Fibromyalgia is a chronic condition characterized by pain and significant functional limitation and can be difficult to live with and manage. Fortunately, new diagnostic advances and treatment strategies are helping patients better cope with fibromyalgia every day.
What is fibromyalgia?
Fibromyalgia is a condition that involves an amplified (i.e. oversensitive) peripheral nervous system. People with fibromyalgia experience chronic pain throughout their body in addition to muscle pain, tenderness, and joint stiffness.
There is also a significant mental and emotional component to fibromyalgia. In addition to pain, people also experience symptoms such as fatigue, sleep disturbance, and cognitive dysfunction.
According to the CDC, fibromyalgia affects about 4 million U.S. adults, about 2% of the adult population. It is a chronic disease that lasts a person’s lifetime, and although there is no cure, there are many treatments and strategies for effective management available.
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Fibromyalgia is characterized by widespread, chronic bodily pain. This primary pain symptom often leads to other associated symptoms such as:
- Tenderness to touch or pressure on the muscles or skin
- Joint pain
- Sleep disturbance
- Numbness or tingling
People with fibromyalgia also experience significant cognitive dysfunction, and the frustration of living with the condition can also lead to mood disorders and systemic symptoms such as the following.
- Problems thinking or remembering clearly
- Digestive problems: such as abdominal pain, bloating, or constipation
Demographics and risk factors
Women are two times more likely to have the condition than men and is more common in adulthood and less likely to occur in children and teenagers.
Another known risk factor for fibromyalgia is the presence of lupus or rheumatoid arthritis. Many research studies show that if you have these conditions, you are more likely to develop fibromyalgia.
The cause of fibromyalgia is not fully understood. The American College of Rheumatology states that fibromyalgia is not from an autoimmune, inflammation, joint, or muscle disorder. However, research suggests that fibromyalgia can present with many of those symptoms because it is the result of dysfunction and/or dysregulation of multiple systems, including the central and autonomic nervous systems, immune system, and genetics. Furthermore, it is hypothesized that external or environmental factors such as physical stress, injury, and sometimes other diseases can trigger the onset of fibromyalgia and its associated symptoms.
Central nervous system
A recognized etiology of fibromyalgia involves over-sensitivity or abnormal processing of electrical signals in the brain. This phenomenon, known as central sensitization, is defined by an increased response to stimulation mediated by the central nervous system. Essentially, normal stimuli are perceived as stronger or more painful in people with fibromyalgia than those without. The following components of the central nervous system are thought to play a role in central sensitization.
- Nerves: The nerves in people with fibromyalgia may be in a state of over-excitement and contribute to central sensitization.
- Neurotransmitters: Neurotransmitters are chemical signals the brain uses to communicate with the body. People with fibromyalgia may have dysregulated levels of neurotransmitters that can contribute to central sensitization.
- Inhibitory pathways: There are pathways from the brain throughout the body that work to modulate or dampen the response to painful stimuli. In people with fibromyalgia, these pathways may not function properly.
Neuroendocrine and autonomic nervous system
Fibromyalgia is considered a stress-related disorder. The neuroendocrine and autonomic nervous systems are strong regulators of the body’s stress response.
- Neuroendocrine system: People with fibromyalgia may have dysregulated or dysfunctional levels of stress hormones such as cortisol and adrenocorticotropic hormone (ACTH).
- Autonomic nervous system: Some studies show that the sympathetic nervous system (fight or flight response) is persistently hyperactive in people with fibromyalgia.
Many external factors may trigger the onset of fibromyalgia.
- Physical or psychological trauma or stress: Stressful life events and psychological conditions such as depression, anxiety, and panic disorder are more prevalent in people with fibromyalgia than other rheumatologic diseases.
- Other diseases: People with rheumatologic diseases such as lupus or rheumatoid arthritis are more likely to develop fibromyalgia. There is no scientific evidence to say that these conditions are direct causes of fibromyalgia, however.
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Treatment options, relief, and prevention for fibromyalgia
Treatment of chronic fibromyalgia is focused on effective management of symptoms. The main goals of treatment include the following.
- Soothing pain: Pain associated with fibromyalgia is difficult to control. People with chronic pain can quickly develop an addiction or substance abuse, so healthcare providers are cautious about treating fibromyalgia with pain medications such as prescription opioids or non-steroidal anti-inflammatory drugs (NSAIDs). According to the Association of American Family Physicians, antidepressant medications such as SSRIs and tricyclic antidepressants have the strongest evidence of benefit for improvements in pain. Aerobic exercise has also been shown to help significantly with pain symptoms.
- Increasing or improving sleep: In addition to pain reduction, antidepressant medications have also been shown to reduce fatigue and help with sleep disturbances as well.
- Improve function: There is strong evidence that aerobic exercise for 20 to 30 minutes for two to three days per week and cognitive behavioral therapy (CBT) can significantly help improve function in people with fibromyalgia. Other non-pharmacologic treatment options to improve mood and day-to-day function may include acupuncture and hypnotherapy.
People with fibromyalgia experience pain chronically throughout the course of their condition; however, there may be periods of more intense pain than others. To reduce flare-ups of pain, talk with your healthcare provider and try the following preventative strategies.
- Exercise: Exercise can help with all of the primary symptoms related to fibromyalgia. Exercising for 20 to 30 minutes, two to three items a week can go a long way in helping control and prevent symptoms.
- Relaxation: Deep-breathing exercises and meditation will help reduce the stress that can bring on symptoms.
- Stable sleep schedule: Sleep is the body’s way of repairing itself both physically and mentally. Try to go to bed and wake up at the same time each day and aim for at least 8 hours per night. Limit caffeine and avoid daytime naps to help prevent sleep disturbances at night.
When to seek further consultation for fibromyalgia
Fortunately, fibromyalgia does not result in tissue or cellular damage, and there are no medical emergencies associated with the condition. The care and management of fibromyalgia necessitate a multidisciplinary team of physicians, physical therapists, and pain management specialists for optimal success. Work closely with your team to get the appropriate and effective care you need.
- Kodner C. Common Questions About the Diagnosis and Management of Fibromyalgia. Am Fam Physician. 2015 Apr 1;91(7):472-478. AAFP Link
- Fibromyalgia. Centers for Disease Control and Prevention. Reviewed Oct. 11, 2017. CDC Link
- Fibromyalgia. American College of Rheumatology. Updated March 2019. Rheumatology.org Link
- Bellato E, Marini E, Castoldi F, et al. Fibromyalgia syndrome: etiology, pathogenesis, diagnosis, and treatment [published correction appears in Pain Res Treat. 2013;2013:960270]. Pain Res Treat. 2012;2012:426130. NCBI Link