What is Fibromyalgia?
Fibromyalgia, also sometimes referred to as chronic fatigue syndrome, is a chronic condition that causes widespread pain over the entire body. The pain is also coupled with constant fatigue, trouble sleeping, and emotional and psychological issues. Often people with fibromyalgia are more sensitive to pain than those without the condition.
According to the Centers for Disease Control and Prevention, about 4 million Americans have fibromyalgia. Still, that number is just an estimate, as fibromyalgia can be difficult to diagnose and there is no exact cause of the disease.
However there are certain populations that are more susceptible to getting fibromyalgia. People already diagnosed with auto-immune diseases such as rheumatoid arthritis or lupus have a higher risk of also developing fibromyalgia. It is also more common in women: 75-90 percent of people with fibromyalgia are women, according to the National Fibromyalgia Association. Scant research has shown links between fibromyalgia and suffering from post-traumatic stress disorder (PTSD) or some kind of repetitive injury such as knee joint or wrist damage. Diagnoses also typically occur in middle age.
Fibromyalgia presents differently in every patient, and symptoms can affect multiple organ systems and cause psychological symptoms as well.
The signature symptom of fibromyalgia is widespread pain throughout the body. But many other symptoms characterize the condition and help diagnose the disease.
Unlike a centralized, off and on ache that comes with arthritis, the pain of fibromyalgia is constant and widespread through all parts of the body. The intensity of the pain can fluctuate and vary, from muscle aches to stabbing and shooting pain to throbbing. Pain is often worse in the morning, and accompanied by stiffness. Certain outside factors can also influence the severity of pain, such as cold or heat, lack of sleep, stress and too much or too little sleep.
There are 18 signature tender points that doctors look for when diagnosing someone with fibromyalgia. These nine pairs tend to be painful when pressed, and that pain can spread to other parts of the body. The American College of Rheumatology recommendations state that people with fibromyalgia have pain in at least 11 of these tender points when a certain amount of pressure is applied to be diagnosed with fibromyalgia, and the pain has been going on for at least three months. These tender points include:
- Back of the neck
- Crease of the elbows
- On the neck, above the collarbone
- Bottom of lower back
- Insides of the knee
- Where back muscles connect to shoulder blades
- Between shoulder and bottom of the neck
- On the chest below the collarbone
Fibromyalgia patients also have lower levels of serotonin, which regulates body functions and mood.
It is not uncommon for neurological symptoms to accompany the chronic pain. This includes tingling, numbness, stinging and burning. Studies have also shown fibromyalgia patients have an increased likelihood of blurred vision, double vision, poor balance, ringing in the ears, vertigo, lightheadedness, weakness and clumsiness.
There is also a link between fibromyalgia and irritable bowel syndrome (IBS). One study notes the prevalence of patients with fibromyalgia who have IBS is 48 percent. The high amount of overlap suggests there are similar mechanisms at play in both diseases: abnormal pain sensitivity, a nervous system disorder, dysfunction between the brain-stomach connection and immune system dysfunction.
Stress is also a trigger for both fibromyalgia and irritable bowel syndrome, so both illnesses can be occurring at the same time if triggered. Also with both conditions, there is more irregular brain activity in the parts that process pain, therefore pain and the body’s response can be enhanced.
The cardiovascular system can also be affected or linked with fibromyalgia. Because one of the tender points of fibromyalgia is in the chest, patients can feel like they are having heart palpitations. A study in the European Journal of Rheumatology found that many people with chronic cardiac failure could also be diagnosed with fibromyalgia.
There are many psychological symptoms affiliated with fibromyalgia. They include:
- Brain fog (inability to concentrate or focus on tasks)
Depression has even been shown to affect brain waves. In a 2019 study with a small sample of women, patients with fibromyalgia and untreated depression showed a less than normal activity of the left hemisphere compared to fibromyalgia patients without depression. Also, in fibromyalgia patients without depression and women with both fibromyalgia and depression who were taking antidepressant medications, differences in brain wave frequencies were not found.
