When everything hurts: Fibromyalgia explained
6/25/2020 by Dr. Terin Sytsma
Fibromyalgia is a common illness that is characterized by chronic, widespread pain. It also is often accompanied by other symptoms such as fatigue, sleep problems, mood disturbances, and cognitive complaints. Approximately 2-8% of the general population is affected by fibromyalgia and symptoms can range in severity from a nuisance to causing severe limitations in function. Despite it being relatively common, fibromyalgia remains poorly understood by many.
What is fibromyalgia?
The exact cause of fibromyalgia is unclear. Most physicians believe it is a disorder of pain processing and regulation where the body is more sensitive to pain stimuli than would normally be expected. Fibromyalgia often coexists with other acute or chronic pain conditions, including trauma, osteoarthritis, rheumatoid arthritis, and chronic back pain. Mood disorders or stress may also trigger fibromyalgia symptoms. It can develop at any age and affects people of all backgrounds.
What are the symptoms?
The primary symptom of fibromyalgia is chronic, widespread pain that lasts more than three months without another cause, but there are many other potential symptoms. Common symptoms include:
- Widespread musculoskeletal (usually aching) pain for > 3 months
- Fatigue/sleep disruptions
- "Brain fog/Fibro fog" or problems with memory, attention, or concentration
- Other body symptoms: headaches, jaw pain, abdominal pain/bloating, nausea, diarrhea, dizziness, numbness or tingling
What are the risk factors?
There are both modifiable and unmodifiable risk factors for fibromyalgia:
- Unmodifiable risk factors
- Genetics/family history
- Female gender
- Psychiatric disorders such as depression, anxiety, post-traumatic stress disorder, and obsessive-compulsive disorder
- Other coexisting painful or inflammatory conditions
- Modifiable risk factors
- Physical inactivity
- Poor sleep habits
How is fibromyalgia diagnosed?
Fibromyalgia is a clinical diagnosis, meaning it requires a thorough history and physical exam and can be diagnosed without lab tests or imaging. Your clinician may do limited lab workup and/or imaging to rule out other causes of fibromyalgia-like symptoms. He or she may also consider a sleep study if sleep apnea or other sleep disorders as suspected.
What is the treatment?
Fibromyalgia is a chronic disease with no cure, but it can be managed. Treatment focuses on improving function and quality of life and managing symptoms. No single treatment will resolve all symptoms related to fibromyalgia, so a combination of treatments is often needed. Non-medication therapies are the mainstay of treatment. It is also important to treat coexisting conditions such as sleep apnea or depression.
Regular physical activity, including aerobic exercise is very important in the treatment of fibromyalgia. Options for low-impact aerobic exercise include walking, biking, swimming and water aerobics. Other forms of exercise therapy may include strength training, tai chi or yoga. General guidelines recommend that healthy adults should get 150 minutes of moderate-intensity exercise per week: that's 30 minutes, 5 days per week. People with fibromyalgia should gradually build up their exercise tolerance to avoid an increase in symptoms.
Other potential treatment options include:
- Stress management, cognitive behavioral therapy, and mindfulness techniques
- Maintaining good sleep habits
- Balanced diet and weight reduction
- Manual therapies (acupuncture, chiropractics, massage, etc.)
- Medications also have a role in treatment:
- Your clinician may recommend medications such as duloxetine, gabapentin, pregabalin, or amitriptyline. Over-the-counter pain medications may also be helpful.
- Narcotic medications have not been shown to be helpful, may worsen pain, and carry addiction risks.
- Medical cannabis has not been shown to be effective.
Fibromyalgia is a common condition characterized by widespread musculoskeletal pain for more than three months. Treatment focuses on improving function and quality of life and incorporates both medications and non-medication therapies.
Dr. Terin Sytsma is an internal medicine consultant and assistant professor of medicine in Primary Care in Rochester/Kasson's Division of Community Internal Medicine (CIM). She has a particular interest in musculoskeletal medicine, office-based procedures, and medical education.