Everything you need to know about fibromyalgia

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Fibromyalgia is a common cause of chronic generalized musculoskeletal pain. People with fibromyalgia may also be more sensitive to pain than those without the condition.

Around 4 million adults in the United States experience fibromyalgia. Studies show that females are more likely to have fibromyalgia than males. It can affect people of any age, but more commonly begins in middle age. The risk of developing fibromyalgia increases as a person ages.

A person may be more at risk of fibromyalgia following a traumatic injury. RA, other autoimmune diseases, such as lupus, and genetic factors may also increase a person’s likelihood of developing the condition.

Common fibromyalgia symptoms include:

• widespread pain
• joint and muscle stiffness after sleeping
• headaches
• irregular sleep patterns
• tingling and numbness in the hands and feet
• restless legs syndrome
• sensitivity to cold or heat
• difficulties with memory and concentration, known as “fibro fog”
• fatigue
• irritable bowel syndrome (IBS)

The following may also occur:

• problems with vision
• nausea
• pelvic and urinary issues
• rapid weight gain
• dizziness
• cold– or flu-like symptoms
• skin problems
• chest symptoms
• depression and anxiety
• post-traumatic stress disorder (PTSD)
• breathing problems

Symptoms can appear at any time during a person’s life, but they are most common between the ages of 25 and 55.

Fibromyalgia can be difficult for a person to manage alone.

A rheumatologist or other specialist will design a treatment program to help manage the condition. This will typically involve a combination of pharmacological and nonpharmacological therapies.

As fibromyalgia is a syndrome, every person experiences a different set of symptoms, and an individual treatment plan is necessary.

Treatment may include some or all of the following:

• a low impact exercise program
• acupuncture
• psychotherapy
• chiropractic
• massage
• physical therapy
• stress reduction techniques
• psychotherapy, such as cognitive behavioral therapy (CBT)
• drugs, such as antidepressants, muscle relaxers, and nerve pain medication

Medications

A healthcare professional may recommend medications to treat certain symptoms. These may include over-the-counter (OTC) pain relievers.

However, in its updated 2016 guidelines, the European League Against Rheumatism (EULAR) issued a recommendation against using nonsteroidal anti-inflammatory drugs (NSAIDs) to treat fibromyalgia.

Healthcare professionals may also prescribe antidepressants, including duloxetine (Cymbalta) and milnacipran (Savella), and anti-seizure drugs, such as pregabalin (Lyrica).

A person should tell a healthcare professional about any other medications they are taking to avoid side effects and interactions with other drugs.

Learn more about the treatments for fibromyalgia.

Alongside medication programs, alternative and home remedies may help people manage fibromyalgia symptoms.

Exercise

A combination of low impact aerobic exercise and resistance training may reduce pain, tenderness, stiffness, and sleep disturbance in some people. Other practices, such as tai chi, yoga, and qigong, may also prove effective.

If exercise is helping with symptoms, it is important to maintain consistency to see progress.

Acupuncture

Acupuncture therapy may help improve the quality of life in individuals with fibromyalgia. The number of sessions a person may require will depend on the symptoms and their severity.

Complementary treatments, such as acupuncture and massage, may help alleviate pain symptoms. However, evidence of their effectiveness is typically anecdotal and lacks full scientific assessment.

Psychotherapy

Psychotherapy sessions may help those with fibromyalgia cope with pain symptoms.

Behavior modification therapy is a form of CBT that aims to reduce stress- or pain-increasing behaviors and improve positive behaviors. It includes learning new coping skills and relaxation exercises.

CBT exercises can help reduce pain symptoms and aid long-term management of fibromyalgia. A 2017 trial found that emotional awareness and expression therapies can also have a positive impact on pain symptoms in individuals with fibromyalgia.

Some people may also find that meditation can help alleviate stress and pain sensations.

Diet

A person’s diet is an important part of any treatment plan.

