Fibromyalgia is a long-term condition characterized by symptoms of widespread muscle and joint pain, stiffness and fatigue. Diagnosis can be difficult and the focus of treatment is to manage the condition through exercise, rest and stress reduction.
Fibromyalgia can affect anyone at any age but is most commonly diagnosed between the age of 25 and 55 years and is more likely to occur in women than in men. Fibromyalgia appears to be relatively common, with studies suggesting up to 2% of New Zealanders will develop the condition.
Fibromyalgia often overlaps with other painful conditions such as chronic fatigue syndrome, irritable bowel syndrome, complex regional pain syndrome and migraine
. It also commonly occurs together with inflammatory diseases, such as rheumatoid arthritis and systemic lupus erythematosus.
The term 'fibromyalgia' literally means pain in muscles and fibrous tissues (ie: tendons and ligaments). Fibromyalgia is also known as soft tissue rheumatism.
For many years it was thought that fibromyalgia was psychologically based but it is now recognised as a medical condition in its own right and research into the condition has increased.
The cause of fibromyalgia is unknown. There are indications that an injury, infection or illness may trigger the condition. There are also indications that hereditary factors are involved in the development of fibromyalgia as sometimes it occurs in several members of one family.
It is thought that fibromyalgia may be due to a malfunction in the way the central nervous system processes pain signals. This leads to people with fibromyalgia experiencing pain from sensations that other people might perceive only as discomfort.
Two brain chemicals, serotonin and substance P, are thought to play a role in the condition. Serotonin is a neurotransmitter (a chemical that enables the transmission of nerve impulses) that influences mood, appetite, pain perception, sexual function, anxiety, temperature control and sleep. Studies have indicated that levels of this chemical are lower than usual in people with fibromyalgia.
Substance P, another neurotransmitter, is involved in transmitting pain sensations to the brain and also regulates the way we perceive pain. Some studies have found substantially elevated levels of substance P in people with fibromyalgia.
Signs and symptoms
A person with fibromyalgia can experience a wide range of symptoms but the main ones are muscle and joint pain, stiffness and fatigue.
The one symptom experienced by everyone with fibromyalgia is pain. This pain can be described in various ways, such as an ache, a sharp pain, a throbbing or a burning feeling. The pain is felt throughout the body and on both sides of the body. The pain can move from one part of the body to another. The amount of pain experienced can vary throughout the day and can also worsen with a change in weather; increase in stress, noise, and activity; and lack of sleep.
Stiffness of muscles and joints is most noticeable in the morning and after a period of rest. This can interfere with work and daily activities such as driving. Keeping moving is the best way to prevent stiffness. If a person has to sit for long periods, he or she can reduce stiffness by regularly getting up to move around and stretch.
Fatigue is experienced by up to 90% of people with the condition. The level of fatigue can vary from person to person, from being barely noticeable to severe. As with the amount of pain experienced, the degree of fatigue can vary throughout the day, from day to day, and may even be absent on occasion.
Many people with fibromyalgia experience sleep problems. There are a number of stages of normal sleep ranging from light to deep sleep. It seems that people with fibromyalgia often lack the deep restorative stages of sleep and often wake feeling unrefreshed. Over half of people with fibromyalgia experience symptoms such as irritability, forgetfulness, lack of concentration, mood changes, anxiety and depression
Other symptoms that can be experienced by people with fibromyalgia include:
- Migraine and tension headaches
- Recurrent abdominal pain
- Difficulty swallowing
- Irritable bladder leading to frequent or painful urination
- Numbness and tingling of the extremities
- Dry eyes and mouth.
Not everyone feels all symptoms and the severity of symptoms varies greatly between individuals. There may also be days when more symptoms are present than others. A period when there is an increase in the number and severity of symptoms is known as a "flare".
Fibromyalgia can be a difficult condition to diagnose as the symptoms of fibromyalgia are often similar to those of other conditions, such as rheumatoid arthritis
or chronic fatigue syndrome
. Blood tests and x-rays usually return normal results in someone with fibromyalgia but they are often performed in order to rule out other conditions.
