fibromyalgia

What is fibromyalgia

Fibromyalgia also called fibromyalgia syndrome (a set of symptoms), is a disorder that causes muscle pain all over your body and general fatigue (feeling tired). People who have fibromyalgia often experience chronic pain (pain that lasts a long time – possibly your entire life). People with fibromyalgia also have “tender points” on their body. Tender points are specific places on the neck, shoulders, back, hips, arms, elbows and legs. These points hurt when pressure is put on them.

No one knows what causes fibromyalgia. Anyone can get it, but fibromyalgia is most common in middle-aged women (7 times as many women as men). People with rheumatoid arthritis and other autoimmune diseases are particularly likely to develop fibromyalgia.

Fibromyalgia typically develops between the ages of 30 and 60, but can occur in people of any age, including children and the elderly.

It’s not clear exactly how many people are affected by fibromyalgia, although research has suggested it could be a relatively common condition.

Some estimates suggest nearly 1 in 20 people may be affected by fibromyalgia to some degree.

One of the main reasons it’s not clear how many people are affected is because fibromyalgia can be a difficult condition to diagnose.

There’s no specific test for fibromyalgia and the symptoms can be similar to a number of other conditions.

People with fibromyalgia may also have other symptoms, such as:

  • Increased sensitivity to pain
  • Fatigue (extreme tiredness)
  • Muscle stiffness
  • Difficulty sleeping
  • Trouble sleeping
  • Morning stiffness
  • Headaches
  • Painful menstrual periods
  • Tingling or numbness in hands and feet
  • Problems with mental processes known as “fibro-fog” – such as problems with memory, thinking and concentration
  • Pain in the face or jaw, including disorders of the jaw know as temporomandibular joint syndrome (also known as TMJ).
  • Irritable bowel syndrome (IBS) – a digestive condition that causes abdominal pain, constipation and bloating

There will be times when your fibromyalgia may “flare up” and your symptoms will be worse. Other times, you will feel much better. The good news is that your symptoms can be managed.

Fibromyalgia is a condition that is often misunderstood. But your symptoms aren’t “all in your head.” Scientific research has shown that fibromyalgia is a real syndrome that causes real pain. Don’t let anyone discourage you from getting a diagnosis and treatment for your symptoms.

You cannot prevent fibromyalgia because no one is sure what causes it.

There is no cure for fibromyalgia, but fibromyalgia can be effectively treated and managed with medication and self-management strategies. It’s important for you to be responsible for your health. Getting enough sleep, exercising, and eating well may also help.

  • You can join a self-management education class, which helps people with arthritis or other conditions—including fibromyalgia—be more confident in how to control their symptoms, how to live well and understand how the condition affects their lives. You can find more info on Self-Management Resource Center here: https://www.selfmanagementresource.com/
  • Chronic Disease Self-Management Program is an effective self-management education workshop for people with chronic health problems. The program specifically addresses arthritis, diabetes, lung and heart disease, but teaches skills useful for managing a variety of chronic diseases. This program was developed at Stanford University. Locate a Chronic Disease Self-Management Program in your area here: http://www.eblcprograms.org/evidence-based/map-of-programs/

If you think you have fibromyalgia, visit your doctor. Treatment is available to ease some of its symptoms, although they’re unlikely to disappear completely.

It’s important to have a health care team that understands fibromyalgia and has experience treating fibromyalgia. Your team will probably include your family doctor, a rheumatologist, and a physical therapist. Other health care professionals may help you manage other symptoms, such as mood or sleep problems. However, the most important member of your health care team is you. The more active you are in your care, the better you will feel.

Doctors usually treat fibromyalgia with a combination of treatments, which may include:

  • Medications, including prescription drugs and over-the-counter pain relievers.
  • Aerobic exercise and muscle strengthening exercise.
  • Patient education classes, usually in primary care or community settings.
  • Stress management techniques such as meditation, yoga, and massage.
  • Good sleep habits to improve the quality of sleep.
  • Cognitive behavioral therapy (CBT) to treat underlying depression. CBT is a type of talk therapy meant to change the way people act or think.

In addition to medical treatment, people can manage their fibromyalgia with the self-management strategies described below, which are proven to reduce pain and disability, so they can pursue the activities important to them.

However, there isn’t one treatment plan that works best for every person who has fibromyalgia. You’ll have to work with your care team to create a plan that’s right for you. After all, nobody knows more than you do about your feelings, your actions, and how your fibromyalgia symptoms affect you.