Certain dietary changes may help an individual with fibromyalgia live with and manage their condition. These include:

• Eating high-energy foods that are low in sugar: Foods such as almonds, beans, oatmeal, avocado, and tofu can help boost energy throughout the day, helping with tiredness that occurs as a result of the condition.
• Removing foods that have gluten: Studies suggest that removing foods that contain gluten from the diet may help reduce fibromyalgia pain, even in people who do not have celiac disease.
• Avoiding fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP): A 2017 study shows that a diet low in FODMAP could have promising effects on pain levels in people with fibromyalgia.
• Avoiding additives and excitotoxins: Although research is limited, one 2020 study found that avoiding the additives aspartame and monosodium glutamate reduced symptoms of fibromyalgia.

Reaching or maintaining a moderate body weight and following a balanced diet are important for overall health and can improve a person’s quality of life.

Studies found that people with both fibromyalgia and obesity showed an improvement in quality of life and pain symptoms once they lost weight.

Learn more about fibromyalgia and diet.

The exact cause of fibromyalgia is unclear. However, current thinking in the field of rheumatology suggests that fibromyalgia results from an issue with pain processing in the central nervous system (CNS).

Several factors may increase a person’s risk of developing fibromyalgia, including:

• a stressful, traumatic physical or emotional event, such as a car accident
• repetitive injuries
• RA or other autoimmune conditions, such as lupus
• CNS problems
• the way the genes regulate how a person processes painful stimuli

Fibromyalgia may also be hereditary. Females who have a close relative with fibromyalgia have a higher risk of the condition.

People with RA, lupus, or spinal arthritis, known as ankylosing spondylitis, have a higher likelihood of developing fibromyalgia, as do individuals with some other rheumatic conditions.

It can take some time to confirm a diagnosis of fibromyalgia, because the symptoms resemble those of other conditions, such as:

• hypothyroidism
• autoimmune disorders
• Lyme disease

A healthcare professional needs to rule out these conditions before diagnosing fibromyalgia.

There are no laboratory tests for the condition, and this, too, can lead to a delayed diagnosis or misdiagnosis.

The American College of Rheumatology has established three criteria for diagnosing fibromyalgia:

• pain and symptoms over the previous week, as well as levels of fatigue, unrefreshing sleep, or cognitive problems
• symptoms that have been present for at least 3 months
• no presence of another health condition that would explain the symptoms

Previously, healthcare professionals often assessed so-called tender points to diagnose fibromyalgia. However, they no longer use tender points as a diagnostic tool.

Tender points are areas of the body where a person with fibromyalgia is most likely to feel severe pain.

These include:

• the back of the head
• inner knees
• outer elbows
• the neck and shoulders
• the outer hips
• the upper chest

A healthcare professional would diagnose fibromyalgia based on how a person reacts to pressure at these points.

However, they no longer see this as an accurate way to diagnose the condition and no longer use it as a reliable indicator of fibromyalgia.

Fibromyalgia can impact a person’s quality of life, affect physical mobility, and increase their risk of hospitalization.

Individuals with fibromyalgia may also be more likely to experience related conditions, such as:

• irritable bowel syndrome (IBS)
• painful menstruation
• RA
• osteoarthritis
• depression
• ankylosing spondylitis
• lack of sleep
• anxiety

The following are answers to some questions people frequently ask about fibromyalgia.

What part of the body does fibromyalgia affect the most?

Fibromyalgia causes widespread pain throughout the body. It is often felt in areas, such as:

• arms and legs
• chest
• abdomen
• head
• back
• buttocks

What are usually the first signs of fibromyalgia?

The main symptom of fibromyalgia is chronic widespread pain. This is often accompanied by fatigue and sleep issues. A person may also experience stiffness in their muscles.

There is currently no cure for fibromyalgia, and a person may experience its symptoms for the rest of their life. However, treatment plans combining medications with physical and mental therapies can help them manage their condition in the long term.

Treatment for fibromyalgia often involves medications along with complementary treatments, such as exercise, acupuncture, and psychotherapy.

A person should discuss their symptoms and treatment options with a healthcare professional as fibromyalgia can affect each individual differently.