Fibromyalgia (FMS) is a poorly understood disorder characterised by joint pain, deep tissue pain, fatigue, depression, headaches and a lack of sleep. It affects around 2-4% of the population with more women than men suffering. The underlying cause of FMS has confounded conventional medicine for decades.
The pain of fibromyalgia has no boundaries. People with FMS suffer chronic widespread pain, which can be described as burning, throbbing, shooting, or stabbing. Painful areas often include the upper back, shoulders, neck, lower back and other areas around the joints. Many people will say, “I hurt all over”.
Fatigue is another major symptom of FMS and hence the overlap and sometimes confusion with chronic fatigue syndrome. The fatigue can be mild in some FMS patients and yet incapacitating in others. The fatigue has been described as “brain fatigue” in which patients feel totally drained of energy.
Most fibromyalgia patients have an associated sleep disorder. Researchers have found that FMS patients can fall asleep without much trouble, but their deep level sleep is constantly interrupted by bursts of awake brain activity. The sleep pattern for clinically depressed patients is distinctly different from that found in FMS or CFS.
Other symptoms experienced by FMS patients include constipation, diarrhoea, frequent abdominal pain, abdominal gas and nausea. Recurrent migraine or tension-type headaches and sensitivities to odours, noise, bright lights, medications and various foods are also common. Painful menstrual periods (dysmenorrhea), chest pain, morning stiffness, cognitive or memory impairment, numbness and tingling sensations, muscle twitching, irritable bladder, the feeling of swollen extremities, skin sensitivities, dry eyes and mouth, frequent changes in eye prescription, dizziness, and impaired coordination can also occur.
Is it helpful to have a diagnosis?
Some specialists have argued that a diagnosis of fibromyalgia is unhelpful because it over-medicalises the complex of distressing, medically unexplained symptoms. I, however, disagree; many patients find the diagnosis helpful, especially when it provides a common sense explanation for poor sleep, tiredness and pain. A diagnosis can reassure patients that they do not have another, more severe illness, such as inflammatory arthritis or cancer and halt a cycle of repeated normal investigations in search of a diagnosis. Confirmation of FMS can allow patients to move forward and find ways of reducing the impact of their symptoms.
Blood tests or imaging such as Joint X-ray are rarely helpful as they are usually normal in FMS patients although normal results are, of course, reassuring. The American College of Rheumatology (1990) has established a tool for diagnosis whereby 18 tender points are assessed and patients with tenderness at 11 or more of the sites may be classified as having FMS. This system, however, is by no means full proof and the diagnosis of fibromyalgia is made purely on a clinical basis. A diagnosis of FMS is also not a diagnosis of exclusion; it can and does exist with other conditions.
Treatment and management
Exercise, including both both aerobic exercise and strength training, has been shown to be effective in helping with the symptom picture.
Physical therapies such as osteopathy and physiotherapy can be helpful for some, as can psychological therapies.
Research has shown drugs such as pain killers and anti-depressants to help although typically the results are not strong. Great care should be taken as FMS is a long-term condition and drugs such as opioids can lead to addiction.
At Walnut Grove we have a range of physical therapies, exercise approaches and psychological help. Our clinicians all work together to treat the patient and not the condition. We aim to reduce symptoms and improve quality of life.
Summary
Symptoms of fibromyalgia are chronic widespread pain associated with un-refreshing sleep and tiredness. FMS is not a diagnosis of exclusion and often occurs in patients with other conditions, such as inflammatory arthritis and osteoarthritis. No clear pathophysiological mechanism for FMS has been established, but evidence suggests that there is an abnormality in central pain processing. Diagnosing FMS can allow the patient’s polysymptomatic distress to be explained, thereby reducing fear and doubt. The condition has no cure, but a range of drug and non-drug treatments can reduce the symptoms and their impact on the patient’s life. Trial evidence for all forms of treatment in FMS generally shows only small to moderate average effects.
If pain is your major issue, the following guidebook may help in association with working with a practitioner. It is however quite a read!
If this seems overwhelming, then the following short videos may suggest a way forward.
https://www.youtube.com/watch?v=jIwn9rC3rOI
https://www.youtube.com/watch?v=ikUzvSph7Z4
