Fibromyalgia
Overview
Fibromyalgia is a relatively common chronic disorder affecting more than 3 million people in the United States. While symptoms can range from mild to intense, the disease generally causes widespread muscle pain, joint pain, and fatigue. The condition can also impact sleep, memory, or mood. Unfortunately, many patients with fibromyalgia go undiagnosed for extended periods of time because there is no specific test or marker indicative of the disease, but rather a classic pattern of symptoms that varies from person to person.
Because complaints of muscle pain, fatigue or joint pain occur relatively frequently in healthy people, quick diagnosis of fibromyalgia is rare. It can often take weeks to months of debilitating dysfunction before doctors recognize fibromyalgia as the underlying cause of a patient’s symptoms. Patients who have symptoms of fibromyalgia may need to undergo blood testing or imaging to rule out other diagnoses before fibromyalgia is identified.
Symptoms
The most common symptoms of fibromyalgia are widespread musculoskeletal pain and fatigue. Many patients characterize the pain as a dull, extensive ache, with painful areas occurring in all four quadrants of the body. To diagnose fibromyalgia, doctors look for hallmark symptoms of relatively constant, dull, aching pain on both sides of the body as well as in the upper and lower body, which persists for longer than three months.
It is also common for fibromyalgia patients to have classic tender points in the body. These small painful areas are generally found in a symmetrical pattern and are tender to moderate pressure. Some healthcare professionals will use the assessment of the tender points as part of their diagnostic criteria.
People with fibromyalgia often experience significant fatigue that affects basic activities of daily living. Many patients experience a frustrating cycle of severe daytime fatigue coupled with frequent sleepless nights. The ongoing interrupted sleep cycles can compound symptoms and can create issues with memory or mood. For instance, many fibromyalgia patients experience a symptom known as “fibro fog” which can interfere with general wellbeing.
Fibro fog presents differently for every person but usually involves some memory difficulties or concentration issues. The fuzzy-headed feeling can lead to frustrations and distractions that impact relationships, jobs, and everyday life. The symptoms and cognitive changes can increase stress, which further triggers the fibromyalgia, creating a feedback loop that is difficult to break. The far-reaching impacts of fibromyalgia may also lead to emotional symptoms such as sadness, depression, or other mood disorders. Some doctors believe that people with fibromyalgia may have an increased sensitivity to pain as compared to people without the condition. In general, most patients have a baseline of fibromyalgia symptoms and then experience flares or exacerbations when symptoms are significantly worse or more debilitating.
As you can see, the symptoms of fibromyalgia have far-reaching implications and while unique to every individual, can create devastating consequences, especially when flare-ups increase in frequency.
Causes
Doctors are still trying to understand the root causes of fibromyalgia, yet even so, they have identified several triggers to fibromyalgia flares. While triggers certainly vary from person to person, they often remain the same for each flare on an individual person. Identifying a person’s specific triggers is an important step in disease management. Some associated triggers for fibromyalgia include:
- Physical and emotional stress
- Overexerting
- Poor sleep
- Weather changes
- Menstrual cycle changes/hormonal changes
- Illness
- Schedule changes/major events
- Changes in treatment
- Trauma, injury, or surgery
Interestingly, women are more often diagnosed with fibromyalgia, although the reasons remain unclear. Even though there is no specific known cause for fibromyalgia, scientists believe that genetics, traumatic events, and sleep/mood disorders may contribute to the development and progression of the disease.
There is some evidence to indicate that patients with fibromyalgia may have alterations in certain neurotransmitters like serotonin and cortisol that contribute to their clinical presentation. More research is needed to fully understand the regulatory components and biochemical factors of the syndrome.
Treatment
In general, treatment for fibromyalgia can include pharmaceuticals, self-care strategies, and interventions for symptom management. Certain antidepressants and anti-seizure medications are on the FDA-approved list of drugs to treat fibromyalgia. Some doctors find that other drugs also help treat symptoms and manage flares.
Often treatments are focused on easing pain, combatting fatigue, and promoting sleep. Certain interventions like psychotherapy, acupuncture, massage, or body work can improve patient functioning and diminish troubling symptoms. Some patients find that regular cardiovascular exercise eases their symptoms, or that heat, cold, meditation or yoga helps them feel better. For each patient, the treatment plan should be individualized, adaptable, comfortable, and aimed at promoting optimal health and well-being for the long-term.
Understanding the specific triggers that impact each individual can make a significant difference in the ongoing management of fibromyalgia. It is important to take steps that help manage stress, adapt activity levels, and practice sleep hygiene and encourage patients to assume a proactive role in the management of their condition.