Fibromyalgia

Fibromyalgia is a reasonably common, long-term condition that affects the bones and muscles. Symptoms include general muscle and joint pain, stiffness, and fatigue. Treatment aims to manage the condition through exercise, rest, and stress reduction.

Fibromyalgia can affect anyone at any age but is most commonly diagnosed between the ages of 25 and 55 years and is more likely to occur in women than in men. Overseas studies suggest that up to six per cent of New Zealanders may develop the condition.

The term 'fibromyalgia' literally means pain in muscles and fibrous tissues (ie: tendons and ligaments). Fibromyalgia is also known as soft tissue rheumatism.

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, ankylosing spondylitis and systemic lupus erythematosus.

Causes

For many years it was thought fibromyalgia was psychologically based but it is now recognised as a medical condition in its own right.

The cause of fibromyalgia is unknown. It is thought the condition may be due to a malfunction in the way that 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.

There are indications that physical injury, emotional trauma, or an infection or illness may trigger the condition. There are also indications that hereditary (genetic) factors are involved in the development of fibromyalgia as sometimes it occurs in several members of one family.

Signs and symptoms

A person with fibromyalgia can experience a wide range of symptoms but the main ones are widespread muscle and joint pain, stiffness and fatigue.

The nature and severity of these symptoms varies greatly between individuals. A period when there is an increase in the number and severity of symptoms is known as a "flare".

Fibromyalgia pain can be described in various ways - such as an ache, a sharp pain, a throbbing, or a burning feeling – and may 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 may be most noticeable in the morning and after sitting for long periods. Getting up to move around and stretch is the best way to prevent stiffness.

Fatigue is experienced by many people with the condition. The level of fatigue can vary from person to person - from being barely noticeable to severe – and may also vary through the day and on different days.

Many people with fibromyalgia also experience sleep problems. 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
• Diarrhoea
• Difficulty swallowing
• Irritable bladder leading to frequent or painful urination
• Numbness and tingling of the extremities
• Dry eyes and mouth.

Diagnosis

Fibromyalgia can be a difficult condition to diagnose as its symptoms 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.

A doctor may make a diagnosis of fibromyalgia if the patient has had widespread pain for longer than three months in the absence of another medical condition that could cause the pain.

Doctors use certain criteria to help make a diagnosis. Most people with fibromyalgia have 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).

Treatment

While there is no cure for fibromyalgia, the condition can be managed using a variety of measures.

Exercise

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 improving sleep, 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 daily life. A physical therapist can teach exercises that will improve strength, flexibility, and stamina. An occupational therapist can help make adjustments to workstations 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- to 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 beneficial 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.

Medications

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 may be recommended but often has only limited effect in managing the pain of fibromyalgia. Some people may find relief with stronger medications such as tramadol but its use requires close supervision due to the risk of dependency and side effects.

Certain anti-depressant and anti-seizure drugs might also be prescribed in some circumstances.

Further support

Arthritis New Zealand offers support for people with fibromyalgia:

Phone: 0800 663 463
Email: [email protected]
Website: www.arthritis.org.nz

References

Arthritis New Zealand (2014). Fibromyalgia (Information Brochure PDF). Wellington: Arthritis New Zealand. https://www.arthritis.org.nz/wp-content/uploads/2018/10/Fibromyalgia.pdf
Boomershine, C.S. (2018). Fibromyalgia (Web Page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/329838-overview#a4 [Accessed: 19/02/20].
Mayo Clinic (2017). Fibromyalgia (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780 [Accessed: 19/02/20]
O’Toole, M.T. (Ed.) (2017). Fibromyalgia. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.

Last Reviewed: March 2020

Go to our Medical Library Index Page to find information on other medical conditions.