A recent study in the journal Psychology Research and Behavior Management notes that people with fibromyalgia tend to have reduced functioning in physical, social and mental capacities. The pain can also negatively affect a person’s performance at work, their personal and romantic relationships and interrupt their ability to perform daily tasks.
The study also notes that sometimes fibromyalgia patients have thoughts of suicide, suicide attempts, and successful suicide. Patients see the illness as a stigmatized and invisible disorder, and often feel misunderstood by doctors and others alike. This negative connotation can prevent them from getting proper treatment and contribute to depression. Psychological interventions such as therapy may be helpful in addition to medications to improve physical and mental symptoms and reduce the impact of fibromyalgia on their overall quality of life.
There is no clear cut cause of fibromyalgia. But it typically seems to affect people who have had a large amount of physical and/or psychological stress, along with certain genetic backgrounds. People with other musculoskeletal disorders and psychiatric issues are also more likely to have fibromyalgia, along with people who have a number of chronic diseases overall.
Some causes may include:
- Genetics: Fibromyalgia tends to run in families, so there may be some genetic mutation that contributes to developing fibromyalgia.
- A physical/emotional trauma: A traumatic event can trigger fibromyalgia symptoms both at the onset of the condition and throughout a person’s lifetime.
- Infections: Certain illnesses, particularly ones that affect the immune system like viruses, rheumatoid arthritis or lupus, seem to trigger fibromyalgia.
The abnormal sensitivity to pain is thought to cause the brains of people with fibromyalgia to produce more neurotransmitters, the chemicals in the brain that signal pain. It is also believed that the brain “remembers” where pain has occurred and thus makes that area more sensitive and react more strongly to the abundance of neurotransmitters.
Diagnosing fibromyalgia involves a physical exam, bloodwork and ruling out other diseases. Fibromyalgia is a diagnosis of exclusion– a diagnosis made by excluding diseases where only some of the patient’s symptoms might belong, leaving one disease as the most likely diagnosis, although no definitive tests or findings can definitively support the diagnosis. Patients must be thoroughly evaluated for the presence of other disorders that could be the cause of symptoms before a diagnosis of fibromyalgia is made.
During a physical exam, a doctor will evaluate the following:
- Widespread pain index (WPI) of tender points. The doctor will press all 19 tender points on the body where people with fibromyalgia tend to have pain. A person gets one point for every tender point. The American College of Rheumatology guidelines suggest that people have at least 11 tender points for a fibromyalgia diagnosis.
- Ranking the symptom severity score (zero to three) for the symptoms of fatigue, waking up feeling not tired, cognitive symptoms, and a number of physical symptoms such as dizziness, headache, gastrointestinal symptoms and more.
- Whether or not the pain, fatigue and other symptoms have been present for at least three months.
- Ruling out any other conditions that would have the same symptoms or cause widespread pain.
A physician will also order blood tests to rule out other conditions that may have the same symptoms as fibromyalgia. They will likely over a thyroid test, as an underactive thyroid gland can cause similar symptoms. Other blood tests include a complete blood count (which can diagnose anemia and any infections), an erythrocyte sedimentation rate (which can indicate inflammation in the body) and a rheumatoid factor test (which can indicate rheumatoid arthritis or other autoimmune diseases).
Conditions to Rule Out
The physical examination, medical history and lab work will rule out diseases that have similar or overlapping symptoms with fibromyalgia. They include:
- Rheumatoid arthritis (pain in joints, stiffness, trouble sleeping, fatigue)
- Lupus (widespread pain, fatigue)
- Sjogren’s syndrome (fatigue, joint pain)
- Depression (trouble sleeping, changes in mood)
- Multiple sclerosis (widespread pain, neurological symptoms such as numbness or tingling)
- Vitamin D deficiency (fatigue, widespread pain)
- Hypothyroidism (fatigue, mood changes)
Fibromyalgia affects multiple facets of a person’s life, from their ability to work to their relationships with loved ones. All of these facets need to be considered when it comes to setting treatment goals and plans. Both the patient and the physician need to prioritize which symptoms to address. It is also important to set a baseline status to help track progress and determine what treatment is working and what isn’t working.
