What Is Fibromyalgia? Symptoms, Diagnosis & Treatments

Fibromyalgia is a chronic condition that causes severe pain all over the body – widespread discomfort is felt in the muscles and joints with multiple tender points.

Symptoms

The condition can cause a variety of symptoms which may differ from patient to patient.

Pain

fibromyalgia - do not suffer aloneTypically felt all over the body, with the presence of multiple tender points; it can be characterised by anything from aching, to severe stabbing pains. Numbness may also be felt throughout the body.

Classic signs of both hyperalgesia (abnormal sensitivity to pain) and allodynia (central pain sensitisation – a pain response is triggered by stimuli that would not usually be painful, such as a light tap), are frequently demonstrated by patients. In some cases, sensitivity may be such that even the touch of clothes on the skin, bright lights and other substances such as certain foods, may cause pain.

Fatigue and Sleep Disturbances

Fibromyalgia is associated with sleep disturbances, preventing the patient from entering deep sleep cycles – resulting in non-restorative sleep, leaving the individual feeling chronically unrested. Extreme fatigue is frequently described by patients as one of the worst symptoms, affecting their ability to think or remember things properly. Feelings of exhaustion can heavily interfere with daily activities and routines.

Cognitive Difficulties

Often described as brain fog or fibro fog, patients may experience difficulty with concentration, memory or learning new things. Slow and confused speech is another symptom of a cognitive complication associated with fibromyalgia.

Irritable Bowel Syndrome (IBS)

A commonly described symptom of Fibromyalgia, IBS is a long term condition of the digestive system, characterised by bouts of diarrhoea and constipation.

Headaches

Stiffness and pain in the neck and shoulders may result in severe headaches, further impinging on day to day life.

Other associated symptoms may include:

  • painful periods in women
  • an irritable bladder
  • rheumatoid arthritis
  • anxiety and depression
  • restlessness leg syndrome
  • problems relating to the jaw
  • Raynaud’s phenomenon

Diagnosis

One of the main problems in diagnosing fibromyalgia, is although patients complain of suffering from sensations of severe pain, they do not appear clinically unwell. Blood tests, scans and x-rays typically show no changes, muscles and joints demonstrate no sign of disease or inflammation. Such tests, however, are an essential part of the diagnosis, as they rule out other conditions and possible red flags – indicators of serious illnesses. Symptoms may also be confused with those of other conditions such as chronic fatigue syndrome or myalgic encephalomyelitis (ME).

What Causes Fibromyalgia?

The exact cause is currently unknown; however, a number of different theories that consider an interaction between neurological, physical and psychological factors, are currently being investigated to try and understand more about the condition and improve treatment.

Chemical Imbalances and abnormal pain messages

Research suggests that chemical imbalances may be responsible for the condition; patients suffering from fibromyalgia have low levels of certain hormones such as, dopamine, serotonin and noradrenaline. These hormones play a key role in regulating our behaviour, mood, sleep patterns, appetite and how we respond to stressful situations.

Studies indicate that patients suffering from fibromyalgia have developed alterations in the way the central nervous system (the brain and spinal cord) processes pain messages – the aforementioned chemical imbalances further amplify the pain.

Genetics

The condition may run in families, some people are more likely to develop the disease due to their genes.

Age and Gender

Fibromyalgia typically effects more women than men, developing on average between the ages of 30 and 50. Although rare, it can occur in children.

Psychological

A stressful event or period in our lives may trigger fibromyalgia. Pain can be affected by moods and emotions – stress, depression and anxiety can heighten our sense of pain. In fact, chronic pain is intrinsically linked to depression and anxiety; feeling constant pain can be extremely debilitating, causing severe disruptions to daily routines - affecting family and social life. This in turn, can lead to feelings of depression and ultimately more pain - resulting in a vicious cycle.