Key facts 1)

  • Fibromyalgia affects two – four percent of people, women more often than men.
  • Fibromyalgia is NOT an autoimmune, inflammation inflammation, joint or muscle disorder based illness, but research suggests the nervous system is involved.
  • Doctors diagnose fibromyalgia based on all the patient’s relevant symptoms (what you feel), no longer just on the number of tender places during an examination.
  • There is no test to detect this disease, but you may need lab tests or X-rays to rule out other health problems.
  • Though there is no cure, medications can reduce symptoms in some patients.
  • Patients also may feel better with proper self-care, such as exercise and getting enough sleep.

Is fibromyalgia real?

This is the top misconception where people think fibromyalgia isn’t a real medical problem or that it is “all in your head.” Despite there’s a lot that’s unknown about fibromyalgia, researchers have learned more about it in just the past few years.

In people who have fibromyalgia, the brain and spinal cord process pain signals differently. As a result, they react more strongly to touch and pressure, with a heightened sensitivity to pain. It is a real physiological and neurochemical problem.

The power of the mind is a real factor in pain perception. For example, studies have shown that anxiety that occurs in anticipation of pain is often more problematic than the pain experience itself. In that sense, the mind has a negative impact on symptoms. It takes lifestyle changes and small steps toward achieving wellness.

Why do I feel depressed?

Depression or anxiety may occur as a result of your constant pain and fatigue, or the frustration you feel with the condition. It is also possible that the same chemical imbalances in the brain that cause mood changes also contribute to fibromyalgia.

Does fibromyalgia cause permanent damage?

No. Although fibromyalgia causes symptoms that can be very painful and uncomfortable, your muscles and organs are not being damaged. Fibromyalgia is not life-threatening, but it is chronic (ongoing and lasting more than 3 months). Although there is no cure, there are many things you can do to feel better.

Is it hard to diagnose fibromyalgia?

Unfortunately, it can take years for some people who have fibromyalgia to get a correct diagnosis. This can happen for many reasons. The main symptoms of fibromyalgia are generalized muscle pain and fatigue. These are also common symptoms of many other health problems, such as chronic fatigue syndrome, hypothyroidism, and arthritis.

Currently, there is no laboratory test or X-ray that can diagnose fibromyalgia.

It may take some time for your doctor to understand all of your symptoms and rule out other health problems so he or she can make an accurate diagnosis. As part of this process, your family doctor may consult with a rheumatologist. This type of doctor specializes in pain in the joints and soft tissue.

Fibromyalgia signs and symptoms

Fibromyalgia has many symptoms that tend to vary from person to person. The main symptom is widespread pain.

Symptoms of fibromyalgia can include the following:

  • Increased sensitivity to pain.
  • A deep ache or a burning pain that gets worse because of activity, stress, weather changes, or other factors.
  • Muscle stiffness or spasms.
  • Pain that moves around your body.
  • Feelings of numbness or tingling in your hands, arms, or legs.
  • Feeling very tired or fatigued (out of energy), even when you get enough sleep.
  • Trouble sleeping.

There may be periods when your symptoms get better or worse, depending on factors such as:

  • your stress levels
  • changes in the weather
  • how physically active you are

People who have fibromyalgia often also have one or more of the following:

  • Anxiety.
  • Depression.
  • Irritable bowel syndrome (IBS).
  • Restless legs syndrome.
  • Increased sensitivity to odors, bright lights, loud noises, or medicines.
  • Headaches, migraines, or jaw pain.
  • Dry eyes or mouth.
  • Dizziness and problems with balance.
  • Problems with memory or concentration (sometimes called the “fibro fog”).
  • For women, painful menstrual periods.

If you think you have fibromyalgia, visit your doctor. Treatment is available to ease some of the symptoms, although it’s unlikely they’ll ever disappear completely.

The main symptoms of fibromyalgia are outlined below.

Widespread pain

If you have fibromyalgia, one of the main symptoms is likely to be widespread pain. This may be felt throughout your body, but could be worse in particular areas, such as your back or neck. The pain is likely to be continuous, although it may be better or more severe at different times.

The pain could feel like:

  • an ache
  • a burning sensation
  • a sharp, stabbing pain

Temporo-mandibular joint pain

This Temporo-mandibular Joint Dysfunction Syndrome, sometimes referred to as TMJD, causes tremendous face and head pain in one quarter of fibromyalgia patients. However, a 1997 report indicates that as many as 90% of fibromyalgia patients may have jaw and facial tenderness that could produce, at least intermittently, symptoms of temporo-mandibular joint dysfunction. Most of the problems associated with this condition are thought to be related to the muscles and ligaments surrounding the joint and not necessarily the joint itself.

Extreme sensitivity

Fibromyalgia can make you extremely sensitive to pain all over your body, and you may find that even the slightest touch is painful. If you hurt yourself – such as stubbing your toe – the pain may continue for much longer than it normally would.