The most important part for doctors to consider when it comes to fibromyalgia treatment is to research and select the best methods for the patient and to provide a clear understanding of what the results mean for the patient and managing the disease over the long-term. The plan should prioritize treatment goals that are important to the patient and improving their quality of life. Treatment goals should be precise, achievable and measurable and should reflect a patient’s goals.
Both traditional clinical treatments and natural medicine treatments have been shown to be effective in treating fibromyalgia symptoms. Below details these treatments and the symptoms they have been shown to address.
A number of medications are used in the treatment of fibromyalgia, including muscle relaxants, antidepressants, Nonsteroidal anti-inflammatory drugs (NSAIDs), opioid painkillers, antidepressants and anti-seizure medications. No one medication has been proven to be the best treatment for fibromyalgia, as every patient has different symptoms and reacts differently to medications.
- Antidepressants: These medications affect the levels of brain chemicals that influence emotions and pain. Amitriptyline is typically the first-line drug for treating pain and sleep disorders in fibromyalgia. Duloxetine (Cymbalta), a selective serotonin and norepinephrine reuptake inhibitor antidepressant, has also been effective in treating pain.
- Anti-seizure medications: The amount of pain neurotransmitters glutamate and substance P in the central nervous system are elevated in patients with fibromyalgia, causing nerve pain. They can be targeted by anti-seizure medications pregabalin and gabapentin.
- Opioids: These are controlled substances used for severe pain. These should be prescribed with caution, as opioids can become addictive. Because of the unique combination of symptoms and pathology when it comes to fibromyalgia, opioids are typically not a recommended medication to treat the disease.
- NSAIDs: These are over-the-counter painkillers that can be used to treat pain that is mild to moderate. These include ibuprofen and naproxen.
- Muscle relaxants: For patients with fibromyalgia struggling to sleep, low doses of muscle relaxants may help with pain and difficulty sleeping.
The three medications approved by the Food and Drug Administration (FDA) to specifically treat fibromyalgia include:
- pregabalin (Lyrica): which can help calm overactive neurotransmitters
- duloxetine (Cymbalta): which regulates serotonin and norepinephrine to tamp down pain signals
- milnacipran (Savella): which also regulates serotonin and norepinephrine to minimize pain
Naturopathic treatments uses natural remedies to help ease symptoms. It incorporates many therapies, including vitamins, supplements, psychological therapy, acupuncture, exercise, and dietary changes.
Naturopathic medicine often seeks to treat the whole person, mind and body, and ease symptoms in both aspects. Often it attempts to treat or manage multiple symptoms rather than just target one in particular like a medication might.
Fibromyalgia very much has psychological symptoms and effects, as noted above. How a person perceives the disease and its symptoms can have a big impact on how they experience pain. Stress and lack of support can not only trigger pain, but make it feel less manageable and treatable. If a person does not have a supportive workplace or loved ones while dealing with fibromyalgia symptoms, it can be easy for them to fall into states of depression or anxiety.
A 2015 study found that cognitive behavioral therapy (CBT) can help with depression and other anxieties and psychological issues related to fibromyalgia symptoms. CBT can equip patients with coping techniques to deal not only with pain but also the ability to function on a daily basis.
A 2017 journal review found an association between fibromyalgia symptoms and poor sleep quality. Fibromyalgia already makes people fatigued Getting a good night’s sleep means having good sleep hygiene habits. These include:
- Not sleeping during the day
- Going to sleep and waking up at the same time every day
- Limiting caffeine and alcohol intake
Staying physically active has been shown to help reduce and manage pain in fibromyalgia patients. Exercise can also help reduce stiffness in the joints.
