Fibromyalgia

pain of fibromyalgia

Fibromyalgia is a condition that causes chronic (ongoing) problems with generalised pain, tenderness and muscle stiffness throughout the body, alongside an increased response to touch or pressure.

Fibromyalgia is common and affects women more than men – in fact, 80 to 90 per cent of people affected are female. It is most commonly diagnosed in middle age.

Symptoms of fibromyalgia

People with fibromyalgia commonly experience aching pain in various regions of the body, including joints and muscles.

Every person with fibromyalgia will have a different set of symptoms but common symptoms include:

  • muscle stiffness, often noticed most in the morning;
  • increased sensitivity to touch (tenderness), with certain areas being super-sensitive (‘tender points’);
  • problems sleeping;
  • extreme tiredness;
  • problems with memory and concentration (sometimes called ‘fibro-fog’);
  • headaches;
  • tingling and numbness in the hands and feet;
  • sensitivity to temperature, loud noises and bright lights;
  • symptoms of irritable bowel syndrome (IBS) or gastro-oesophageal reflux disease (GORD); and
  • in women, painful periods.

Symptoms can range from mild to severe, and may be persistent or come and go.

Some people may experience depression and/or anxiety.

Causes and risk factors

Fibromyalgia does not cause inflammation or damage to organs or tissues. Instead, people with fibromyalgia perceive certain things as painful that most other people would not find painful. Their bodies process pain differently.

The exact cause of fibromyalgia remains unknown, but it is believed to result from abnormal activation of the central pain system, as if pain was amplified. Genetic factors may play a role in this.

There are several factors that are thought to increase the risk of having this condition, or act as trigger factors for fibromyalgia, including:

  • having certain conditions, such as rheumatoid arthritis, osteoarthritis, systemic lupus erythematosis (SLE), chronic fatigue syndrome or ankylosing spondylitis;
  • ongoing pain from an injury or a repetitive injury;
  • a stressful, traumatic event (such as a car accident);
  • emotional distress;
  • illnesses such as viral infections; and
  • a family history of fibromyalgia.

Tests and diagnosis

There are no specific tests or scans that can be used to make the diagnosis of fibromyalgia, so the diagnosis depends on the combination of your symptoms and signs, how long you have had symptoms, and ruling out other conditions.

Your doctor will ask about:

  • your pain and symptoms and how long you have had them;
  • your level of fatigue (tiredness);
  • whether you feel refreshed when you wake up; and
  • whether you have had problems with memory and concentration.

Your doctor will also perform a physical examination. As part of their assessment, they will assess whether you have tenderness in several areas of the body.

Sometimes tests are suggested to rule out other possible causes for your symptoms. A blood test may be recommended to rule out inflammation as a cause for symptoms. Blood tests that can detect inflammation include C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).

Treatment

There is no single simple cure for treating fibromyalgia, but the disease is not progressive or life-threatening.

If you have been diagnosed with fibromyalgia, the treatment will largely depend on the severity and frequency of your symptoms.

Your doctor can help with explanations, reassurance, medicines and management suggestions, but fibromyalgia is a condition in which self-management plays a key role. There are enormous benefits to be gained by using your own strategies to manage your symptoms and cope with fibromyalgia.

Often, a combination of treatments is best for controlling symptoms.

Self-management

Learning how to self-manage your fibromyalgia is the cornerstone of treatment and will help you get relief from pain, improve your sleep and help you cope emotionally.

Exercise

Regular exercise is extremely important when you have fibromyalgia. Despite exercise being painful and difficult initially, with time you can become aerobically fit, though it may take you longer to achieve this than someone who doesn’t have fibromyalgia.

You should start slowly – your initial aim may be just a few minutes of gentle exercise several times per week. Gradually try to increase the amount of exercise. Low-impact exercises such as walking, swimming or bike-riding are ideal.

Your exercise programme should also include stretching and strengthening exercises, which are useful in managing fibromyalgia.

In addition to helping reduce symptoms, including pain, sleep problems and tiredness, exercise can help you maintain a healthy weight. This is important because being overweight can make symptoms worse.

Stress management

Psychological factors are important in managing fibromyalgia. Some people with fibromyalgia find that stress acts as a trigger for their symptoms, so stress minimisation and avoidance are important.

