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. 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.
Between two and four percent 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, poor sleep, chronic inflammatory or autoimmune disorders, and trauma.
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), and urinary frequency. Signs of inflammation are usually absent, but some patients may experience inflammation in response to other symptoms.
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:
Pain lasting more than three months
Pain that is symmetrical and located above and below the waist (widespread)
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 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, and vitamin D levels and although none of these on their own will diagnose fibromyalgia, 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.
Certain fibromyalgia treatments can significantly improve your everyday symptoms and 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 (OTC) - 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 and 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.
