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  • Writer's pictureDr. Harold Pierre

Fibromyalgia

Updated: Dec 26, 2023

What You Need to Know About Fibromyalgia


Is your body constantly aching? Do you feel tenderness and pain all over your muscles and joints? Does exhaustion follow you around like a dark cloud? Have you been suffering for months or even years, but doctors can't find anything wrong?

You may have fibromyalgia.


This invisible illness plagues millions. Lady Gaga has it. So does Morgan Freeman. But no celebrity status protects you from the relentless pain and fatigue.


If your life has become a nonstop hurt fest, keep reading. Understanding fibromyalgia may free you from medical maze madness. This guide will explore the symptoms that make this condition so crushing. It will look at how doctors finally diagnose it. And it will share the many ways patients find relief.


You deserve to stop hurting and start living again. Knowledge is power. Use it to take back your life!


What is Fibromyalgia?


Collage with people experiencing muscle pain from different parts of the body in white background.

Fibromyalgia is a chronic pain condition. Fibromyalgia causes pain and tenderness in muscles, joints, and tissues. Patients with fibromyalgia typically have body-wide pain. They also have extreme fatigue, insomnia, anxiety, depression, and attention difficulties. The exact cause of fibromyalgia is unknown. But it relates to abnormal pain processing in the nervous system. People with fibromyalgia feel pain more than others. This links to increased excitability in the brain and dysfunctional natural pain pathways.


About 2 to 8% of the population have fibromyalgia. More women are affected than men. Symptoms often start after trauma, infection or stress. But sometimes there's no clear trigger. There's no cure yet. But symptoms can be managed with medications, lifestyle changes and alternative treatments.


Common Symptoms of Fibromyalgia?


The main symptom is chronic widespread pain and tenderness to touch. But it causes other symptoms too:


  • Extreme fatigue - People with fibromyalgia often feel exhausted no matter how much they rest. Simple tasks can be extremely tiring.

  • Trouble sleeping - Most patients report unrefreshing sleep and insomnia. Waking up feeling tired is common.

  • Cognitive dysfunction - Known as “fibro fog,” many patients experience memory issues, impaired concentration, and difficulty thinking clearly.

  • Mood disorders - Anxiety, depression, and irritability frequently occur with fibromyalgia.

  • Headaches and migraines - Recurring headaches are a common complaint. Migraines also affect about 30-50% of patients.

  • Sensitivity to temperature, weather changes, noise, and bright lights - Sudden temperature changes or too much noise and light can increase pain and discomfort.

  • Numbness and tingling sensations - Numbness, burning, prickling, and stabbing sensations can occur, most often in the hands and feet.

  • Dizziness and balance problems - Episodes of lightheadedness and loss of balance are not uncommon.

  • Digestive issues - Constipation, diarrhea, nausea, bloating, and abdominal pain affect the majority of patients.


Other possible symptoms include restless leg syndrome, pelvic pain, bladder problems, dry eyes and mouth, jaw pain, nerve pain, night sweats, and morning stiffness.


What Causes Fibromyalgia?


Researchers still aren’t sure what causes fibromyalgia, but it’s believed to be multifactorial - meaning it’s caused by a combination of physical, mental, and environmental factors:


  • Genetics - Fibromyalgia often runs in families, so genetics are thought to play a role. Certain genetic mutations may predispose someone to developing fibromyalgia.

  • Infections - Prior illnesses from viruses, bacteria, and parasites may trigger fibromyalgia in some people.

  • Physical or emotional trauma - Post-traumatic stress disorder and past physical injuries increase the risk of developing fibromyalgia. Psychological stress is a common trigger.

  • Abnormal nervous system processing - People with fibromyalgia have enhanced pain sensation due to amplified pain signals and dysfunctional natural pain inhibition pathways in the brain and spinal cord.

  • Sleep disturbances - Poor sleep aggravates pain perception and can initiate fibromyalgia symptoms in healthy individuals. Disruptions in deep, restorative sleep play a key role.

  • Hormonal imbalances - Changes in hormone levels or dysregulation of the hypothalamic-pituitary axis may contribute to fibromyalgia in some patients.

  • Inflammation - Increased inflammatory cytokines and substances that cause neuroinflammation may initiate or sustain fibromyalgia symptoms.

