Fibromyalgia

What is Fibromyalgia?

Fibromyalgia can be a debilitating condition associated with widespread musculoskeletal pain, fatigue, memory, mood and sleep issues. Recent research has shown that the way the brain of patients with fibromyalgia process pain signals is altered which causes an increase in painful sensations.

Symptoms can gradually worsen over time without any inciting event, while other times patients may have experienced a significant physical trauma, psychological stress, infection or surgery.

For unknown reasons, women are more prone to develop fibromyalgia. Patients with fibromyalgia are also more likely to have other co-existing disorders such as tension headaches, irritable bowel syndrome, anxiety, depression and temporomandibular joint (TMJ) disorders.

Unfortunately, there is no cure for fibromyalgia. Symptom improvement can take a significant amount of time as different treatments are implemented. Lifestyle modifications, like exercise, meditation, relaxation and stress-reduction, play a large role in improving symptoms and overall well-being.

What Are The Symptoms?

For most fibromyalgia sufferers, the dominant symptom is widespread pain commonly in the back of the head, upper back, neck, elbows, hips, and knees. Fibromyalgia flare-ups may also come with the following symptoms:

  • Anxiety
  • Depression
  • Sleep disorders
  • Irritable bowel syndrome (IBS) symptoms (e.g., constipation, diarrhea, and abdominal pain)
  • Persistent pain often accompanied by stiffness
  • Mood disorders (anger, irritability)
  • Dizziness
  • Headaches with facial pain related to tenderness experienced in the neck and shoulders
  • Increased sensitivity to pain (hyperesthesia)
  • Urinary frequency
  • Painful menstrual cramps
  • Tingling and/or numbness in the hands, legs, feet or arms

What Are The Causes?

Central sensitization syndrome (also referred to as allodynia) is often cited as both a cause and a symptom of fibromyalgia. This common complication of chronic pain is a development that involves both the peripheral nervous system (PNS) and the central nervous system (CNS). Local tissue injury and inflammation activate the PNS, which sends signals through the spinal cord to the brain. Central sensitization occurs when there is an increase in the excitability of neurons within the CNS.

Between two and 4% of people in the U.S. suffer from fibromyalgia. Fibromyalgia is most commonly seen in women ages 20 to 55, occurring at about nine times the rate in women as men.

Other than gender, risks factors for fibromyalgia include:

  • Genetics: People with first-degree relatives who suffer from fibromyalgia are also eight times more likely to have it themselves
  • Poor sleep: A 2014 study found that people with poor sleep were more likely to suffer widespread, chronic pain conditions
  • Chronic inflammatory or autoimmune disorders: Hepatitis C infections and other rheumatic disorders, such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and osteoarthritis (OA), are risk factors for fibromyalgia
  • Trauma: Patients with trauma, either physical or psychological, are more likely to suffer from chronic pain conditions like fibromyalgia

Diagnosis

A thorough history and physical exam is vital in diagnosing fibromyalgia. New diagnostic criteria published by the American College of Rheumatology states that patients must:

  • Have symptoms for at least three months

  • Have a widespread pain index (WPI) score of seven or higher and a symptom severity scale (SS) score of five or higher; Or a WPI score of three to six and a SS score of nine or higher

  • Not have another disorder that could explain their symptoms

The WPI is determined by your history of pain in the last seven days in 19 areas of your body. The SS is an assessment of symptoms in four categories unrelated to pain, including fatigue, cognitive problems, and other possible signs of fibromyalgia.

There is no blood test that can diagnose fibromyalgia; However, sometimes your pain management specialist will order blood tests to assess for different causes of your symptoms. These can include:

  • Complete blood count (CBC)

  • Erythrocyte sedimentation rate (ESR)

  • C-reactive Protein (CRP)

  • Cyclic citrullinated peptide test (CCP)

  • Rheumatoid factor

  • Thyroid function tests

What Are The Treatments?

Fibromyalgia can be a difficult and slow condition to treat as lifestyle changes take time to begin showing effect, and some medications may work better for some patients and not at all for others. There is no one treatment for all symptoms, and typically multiple lifestyle changes and medications are needed to begin the recovery process.

Lifestyle Modifications

Lifestyle modifications are very important for patients with fibromyalgia. These can include diet changes (low inflammatory diets, cutting out processed foods and gluten), sleep hygiene, meditation, relaxation, and stress reduction.

Medications

Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:

  • Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others) may be helpful. Your pain management specialist might suggest a prescription pain reliever such as oxytocin, tramadol (Ultram), buprenorphine (Belbuca), or low-dose naltrexone.

  • Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Amitriptyline or the muscle relaxant cyclobenzaprine can help promote sleep.

  • Anti-convulsants. Gabapentin (Neurontin) can help reduce fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration (FDA) to treat fibromyalgia.

  • Supplementation. Sometimes over-the-counter supplements such as vitamin D, magnesium and arginine can help with fibromyalgia related pain and symptoms.

  • Infusions. Meyers cocktail infusion can help some patients’ symptoms as this infusion is high in B vitamins, vitamin C, magnesium and calcium. This infusion is typically administered once a week for eight weeks. Intravenous ketamine infusions have also been used to help treat fibromyalgia symptoms.

Therapy

A variety of different therapies can help reduce the effect that fibromyalgia has on your body and your life. Examples include:

  • Physical therapy. Improve your strength, flexibility and stamina. Water-based exercises might be particularly helpful.

  • Occupational therapy. Make adjustments to your work area or the way you perform certain tasks that will cause less stress on your body.

  • Psychotherapy. A pain psychologist can help teach you strategies for coping with your pain and certain stressful situations, as well as other techniques for reducing your pain.

Additional Resources

www.MayoClinic.org

www.webMD.com