What is fibromyalgia?
Fibromyalgia is a long-term (chronic) condition.
- pain in the muscles and bones (musculoskeletal pain)
- areas of tenderness
- general fatigue
- sleep and cognitive disturbances
This condition can be hard to understand, even for healthcare providers. Its symptoms mimic those of other conditions, and there aren’t any real tests to confirm the diagnosis. As a result, fibromyalgia is often misdiagnosed.
In the past, some healthcare providers even questioned whether fibromyalgia was real. Today, it is much better understood. Some of the stigma that used to surround it has eased.
Fibromyalgia can still be challenging to treat. But medications, therapy, and lifestyle changes can help you to manage your symptoms and to improve your quality of life.
Fibromyalgia causes what’s now referred to as “regions of pain.” Some of these regions overlap with what was previously referred to as areas of tenderness called “trigger points” or “tender points.” However, some of these previously noted areas of tenderness have been excluded.
The pain in these regions feels like a consistent dull ache. Your healthcare provider will consider a diagnosis of fibromyalgia if you’ve experienced musculoskeletal pain in 4 out of the 5 regions of pain outlined in the 2016 revisions to the fibromyalgia diagnostic criteria.
This diagnostic protocol is referred to as “multisite pain.” It’s in contrast to the 1990 fibromyalgia diagnostic criteria definition for “chronic widespread pain.”
This process of diagnosis focuses on the areas of musculoskeletal pain and severity of pain as opposed to an emphasis on pain duration, which was the previously the focal criteria for a fibromyalgia diagnosis.
Other symptoms of fibromyalgia include:
- trouble sleeping
- sleeping for long periods of time without feeling rested (nonrestorative sleep)
- trouble focusing or paying attention
- pain or a dull ache in the lower belly
- dry eyes
- bladder problems, such as interstitial cystitis
In people with fibromyalgia, the brain and nerves may misinterpret or overreact to normal pain signals. This may be due to a chemical imbalance in the brain or abnormality in the dorsal root ganglion affecting central pain (brain) sensitization.
Fibromyalgia can also affect your emotions and energy level.
Fibromyalgia fog | Fog
Fibromyalgia fog also known as “fibro fog” or “brain fog” is a term some people use to describe the fuzzy feeling they get. Signs of fibro fog include:
- memory lapses
- difficulty concentrating
- trouble staying alert
Some people find mental fogginess from fibromyalgia more upsetting than pain.
Fibromyalgia symptoms in women | Symptoms in women
Fibromyalgia symptoms have generally been more severe in women than in men. Women have more widespread pain, IBS symptoms, and morning fatigue than men. Painful periods are also common.
However, when the 2016 revisions to the diagnostic criteria are applied, more men are being diagnosed with fibromyalgia, which may reduce the degree of distinction between the pain levels men and women experience. More research needs to be done to further evaluate that distinction.
The transition to menopause could make fibromyalgia worse.
Complicating things is the fact that some symptoms of menopause and fibromyalgia look almost identical.
Fibromyalgia in me
Men also get fibromyalgia. Yet, they may remain undiagnosed because this is seen as a woman’s disease. However, current statistics show that as the 2016 diagnostic protocol is more readily applied, more men are being diagnosed.
Men also have severe pain and emotional symptoms from fibromyalgia. The condition affects their quality of life, career, and relationships.
Part of the stigma and difficulty in getting diagnosed stems from society’s expectation that men who are in pain should “suck it up.”
Fibromyalgia trigger points
In the past, people were diagnosed with fibromyalgia if they had widespread pain and tenderness in at least 11 out of 18 specific trigger points around their body. Healthcare providers would check to see how many of these points were painful by pressing firmly on them.
Common trigger points included the:
- back of the head
- tops of the shoulders
- upper chest
- outer elbows
For the most part, trigger points are no longer a part of the diagnostic process.
Instead, healthcare providers may diagnose fibromyalgia if you’ve had pain in 4 out of the 5 areas of pain as defined by the 2016 revised diagnostic criteria, and you have no other diagnosable medical condition that could explain the pain.
Pain is the hallmark fibromyalgia symptom. You’ll feel it in various muscles and other soft tissues around your body.
The pain can range from a mild achiness to an intense and almost unbearable discomfort. Its severity could dictate how well you cope day to day.
Fibromyalgia appears to stem from an abnormal nervous system response. Your body overreacts to things that shouldn’t normally be painful. And you may feel the pain in more than one area of your body.
However, available research still doesn’t pinpoint an exact cause for fibromyalgia. Research continues to evolve in better understanding this condition and its origin.