You may hear the condition described in the following medical terms:

  • hyperalgesia – when you’re extremely sensitive to pain
  • allodynia – when you feel pain from something that shouldn’t be painful at all, such as a very light touch

You may also be sensitive to things such as smoke, certain foods and bright lights. Being exposed to something you’re sensitive to can cause your other fibromyalgia symptoms to flare up.

Multiple Chemical Sensitivity Syndrome

Sensitivities to odors, noise, bright lights, medications and various foods is common in roughly 50% of fibromyalgia patients.

Stiffness

Fibromyalgia can make you feel stiff. The stiffness may be most severe when you’ve been in the same position for a long period of time – for example, when you first wake up in the morning.

It can also cause your muscles to spasm, which is when they contract (squeeze) tightly and painfully.

Fatigue

Fibromyalgia can cause fatigue (extreme tiredness). This can range from a mild, tired feeling to the exhaustion often experienced during a flu-like illness.

Severe fatigue may come on suddenly and can drain you of all your energy. If this happens, you may feel too tired to do anything at all.

Poor sleep quality

Fibromyalgia can affect your sleep. You may often wake up tired, even when you’ve had plenty of sleep. This is because the condition can sometimes prevent you from sleeping deeply enough to refresh you properly.

You may hear this described as “non-restorative sleep”.

Cognitive problems (‘fibro-fog’)

Cognitive problems are issues related to mental processes, such as thinking and learning. If you have fibromyalgia, you may have:

  • trouble remembering and learning new things
  • problems with attention and concentration
  • slowed or confused speech

Headaches

If fibromyalgia has caused you to experience pain and stiffness in your neck and shoulders, you may also have frequent headaches.

These can vary from being mild headaches to severe migraines, and could also involve other symptoms, such as nausea (feeling sick).

Irritable bowel syndrome (IBS)

Some people with fibromyalgia also develop irritable bowel syndrome (IBS).

IBS is a common digestive condition that causes pain and bloating in your stomach. It can also lead to constipation or diarrhoea.

Other symptoms

Other symptoms that people with fibromyalgia sometimes experience include:

  • dizziness and clumsiness
  • feeling too hot or too cold – this is because you’re not able to regulate your body temperature properly
  • restless legs syndrome (an overwhelming urge to move your legs)
  • tingling, numbness, prickling or burning sensations in your hands and feet (pins and needles, also known as paresthesia)
  • in women, unusually painful periods
  • anxiety
  • depression

Depression

In some cases, having the condition can lead to depression. This is because fibromyalgia can be difficult to deal with, and low levels of certain hormones associated with the condition can make you prone to developing depression.

Depression can cause many symptoms, including:

  • constantly feeling low
  • feeling hopeless and helpless
  • losing interest in the things you usually enjoy

If you think you may be depressed, it’s important to get help from your doctor or your fibromyalgia healthcare professional, if you’ve been seeing one.

What are the complications of fibromyalgia?

Fibromyalgia can cause pain, disability, and lower quality of life. US adults with fibromyalgia may have complications such as:

  • More hospitalizations. If you have fibromyalgia you are twice as likely to be hospitalized as someone without fibromyalgia.
  • Lower quality of life. Women with fibromyalgia may experience a lower quality of life.
  • Higher rates of major depression. Adults with fibromyalgia are more than 3 times more likely to have major depression than adults without fibromyalgia. Screening and treatment for depression is extremely important.
  • Higher death rates from suicide and injuries. Death rates from suicide and injuries are higher among fibromyalgia patients, but overall mortality among adults with fibromyalgia is similar to the general population.
  • Higher rates of other rheumatic conditions. Fibromyalgia often co-occurs with other types of arthritis such as osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis.

Fibromyalgia causes

The exact cause of fibromyalgia is unknown, but fibromyalgia is thought to be related to abnormal levels of certain chemicals in the brain and changes in the way the central nervous system (brain, spinal cord and nerves) processes pain messages carried around the body.

It’s also suggested that some people are more likely to develop fibromyalgia because of genes inherited from their parents.

There is most often some triggering factor that sets off fibromyalgia. It may be spine problems, arthritis, injury, or other type of physical stress. Emotional stress also may trigger fibromyalgia. The result is a change in the way your body “talks” with your spinal cord and brain. Levels of brain chemicals and proteins may change. More recently, fibromyalgia has been described as Central Pain Amplification disorder, meaning the volume of pain sensation in the brain is turned up too high.

In many cases, fibromyalgia appears to be triggered by a physically or emotionally stressful event, such as:

  • an injury or infection
  • giving birth
  • having an operation
  • the breakdown of a relationship
  • the death of a loved one
  • illness or other diseases
  • post-traumatic stress disorder (PTSD)
  • repetitive injuries
  • obesity.