  • Abnormal increases in glutamate - Excess glutamate, a neurotransmitter in the brain, can increase pain signaling. Fibromyalgia patients show elevated glutamate in key pain processing areas.

  • Small fiber neuropathy - Damage to small nerve fibers in the peripheral nervous system may precede or contribute to the central sensitization of fibromyalgia.


No single cause for fibromyalgia has been found. Research shows it likely arises from a mix of genetic, lifestyle and environmental factors. These factors combine to push someone over the threshold into getting fibromyalgia.


How is Fibromyalgia Diagnosed?


There are no blood tests or scans to definitively diagnose it. Diagnosis of fibromyalgia involves carefully examining someone and evaluating their medical history and symptoms. To get a fibromyalgia diagnosis, someone must have widespread pain for at least three months. And they must have tenderness in at least 11 of 18 specific tender points in the body. First, other possible conditions causing the symptoms need to be ruled out. Here are the key steps in making a fibromyalgia diagnosis:


  • Comprehensive medical history - Your doctor will ask detailed questions about your symptoms, when they started, and any events or illnesses that occurred around that time. Information about your family history, stress levels, and sleep patterns is also important.

  • Complete physical exam - This will include assessing pain thresholds in tender point locations, testing muscle strength and tone, evaluating range of motion, and examining you for signs of other conditions.

  • Review of symptoms - You’ll be asked to describe all of your symptoms thoroughly, even those that may not seem directly related to widespread pain, like digestive issues or cognitive problems. This helps build a broader picture.

  • Ruling out other disorders - Your doctor will run tests to help confirm that your pain isn’t being caused by rheumatoid arthritis, lupus, multiple sclerosis, or thyroid disease. These tests might include blood work, x-rays, or MRI scans.

  • Applying diagnostic criteria - If no other cause for your chronic widespread pain is found, your doctor will determine if your symptoms meet the established criteria for fibromyalgia.


Getting a diagnosis of fibromyalgia can be frustrating, as many doctors aren’t well-educated on the condition. Being prepared with a thorough symptom history and keeping a pain log can help make the process easier.


Available Fibromyalgia Treatments


Although there is no cure for fibromyalgia, many treatments can help ease symptoms. A combination treatment plan works best. This involves both medications and non-drug therapies. Doctors customize the plan to each patient's needs.


Medications:


These are the main types of medications used to treat fibromyalgia pain and other symptoms:


  • Analgesics - Acetaminophen, NSAIDs, and opioid pain medications may be options for mild to moderate pain relief.

  • Antidepressants - Duloxetine, milnacipran, amitriptyline, and other tricyclic antidepressants help reduce pain and improve sleep and energy levels.

  • Anti-seizure drugs - Pregabalin and gabapentin are often effective for calming fibromyalgia pain and aiding sleep.

  • Muscle relaxants - Tizanidine may lessen muscle tension and spasms.

  • Stimulants - Adderall, Ritalin, and Vyvanse can boost mental clarity and energy in some patients.

  • Medical marijuana - Where legal, cannabis may decrease pain, improve sleep quality, and reduce stiffness in muscles and joints.

  • Low-dose naltrexone (LDN) - This opioid antagonist can help reduce pain and fatigue in some patients at doses lower than what is used to treat addiction.

  • Sodium oxybate - Also known as Xyrem, this central nervous system depressant can improve sleep quality and reduce pain.

  • Growth hormone injections - Rectifying growth hormone deficiency may lessen pain and tenderness in certain fibromyalgia patients.

  • Cortisol injections - Providing supplemental cortisol alleviates symptoms for some patients with low cortisol levels.

  • Modafinil - This stimulant can be used to overcome excessive daytime sleepiness and fatigue.

  • Tramadol - This opioid pain medication may be used for acute pain flares in some cases. It's always best to avoid using opioid medications due to the risks of dependency.

  • Low-dose ketamine infusions - Ketamine's dissociative effects may disrupt pain signals and provide temporary relief for severe fibromyalgia.


Finding the most effective medications often takes some trial and error. Most fibromyalgia patients take a combination of 2-3 drugs to treat their symptoms.

Non-Drug Therapies


In addition to medication, non-pharmacological therapies should be a key component of any fibromyalgia treatment plan:


  • Exercise - Low-impact activities like walking, swimming, gentle yoga, tai chi, and Pilates can help reduce pain. Start slowly.

