Understanding Fibromyalgia

Author: J. Flowers Health Staff

Fibromyalgia is a condition that can be hard to understand, even for healthcare providers. Surrounded by plenty of speculation and with no known cause, it affects millions of people worldwide.

What Is Fibromyalgia?

Fibromyalgia is a chronic disorder and one of the most misunderstood conditions in the medical world today. It is characterized by widespread pain in the muscles. Unlike rheumatoid arthritis, where the pain is concentrated initially on the hands, wrists, knees, and feet, the pain from fibromyalgia is more widespread throughout the body.

This condition affects about 4 million US adults, about 2% of the adult population.¹ . According to the National Fibromyalgia Association, the disorder affects about 3%-6% of the world’s population.

While pain can vary in intensity, patients describe it as a deep, persistent ache or shooting muscular pain. The disorder can result in severe pain that may interfere with the ability to perform even the simplest tasks.

What Is Myalgia?

The term “myalgia” means “pain. It describes muscle aches and pain in the ligaments, tendons, bones, fascia, and organs. Some common causes for myalgia include trauma, injuries, and tension.

Types of Pain

Acute

Acute pain is a sudden, severe pain that is usually quite short-lived but can also be persistent and debilitating. Acute pain is often the result of an injury, surgery, or a dental procedure. In some cases, acute pain can also be a sign of a chronic pain condition.

Chronic

Chronic pain is a symptom of an underlying condition or illness. The pain can last for more than six months, and it can be severe enough to interfere with daily activities. It is estimated that the prevalence of chronic pain in the US is 20.4%, and the prevalence of high-impact chronic pain is 7.4%² .

Nociceptive Pain

Nociceptive pain is a type of pain caused by tissue damage, disease, or any other event that produces pain receptors. Nociceptors are located in the same tissue affected by injury or trauma, which means that those receptors can be stimulated and send signals to the brain. This stimulation can cause nociceptive pain, usually described as sharp, dull, and deep.

Neuropathic Pain

Neuropathic pain is chronic pain caused by damaged or dysfunctional nerve fibers. This type of pain is prolonged, partially understood, and difficult to treat. It is different from pain caused by injury or inflammation and can be triggered by diabetes, diseases of the spine, and infections, among other conditions.

Is There a Cure?

There is presently no cure for the disorder. However, a range of treatment options is available to help relieve symptoms and make the condition easier to live with.

Is There a Defined Test for Fibromyalgia?

There is no single test that can confirm a diagnosis of fibromyalgia. One tool that doctors use to diagnose fibromyalgia is known as tender point examination. It involves pressing on various points on the body, known as trigger points. To be diagnosed with fibromyalgia, the patient must be sensitive in at least 11 of the 18 possible tender points for at least three months.

Doctors may also use other assessment tools like a questionnaire to help understand the extent and severity of the pain and fibromyalgia symptoms. Other conditions with similar symptoms may be ruled out by blood tests such as complete blood count, thyroid function tests, and rheumatoid function.

Is Fibromyalgia a Syndrome?

Fibromyalgia is considered a syndrome as it is characterized by a set of associated symptoms. The exact cause of remains unknown, but ongoing studies have been unraveling some of the mysteries surrounding the condition³ .

Medical experts have had a hard time figuring out how to diagnose and classify fibromyalgia. Over the years, there has been great controversy surrounding the condition. Some scientists claimed that since fibro is linked to psychological factors, it should be regarded as a somatic symptom disorder. Other researchers have argued that since it can be triggered by other factors such as biology or the environment, it should be classified as something else.

Some experts believe that fibromyalgia should be classified as an autoimmune disease as its symptoms overlap with the symptoms of some autoimmune disorders. However, more evidence is needed to explore whether fibromyalgia produces antibodies or causes harm to surrounding tissues.

What Causes Fibromyalgia?

Genetics

One of the most common factors for fibromyalgia is genetics. Genome-wide association studies investigated the connection between fibromyalgia and genes and found that genetic factors are possibly responsible for up to 50% of the disease susceptibility⁴ . Researchers have discovered that people with this condition have abnormally low levels of serotonin, noradrenaline, and dopamine in their brains⁵ .

Central Nervous System (CNS)

Fibromyalgia can occur due to abnormalities in how the central nervous system processes pain signals. People with the condition have a heightened sense of pain, sometimes described as muscle pain⁶ .

Infections

Infections are also believed to provoke the development of fibromyalgia. Infections like hepatitis C virus, HIV, and Lyme disease that may have long-term effects on the immune system are associated with the onset. ⁷ Another possibility for the onset of the disease is the attachment of viral particles to glial cells, which are brain cells that affect neurotransmission and influence the pain response. ⁸ .

Physical/Emotional Events

Patients who have had significant injuries or experienced psychological trauma, especially in childhood, are more prone to developing fibromyalgia. In one 2012 study, researchers discovered that in addition to sexual and physical maltreatment, patients also experienced a poor emotional relationship with both parents, a lack of physical affection, addiction in the mother, separation, and a poor financial situation before the age of seven ⁹. However, this study does not mean that everyone with fibromyalgia has experienced trauma in their lives – it is just one risk factor.