Here are some of the main factors thought to contribute to fibromyalgia:

Abnormal pain messages

One of the main theories is that people with fibromyalgia have developed changes in the way the central nervous system processes the pain messages carried around the body. This could be due to changes to chemicals in the nervous system.

The central nervous system (brain, spinal cord and nerves) transmits information all over your body through a network of specialized cells. Changes in the way this system works may explain why fibromyalgia results in constant feelings of, and extreme sensitivity to, pain.

Chemical imbalances

Research has found that people with fibromyalgia have abnormally low levels of the hormones serotonin, noradrenaline and dopamine in their brains.

Low levels of these hormones may be a key factor in the cause of fibromyalgia, as they’re important in regulating things such as:

  • mood
  • appetite
  • sleep
  • behavior
  • your response to stressful situations

These hormones also play a role in processing pain messages sent by the nerves. Increasing the hormone levels with medication can disrupt these signals.

Some researchers have also suggested that changes in the levels of some other hormones, such as cortisol (which is released when the body is under stress), may contribute to fibromyalgia.

Sleep problems

It’s possible that disturbed sleep patterns may be a cause of fibromyalgia, rather than just a symptom.

Fibromyalgia can prevent you from sleeping deeply and cause fatigue (extreme tiredness). People with the condition who sleep badly can also have higher levels of pain, suggesting that these sleep problems contribute to the other symptoms of fibromyalgia.

Genetics

Research has suggested that genetics may play a small part in the development of fibromyalgia, with some people perhaps more likely than others to develop the condition because of their genes.

If this is the case, genetics could explain why many people develop fibromyalgia after some sort of trigger.

Possible triggers

Fibromyalgia is often triggered by a stressful event, including physical stress or emotional (psychological) stress. Possible triggers for the condition include:

  • an injury
  • a viral infection
  • giving birth
  • having an operation
  • the breakdown of a relationship
  • being in an abusive relationship
  • the death of a loved one

However, in some cases, fibromyalgia doesn’t develop after any obvious trigger.

Associated conditions

There are several other conditions often associated with fibromyalgia. Generally, these are rheumatic conditions (affecting the joints, muscles and bones), such as:

  • osteoarthritis – when damage to the joints causes pain and stiffness
  • lupus – when the immune system mistakenly attacks healthy cells and tissues in various parts of the body
  • rheumatoid arthritis – when the immune system mistakenly attacks healthy cells in the joints, causing pain and swelling
  • ankylosing spondylitis – pain and swelling in parts of the spine
  • temporomandibular disorder – a condition that can cause pain in the jaw, cheeks, ears and temples

Conditions such as these are usually tested for when diagnosing fibromyalgia.

Risk factors for fibromyalgia

Known risk factors include:

  • Age. Fibromyalgia can affect people of all ages, including children. However, most people are diagnosed during middle age and you are more likely to have fibromyalgia as you get older.
  • Lupus or Rheumatoid Arthritis. If you have lupus or rheumatoid arthritis (RA), you are more likely to develop fibromyalgia.

Some other factors have been weakly associated with onset of fibromyalgia, but more research is needed to see if they are real. These possible risk factors include:

  • Sex. Women are seven times as likely to have fibromyalgia as men.
  • Stressful or traumatic events, such as car accidents, post-traumatic stress disorder (PTSD).
  • Repetitive injuries. Injury from repetitive stress on a joint, such as frequent knee bending.
  • Illness (such as viral infections).
  • Family history.
  • Obesity.

Fibromyalgia diagnosis

If you think you have fibromyalgia, visit your doctor. Diagnosing fibromyalgia can be difficult, as there’s no specific test to diagnose the condition.

The symptoms of fibromyalgia can vary and are similar to those of several other conditions.

During diagnosis, you’ll be asked about how your symptoms are affecting your daily life. If you have had any trouble sleeping or fatigue, tell your doctor how long you have had this problem. Your doctor may ask whether you have been feeling anxious or depressed since your symptoms began.

Your body will also be examined to check for visible signs of other conditions – for example, swollen joints may suggest arthritis, rather than fibromyalgia.

Ruling out other conditions

If your doctor thinks you may have fibromyalgia, they’ll first have to rule out all other conditions that could be causing your symptoms. These conditions may include:

  • chronic fatigue syndrome (also known as myalgic encephalomyelitis) – a condition that causes long-term tiredness
  • rheumatoid arthritis – a condition that causes pain and swelling in the joints
  • multiple sclerosis (MS) – a condition of the central nervous system (the brain and spinal cord) that affects movement and balance

Tests to check for some of these conditions include urine and blood tests, although you may also have X-rays and other scans. If you’re found to have another condition, you could still have fibromyalgia as well.

