What is fibromyalgia?
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Fibromyalgia is a condition characterized primarily by chronic widespread pain (CWP) in the muscles, ligaments and tendons, and a heightened sensitivity to touch resulting in pain that can last for months. The condition itself is not rheumatic, meaning it does not affect the joints; however, fibromyalgia often co-occurs with different types of arthritis such as osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis.
Main symptoms of fibromyalgia
The hallmark symptoms of fibromyalgia are pain and sensitivity. Other common signs and symptoms of fibromyalgia can include1
Who gets fibromyalgia
- Pain and stiffness all over the body
- Fatigue and tiredness
- Depression and anxiety
- Sleep problems
- Problems with thinking, memory, and concentration
- Headaches, including migraines
- Tingling or numbness in hands and feet
- Pain in the face or jaw, including disorders of the jaw known as temporomandibular joint syndrome (also known as TMJ)
- Digestive problems, such as abdominal pain, bloating, constipation, and even irritable bowel syndrome (also known as IBS)
Fibromyalgia affects between 2 to 4% in the general population and is more common in women than in men2
.The cause of fibromyalgia remains unknown, but several theories exist. One is called "central sensitization"3
. It is believed that people with fibromyalgia have an increased sensitivity to pain signals in the brain. Another theory is the presence of higher-than-normal levels of a nerve chemical, called "substance P", in the spinal fluid of people experiencing symptoms of fibromyalgia4
. This chemical causes increased pain signals to and from the brain. In other words, for someone diagnosed with fibromyalgia, the "volume control" for pain is turned up too high in the brain.
Other theories about the cause of fibromyalgia include:
Getting a diagnosis of fibromyalgia
- Poor functioning of the nervous system, which regulate senses (e.g., touch)
- Suboptimal control of the systems that fight infection and regulate hormones
- Chronic sleep disorders
- Emotional stress or trauma
The diagnosis of fibromyalgia is difficult to arrive at because there is no specific diagnostic laboratory tests, like a blood test or an x-ray. A physician makes a diagnosis of fibromyalgia based on the patient's history and physical examination. The American College of Rheumatology has created guidelines to help with assessment and diagnosis of fibromyalgia. According to the guidelines, diagnosis requires a patient to4
Treatment of fibromyalgia
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- Have experienced widespread aching pain for at least three months
- Have experienced fatigue, waking up feeling unrefreshed, cognitive (memory or thought) problems
- Have no other health problem that would explain the pain and other symptoms
- Have a minimum of 11 locations on your body that are abnormally tender under relatively mild, firm pressure
While there is no known cure for fibromyalgia, treatments exist that can help to manage the symptoms of the disease. In general, treatment for fibromyalgia includes both medication (for symptom management) and self-care.
Lifestyle changes can have a strong positive impact on the relief of fibromyalgia symptoms and enable a person to manage their disease. These include:
- Exercise – The single most effective "treatment". A review of clinical studies found that aerobic exercise (i.e., walking, swimming) has positive effects on well-being, physical function and has the potential to reduce pain5. Strength training has shown similar benefits6. It is currently unclear if one type of exercise is superior or if a combined routine is optimal.
- Stress – Research on mindfulness techniques suggest short term benefits for pain and quality of life7. Mindfulness therapy usually includes a combination of meditation, yoga, and daily exercises. These techniques are thought to act on symptoms by directing one’s attention to other things.
- Sleep - Many studies have shown complex interactions between sleep disturbances, cognitive, hormonal, and immune abnormalities. These interactions suggest that sleep disturbances may be both a cause and a consequence of fibromyalgia8. More research is needed to determine the most effective therapies to improve sleep, but setting a sleep schedule (e.g., going to bed and waking up at the same times) may help.
- Pacing - Pacing involves breaking down activities into smaller bits and planning one’s day around big events. It is important to note that pacing is not avoiding activity, but instead it is figuring out the optimal timing for your body. Pacing is thought to reduce flares while improving tolerance for activities over time, however more research is needed9.
The most recent research has shown that the role of dietary supplements remains controversial, although trials with vitamin D, magnesium, iron and probiotics’ supplementation show promising results. Diets that are rich in healthy fats (e.g., olive oil), whole grains, and limit irritating/inflammatory foods or chemicals such as monosodium glutamate and aspartame have been shown to be beneficial.
When exercise and other lifestyle approaches are not enough, medications can be added to the treatment plan to help reduce pain. Some common medication choices a doctor may prescribe include1,2,3
- Analgesics, such as acetaminophen (such as Tylenol®)
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen (or Advil®) and naproxen (or Naprosyn®)
- Antidepressants, such as tricyclic anti-depressants (TCA), selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs)
- Muscle relaxants to help treat pain and muscle spasms.
- Antiepileptic medications, such as gabapentin (Neurontin®) and pregabalin (Lyrica®), which was the first drug approved by the Food and Drug Administration (FDA) to treat fibromyalgia.
In addition to the medications listed above, prescription sleep medications have been used to help deal with sleep disturbances and pain; however, it is important to note that many doctors advise against their long-term use because the body can become resistant to them, which may result in more sleeping problems. Sleeping medicines like zolpidem (Ambien®) or benzodiazepine medications are no longer recommended.
Cognitive behavioral therapy11
Cognitive behavioral therapy (CBT) is a practical form of psychotherapy and can be used to help a person with fibromyalgia develop skills for dealing with situations that may trigger symptoms. For instance, individuals learn to identify, question, and change thoughts related to emotional and behavioural reactions to pain.
- Fibromyalgia is not a type of arthritis, but it affects many individuals living with arthritis
- Self-management for fibromyalgia include exercise and having a whole food diet
- Psychotherapy has the potential to help patients manage symptoms and overcome functional limitation
|7||Meeus et al. (2015). The effect of relaxation therapy on autonomic functioning, symptoms and daily functioning, in patients with chronic fatigue syndrome or fibromyalgia: a systematic review. http://doi.org/10.1177/0269215514542635|