Causes of Fibromyalgia
The cause of fibromyalgia is still unknown. Researchers believe that this disorder causes amplified sensations by affecting the way your brain and spinal cord process painful signals. Various factors are thought to contribute, including:
Genetic predisposition (more likely in women than men, runs in families)
Autoimmune
Environmental triggers like physical or psychosocial stress
Dysregulation of neuroendocrine and autonomic nervous systems
Associated Conditions
Migraine, tension, or other types of headaches
Temporomandibular joint (TMJ) disorders
Irritable bowel syndrome
Anxiety and depression
Chronic fatigue syndrome
Painful bladder syndrome
Other autoimmune conditions like systemic lupus erythematosus, rheumatoid arthritis
Symptoms of Fibromyalgia
The most common symptoms of fibromyalgia are widespread chronic musculoskeletal pain (without objective physical exam findings), fatigue, and unrefreshing sleep. Additional symptoms can be common:
- Fibro fog: a form of cognitive dysfunction that includes difficulty concentrating
- Headaches
- Morning stiffness
- Memory deficits
- Abdominal pain or cramps; diarrhea or constipation
- Changes with your autonomic nervous system like dry eyes, vision changes
- Restless leg syndrome
Diagnosis of Fibromyalgia
The diagnosis of fibromyalgia is based on symptoms alone:
Medical History: Discussion of symptoms and timing. To meet criteria, you must have pain in at least four out of five areas for at least 3 months:
Left shoulder, arm, or jaw
Right shoulder, arm, or jaw
Left hip, buttock, or leg
Right hip, buttock, or leg
Neck, back, chest, or abdomen
Physical Examination: Assessment of joints, muscles, and tendons in affected areas to rule out other causes of pain.
Labs: Your doctor may want to rule out other conditions that may have similar symptoms, like hypothyroidism, anemia, polymyalgia rheumatica, rheumatoid arthritis, or other inflammatory conditions. Lab testing will include:
Complete blood count
Erythrocyte sedimentation rate
Cyclic citrullinated peptide test
Rheumatoid factor
Thyroid function tests
Anti-nuclear antibody
Celiac serology
Diagnostic Imaging: All imaging will be normal and is not done unless a different condition is suspected.
Treatment of Fibromyalgia
Treatment of fibromyalgia should include a multidisciplinary team and include the following components:
Patient education
Exercise, including strength training
Supportive therapy
Physiotherapy: stretching, hydrotherapy, and heat application
- Yoga
- Massages
Cognitive Behavioral Therapy: with a trained therapist to help with perception of pain, anxiety, and depression
Stress management therapy
Antidepressants
Pain medication (see below): traditional pain medications like NSAIDs and opioids are generally ineffective for the treatment of fibromyalgia
Treatment Videos
Non-medication treatments
Pain Medicine Intervention
Pain medicine doctors can supplement the treatment regimen for fibromyalgia in several ways:
Prescribing physical or occupational therapy: can improve strength, flexibility, and stamina and can help make adjustments to everyday tasks so they cause less stress on your body
Prescribing medications: antidepressants like Duloxetine (Cymbalta) and milnacipran (Savella) may help ease pain and fatigue associated with this disorder. Amitriptyline is another antidepressant that can help with sleep. Muscle relaxers like cyclobenzaprine can also help with sleep. Anti-seizure drugs like Gabapentin and pregabalin (Lyrica) can also be helpful in treating certain types of pain associated with fibromyalgia.
Acupuncture
Prognosis and Impact of Fibromyalgia
Fibromyalgia is a dynamic condition and symptoms can fluctuate over time. Every person is different and how fibromyalgia affects your body will be unique. Maintaining your overall health can help reduce the severity of fibromyalgia symptoms (manage stress, follow a diet and exercise plan that works for you, get enough sleep and practice good sleep hygiene). There is no cure for fibromyalgia, you should expect to manage the symptoms of this disorder for a long time, maybe the rest of your life.People with fibromyalgia are more likely to be hospitalized because of pain, fatigue, or mental health symptoms. Finding the right treatment plan for you can help manage flares and reduce their frequency and severity.