Criteria for diagnosing fibromyalgia

Criteria Needed for a Fibromyalgia Diagnosis (American College of Rheumatology Fibromyalgia Diagnostic Criteria 2010)

  1. Pain and symptoms over the past week, based on the total of number of painful areas out of 19 parts of the body plus level of severity of these symptoms:
    • a. Fatigue
    • b. Waking unrefreshed
    • c. Cognitive (memory or thought) problems
    • Plus number of other general physical symptoms
  2. Symptoms lasting at least three months at a similar level
  3. No other health problem that would explain the pain and other symptoms

For fibromyalgia to be diagnosed, certain criteria usually have to be met. The most widely used criteria for diagnosis are:

  • you either have severe pain in three to six different areas of your body, or you have milder pain in seven or more different areas
  • your symptoms have stayed at a similar level for at least three months
  • no other reason for your symptoms has been found

The extent of the pain used to be assessed by applying gentle pressure to certain “tender points”, where any pain is likely to be at its worst. However, this is less common nowadays.

Diagnosing other conditions

It’s also possible to have other conditions alongside your fibromyalgia, such as:

  • depression
  • anxiety
  • irritable bowel syndrome (IBS)

If your symptoms suggest that you have another condition as well as fibromyalgia, you may need further tests to diagnose these. Identifying all possible conditions will help to guide your treatment.

Fibromyalgia test

Fibromyalgia is usually diagnosed by documenting the patient’s medical history, ruling out disorders and diseases that may be mimicking or exacerbating fibromyalgia, and by utilizing the criteria last updated by the American College of Rheumatology in 2010.

The American College of Rheumatology criteria evaluate pain location and severity. They also take into account a person’s symptoms — how the person feels. A person would be considered to have fibromyalgia if that person met the following:

  • Has had pain and symptoms over the past week
  • Number of painful areas out of 19 parts of the body
  • Plus the level of severity of these symptoms:
  • Fatigue
  • Waking unrefreshed
  • Cognitive (memory or thought) problems
  • Plus the number of other general physical symptoms
  • Symptoms have been present at a similar severity level for at least 3 months.
  • The person does not have another disorder that would explain the pain.

Laboratory Tests

Laboratory tests can be useful to help diagnose conditions with symptoms similar to fibromyalgia, such as rheumatoid arthritis, Sjögren syndrome, thyroid disease, and lupus. It is not usually cost effective or necessary to do extensive screening. General tests that may be ordered include:

  • Comprehensive metabolic panel – to examine electrolytes, proteins, liver and kidney function, calcium, and glucose
  • CBC (complete blood count) – to look for anemia, a possible cause of weakness and fatigue
  • TSH (thyroid stimulating hormone) and/or other thyroid testing since hypothyroidism can cause symptoms similar to fibromyalgia
  • ANA (anti-nuclear antibody) – to rule out autoimmune disorders, such as lupus or Sjogren syndrome
  • CK (creatine kinase) – to rule out other conditions that can cause muscle weakness or pain

A healthcare practitioner will typically consider the following in developing a diagnosis: results of the general tests, the patient’s history (including family history and risk factors for certain diseases), and results of the physical examination. Based on these findings, some additional tests could be done.

Meanwhile, researchers continue to look for new testing protocols that may be more specific for fibromyalgia.

Non-Laboratory Tests

Electromyography (EMG) may be performed to assess the health of muscles and the nerves that control them. Occasionally, an imaging scan such as an MRI (magnetic resonance imaging) may be ordered to help rule out the possibility of multiple sclerosis or other diseases that may cause symptoms similar to fibromyalgia.

Fibromyalgia treatment

Your doctor may recommend treating your symptoms with acetaminophen (paracetamol) first. He or she may also recommend an anti-depressant, such as duloxetine or milnacipran. Anti-seizure medicines, such as preglabin, may also be effective in managing your pain. Nonsteroidal anti-inflammatory medicines (which include ibuprofen, aspirin, and naproxen) are not usually effective in treating fibromyalgia when taken alone.

Making changes in your lifestyle and daily habits can help you feel better. Remember, your treatment won’t be as effective if you don’t take an active role in your health care. The following are some ways you can take an active role in managing your fibromyalgia symptoms.

Join a self-management education class, which helps people with arthritis or other conditions—including fibromyalgia—be more confident in how to control their symptoms, how to live well and understand how the condition affects their lives. You can find more info on Self-Management Resource Center here: https://www.selfmanagementresource.com/

Chronic Disease Self-Management Program is an effective self-management education workshop for people with chronic health problems. The program specifically addresses arthritis, diabetes, lung and heart disease, but teaches skills useful for managing a variety of chronic diseases. This program was developed at Stanford University. Locate a Chronic Disease Self-Management Program in your area here: http://www.eblcprograms.org/evidence-based/map-of-programs/

Self-help

If you have fibromyalgia, there are several ways to change your lifestyle to help relieve your symptoms and make your condition easier to live with.