The type of exercise chosen should be able to be tolerated by the patient. This may include just a walk or structured physical therapy or massage therapy.
Other forms of exercise and physical activity that research has shown helps fibromyalgia symptoms include:
- Yoga, which also incorporates breathing techniques, according to a 2017 study
- Tai chi, which also uses meditation, according to a 2018 study
- Running, cardiovascular classes, or swimming, supported by a 2017 study
Eating a healthy and balanced diet is important to a feeling of overall health. But certain specific changes in diet may help people with fibromyalgia.
Because fibromyalgia and inflammation in the body are closely linked, staying away from foods containing ingredients that can cause inflammation may help. These ingredients include dairy, alcohol, artificial and pure sugar, salt and gluten.
Fibromyalgia symptoms also develop when there is not enough serotonin in the body. Serotonin derives from an amino acid called tryptophan, which could be altered by high levels of fructose, a type of sugar. A study notes that a diet low in fructose may help alleviate symptoms– this mans avoiding candy, fruit juices, some bread products, artificial sweeteners such as aspartame (found in diet sodas) and more.
Vitamins and Supplements
Taking certain vitamins and supplements may help ease certain symptoms such as fatigue or pain. It is important to speak with your doctor about taking supplements to ensure they won’t cause different symptoms or interfere with other treatments. Lab work can also be done to determine if there are significant vitamin deficiencies that are causing symptoms.
Limited research has shown that low vitamin D levels and low magnesium levels can cause fibromyalgia symptoms and that supplements can help. A vitamin D blood level (25-hydroxyvitamin D) is typically suggested to be optimal between 40 and 80 ng/ml (100-200 nmol/l). Supplementing is a great way to get the extra vitamin D you need if you’re not getting 20-30 minutes of full sunlight on most of your body each day!
Fish oil supplements are widely used for a number of conditions because of its anti-inflammatory properties. One gram per day is recommended for those who don’t eat a diet rich in omega-3. However, 2 to 3 grams per day is often prescribed for fibro patients. Omega-3 rich foods include fatty fish, walnuts and soybeans.
S-adenosyl-L-methionine (SAMe) is a substance made naturally in the body that helps regulate the production of serotonin and dopamine. It has been shown to reduce trigger point pain and depression symptoms. The Arthritis Foundation recommends 200 to 800 mg twice daily.
D-ribose is a type of sugar that comes in supplement form. It has had a huge amount of success with cardiovascular patients, treating everything from palpitations to heart failure. It increases cellular energy in the heart and skeletal muscle cells. Anecdotal reports are generally positive. There was one small pilot study of 41 patients with confirmed diagnosis fibromyalgia and/or chronic fatigue syndrome. The results were 66% of patients had “significant improvement in all five visual analog scale (VAS) categories: energy; sleep; mental clarity; pain intensity; and well-being, as well as an improvement in patients’ global assessment.”
Acupuncture is a type of Chinese medicine where a certified practitioner insert small needles into specific trigger points on the body. The needles supposedly alter blood flow and chemical levels, reducing pain in those fibromyalgia trigger points and throughout the body. A 2014 review of multiple studies found limited evidence that acupuncture can improve pain and stiffness.
Fibromyalgia is characterized by chronic pain throughout the body, along with intense fatigue and joint pain. It also causes emotional and mental symptoms, and significantly affects a person’s quality of life.
While the exact cause of fibromyalgia has not yet been pinpointed, research shows that patients with the disease have abnormal neurotransmitters, making them overly sensitive to pain. It often overlaps with other diseases such as lupus or rheumatoid arthritis. It affects women more than men.
There are a variety of treatments to manage fibromyalgia symptoms, from medications that can manage pain and the level of brain chemicals that cause symptoms. Naturopathic treatments such as acupuncture, cognitive therapy, vitamins and supplements have also been known to alleviate symptoms dramatically. Fibromyalgia can be effectively managed through symptom monitoring and management with your doctor.
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