Fibromyalgia

Fibromyalgia is characterized by long-term pain throughout the body and is often accompanied by fatigue, mood problems, inability to sleep, headaches, weight gain, memory problems, and sleep disturbances. The diagnosis is made by documenting the symptoms you report and is no longer based on having tender points or trigger points throughout the body.  Laboratory testing is not required to make a diagnosis of fibromyalgia unless you have other symptoms and signs concerning for a widespread inflammatory condition, such as rheumatoid arthritis.  Providing a diagnosis for fibromyalgia can often be a relief for patients and can help clarify your path of treatment.  People with this condition can also have irritable bowel syndrome and other functional gastrointestinal disorders, interstitial cystitis/painful bladder syndrome, endometriosis, and other regional pain syndromes (especially back and neck pain). What might appear to one health care practitioner as a new episode of acute pain can in fact be simply another region of the body associated with pain.  Pain often begins in childhood and can be worsened by trauma and stress.  Individuals with fibromyalgia more likely have psychiatric disorders, including depression, anxiety, obsessive-compulsive disorder, and posttraumatic stress disorder. This may result from common triggers for these psychiatric conditions and fibromyalgia like early-life stress or trauma. Females are affected more commonly than males.  There is no evidence that fibromyalgia has a higher prevalence in industrialized countries and cultures. It is known that the nervous system, which senses the input from the world around you, including pain signals, is more sensitive to pain in patients with fibromyalgia.  This means that sensations which normally don’t cause pain such as touch or even stress can cause and worsen pain felt throughout the body.  Family members of patients with fibromyalgia may also have a history of chronic pain and we know there are many genes that can affect pain sensation and the chemicals in your body that control this perception.  Therefore, medications may work differently for you than for a relative or another person affected by fibromyalgia.

Simple interventions such as stress reduction, improved sleep patterns, and increased activity and exercise should form the foundation of your treatment for fibromyalgia given that stress, decreased sleep, and decreased activity all worsen fibromyalgia symptoms.  Specifically, low-impact aerobic exercise, cognitive-behavioral therapy provided by a trained psychologist, alternative therapies, such as yoga and acupuncture are common treatments that don’t require medications.  Certain medications have strong evidence for benefit in fibromyalgia, including anti-depressants such as cymbalta, as well as gabapentin, Lyrica, and cyclobenzaprine or Flexeril.  There is promising evidence for cannabinoid compounds, but nothing is approved for medical use.  Opioids and NSAIDs are not recommended for the treatment of fibromyalgia.  Occasionally, procedures such as steroid injections can be helpful for focal areas of pain, such as when a patient with fibromyalgia develops sciatica, or low back pain radiating into the leg due to arthritis or disc problems in the low back.  Trigger point injections can help especially painful areas in the setting of generalized body pain.  But, typically we pursue non-injection therapies first and are very careful about using injection therapy in patients with fibromyalgia since this can sometimes flare pain throughout the body.  We often work in a multidisciplinary manner (see my blog regarding multidisciplinary treatment for pain) to provide the maximum amount of improvement in pain and function for a person with fibromyalgia.  We need to address your widespread body pain from as many different angles as possible since your pain is often worsened by a variety of experiences as mentioned above.  Living with fibromyalgia is a daily challenge, but we want to work with you and with other care providers to make this struggle more tolerable and less painful, so you can get your life back!

References:

  • Clauw DJ. FibromyalgiaA Clinical Review. JAMA. 2014;311(15):1547–1555. doi:10.1001/jama.2014.3266
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