Your doctor, or another healthcare professional treating you, can offer advice and support about making these changes part of your everyday life.

There are organizations to support people with fibromyalgia that may also be able to offer advice.

Below are some tips that may help relieve symptoms of fibromyalgia. You can also read more information about living with pain.

Exercise

One of the best things you can do if you have fibromyalgia is engage in moderate exercise on a regular basis. Exercise can reduce your pain, give you more energy, reduce stress, and help you sleep better. If you’re not used to exercising, be sure to talk to your doctor before you start. If you have a physical therapist on your health care team, he or she can help you develop an exercise routine that’s right for you. It’s usually best to start with low-impact aerobic exercise (for example, walking or water aerobics) for a short period of time a few days a week. As your pain decreases and your energy increases, you can gradually increase the intensity and frequency of your exercise.

Aerobic exercise

Aerobic activities are any kind of rhythmic, moderate-intensity exercises that increase your heart rate and make you breathe harder. Examples include:

  • walking
  • cycling
  • swimming

Research suggests that aerobic fitness exercises should be included in your personalised exercise plan, even if you can’t complete these at a high level of intensity. For example, if you find jogging too difficult, you could try brisk walking instead.

A review of a number of studies found that aerobic exercises may improve quality of life and relieve pain. As aerobic exercises increase your endurance (how long you can keep going), these may also help you function better on a day-to-day basis.

Resistance and strengthening exercises

Resistance and strengthening exercises are those that focus on strength training, such as lifting weights. These exercises need to be planned as part of a personalised exercise programme; if they aren’t, muscle stiffness and soreness could be made worse.

A review of a number of studies concluded that strengthening exercises may improve:

  • muscle strength
  • physical disability
  • depression
  • quality of life

People with fibromyalgia who completed the strengthening exercises in these studies said they felt less tired, could function better and experienced a boost in mood.

Improving the strength of your major muscle groups can make it easier to do aerobic exercises.

Pacing yourself

If you have fibromyalgia, it’s important to pace yourself. This means balancing periods of activity with periods of rest, and not overdoing it or pushing yourself beyond your limits.

If you don’t pace yourself, it could slow down your progress in the long term. Over time, you can gradually increase your periods of activity, while making sure they’re balanced with periods of rest.

If you have fibromyalgia, you will probably have some days when your symptoms are better than others. Try to maintain a steady level of activity without overdoing it, but listen to your body and rest whenever you need to.

Avoid any exercise or activity that pushes you too hard, because this can make your symptoms worse. If you pace your activities at a level that’s right for you, rather than trying to do as much as possible in a short space of time, you should make steady progress.

For example, it may help to start with gentler forms of exercise – such as tai chi, yoga and pilates – before attempting more strenuous aerobic or strengthening exercises.

Recognize stress and take steps to reduce it

Because stress makes the symptoms of fibromyalgia worse, it’s important to recognize when you’re feeling stressed. Signs of stress may include a feeling of tension in your shoulders or neck, an upset stomach, or a headache. Unfortunately, there isn’t a way to completely get rid of stress in your life. However, you can focus on changing the way you react to stress. For example, you might set aside time each day to practice deep-breathing techniques or meditation.

Relaxation

If you have fibromyalgia, it’s important to regularly take time to relax or practice relaxation techniques. Stress can make your symptoms worse or cause them to flare up more often. It could also increase your chances of developing depression.

There are many relaxation aids available, including books, tapes and courses, although deep-breathing techniques or meditation may be just as effective. Try to find time each day to do something that relaxes you. Taking time to relax before bed may also help you sleep better at night.

Talking therapies, such as counseling, can also be helpful in combating stress and learning to deal with it effectively. Your GP may recommend you try this as part of your treatment.

Establish healthy sleep habits

Lack of sleep can make your fibromyalgia symptoms worse. And increased pain makes it hard to get restful sleep. To avoid getting caught in this cycle, try to have healthy sleeping habits. Avoid caffeine and alcohol before bedtime, go to bed and wake up at the same time each day (including weekends), and limit naps during the day.

