WHAT IS FIBROMYALGIA?

Fibromyalgia (pronounced fy-bro-my-AL-ja) is a complex chronic pain condition characterized by widespread debilitating pain (most commonly in the neck, shoulders, back, hips, arms and legs), tender points, psychological distress and a heightened pain response to pressure or other stimuli that would not normally produce pain. It is believed to involve psychological, genetic, neurobiological and environmental factors. Fibromyalgia has come to be seen as a legitimate disorder and its cause and nature studied acutely only in the last 10 years. Not until 2007 was the first drug, Lyrica® (pregabalin) approved specifically for the treatment of fibromyalgia by the FDA. Because fibromyalgia does not follow the classic medical model, based on the correlation of specific tissue pathology with distinctive symptoms, many practitioners presented with these cases have ascribed them to purely psychological diagnosis such as stress, depression or even hypochondria. The term fibromyalgia syndrome is many times used to describe the condition because it involves a set of medical problems that tend to occur together not related to a specific, identifiable cause.

Though the cause and nature of fibromyalgia is still being debated by rheumatologists, neurologists, pain specialists and psychiatrists, it has been recognized as a diagnosable disorder by the U.S. National Institutes of Health and the American College of Rheumatology. It is described as a central sensitization syndrome caused by neurobiological abnormalities that produce physiological pain and cognitive impairments as well as neuro-psychological symptoms. Central to understanding fibromyalgia is an understanding of abnormal pain processing, which in people with fibromyalgia appears to be the result of neuro-chemical imbalances including activation of inflammatory pathways in the brain. This abnormal pain processing, also referred to as disordered sensory processing, accounts for pain being experienced when no sensory stimuli have occurred.

It is also important to understand that pain has not only a sensory component (an unconscious reflex avoidance reaction), but an emotional or affective-evaluating component, which can include past experiences, genetic factors, general state of health, the presence of depression or other psychological diagnosis, coping strength, and beliefs and fears surrounding the diagnosis of a chronic pain condition. Some of the neurochemical abnormalities that occur in fibromyalgia also regulate mood, sleep and energy, thus explaining why mood, sleep and fatigue problems are commonly co-morbidities with fibromyalgia.

It is estimated that about 2 percent of the population has fibromyalgia, with the ratio of men to women being 1:9. In addition to widespread pain, people with fibromyalgia also experience moderate to extreme fatigue, sleep disturbances, sensitivity to touch, light and sound and cognitive difficulties, sometimes referred to as fibro fog. Many individuals also experience other symptoms and co-morbidities, such as irritable bowel syndrome, lupus and arthritis.

    • Pain – Fibromyalgia pain is profound, chronic, widespread and debilitating. It can present throughout the body in varying levels of intensity. FM can cause stabbing and shooting pain and deep muscular aching, throbbing and twitching. Neurological problems such as numbness, tingling and burning are often present. The severity of the pain and stiffness is often worse in the morning. Aggravating factors include cold or humid weather, non-restorative sleep, physical and mental fatigue, excessive physical activity, physical inactivity, anxiety and stress.
    • Fatigue – The fatigue that presents with FM is often a profound, overwhelming exhaustion that can interfere with work, personal, social or educational activities.
    • Impaired cognition – “Fibro fog”: difficulty reasoning, confusion, impaired concentration and impaired memory
    • Sleep problems – Many fibromyalgia patients have sleep disorders that affect Stage 4 sleep, which is important in getting a deep, restorative sleep. Sleep studies of people with fibromyalgia show bursts of brain activity that limit or even eliminate the time they are able to spend in deep sleep.
    • Other symptoms/co-morbidities – Irritable bowel and bladder, headaches and migraines, restless legs syndrome, skin sensitivities and rashes, dry eyes and mouth, anxiety, major depressive disorder, ringing in the ears, dizziness, vision problems, Raynaud’s Syndrome, neurological symptoms and impaired coordination.

Treatment

Becoming educated in both the physiological and affective/evaluating (emotional) aspects of fibromyalgia pain is essential to decreasing pain and improving quality of life. Both peripherally generated sensations (sensory), and thoughts (beliefs, fears, depression, anxiety, anger, helplessness), can either heighten or dampen the experience of pain. In addition, changing one’s lifestyle can bring about significant improvement in function and pain levels. Continuing mild movement on a bad day and refraining from overdoing on a good day is essential for good symptom management.

Also important is partnering with a physician who is both experienced in FM treatment and empathetic to the FM sufferer. Medication, nutrition, relaxation techniques and exercise regime are all part of successfully managing FM. An individualized and integrative approach that works for each patient must be implemented and adjusted as needed for the best possible result.

      • Pain management – There are now several pharmacological treatments for fibromyalgia available. As mentioned, the first to be approved by the U.S. Food and Drug Administration to treat fibromyalgia was pregabalin (Lyrica®); the second was duloxetine (Cymbalta®); and the third was milnacipran (Savella®). Other FM medications are currently being developed. Health care providers may treat patients’ FM symptoms with non-narcotic pain relievers (e.g., tramadol) or low doses of antidepressants (e.g., tricyclic antidepressants, serotonin reuptake inhibitors) or benzodiazepines. Antidepressants are “serotonin builders” and can be prescribed at low doses to help improve sleep and relieve pain. If the patient is experiencing depression, higher levels of these or other medications may be needed. Lidocaine injections into the patient’s tender points may also work on localized pain areas. Also important is a regular program of gentle exercise and stretching, which helps maintain muscle tone and reduces pain and stiffness. In addition, people report lower levels of pain when they can slow their heart rate by deep breathing and performing other relaxation techniques.
      • Sleep management – Healthy sleep habits are essential. This includes sticking to a sleep schedule every day; creating a quiet, comfortable sleep environment with a supportive mattress; avoiding caffeine, sugar, alcohol and eating immediately before bed; avoiding napping; doing some type of light exercise during the day; developing a relaxing bedtime routine that signals the body that it’s time to sleep; and practicing relaxation exercises while attempting to fall asleep. Sleep medications can be prescribed, some of which can be especially helpful if restless legs or periodic limb movement disorder disturbs the patient’s sleep.
      • Psychological support – Acceptance of living one’s life with a chronic illness can be difficult. The FM patient should structure a mental health program that provides emotional support and increases communication with family and friends. In-person as well as online support groups and forums can be helpful in finding new information and gaining emotional strength from others with FM. Cognitive behavioral therapy (CBT) with a trained professional who understands chronic pain and its challenges, coupled with an exercise program has been shown to benefit those with FM.
      • Alternative treatments – Alternative therapies should not be overlooked. These include: physical therapy, therapeutic massage, myofascial release therapy, water therapy (in a warm pool with warm surroundings), light aerobics, acupressure, application of heat or cold, acupuncture, yoga, relaxation exercises, breathing techniques, aromatherapy and biofeedback.
      • Nutrition – There is no food regime that is known to give fibromyalgia relief. Stick to the basics: a healthy, balanced diet.

Links and Support

National Fibromyalgia Association (NFA)
National Fibromyalgia & Chronic Pain Association
NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases
Fibromyalgia Support Net
Fibromyalgia Support Group on Facebook
Fibromyalgia Forum and Support Group
Fibromyalgia Network