You need to find the balance between work, rest and play by developing strategies to deal with both everyday stresses and those associated with the chronic pain you are experiencing. Sometimes this may simply require a change in attitude — viewing problems as opportunities or challenges, and replacing negative thoughts with positive ones.

You may require the help of a professional, such as a doctor who deals with chronic pain, or a clinical psychologist, to help you with stress management strategies.

Relaxation techniques

Different techniques for relaxation, such as pursuing a hobby or increasing the amount of free time you have, are beneficial in fibromyalgia, but sometimes you may need more formal techniques to deal with the muscle tightness and the emotional problems associated with this condition.

Meditation and mindfulness techniques may help with symptoms.

Learning breathing techniques, yoga, meditation and tai chi may also be of benefit. Massage and acupuncture are treatments that some people with fibromyalgia find useful.

Some people find that a warm bath before bedtime helps with muscle pain and helps them go to sleep.

Sleep management

Good ‘sleep hygiene’ principles (no daytime napping, having a regular waking time, doing regular exercise, following a wind-down routine at night, and restricting bed use to sleeping only) can lead to a general improvement in sleep. This may help improve the symptoms of fibromyalgia.

Managing your time

People with fibromyalgia find they manage better if they pace themselves. Learn to say ‘no’ to avoid over-committing yourself and causing undue stress, which will only serve to exacerbate your fibromyalgia symptoms. Work within your energy levels and leave enough time to nourish yourself with rest and gentle exercise.

Eating a healthy diet

Eating a variety of healthy foods and getting adequate nutrition can help with energy levels and help you maintain a healthy weight.

Avoiding caffeine may help reduce anxiety and restlessness and make it easier to sleep at night.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) involves working with a psychologist to identify and challenge negative thinking patterns and develop alternative ways of thinking and acting. People with fibromyalgia may find this type of therapy useful to find different ways to think about and react to pain, which may help relieve it.

A psychologist can also help you develop other pain management skills and practise mindfulness techniques.

Medicines

In Australia, there are currently no specific medicines indicated to treat fibromyalgia, but there are medicines that can improve symptoms in some people.

Some antidepressant medicines may be recommended to help treat pain and sleep problems.

Some medicines used to prevent seizures and treat neuropathic pain may also be helpful in the treatment of fibromyalgia.

Pain relieving medicines are usually not helpful, and are generally not recommended for long-term use.

Seeing a specialist for fibromyalgia

Your doctor may refer you to a rheumatologist for further evaluation and treatment. Rheumatologists are specialists who treat conditions that affect joints and soft tissues in the body.

Depending on your symptoms, you may also benefit from seeing other health professionals, such as a physiotherapist, occupational therapist or psychologist.

Find a fibromyalgia support group

Many people with fibromyalgia find that a fibromyalgia support group can help them manage their symptoms. Talking to others who have fibromyalgia and understand what you are going through can lessen feelings of isolation.

Last Reviewed: 21 March 2016
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References

1. Arthritis Australia. Fibromyalgia (updated Jul 2015). Available from: http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/2015/Condition%20specific/Fibromyalgia_infosheet_updated_150722.pdf (accessed Mar 2016).
2. National Institute of Arthritis and Musculoskeletal and Skin Diseases. What is fibromyalgia? (updated Nov 2014). Available from: http://www.niams.nih.gov/Health_Info/Fibromyalgia/fibromyalgia_ff.asp (accessed Mar 2016).
3. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Questions and answers about fibromyalgia (updated Jul 2014). Available from: http://www.niams.nih.gov/health_info/Fibromyalgia/ (accessed Mar 2016).
4.Generalised noninflammatory chronic pain syndrome (including fibromyalgia) (revised October 2010). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2015 Nov. http://online.tg.org.au/complete/ (accessed Mar 2016).
5.Arthritis Australia. Exercise and fibromyalgia (updated May 2015). Available from: http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/2015/General%20management/Exerciseandfibromyalgia.pdf (accessed Mar 2016).
6. American College of Rheumatology (ACR). Preliminary diagnostic criteria for fibromyalgia (2011). https://www.umassmed.edu/uploadedFiles/cme/CME_Members_Area/C1-Handout-Fibromyalgia.pdf (accessed Mar 2016).
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