Fibromyalgia is a common, chronic syndrome which causes mental distress and body pain.
Fibromyalgia symptoms can be confused with those of arthritis, or joint inflammation. Unlike arthritis, however, it has not been shown to cause inflammation and damage to the joint or muscle. It is known as a rheumatic condition, that is, one that causes pain to the soft tissue or myofascial pain.
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), approximately 5 million people aged 18 years or older encounter fibromyalgia in the United States and 80 to 90 percent of patients with fibromyalgia are women.
Important facts about fibromyalgia:
Here are some key points about fibromyalgia. More detail is in the main article.
- Fibromyalgia causes widespread pain, fatigue, and other types of discomfort.
- Symptoms resemble those of arthritis, but fibromyalgia affects the soft tissue, not the joints.
- The cause is unknown, but risk factors include traumatic injury, rheumatoid arthritis and other autoimmune disorders, such as lupus, and genetic factors.
- There is no cure, but medications, exercise, acupuncture, and behavioral therapy can help relieve symptoms and improve sleep quality.
Symptoms
Common symptoms include:
- widespread pain
- jaw pain and stiffness
- pain and tiredness in the face muscles and adjacent fibrous tissues
- stiff joints and muscles in the morning
- headaches
- irregular sleep patterns
- irritable bowel syndrome (IBS)
- painful menstrual periods
- tingling and numbness in the hands and feet
- restless leg syndrome (RLS)
- sensitivity to cold or heat
- difficulties with memory and concentration, known as “fibro-fog”
- fatigue
The following are also possible:
- problems with vision
- nausea
- pelvic and urinary problems
- weight gain
- dizziness
- cold or flu-like symptoms
- skin problems
- chest symptoms
- depression and anxiety
- breathing problems
During a person’s life, symptoms may occur at any time but they are more often recorded around the age of 45.
Treatment
Medical attention is needed, since it can be difficult to treat fibromyalgia. As it is a disease, each patient will have a different set of symptoms and need to have a specific care plan.
Treatment may include any or more of the following:
- an active exercise program
- acupuncture
- psychotherapy
- behavior modification therapy
- chiropractic care
- massage
- physical therapy
- low-dose anti-depressants, although these are not a first-line treatment
People with fibromyalgia need to consult with their doctor to create a treatment plan that offers the best possible outcomes.
Drugs
Drugs may be advisable for treating such symptoms.
These can involve pain relievers which are over-the-counter (OTC). However, in their revised recommendations for 2016, the European League Against Rheumatism ( EULAR) has issued a recommendation against the use of non-steroidal anti-inflammatory drugs (NSAIDs) to treat fibromyalgia.
Antidepressants like duloxetine, or Cymbalta, and milnacipran, or Savella, can help to relieve pain. It is possible to prescribe anti-seizure medications such as gabapentin, also known as neurontin, and pregabalin, or lyrica.
However, a study indicated that patients often avoid using these medications due to their ineffectiveness in relieving pain or adverse effects.
To prevent adverse effects and reactions with other drugs, patients should inform the doctor of any other medications they are taking.
Exercise
A combination of aerobic exercise and resistance training, or strength training, in some patients was associated with a decrease in discomfort, tenderness, stiffness, and sleep disturbance.
If exercise helps with symptoms, consistency is crucial to keep in order to see results. Working with a partner or personal trainer can help maintain active exercise program.
Acupuncture
Since beginning acupuncture treatment for fibromyalgia several patients reported changes in their quality of life. The number of sessions that will be needed depends on the symptoms and their severity.
One research showed that within 2 years of diagnosis 1 in 5 people with fibromyalgia are using acupuncture. It can improve pain and stiffness, the researchers concluded. They do call for further research, however.
Behavior modification therapy
Behavior management therapy is a type of cognitive behavioral therapy ( CBT) aimed at minimizing negative, stress- or pain-enhancing behaviors and promoting positive, mindful behaviors. It involves learning new coping skills, and exercises for relaxation.
