It’s been over three months. You haven’t slept well or thought straight since the pain started. It’s hard to name a muscle that doesn’t ache. Yet the lab tests have revealed little. Finally, you decide to see a pain specialist. After ascertaining that your pain extends to all four sections of your body, he diagnoses you with fibromyalgia.
By Katherine Ladny Mitchell
Fibromyalgia is a chronic musculoskeletal pain disorder that can greatly affect your sense of health and well-being. It is often associated with other health problems such as sleep disturbances, fatigue, recall issues, headaches, and irritable bowel syndrome. On average, those with fibromyalgia miss about 17 days of work per year – almost three times as many as those without fibromyalgia.
Thankfully, fibromyalgia is never life-threatening, and there are several things you can do to minimize its symptoms. Here is an overview of the condition, its diagnosis process, treatment options, and self-care tips to help those with fibromyalgia to enjoy a higher quality of life.
While the exact cause of fibromyalgia is unknown, there are several factors that correlate with the condition. The first of these is gender. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, over 80% of those with fibromyalgia are women. However, about one in 200 men also develop it. While most people with fibromyalgia are middle-aged, doctors occasionally diagnose children with the disease.
Genetics could be a potential factor in causing fibromyalgia as the condition seems to affect members of the same family. Researchers are studying whether genetics associated with how the central nervous system perceives pain may be a cause of fibromyalgia. It’s hypothesized that those with certain genes may react painfully to stimuli others do not consider painful.
Factors that appear to trigger fibromyalgia include the development of conditions like lupus, rheumatoid arthritis, or hypothyroidism, certain infections, or experiencing an emotionally or physically traumatic occurrence.
Fibromyalgia has three main symptoms: extensive pain, fatigue, and mental difficulties. The first major symptom is widespread pain lasting more than three months. This pain occurs in the muscles, ligaments, and tendons, and feels similar to having pulled muscles or a general flu-like achiness. Those with fibromyalgia often feel fatigued despite sleeping for extended periods and may have other sleep-disturbing conditions such as sleep apnea or restless legs syndrome. Many patients report having difficulty concentrating or remembering things (a.k.a. “fibro fog”). Those with fibromyalgia may also have a host of other conditions such as irritable bowel syndrome, headaches, sensitivity to light, temperature, and noise, painful periods, chronic fatigue syndrome, and stiffness.
Julie Brown, a psychotherapist and vice chair of the board of directors at the Center for Mindful Living, describes some of the emotional side effects of living with chronic pain. “Pain is trauma, and when we can’t make sense of that, our human reflex is to begin spinning stories around why we have it, which can exacerbate anxiety and sadness and confusion. These stories can perpetuate the negative emotions, deepen them, and develop a pattern in the brain.”
Brown says these emotional disturbances have a physical toll, too. “People feel betrayed by their bodies, almost like they constantly have to fight themselves,” she says. “So they have this pent up resistance that leads to constant muscular tightness and fast, shallow breathing. This only compounds the problem.”
The American College of Rheumatology (ACR) has outlined 18 sites on the body called “tender points” around major joints including the neck, shoulder, elbow, hip, and knee areas as well as on the chest. A doctor may perform an exam to see how many of these points are sensitive to pain in response to light pressure. However, a doctor can also diagnose fibromyalgia if a patient reports pain present on both sides of the body, both above and below the waist lasting more than three months. Health care professionals will likely order lab tests to rule out other possible conditions.
Although there is no current cure for fibromyalgia, taking a holistic approach to treatment and improving your overall health can alleviate your symptoms. Seeking advice and expertise from various medical experts can help you develop a personalized care plan. Depending on a patient’s unique case, his or her team may include a neurologist, rheumatologist, physical therapist, pain management professional, and/or counselor.
There are some medications available that may help relieve some fibromyalgia symptoms. The U.S. Food and Drug Administration (FDA) has approved three medications – duloxetine (Cymbalta®), milnacipran (Savella®), and pregabalin (Lyrica®) –
to help treat the condition. Doctors also prescribe duloxetine and milnacipran to patients battling depression, and pregabalin to those with pain associated with nervous-system damage. Over-the-counter (OTC) pain relievers such as acetaminophen and ibuprofen can also reduce general achiness, but particular care should be taken to avoid overuse. These drugs are not designed to treat chronic disorders or pain – so if you are using them regularly or plan to for an extended period of time, pursue a doctor’s supervision and take special precautions to know all of their potential side effects and drug interactions.
“Medication is just a small piece of the puzzle,” says Dr. Sadiq Sohani, an anesthesiologist and pain medicine specialist at Center for Spine and Pain Medicine, P.C. – Ambulatory Surgery Center. “Most treatments are non-pharmacological – they may include postural correction, limiting repetitive injuries, nutritional changes, correction of the sleep cycle or insomnia, physical therapy, stress reduction, acupuncture, and aerobic exercise.”
Dr. Sohani says that in many cases, it can be helpful to first address psychological components such as sleeping problems and underlying conditions like depression. “To help with that, following an aerobic exercise program and keeping up structured activity are both extremely important,” he says. “Once you give in to the challenges of pain, it can be really hard to get out of that again. Cognitive behavioral therapy can be very helpful.”
Some people with fibromyalgia have found relief in alternative medicine. Practicing yoga, tai chi, or meditation can help reduce stress. Massage therapy and acupuncture can also serve to provide pain relief.
The practice of mindfulness, which is about listening to your thoughts so that you can discover their habitual patterns, has shown to be very helpful to many people suffering from chronic pain. “Instead of turning away from pain in fear or looking to ‘quick fixes’ that can hurt you in the long run, mindfulness asks people to turn toward the pain,” says Brown. “Becoming aware of your fear, self-blame, or confusion, releasing judgement, and treating yourself with compassion, can actually release tension and decrease pain. Instead of just reacting instinctively to pain, you bring yourself into the decision on how to cope with it.”
These medications and therapies have helped many with fibromyalgia. But in conjunction with any treatment plan, one of the best things you can do is to make wise lifestyle choices that will not only improve your health in general, but help reduce your symptoms. These include:
More rest. Following a regular sleep routine and minimizing naps can be very helpful for reducing fatigue. If you are having serious trouble getting your zzz’s, undergoing a sleep study can help you find ways to quantify and improve your quality of sleep.
Regular exercise. Low-intensity exercise can help reduce pain symptoms over time. Build your endurance level slowly and enjoy moderate activities such as walking, swimming, biking, and flexibility exercises.
A lighter load. Adjusting your working environment and/or schedule can significantly improve your life and make the pain more manageable. If workplace demands worsen your symptoms, consider reducing your hours, switching jobs, replacing uncomfortable office furniture, or seeking advice from an occupational therapist for improved workplace strategies.
Coping and Support
Getting diagnosed with fibromyalgia may seem frustrating and overwhelming, but remember, you are not alone. There are resources and social networks available both online and in local support groups. The National Fibromyalgia Association (fmaware.org) is a nonprofit organization that educates and encourages those in the fibromyalgia community. The American Chronic Pain Association (theacpa.org) can provide helpful information to friends and family members of those with the condition. Inquire at your doctor’s office, local library, or hospital for information on local support groups. While fibromyalgia may impact your life, it need not define it.