Sleep Disturbances

One possible theory is that interrupted sleep patterns may actually be a cause, rather than merely a symptom of fibromyalgia. Studies using electroencephalograms showed patients with fibromyalgia were unable to achieve uninterrupted delta sleep, the deep sleep phase of the sleep cycle. The research illustrated that during this phase, characterised by delta waves, (the slowest of all the brainwave frequencies), patients experienced an intrusion of alpha waves (typically present during relaxation when the brain is in an idling state – a bridge between consciousness and sleep). This abnormality may be responsible for the symptoms of non-refreshing sleep.

In another study, healthy volunteers were repeatedly woken during the deep sleep stage over a period of time. Many of which developed a number of symptoms associated with fibromyalgia.

Other possible triggers of fibromyalgia include:

  • Injury/trauma
  • Infection
  • Surgery
  • Giving birth
  • Arthritis or other chronic conditions

Treatment

At present there is no one cure for fibromyalgia; there are however, many different forms of treatment that can help ease the symptoms. It is also important to note that although symptoms can be extremely painful, no lasting damage is caused to the body’s tissue.

Pain Relief Medication

Over the counter analgesics such as paracetamol are normally not strong enough to relieve symptoms. Depending on the individual, there are a variety of other possible medications.

Opioids

Tramadol and other opioids can be extremely effective in the treatment of severe pain.

Antidepressants

Tricyclic antidepressants as well as newer antidepressants have shown efficacy in the treatment of many chronic pain conditions. Low levels of neurotransmitters are often a characteristic of fibromyalgia, antidepressants can help boost neurotransmitter levels. Some antidepressants can also help improve sleep.

Anticonvulsants

Research has shown that anticonvulsants such as gabapetin and pregablin, usually used in the treatment of epilepsy, are useful in the treatment of the chronic pain associated with fibromyalgia.

Sleeping Medication

Benzodiazepines such as temazepam or other newer tranquillising drugs may be prescribed in the treatment of the sleep disturbances linked to fibromyalgia.

Capsaicin gel or non-steroidal anti-inflammatory

Topical analgesics such as capsaicin gels can be effective in the treatment of chronic pain.

Psychological

Emotional support from both health professionals and family is extremely important for patients. Due to the unclear diagnosis and negative test results, patients may feel as though their condition is somewhat shrouded in a cloud of disbelief. The lack of a concrete diagnosis can be stressful in itself, leading to an increase in anxiety, depression and other negative emotions – ultimately augmenting the painful symptoms. Believing in and listening carefully to the patient’s experience of pain and how it is affecting their daily life, is an important aspect of treatment.

Those suffering from chronic pain may also develop fear-avoidance behaviour, whereby negative beliefs of physical limitations cause the patient to avoid activities and withdraw from normal social interaction. This inadvertent isolation can lead to low moods and feelings of depression and anxiety. Cognitive behavioural therapy may be useful as it can help patients not only accept their condition, but cope with the stress of chronic pain and learn techniques for relaxation. An improvement in mental well being often sees a marked improvement in physical symptoms at the same time.

Physiotherapy and Exercise

Exercise and keeping active plays a vital role in the treatment, it not only lifts the mood and improves well being, but also helps balance, coordination and overall body strength. Those suffering from chronic pain may avoid doing any type of physical exercise for fear of worsening their symptoms, this can cause muscle weakness – leading to further disability and an increase in negative symptoms such as isolation, depression, more fatigue and so forth.

A physiotherapist can design personalised exercise programs to suit individual patient needs, this may involve a combination of aerobic and strengthening exercises. Other forms of relaxation exercise, or swimming in a heated swimming pool, may also be beneficial.

Pain Management Clinics

The multi-disciplinary approach of the pain management clinic can be extremely beneficial in the treatment and management of fibromyalgia. Based on the bio-psycho-social model, the pain management clinic takes into consideration the physical, socio-economic and psychological state of the patient when devising any individual treatment plan – providing complete, all round treatment. This may include educating the patient on the condition itself, prescribing appropriate pain-relief medication, devising a physical exercise plan, and providing psychological treatment to help address any unhelpful beliefs, as well as teaching coping mechanisms – consequently encouraging individuals to actively participate in the self management of their symptoms.

Nerve Pain

nerve pain

Back Pain

back pain

Treatments

pain treatment