Many times patients come to me after suffering for years from unexplained pain, fatigue, and sleep problems. For those that I diagnose with fibromyalgia (FM), it can be a relief for them to finally know what’s causing their pain.
Fibromyalgia is characterized by chronic, widespread, achy musculoskeletal pain that occurs throughout the body. FM impacts the central nervous system, which affects the way the brain processes messages.
It is the second most common rheumatic disorder after osteoarthritis affecting 2–8% or millions of Americans. Women are diagnosed with fibromyalgia more frequently than men (about 80% vs. 20%), and it is more common in young to middle-aged women.
There is no definitive cause of FM, but genetics do play an important role as there is usually a strong family history of the condition. Infections such as mononucleosis and Lyme disease; chronic diseases such as osteoarthritis, rheumatoid arthritis, and diabetes; psychological stress (PTSD, depression, bipolar, ADHD); or trauma or injury to the body can act as triggers.
The most common symptom of FM is widespread pain, tenderness, and stiffness that affects both sides of the body, both above and below the waist. Most people with FM suffer from severe fatigue, cognitive or memory problems (“fibro fog”), trouble falling or staying asleep, and mood disturbances (anxiety or depression). Pain levels can vary from day-to-day.
Some patients report occasional ringing in the ear, jaw pain/temporomandibular joint disorder (TMJ), dry eye, enlarged lymph nodes, nasal congestion, multiple allergies, irritable bowel syndrome (IBS) or difficulty digesting.
Associated neurological symptoms include tension headaches or migraines or tingling/“pins and needles” sensations in the arms, hands, feet or legs.
Newly identified syndromes such as heart palpitations or a drop in blood pressure due to postural orthostatic tachycardia syndrome (POTS) have also been linked to FM.
Getting a diagnosis for fibromyalgia can be challenging because there is no individual test that will confirm that you have fibromyalgia. Many of the symptoms mimic other medical conditions, so FM becomes a diagnosis of exclusion. Your physician will review your symptoms and may order blood tests to rule out other conditions such as an auto-immune disorder, arthritis, or a thyroid imbalance. There are 18 designated tender points at the shoulders, legs, and back of the head that your physician will likely examine during your visit.
While there is no cure for fibromyalgia, I work with my patients to come up with a treatment plan that includes a combination of lifestyle changes and medication. Although the pain will likely never completely disappear, the goal is to ease the symptoms and improve the quality of life.
The non-medication approach involves lifestyle changes which are vital for the improvement of symptoms. Medication alone will not help if one does not change their lifestyle.
Sleep – First, we ensure that patients are practicing good sleep hygiene. If sleep apnea is suspected, we may recommend seeing a sleep specialist and possibly having a sleep study.
Mental Health – It is important for those diagnosed with fibromyalgia to keep their stress levels at bay as stress can increase symptoms. We encourage patients to work with a mental health provider to address any psychological factors such as post-traumatic stress disorder (PTSD), depression, anxiety, or attention-deficit/hyperactivity disorder (ADHD).
Exercise – I would say that exercise is the most critical part of a treatment plan. Exercise helps to produce endorphins, which are our natural pain killers. Patients should aim to do some form of cardio/aerobic exercise for 30 minutes at least three times a week as well as strength training three times a week. Yoga and meditation are also helpful in decreasing anxiety while gently strengthening the muscles. Swimming in warm water is a great alternative form of low impact exercise. Tai Chi has also been shown to reduce pain.
Alternative Medicine – Acupuncture, massage therapy, physical therapy, and chiropractic manipulation have all shown benefits to improving symptoms of fibromyalgia.
Diet – Although there is still not enough data about diet, I always recommend that my patients follow an anti-inflammatory diet rich in fruits, vegetables, nuts, whole grains, fish, and healthy oils. There is a hypothesis that small fiber nerve damage may come from too much sugar, causing insulin resistance without overt diabetes. Eliminating added and refined sugar in your diet can be helpful in many ways.
Supplements – Some vitamins may help with fatigue such a B complex and magnesium. Turmeric and glucosamine-chondroitin have little evidence but may help in relieving pain if there is underlying osteoarthritis. Cannabidiol (CBD) oil has analgesic properties as well; however, like any supplements, they are not FDA regulated. It’s hard to find a pure CBD without having some of the THC substance which gives the euphoria. More research is still needed in that field.
Medications – While we start by trying to minimize the symptoms of FM with lifestyles changes, there are circumstances where prescription medications are appropriate.
We rarely recommend opioids as they can lead to addiction and cause a rebound effect.
It is essential to understand that not all medications or techniques will work for everybody. Patients may need to go through a trial and error process with their physician.
The one thing that I want patients to know is that there is hope for a better quality of life. Although there is no cure for fibromyalgia, and we may not be able to relieve all of your pain, there are many ways we can help you manage your symptoms.