Fibromyalgia

Fibromyalgia, also known as fibromyalgia syndrome (FMS), is a chronic condition that is characterised by pain occurring all over the body.

The name fibromyalgia is made up from “fibro” for fibrous tissues such as tendons and ligaments; “my” indicating muscles; and “algia” meaning pain. The fatigue ranges from generally feeling tired to the exhaustion of a flu-like illness. It may come and go and people can suddenly feel drained of all energy – as if someone just “pulled the plug”. The pain tends to be felt as diffuse aching or burning, often described as ‘head-to-toe pain.’ It may be worse at certain times and may also change location, usually becoming more severe in the parts of the body that tend to be the most active.

Fibromyalgia can occur by itself or along with forms of arthritis or other autoimmune conditions, including scleroderma. Although it is never fatal, it is usually difficult to manage and can cause significant disability and disruption to quality of life. It can also lead to depression and social isolation.

Fibromyalgia is a common illness, more so than rheumatoid arthritis* and can be even more painful. People with mild to moderate cases of fibromyalgia are usually able to live a normal life, with the appropriate treatment.

If symptoms become severe, however, it may become increasingly difficult to continue working or to take part in social activities in the same ways as before.

Symptoms of fibromyalgia include muscle and joint pain, profound fatigue, disturbed sleep and many others, including:

  • Pain and stiffness all over the body
  • Fatigue (extreme tiredness)
  • Increased sensitivity to pain
  • Tenderness to touch
  • Difficulty sleeping/unrefreshed sleep – waking up tired and stiff
  • Sexual dysfunction
  • Mood disturbances
  • Anxiety/psychological distress
  • Problems with mental processes (known as “fibro-fog”) – cognitive problems including lack of concentration, temporary memory impairment and word mix-up
  • Clumsiness and dizziness
  • Dryness in mouth, eyes and nose
  • Headaches – ranging from ordinary types to migraine
  • Irritable bowel syndrome (IBS) – a digestive condition alternating diarrhoea and constipation, sometimes accompanied by stomach pain, bloating or nausea
  • Allergies and chemical sensitivities
  • Hypersensitivity to cold/heat changes in the weather and to noise, bright lights, smoke and other environmental factors

Fibromyalgia often develops after some sort of trauma that seems to act as a trigger, such as a fall or car accident, a viral infection, childbirth, an operation or an emotional event. Sometimes the condition begins without any obvious trigger. The actual cause of fibromyalgia has not yet been identified. In recent years, however, research has produced some insights into this puzzling condition. For instance, it is now known that most people with fibromyalgia are deprived of deep, restorative sleep. Current studies may discover how to improve the quality of sleep and some of the prescribed medicines are specifically aimed at addressing this issue.

Research has also identified a deficiency in serotonin within the central nervous system coupled with a threefold increase in the neurotransmiter substance P, that is found in spinal fluid and transmits pain signals.

The effect is disordered sensory processing. The brain registers pain when others might experience a slight ache or stiffness. It is hoped that more research will discover the cause and result in more effective treatments.

Medication does not deal with the underlying cause or causes of fibromyalgia, however it does help to relieve the symptoms. Specific recommendations on treatments may include:

  • Tramadol is an opioid analgesic recommended for the management of pain. Although other treatment options may include simple analgesics (such as paracetamol) and other weak opioids, nonsteroidal anti-inflammatory drugs (NSAIDS) have not been found to be effective. Corticosteroids and strong opioids are not recommended
  • Antidepressants are recommended because they decrease pain and often improve function. Appropriate options may include tricyclic antidepressants such as amitriptyline, as well as newer drugs such as fluoxetine, duloxetine and paroxetine
  • Pramipexole, a treatment for Parkinson’s disease and restless legs syndrome, has been found to reduce pain in FMS
  • Pregabalin is an anti-epileptic drug that has also been found to help relieve pain symptoms

Complementary therapies, although these are not well-tested, can help manage the symptoms of fibromyalgia. For instance, therapeutic massage manipulates the muscles and soft tissues of the body and helps to ease deep muscle pain. It also helps relieve pain of tender points, muscle spasms and tense muscles. Similarly, myofascial release therapy, which works on a broader range of muscles, can gently stretch, soften, lengthen and realign the connective tissue to ease discomfort.

Cognitive behavioural therapy (CBT), relaxation techniques and physiotherapy may help some patients. Moderately intense aerobic exercise at least two or three times a week can help with symptoms, and although the scientific evidence may not be strong, the benefits of exercise for general health and feelings of wellbeing suggest its use should be encouraged. Hydrotherapy in a heated pool may also be beneficial.

Techniques such as hypnosis, acupuncture and chiropractic manipulation may help relieve pain in individual cases, but further evaluation of these methods is required.

Along with complementary therapies, it is important to allow time each day to rest and relax. Relaxation therapies such as deep muscle relaxation or deep breathing exercises can help reduce the added stress that can trigger fibromyalgia symptoms. Having a regular bedtime is also important.

FMS is not new, but for most of the last century it was difficult to diagnose. Part of the problem has been that the condition could not be identified in the standard laboratory tests or x-rays. Moreover, many of its signs and symptoms are found in other conditions as well – especially in chronic fatigue syndrome (CFS).

Two Canadian doctors developed a way of diagnosing fibromyalgia in the 1970s and in 1990 an international committee published requirements for diagnosis that are now widely accepted.

Once other medical conditions have been ruled out through tests such as a full blood count and a thyroid test, the diagnosis of fibromyalgia depends upon two primary symptoms:

  1. Pain in all four quadrants of the body for at least three months, together with:
  2. Pain in at least 11 out of 18 tender point sites when they are pressed. The “tender points”, or spots of extreme tenderness, are rarely noticed by the patient until they are pressed

There is no cure for fibromyalgia, with no single therapy that will address every symptom. What is available is a wide range of both medical and complementary treatments, that have been shown to be effective in treating particular aspects of this complex syndrome. A treatment programme may include a combination of medication, exercise, (both strengthening and aerobic conditioning) and behavioural techniques.