Causes
It is unknown the precise cause of the fibromyalgia. However, current theory in the field of Rheumatology indicates that fibromyalgia is a problem with the processing of central pain in the brain, where an increased sensitivity or perception of pain can occur to a given cause.
There are a variety of risk factors likely to occur including:
- a stressful, traumatic physical or emotional event, such as a car accident
- repetitive injuries
- rheumatoid arthritis or other autoimmune diseases, such as lupus
- central nervous system (CNS) problems
- the way our genes regulate how we process painful stimuli
In addition, fibromyalgia may be inherited. Females with a close relative of fibromyalgia have an increased chance of developing it themselves.
People with rheumatoid arthritis, lupus, or spinal arthritis, known as ankylosing spondylitis, have an elevated risk of developing fibromyalgia, as do patients with certain other rheumatic disorders.
Diagnosis
Confirming a diagnosis of fibromyalgia will take some time since the symptoms mimic those of other disorders, such as hypothyroidism. Until diagnosing fibromyalgia these symptoms must be removed first.
The disorder does not have laboratory tests, and this, too, can lead to delayed or missing diagnosis.
The American College of Rheumatology has developed three diagnostic criteria for fibromyalgia.
- pain and symptoms over the previous week, out of 19 identified body parts, plus levels of fatigue, unsatisfactory sleep, or cognitive problems
- symptoms that have been ongoing for at least 3 months
- no presence of another health problem that would explain the symptoms
The ‘tender points’ were traditionally used to diagnose the condition. These are no longer recommended to help in fibromyalgia diagnosis, however.
Diet
Dietary measures have been suggested for improving the symptoms of fibromyalgia.
These include:
- High-energy foods that are low in sugar: Foods such as almonds, beans, oatmeal, avocado, and tofu contain plenty of fiber but no added sugar. These can help boost energy throughout the day, helping to improve tiredness symptoms that occur as a result of the condition.
- Avoiding foods that have gluten: A 2014 study has suggested that gluten sensitivity can contribute to fibromyalgia. The study showed that removing foods that contain gluten from the diet may be able to reduce the pain, even in patients who do not have celiac disease. This is also linked to a diet plan for reducing inflammation.
- Cutting out fermentable oligo-di-mono-saccharides and polyols (FODMAP): A recent study showed that a diet low in FODMAP could have promising effects on pain levels in people with fibromyalgia.
- Not eating additives and excitotoxins: One report showed that cutting out additives from the diet, such as aspartame and monosodium glutamate (MSG), can reduce pain symptoms significantly. The pain of the people involved in the study was also shown to increase once these additives were put back in the diet.
- Eating more seeds and nuts: There is little evidence to support a direct relationship between seeds, nuts, and an improvement in fibromyalgia symptoms. However, they are known to contain powerful micronutrients and minerals that are important for cell function, and this may support people with the condition.
Maintaining a good diet and a healthy weight is important to continued health and can improve the quality of life of an individual. Studies have shown that, after they lose weight, people with both fibromyalgia and obesity experienced an increase in the quality of life and pain symptoms.
Further research on the effects of diet on fibromyalgia is required, however ensuring the diet is low in sugar and a good starting point for gluten. There is definitely no harm in seeking to help care with those choices.
Tender points
You may have come across the word ‘tender points’ while reading up on fibromyalgia.
There are some parts of the body where the most pain is known to cause fibromyalgia. This include the back of the head, knees inside, and elbows outside. Pressure in the neck and back, outer hips and upper chest can also increase.
Doctors used to diagnose fibromyalgia based on how they respond at certain points under pressure. However, this is no longer used as an effective means of diagnosing the disease and tender points are no longer used as a valid fibromyalgia measure.
At these points no injections are recommended. Still, however, the pain is thought to be more common in different individuals and present differently. Instead of small areas or dots of pain, the severity and chronic nature of the pain defines fibromyalgia.
Seek medical attention to rule out other causes of pain in these areas.
Outlook
Fibromyalgia is not completely healed but there are now more treatment options and better diagnosis guidelines available.
Symptoms will greatly improve, as long as the patient follows their care plan.