Fibromyalgia Symptoms

Widespread Pain

Fibromyalgia is characterized by widespread pain throughout the body that patients describe as a deep, persistent ache or shooting muscular pain. The pain occurs on both sides of the body and above and below the waist. Some of the areas that are affected include:

Head/neck
Upper chest/back
Outside of elbow
Lower back
Buttocks
Inner side of knees

Fatigue

Fatigue is another common symptom of this chronic pain. The fatigue can be persistent, chronic, and quite debilitating for patients.

Cognitive Difficulties

Patients may have difficulty focusing and keeping attention on certain tasks. The condition is commonly referred to as “fibro-fog,” or unclear thinking.

Trigger Points

One of the unique aspects of is the presence of pain points in specific locations on the body. When these pain points are pressed, people with this condition would feel pain, while people without the condition would only feel pressure. To be diagnosed with fibromyalgia, the patient must be sensitive to at least 11 of the 18 possible pain points.

Co-Existing Conditions

IBS

Irritable bowel syndrome (IBS) is a common condition that co-exists with fibromyalgia. It is characterized by bowel habit changes, with fluctuating constipation, diarrhea, or both.

Chronic Fatigue Syndrome

People suffer from terrible fatigue, known as chronic fatigue syndrome. The Arthritis Foundation estimates that 50%-70% of patients with fibromyalgia also fit the criteria of chronic fatigue syndrome¹⁰

Migraine

Fibromyalgia patients can also have migraine issues. Migraines are unilateral and pulsatile headaches or pounding pain on one side of the head. Migraine headaches may be associated with aura, nausea, vomiting, and sensitivity to light and sound.

Interstitial Cystitis

People with fibromyalgia are more prone to developing a condition known as interstitial cystitis. Interstitial cystitis is characterized by intense pelvic pain that people experience below the belly button.

Depression

In addition to physical and social side effects, it may also affect people mentally. According to the Anxiety and Depression Association of America, around 20% of people with fibromyalgia also suffer from an anxiety disorder or depression¹¹

Anxiety

Anxiety is strongly associated with fibromyalgia. People with fibromyalgia may end up feeling isolated and missing out on things they used to enjoy. This can significantly contribute to the development of anxiety, which can negatively affect the patient’s quality of life.

TMJ

According to the National Institutes of Health research, patients with fibromyalgia have a higher prevalence of TMJ disorder. Furthermore, they exhibit some of the most common symptoms of TMJ, including clicking sounds during mouth movement, facial pain, and muscle pain in the head and neck¹²

Postural Tachycardia Syndrome

Another common co-condition of fibromyalgia is postural tachycardia syndrome. This condition is characterized by an increase in heart rate of more than 30 beats per minute after standing upright for more than three minutes.

Sleep Problems

Sleep issues can often occur in people with fibromyalgia. Patients report being easily awoken in the early morning hours and having difficulty getting back to sleep. The lack of sleep unlocks another set of issues, such as increased fatigue which can be very problematic for patients.

How Is Fibromyalgia Diagnosed

Process of Elimination: The fibromyalgia symptoms and the symptoms of other conditions, such as chronic fatigue syndrome, can overlap to a great extent. For this reason, one of the best ways to diagnose is through a process of elimination. The process of elimination can be a good way since there are no definitive tests for the condition.
Pain Symptoms: Patients describe the pain associated as a constant dull ache. One must either have severe pain in 3 to 6 different areas of their body or milder pain in 7 or more different areas.
Pain Timeline: For fibromyalgia to be diagnosed, the patient’s symptoms must have stayed at a similar level for at least three months.

Fibromyalgia Treatment

Patients require a comprehensive treatment plan that can include different types of treatments, including medication, behavioral therapy, and neuro-training.

Medication

Medication is often used to relieve pain and improve sleep. The most commonly prescribed medications include:

Antidepressants like duloxetine (Cymbalta) and milnacipran (Savella)
Over-the-counter pain relievers such as acetaminophen (Tylenol) and ibuprofen (Advil)
Anti-seizure drugs such as pregabalin (Lyrica)

Physical Therapy

Physical therapy may include exercises to improve strength, flexibility, and stamina. In addition, physical therapy can also help relieve the patient’s pain. Patients generally receive a program tailored to their unique needs to help them manage specific symptoms.

Acupuncture

According to a study published in the Journal of Rehabilitation Medicine, the benefits of acupuncture therapy can last for at least three months after the end of treatment¹³

Acupressure

Acupoint stimulation is another popular treatment. It is also a beneficial option for patients who cannot tolerate the needles involved in acupuncture therapy.

Behavioral Therapy

Cognitive-behavioral therapy has proven helpful in treatment. It aims to prevent patients from focusing on or panicking about their pain. This type of therapy can be particularly effective in patients suffering from both fibromyalgia and depression/anxiety¹⁴

Psychotherapy

Psychotherapy can help patients to understand and better address their feelings about the syndrome. Over time, they will be able to manage their situation with a positive outlook.

Diet

Patients with fibromyalgia should follow a carefully planned diet that helps keep their symptoms at bay. The ideal diet is high in lean protein and fiber and low in carbohydrates. Some foods that can help include fruits with a low glycemic index, vegetables, and whole grains.

Neuro-Training

Neuro-Training is a revolutionary new method of improving the cognitive function of the brain. It utilizes the science of neuroplasticity to rewire your brain for optimal mental performance. The process entails multiple computer-based tests and challenges, designed to measure and build specific areas of brain function.