When fibromyalgia pain is in your chest, it can feel frighteningly similar to the pain of a heart attack.
Chest pain in fibromyalgia is actually centered in the cartilage that connects your ribs to your breastbone. The pain may radiate to your shoulders and arms.
Fibromyalgia chest pain may feel:
- like a burning sensation
And similar to a heart attack, it can make you struggle to catch your breath.
Your back is one of the most common places to feel pain. About 80 percent of Americans have low back pain at some point in their lives. If your back hurts, it may not be clear whether fibromyalgia is to blame, or another condition like arthritis or a pulled muscle.
Other symptoms like brain fog and fatigue can help pinpoint fibromyalgia as the cause. It’s also possible to have a combination of fibromyalgia and arthritis.
The same medications you take to relieve your other fibromyalgia symptoms can also help with back pain. Stretching and strengthening exercises can help provide support to the muscles and other soft tissues of your back.
You can also feel fibromyalgia pain in the muscles and soft tissues of your legs. Leg pain can feel similar to the soreness of a pulled muscle or the stiffness of arthritis. It can be:
Sometimes fibromyalgia in the legs feels like numbness or tingling. You may have a creepy crawling sensation. An uncontrollable urge to move your legs is a sign of restless legs syndrome (RLS), which can overlap with fibromyalgia.
Fatigue sometimes manifests in the legs. Your limbs can feel heavy, as if they’re held down by weights.
Doctors aren’t sure what causes it, but some think it’s a problem with how your brain and spinal cord process pain signals from your nerves.
We do know certain things suggest you’re more likely to get it:
- You’re a woman.
- You have another painful disease, such as arthritis, or an infection.
- You have a mood disorder, like anxiety or depression.
- You were physically or emotionally abused or have PTSD.
- You rarely exercise.
- Other family members have it.
Medical attention is needed because fibromyalgia can be difficult to manage. As it is a syndrome, each patient will experience a different set of symptoms, and an individual treatment plan will be necessary.
Treatment may include some or all of the following:
- an active exercise program
- behavior modification therapy
- chiropractic care
- physical therapy
- low-dose anti-depressants, although these are not a first-line treatment
People with fibromyalgia need to work with their doctor to come up with a treatment plan that provides the best results.
Drugs may be recommended to treat certain symptoms.
These may include over-the-counter (OTC) pain relievers. However, the European League Against Rheumatism (EULAR) issued a recommendation against using non-steroidal anti-inflammatory drugs (NSAIDs) to treat fibromyalgia in their updated 2016 guidelines.
Antidepressants, such as duloxetine, or Cymbalta, and milnacipran, or Savella, may help reduce pain. Anti-seizure drugs, such as gabapentin also known as Neurontin, and pregabalin, or Lyrica, may be prescribed.
However, a review has suggested that patients often stop using these drugs because they are not effective in relieving pain or because of their adverse effects.
Patients should tell the doctor about any other medications they are taking to avoid side-effects and interactions with other drugs.
A combination of aerobic exercise and resistance training, or strength training, has been linked to a reduction in pain, tenderness, stiffness, and sleep disturbance, in some patients.
If exercise is helping with symptoms, it is important to maintain consistency in order to see progress. Working out with a partner or personal trainer may help to keep the exercise program active.
Some patients have experienced improvements in their quality of life after starting acupuncture therapy for fibromyalgia. The number of sessions required will depend on the symptoms and their severity.
One study found that 1 in 5 people with fibromyalgia use acupuncture within 2 years of diagnosis. The researchers concluded that it may improve pain and stiffness. However, they call for more studies.
Behavior modification therapy
Behavior modification therapy is a form of cognitive behavioral therapy (CBT) that aims to reduce negative, stress- or pain-increasing behaviors and improve positive, mindful behaviors. It includes learning new coping skills and relaxation exercises.
The exact cause of fibromyalgia is unclear. However, current thinking in the field of Rheumatology suggests that fibromyalgia is a problem with central pain processing in the brain, where there may be an increased sensitivity or perception of pain to a given trigger.
There is a range of likely risk factors, including:
- a stressful, traumatic physical or emotional event, such as a car accident
- repetitive injuries
- rheumatoid arthritis or other autoimmune diseases, such as lupus
- central nervous system (CNS) problems
- the way our genes regulate how we process painful stimuli
Fibromyalgia may also be hereditary. Females who have a close relative with fibromyalgia have a higher risk of experiencing it themselves.
People with rheumatoid arthritis, lupus, or spinal arthritis, known ankylosing spondylitis, have a higher risk of developing fibromyalgia, as do patients with some other rheumatic diseases.
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