Doctors use certain criteria to help make a diagnosis. Most people with fibromyalgia have symptoms of widespread pain not explained by other conditions, and tenderness in at least 11 out of 18 tender points located at precise locations on the body (shown in the diagram below). However, some people may still have fibromyalgia even without these symptoms.
Graphic courtesy of A. Bonsall and MedicineNet.com
Other indicators doctors will look for include:
- Normal blood tests
- Chronic fatigue
- Sleep disturbances
- Skeletal pain (mainly in the neck and back).
While there is no cure for fibromyalgia, the condition can be managed using a variety of measures. Optimal management requires cooperation between the patient and various treatment providers.
Exercise is highly recommended even though people with fibromyalgia may be reluctant to exercise because of their pain. Exercise is important to prevent the muscles from losing strength due to lack of use. Other benefits of regular exercise include sleep promotion, aiding digestion, increasing blood flow and improving muscle tone. It is best to start with small amounts of low impact exercise (such as walking) on a daily basis, and gradually increase this as tolerated.
Physical and occupational therapy may help to reduce the effects of fibromyalgia on everyday life. A physical therapist can teach exercises that will improve strength, flexibility and stamina. An occupational therapist can help make adjustments to work stations or the way that certain tasks are performed to reduce the level of stress on the body.
Rest and sleep
Rest is also important in managing fibromyalgia. People with fibromyalgia often feel exhausted after only small amounts of activity. It is often helpful therefore, to rest regularly during the day and even during activity if it is needed. Even 5-10 minute periods of rest can be helpful. Sleep is often inadequate in quality for people with fibromyalgia. It is not advisable to use sleeping tablets unless they are absolutely necessary, and then only for brief periods of time. Some methods that may help to gain more restful sleep include avoiding alcohol and coffee in the evening, using the bedroom only for sleep (ie: not for working or eating), ensuring the room is dark when trying to sleep and having a regular time for going to bed.
Stress reduction and relaxation
Stress reduction is important as increased stress
can worsen fibromyalgia symptoms. Finding methods of relaxation (such as reading or listening to music) that suit the individual with fibromyalgia can be helpful in stress reduction. Talking about the condition with friends and family can also be helpful. Some people may find it helpful to work with a professional counsellor or psychologist to develop relaxation techniques and strategies to cope with the pain. A psychological technique known as Cognitive Behavioural Therapy (CBT) has been shown to help people with fibromyalgia.
Alternative therapies such as acupuncture/acupressure, homeopathy, hot and cold packs, massage therapy, yoga and tai chi, nutritional supplements and dietary modifications, herbal preparations, osteopathy or chiropractic treatment, have proved beneficial for some people in managing the symptoms of fibromyalgia.
Medications can help reduce the pain of fibromyalgia and improve sleep. The medications given will be tailored to the individual and will depend on the nature and severity of the symptoms experienced.
Common pain relief medications such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAID’s) may be recommended. However, they seem to have only limited effect in managing the pain of fibromyalgia. Some people may find relief with stronger medications such as tramadol (a morphine-like pain relief).
Low doses of tricyclic antidepressants, such as amitriptyline or nortriptyline, can be helpful in relieving the pain of fibromyalgia. These medications also improve quality of sleep and can help address the imbalance of neurotransmitters in the pain conduction pathways. While these medications help some people with fibromyalgia, they are not effective in all cases.
Medications that act directly on the pain pathways may also be prescribed. Examples of these medications include gabapentin and pregabalin.
Arthritis New Zealand offers information for fibromyalgia sufferers:
Phone: 0800 663 463
Arthritis New Zealand (2014). Fibromyalgia (Information Brochure). Wellington: Arthritis New Zealand. http://www.arthritis.org.nz/pdfs/brochures/Fibromyalgia.pdf
Mayo Clinic (2016). Fibromyalgia (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/diseases-conditions/fibromyalgia/home/ovc-20317786 [Accessed: 10/05/17]
O’Toole, M.T. (Ed.) (2013). Fibromyalgia. Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed.). St Louis, MI: Elsevier Mosby.
Boomershine, C.S. (2016). Fibromyalgia (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/329838-overview#a1 [Accessed: 10/05/17].
Last Reviewed May 2017