  • Physical therapy - Working with a physical therapist can improve strength, flexibility, and pain levels through massage, stretching, ultrasound treatments, and special exercises.

  • Sleep hygiene - Making lifestyle changes to improve sleep quality is essential. Things like limiting caffeine, establishing a bedtime routine, and keeping the bedroom cool and dark can help.

  • Stress reduction techniques - Relaxation methods like meditation, deep breathing, massage therapy, music therapy, and hydrotherapy may lower stress and improve pain tolerance.

  • Cognitive behavioral therapy (CBT) - CBT focuses on modifying negative thought patterns that exacerbate pain and changing detrimental behaviors. It can be very effective for fibromyalgia.

  • Acupuncture - Fine needles are inserted into trigger points to relieve muscle tension and pain sensation. It may boost natural endorphins.

  • Chiropractic care - Spinal manipulation and massage can alleviate muscle spasms and joint pain associated with fibromyalgia.

  • Nutritional adjustments - Some patients find a gluten-free, anti-inflammatory diet along with vitamins D, B12, and magnesium supplements helpful.


Experiment to find the right mix of medications, exercise, stress-busters, and lifestyle changes to best manage your symptoms long-term. Be patient - it can take some time.


Living with Fibromyalgia


The word Fibromyalgia written by colorful medicines, pills, drugs, tablets, capsules, with purple butterfly on a blue background copy

Fibromyalgia significantly impacts daily functioning and quality of life. Fatigue and pain often interfere with work, household duties, and social activities. The unpredictability of flare-ups can be very frustrating. Emotional health also suffers from anger, sadness, and reduced self-esteem.


However, there are many things you can do to better cope with fibromyalgia:


  • Learn your limits - Figure out your limits for physical and mental activity and try not to overexert yourself. Allow plenty of rest time.

  • Pace yourself - Break tasks into smaller steps. Alternate activity with rest periods to avoid flare-ups. Don’t rush.

  • Schedule wisely - Plan your most important activities for when you feel your best. Don’t overbook your schedule.

  • Ask for help when needed - Don’t be afraid to ask for assistance with chores, errands, and childcare during bad periods.

  • Find support - Joining local fibromyalgia support groups or online communities can help you feel less alone.

  • Avoid triggers - Notice what makes your symptoms worse, like stress or cold weather, and avoid those triggers when possible.

  • Practice relaxation techniques - Deep breathing, guided imagery, and mindfulness meditation can reduce anxiety and muscle tension.

  • Stay positive - Keep a gratitude journal, pursue hobbies you enjoy, and surround yourself with supportive loved ones. Laughter helps!


While fibromyalgia is a challenge to deal with, using healthy coping strategies and self-care can greatly improve your ability to manage symptoms and lead a fulfilling life.


The Bottom Line


Fibromyalgia is a complex chronic pain syndrome. It is often misunderstood, misdiagnosed, and mistreated. Widespread pain, extreme fatigue, sleep and mood issues make it debilitating for many. The exact mechanisms are still being figured out. But it seems to arise from abnormalities in the central and peripheral nervous systems. These heighten pain sensitivity.


If you have persistent body pain and tenderness, constant exhaustion, brain fog, or other symptoms, consider getting evaluated for fibromyalgia. Diagnosis means ruling out other potential causes first. Keeping a detailed symptom journal and knowing the criteria aids in getting an accurate diagnosis.


There is no cure yet. But symptoms can improve through medications, gentle exercise, stress reduction, cognitive behavioral therapy, and complementary treatments. Lifestyle adjustments, pacing activities, and asking for help make living with it more manageable. Being proactive with your treatment and finding support can help a lot.


Chinn, S., Caldwell, W., & Gritsenko, K. (2016). Fibromyalgia Pathogenesis and Treatment Options Update. Current Pain and Headache Reports, 20(25). https://doi.org/10.1007/s11916-016-0556-x


Giorgi, V., Sirotti, S., Romano, M. E., Marotto, D., Ablin, J. N., Salaffi, F., & Sarzi-Puttini, P. (2022). Fibromyalgia: one year in review 2022. Clinical and Experimental Rheumatology, 40, 1065-1072.


About the author: 


Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 20 years of experience. He is certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.



This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician or another qualified medical professional. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.







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