Fibromyalgia Causes and Treatment Approaches

What is fibromyalgia?

Fibromyalgia is a chronic connective tissue disorder characterized by widespread pain, fatigue, and weakness.

The disease is often characterized by “tender points” on the body. There are 18 pairs of tender points on the body, located symmetrically (i.e., on the sides of the neck or the lower back). Pain may intensify during flare-ups, becoming debilitating, before gradually decreasing. Some patients report pain as a constant presence, while others seem to have regular intervals of flare-up and remission.

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.

For you, this means normal inputs from the PNS begin to produce abnormal responses. Low-threshold sensory fibers are activated by very light touch of the skin activate neurons in the spinal cord that normally only respond to noxious, or more severe, stimuli.

Who suffers from fibromyalgia?

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

What are common fibromyalgia symptoms?

For most fibromyalgia sufferers, the dominant symptom is widespread pain commonly in the back of the head (occiput), 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

Signs of inflammation are usually absent, but some patients may experience inflammation in response to other symptoms.

Do I have fibromyalgia?

The main challenge with fibromyalgia starts with getting a diagnosis. The average time to receive a fibromyalgia diagnosis is five years. Because fibromyalgia symptoms overlap with symptoms of other conditions, the American College of Rheumatology has established preliminary diagnostic criteria for fibromyalgia.

These include the following three criteria:

1. Pain lasting more than three months
2. Pain that is symmetrical and located above and below the waist (widespread)
3. Other symptoms of fibromyalgia (e.g., fatigue, gastrointestinal issues, headache, etc.)

Old diagnostic guidelines used to define it as a patient having pain in 11 of the 18 tender points, but this is no longer required for a diagnosis.

In addition to these criteria, a fibromyalgia pain specialist will rule out other possible causes of the pain, including:

• Rheumatic diseases: Rheumatoid arthritis, Sjogren’s syndrome, and lupus can produce similar types of pain
• Mental health problems: Depression and anxiety often come with pain
• Neurological disorders: Disorders such as multiple sclerosis and myasthenia gravis

Lab tests that can help paint the full picture to get a better diagnosis include:

• Complete blood count
• Erythrocyte sedimentation rate
• Thyroid function tests
• Vitamin D levels

None of these on their own will diagnose fibromyalgia, but they can rule out similar disorders. Finally, a complete physical exam, including taking a full patient and family history, can help diagnose this complicated condition. Above all, fibromyalgia must not be able to be attributed to another diagnosed disorder.

How to treat fibromyalgia

This is not a progressive or life-threatening condition, and certain fibromyalgia treatments can significantly improve your everyday symptoms. Although the intensity and frequency of the symptoms may vary, they will most likely never disappear completely on their own. Treatments offer hope for extended periods of remission and shorter painful flare-ups.

The best fibromyalgia treatment protocols are holistic and address both your physical and psychological aspects of pain. Living with a chronic pain condition is not just about how much it hurts your body. A mental toll is taken as well. The following treatments can help with both aspects of this condition.

Exercise

Moving around may be the last thing you want to do when symptoms flare up, but there is good benefit to moving your body, even just a little. Exercise produces serotonin, the “feel-good” hormone that promotes a good mood.

Additionally, exercise relieves stress, improves mobility, and promotes mental health. Even a slow walk around the block helps.

However, we know that exercise alone won’t cure your fibromyalgia. It’s a complementary part of treatment that is undertaken alongside other therapies.

Nutrition changes

Eating a pain-friendly diet that supports good health means loads of fresh fruit and veggies, lean proteins, and whole grains. Even if inflammation is not a primary symptom, this type of eating paves the way for healing.

Biofeedback

One of the main triggers of fibromyalgia flare-ups is stress. Biofeedback helps patients to recognize the signs of stress in their body in order to control the physical response to pain.

Water therapy and float tanks

Stress relief and relaxation provided by float tanks can also help minimize painful flare-ups. There is an emerging body of research that points to water therapy and float tanks as a side-effect free way to better manage pain and stress of all kinds.

Cognitive behavioral therapy (CBT)

While this treatment does not change the physical pain, it can affect your relationship to that pain. Journaling, conditioning, and systematic desensitization are all tools with this type of therapy.

Lifestyle changes

Yoga, massage therapy, and meditation all offer stress-relieving and mobility-improving benefits. The gentle movements of yoga increase serotonin levels with low-impact exercises, and massage therapy can gently ease knotted muscles.

Meditation is a proven stress reliever and can literally change the way you think about pain.

Medications: Over-the-counter

Some patients report good results with over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen sodium. For patients without any inflammation, acetaminophen may work to treat their pain.

Medications: Prescription

If you experience an increase in pain due to tensing muscles as flare-ups continue, your doctor might prescribe a muscle relaxant as well. Patients who experience issues with sleep may also benefit from sleep aids.

It is important to note that there is no evidence that opioids are helpful for fibromyalgia. Indeed, they have a great potential to do more harm than good and should be avoided in the vast majority of cases.

Acupuncture

Additionally, acupuncture has been proven to offer pain relief (when studied alongside placebo or “sham” acupuncture). Hair-thin needles placed on specific points release blocked energy and can provide pain relief.

Other treatments

Other potential future treatments for pain and the side effects associated with this condition include:

• Medical marijuana
• Vitamin D supplementation
• Transcranial magnetic stimulation (rTMS)
• TENS unit therapy
• Light therapy

When treating this condition, we focus on the improvement of your physical pain, increased daily activities, and restoration of normal sleep cycles. A combination of treatments including pharmacotherapy with alternative therapies such as acupuncture, lifestyle changes, and activities increasing physical movement is typically your best course of action. This combination addresses both the physical and mental challenges of fibromyalgia.

References

• Fibromyalgia Treatment Update. PMID: 17278924. Curr Opin Rheumatol. 2007 Rooks DS. Mar;19(2):111-7. Study finds acupuncture improves fibromyalgia symptoms. PMID: 17102788.
• Mayo Clin Womens Healthsource. 2006 Dec;10(12):3. Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial. PMID: 16770975 Mayo Clin Proc. 2006 Jun;81(6):749-57.
• Effectiveness of Massage Therapy for Chronic, Non-malignant Pain: A Review. PMID: 17549233 Evid Based Complement Alternat Med. 2007 Jun;4(2):165-79. Epub 2007 Feb 5 Tsao 2007
• Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment. PMID: 16078356 J Rheumatol Suppl. 2005 Aug;75:6-21. Mease 2005
• An open, pilot study to evaluate the potential benefits of coenzyme Q10 combined with Ginkgo biloba extract in fibromyalgia syndrome. J Int Med Res. 2002 Mar-Apr;30(2):195-9 Lister 2002