentation rate for inflammation, and a complete blood count.

If everything checks out okay with your lab results and other tests, your doctor will then look at your symptoms according to a set of criteria. This includes:

Pain that is widespread for 3 months or longer. For pain to be considered widespread, it must occur on both sides of your body, all along your spine, and below/above the waist area.

Tenderness to touch at 11 out of 18 pressure points on the body. This system is considered outdated but sometimes is used in conjunction with the above. The doctor will press on 18 different pressure points and if the pain is experienced with pressure on at least 11 then a diagnosis of fibromyalgia can be given. Tender pressure points are as follows:

  • Elbows
  • Knees
  • Hips
  • Back of the Head
  • Breastbone
  • Lower back below the waist area
  • The neck
  • Shoulder blades
  • Upper back

The latest diagnostic system states that if a person experiences the following symptoms for the last week before the doctor’s office visit, plus widespread pain for at least 3 months:

  • Number of places pain is felt over one week (each place is one point)
  • Symptom severity on a scale of 0 to 3 for unrefreshing sleep, cognitive issues, fatigue
  • Three points added for numbness, dizziness, depression, nausea, and irritable bowels

A diagnosis of fibromyalgia can be given for the following point scales:

  • Pain in 7 or more areas of the body or symptom severity score of 5 or higher
  • Pain in 3 to 6 areas of the body or symptom severity score of 9 or higher

To be conclusive, all symptoms should have been present for 3 months or longer.

Treatments

Treating fibromyalgia calls for a combination of interventions to address all of the symptoms. There is no single medication that will either cure or completely remove the symptoms, but you and your doctor can agree upon a treatment plan that works best for you. The following are treatments that are helpful to fibromyalgia patients:

Antidepressants. The type used for fibromyalgia will have an effect on the body’s pain responses and have been shown to reduce pain by 30%.

Anti-seizure drugs. Some anti-seizure medications can calm nerve pain and may improve sleep. These drugs can have side-effects, including swelling, dizziness, and drowsiness.

Cognitive-behavioral therapy. Teaching coping skills and techniques to lessen the effects of the disorder are reported to be extremely helpful to patients.

Physical therapy and exercise. A graded exercise program can help you increase your tolerance to activity, reduce fatigue, and help you sleep better.

Pain medications and anti-anxiety medications. These may be used short-term, but the above treatments are the most successful for the long-term. These along with lifestyle changes can improve your quality of life.

Alternative Treatments and Home Remedies

Some alternative medicine treatments can be helpful for fibromyalgia including:

  • Acupuncture
  • Chiropractic care
  • Yoga
  • Melatonin for sleep
  • SAMe – may help with depression, inflammation, and pain
  • 5-HTP – a natural anti-depressant

Always talk to your doctor before using herbal supplements. They can have unwanted side-effects or drug interactions with your other medications. Your doctor can help you work safe herbal remedies into your treatment plan.

Lifestyle Changes

The following lifestyle changes are an especially important part of treating fibromyalgia. They improve the quality of life in patients with the disorder:

Proper Sleep. The following tips can help you get proper sleep which lessens pain and fatigue:

  • No caffeine less than four hours before bedtime
  • No alcohol less than four hours before bedtime
  • Reduce fluid intake an hour before sleep
  • Do not exercise in the evening hours
  • Try not to nap
  • Eat a light snack before sleep, but no large meals
  • Keep your room cool
  • No TV or electronics in your room

Eat the right diet. It has been shown that if fibromyalgia patients eat a diet high in omega-3 fatty acids, high fiber, and plenty of fresh fruits and vegetables, they feel better. Eat at least two servings of salmon or flaxseeds weekly for omega-3 fatty acids.

Reduce stress. Reducing stress helps to lower pain and help improve sleep. Try deep breathing, meditation, biofeedback techniques, and massages.

Pace activities. Alternate periods of activity with periods of rest. Try not to overdo things and listen to your body. If you have pain, take it easy. If you have a good day, still take it easy and do not push your body. Do a little, then rest a little.

References

Bennett, R. B., & Goldenberg, D. L. (2011, June). Fibromyalgia, myofascial pain, tender points, and trigger points: Splitting or lumping? Arthritis Research and Therapy, 13(3), 117. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218900/

Branco, J. C., et. al. (1994, June). Viral infection and fibromyalgia. Acta Medica Portugues, 7(6), 337-341. Retrieved from PubMed: https://pubmed.ncbi.nlm.nih.gov/7942134/

Centers for Disease Control. (2012, November 7). Fibromyalgia. Retrieved from Centers for Disease Control: https://www.cdc.gov/arthritis/basics/fibromyalgia.htm

Hawkins, R. A. (2013, September). Fibromyalgia: A clinical update. Journal of the American Osteopathic Association, 113, 680-689. Retrieved from: https://jaoa.org/article.aspx?articleid=2094606

Humphrey, L., et. al. Fatigue in fibromyalgia: a conceptual model informed by patient interviews. BMC Musculoskeletal Disorders, 11(216). Retrieved from: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-11-216

Jahan, F., Nanji, K., Qidwai, W., & Qasim, R. (2012, May). Fibromyalgia Syndrome: An overview of Pathophysiology, Diagnosis, and Management. Oman Medical Journal, 27(3), 192-195. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/#:~:text=Fibromyalgia%20Syndrome%20(FMS)%20is%20a,and%20disturbances%20in%20bowel%20functions

Mayo Clinic Staff. (2014, February 20). Fibromyalgia: Causes and Risk Factors. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/fibromyalgia/basics/causes/con-20019243

University of Maryland Medical Center. (2012, February 7). Fibromyalgia. Retrieved from University of Maryland: https://umm.edu/health/medical/reports/articles/fibromyalgia
Web MD. (2014, November 11). Fibromyalgia Treatments. Retrieved from Web MD: https://www.webmd.com/fibromyalgia/guide/fibromyalgia-treatments?page=1

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