Fibromyalgia can make it difficult to fall asleep or stay asleep (known as insomnia). If you have problems sleeping, it may help to:

  • get up at the same time every morning
  • try to relax at least 1 hour before going to bed
  • try to create a bedtime routine, such as taking a bath and drinking a warm, milky drink every night
  • avoid caffeine, nicotine and alcohol before going to bed
  • avoid eating a heavy meal late at night
  • make sure your bedroom is a comfortable temperature, and is quiet and dark – use thick curtains, blinds, an eye mask or ear plugs
  • exercise regularly during the day
    make sure your mattress, pillows and covers are comfortable
  • avoid checking the time throughout the night

Everyone needs different amounts of sleep. On average we need:

  • adults – 7 to 9 hours
  • children – 9 to 13 hours
  • toddlers and babies – 12 to 17 hours

You probably don’t get enough sleep if you’re constantly tired during the day.

Get into a routine

Many people who have fibromyalgia do better when their schedule follows a routine pattern. This usually means that each day they have meals at the same times, go to bed and get up at the same times, and exercise at the same time. Try to keep your weekend and holiday schedules as similar to your weekday schedule as possible.

Make healthy lifestyle choices

By making healthy choices, you’ll have more energy, you’ll feel better, and you’ll lower your risk for other health problems. Eat a healthy, balanced diet. Limit the amount of alcohol you drink. If you use tobacco products, stop. Lose weight if you are overweight.

Medication

People with fibromyalgia are typically treated with pain medicines, antidepressants, muscle relaxants, and sleep medicines. You may need to take several different types of medicines for fibromyalgia, including painkillers and antidepressants. These are described below.

The U.S. Food and Drug Administration has approved three drugs for the treatment of fibromyalgia. In June 2007, Lyrica (pregabalin) became the first FDA-approved drug for specifically treating fibromyalgia; a year later, in June 2008, Cymbalta (duloxetine hydrochloride) became the second; and in January 2009, Savella (milnacipran HCI) became the third 2). Older drugs that affect these same brain chemicals also may be used to treat fibromyalgia. These include amitriptyline (Elavil) and cyclobenzaprine (Flexeril). Other antidepressant drugs can be helpful in some patients. Side effects vary by the drug. Ask your doctor about the risks and benefits of your medicine.

Lyrica, Cymbalta and Savella reduce pain and improve function in some people with fibromyalgia. While those with fibromyalgia have been shown to experience pain differently from other people, the mechanism by which these drugs produce their effects is unknown. There is data suggesting that these drugs affect the release of neurotransmitters in the brain. Neurotransmitters are chemicals that transmit signals from one neuron to another. Treatment with Lyrica, Cymbalta, and Savella may reduce the level of pain experienced by some people with fibromyalgia.

Lyrica, marketed by Pfizer Inc., was previously approved to treat seizures, as well as pain from damaged nerves that can happen in people with diabetes (diabetic peripheral neuropathy) and in those who develop pain following the rash of shingles. Side effects of Lyrica including sleepiness, dizziness, blurry vision, weight gain, trouble concentrating, swelling of the hands and feet, and dry mouth. Allergic reactions, although rare, can occur.

Cymbalta, marketed by Eli Lilly and Co., was previously approved to treat depression, anxiety, and diabetic peripheral neuropathy. Cymbalta’s side effects include nausea, dry mouth, sleepiness, constipation, decreased appetite, and increased sweating. Like some other antidepressants, Cymbalta may increase the risk of suicidal thinking and behavior in people who take the drug for depression. Some people with fibromyalgia also experience depression.

Savella, marketed by Forest Pharmaceuticals, Inc., is the first drug introduced primarily for treating fibromyalgia. Savella is not used to treat depression in the United States, but acts like medicines that are used to treat depression (antidepressants) and other mental disorders. Antidepressants may increase suicidal thoughts or actions in some people. Side effects include nausea, constipation, dizziness, insomnia, excessive sweating, vomiting, palpitations or increased heart rate, dry mouth and high blood pressure.

Studies of both drugs showed that a substantial number of people with fibromyalgia received good pain relief, but there were others who didn’t benefit.

Lyrica and Cymbalta are approved for use in adults 18 years and older 3). The drug manufacturers have agreed to study their drugs in children with fibromyalgia and in breastfeeding women.

Painkillers

Simple painkillers that are available over the counter from a pharmacy, such as paracetamol, can sometimes help relieve the pain associated with fibromyalgia. However, these aren’t suitable for everyone, so make sure you read the manufacturer’s instructions that come with the medication before using them.

If over-the-counter painkillers aren’t effective, your doctor (or another healthcare professional treating you) may prescribe a stronger painkiller, such as codeine or tramadol.

However, these painkillers can be addictive and their effect tends to weaken over time. This means that your dose may need to be gradually increased and you could experience withdrawal symptoms if you stop taking them. Other side effects include diarrhea and fatigue (extreme tiredness).

Antidepressants

Antidepressant medication can also help to relieve pain for some people with fibromyalgia. They boost the levels of certain chemicals that carry messages to and from the brain, known as neurotransmitters.

