Fibromyalgia Syndrome Overview

Fibromyalgia is a chronic syndrome that can cause widespread body pain, fatigue, and cognitive issues. Various treatments can help a person manage their symptoms.

A person may confuse fibromyalgia symptoms with those of arthritis, or joint inflammation..

The condition can commonly coexist with autoimmune disorders, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), but it is not an autoimmune disorder.

Fibromyalgia does not cause joint or muscle inflammation and damage, but it can increase a person’s feelings of joint or muscle pain.

Facts about fibromyalgia include the following:

  • Fibromyalgia occurs mainly in females.

    Symptoms include:

    • Fatigue
    • Somatic and cognitive or psychiatric symptoms
    • Unrefreshing sleep 
    • Widespread pain
  • Although there is no test for fibromyalgia, doctors may order laboratory tests and X-rays to rule out conditions resembling fibromyalgia.
  • There is no single known cause of fibromyalgia. Genetics, traumatic emotional or physical events, and sleep and mood disorders may all contribute to the condition.
  • Currently, there is no cure for fibromyalgia. However, medications, exercise, acupuncture, and behavioral therapy can help relieve symptoms and improve sleep quality.


How common is Fibromyalgia?

Fibromyalgia is a common cause of chronic generalized musculoskeletal pain.

Around 5 million adults aged 18 years or over in the United States experience fibromyalgia. Studies show that natal females are more likely to have fibromyalgia than natal males.

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.

Signs and Symptoms of Fibromyalgia

Common fibromyalgia symptoms include the following:

The following may also occur:

Symptoms can appear at any time during a person’s life, but they are most common between the ages of 30 and 50.

Causes of Fibromyalgia

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
  • CNS problems
  • Repetitive injuries
  • RA or other autoimmune conditions, such as lupus lupus
  • 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.

Patients 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.

Diagnosis of Fibromyalgia

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

A doctor 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:

  • No presence of another health condition that would explain the symptoms
  • 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


Tender Points

Previously, doctors often assessed so-called tender points to diagnose fibromyalgia. However, healthcare professionals 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:

  • Back of the head
  • Inner knees
  • Outer elbows
  • Neck and shoulders
  • Outer hips
  • Upper chest

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

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


Treatment of Fibromyalgia

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 will experience a different set of symptoms, and an individual treatment plan will be necessary.

Treatment may include some or all of the following:

  • A low impact exercise program
  • Acupuncture 
  • Chiropractic
  • Drugs such as antidepressants, muscle relaxers, and nerve pain medication.
  • Psychotherapy
  • Massage
  • Physical therapy
  • Stress reduction techniques
  • Psychotherapy, such as cognitive behavioral therapy (CBT)


Medications

A medical professional may recommend medications to treat certain symptoms. These may include over-the-counter pain relievers.

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

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

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

Alternative and Home Remedies

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

Acupuncture

Acupuncture therapy may help improve 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.

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 patients with fibromyalgia.
  • Avoiding additives and excitotoxins: Although research is limited, one 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 vital 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.

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 qi gong, may also prove effective.

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

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.

Complications 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:

Outlook

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.

Outlook for people with fibromyalgia will depend on a person’s individual circumstances. For example, studies show that those receiving treatment from primary care sources have a better outlook than those using referral centers.

Other factors, such as an individual’s economic status, medical history, and access to mental health support, will also play a role.

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