Low levels of neurotransmitters may be a factor in fibromyalgia, and it’s believed that increasing their levels may ease the widespread pain associated with the condition.

There are different types of antidepressants. The choice of medicine largely depends on the severity of your symptoms and any side effects the medicine may cause.

Antidepressants used to treat fibromyalgia include:

  • tricyclic antidepressants – such as amitriptyline
  • serotonin-noradrenaline reuptake inhibitors (SNRIs) – such as duloxetine and venlafaxine
  • selective serotonin reuptake inhibitors (SSRIs) – such as fluoxetine and paroxetine

A medication called pramipexole, which isn’t an antidepressant, but also affects the levels of neurotransmitters, is sometimes used as well.

Antidepressants can cause a number of side effects, including:

  • feeling sick
  • dry mouth
  • drowsiness
  • feeling agitated, shaky or anxious
  • dizziness
  • weight gain
  • constipation

For information on the side effects of your particular medication, check the patient information leaflet that comes with it.

Medication to help you sleep

As fibromyalgia can affect your sleeping patterns, you may want medicine to help you sleep. If you’re sleeping better, you may find that other symptoms aren’t as severe.

For sleep problems, some of the medicines that treat pain also improve sleep. These include cyclobenzaprine (Flexeril), amitriptyline (Elavil), gabapentin (Neurontin) or pregabalin (Lyrica). It is not recommended that patients with fibromyalgia take sleeping medicines like zolpidem (Ambien) or benzodiazepine medications.

Speak to your doctor if you think you could benefit from a medicine like this. They may recommend an over-the-counter remedy, or prescribe a short course of a stronger medication. Some antidepressants may also improve your sleep quality.

Muscle relaxants

If you have muscle stiffness or spasms (when the muscles contract painfully) as a result of fibromyalgia, your doctor may prescribe a short course of a muscle relaxant, such as diazepam.

These medicines may also help you sleep better because they can have a sedative (sleep-inducing) effect.

Anticonvulsants

You may also be prescribed an anticonvulsant (anti-seizure) medicine, as these can be effective for those with fibromyalgia.

The most commonly used anticonvulsants for fibromyalgia are pregabalin and gabapentin. These are normally used to treat epilepsy, but research has shown they can improve the pain associated with fibromyalgia in some people.

Some common side effects of pregablin and gabapentin include:

  • dizziness
  • drowsiness
  • swelling of your hands and feet (oedema)
  • weight gain

Antipsychotics

Antipsychotic medicines, also called neuroleptics, are sometimes used to help relieve long-term pain. Studies have shown that these medications may help conditions such as fibromyalgia, but further research is needed to confirm this.

Possible side effects include:

  • drowsiness
  • tremors (shaking)
  • restlessness

Other treatment options

As well as medication, there are other treatment options that can be used to help cope with the pain of fibromyalgia, such as:

  • swimming, sitting or exercising in a heated pool or warm water (known as hydrotherapy or balneotherapy)
  • an individually tailored exercise programme
  • cognitive behavioural therapy (CBT) – a talking therapy that aims to change the way you think about things, so you can tackle problems more positively
  • psychotherapy – a talking therapy that helps you understand and deal with your thoughts and feelings
  • relaxation techniques
  • psychological support – any kind of counseling or support group that helps you deal with issues caused by fibromyalgia

See self-help for fibromyalgia for more information about exercise and relaxation techniques.

Alternative therapies

Some people with fibromyalgia try complementary or alternative treatments, such as:

  • acupuncture
  • massage
  • manipulation
  • aromatherapy

There’s little scientific evidence that such treatments help in the long term. However, some people find that certain treatments help them to relax and feel less stressed, allowing them to cope with their condition better.

Research into some complementary medicines, such as plant extracts, has found they’re not effective in treating fibromyalgia. If you decide to use any complementary or herbal remedies, check with your GP first. Some remedies can react unpredictably with other medication, or make it less effective.
Treating other conditions

If you’ve been diagnosed with fibromyalgia and another condition, such as depression or irritable bowel syndrome (IBS), you may need to have separate treatment for these. For example, additional counselling or medication may be recommended.

Fibromyalgia diet

Some people say their fibromyalgia symptoms are worsened by certain foods or food additives — such as refined flour, dairy products, sugar, sugar substitutes or MSG — but there’s no clear research-based evidence to support this.

Some studies show a benefit in avoiding certain foods or additives, while other studies don’t show such a correlation. Scientists are investigating possible connections between the consumption of gluten and fibromyalgia symptoms, but more research is needed.

People who have fibromyalgia are also more likely to be overweight or obese, and both problems impact quality of life. For some people, losing weight can help reduce fibromyalgia symptoms.

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Health Jade