What is Fibromyalgia?
Fibromyalgia, also known as Fibromyalgia Syndrome (FMS), is a chronic pain condition in which pain is experienced all over the body. It usually develops between the ages of 30-60 years and is seen more commonly in women of child bearing age. However, it may occur at age including children and the elderly.
Symptoms of Fibromyalgia
Symptoms usually include widespread muscle pain above and below the waist on both sides of the body together with stiffness, debilitating tiredness and sleep disturbance.
The condition usually presents as tender points throughout the body which are painful when pressed. Pain is often felt in the shoulders, back, neck and hips. The pain is usually constant but may vary in severity at different times. The pain can feel like an ache, a burning pain or a sharp stabbing sensation. The condition is not caused by damage to the muscles. Fibromyalgia can make people more sensitive to pain all over their body which may be described using the following medical terms:
- Hyperalgesia
Extreme sensitivity to pain (for example the pain felt when stubbing a toe may be more intense or last longer than expected)
- Allodynia
Increased sensitivity to normal things such as a light touch on the skin, clothing or bed sheets or draughts which is felt as pain
Fibromyalgia can cause stiffness, particularly if the body is in one position for a long period of time such as first thing in the morning. Fibromyalgia can also cause muscle spasms (this is when muscle squeezes together tightly causing pain).
Fatigue, sleep disturbance and extreme tiredness are a common feature of Fibromyalgia. This may range from a mild tired feeling to severe exhaustion. Fibromyalgia may interfere with cognitive processes such as thinking and learning. People may have trouble learning or remembering new things and may have problems with concentration and slowed or confused speech. Depression and anxiety are commonly seen in Fibromyalgia.
Headaches are often caused by stiffness in the neck and shoulders. The headaches may range from mild to severe (migraines).
Irritable Bowel Syndrome (IBS) is also associated with Fibromyalgia which can cause bloating, abdominal pain, diarrhoea and/or constipation.
Other symptoms
- feeling too hot or too cold (people with fibromyalgia may be sensitive to changes in the weather)
- parathesia (a tingling sensation in the hands or the feet)
- tinnitus (a constant noise/buzzing in one or both ears)
- restless leg syndrome (an unpleasant feeling in the legsHome – Pelvic Pain Foundation which feels like it requires constant movement to get relief)
- painful periods for women
Causes of Fibromyalgia
The cause of Fibromyalgia is not known. It may start after an infection, an accident or a stressful life event but it may also begin for no particular reason. Experts have some theories about what causes Fibromyalgia. These include:
- Disturbed pain messages
It is thought the nervous system may have become oversensitive to normal aches and pains and other sensations such as temperature and touch which the brain registers as pain. This may explain why Fibromyalgia causes constant feelings of pain and extra sensitivity to pain.
- Low levels of hormones
Low levels of hormones, serotonin, noradrenalin and dopamine have been found in people with the condition. These hormones are responsible for mood control, appetite and our response in stressful situations.
- Sleep disturbance
It has been suggested that the disturbed sleep patterns that accompany Fibromyalgia may contribute to the pain experienced.
Diagnosis of Fibromyalgia
There is no specific test for diagnosing Fibromyalgia and it is not identifiable on x-ray or scans. The doctor will review a person’s medical history and symptoms suggestive of the condition. Symptoms include widespread pain for greater than three months on both the left and right side of the body both above and below the waist, painful tender points and a history of any depression or stress.
Other conditions with similar symptoms to Fibromyalgia may need to be investigated and ruled out. These include Rheumatoid Arthritis, Multiple Sclerosis and Chronic Fatigue Syndrome.
Treatment
There is no known cure for Fibromyalgia. Treatment is aimed at managing the condition and relieving the symptoms:
Medication
There are a several classes of medications which have been found to partly help with the pain and symptoms of Fibromyalgia. The drugs work in different ways and a combination of different types may be required:
- Analgesia
Simple over-the-counter pain medication such as Paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen help with the pain associated with Fibromyalgia. There is some evidence that a more potent medication such as Tramadol may be effective in the treatment of Fibromyalgia.
- Antidepressant
A tricyclic antidepressant drug such as Amitriptyline which was originally designed to treat depression has been found to partly help with the pain of Fibromyalgia and assist with sleep. These drugs may cause side effects such as a dry mouth, drowsiness, constipation or nausea.
- Anticonvulsant
Medication such as Gabapentin or Lyrica were originally designed to treat epilepsy but have been found to be a useful treatment for Fibromyalgia. Possible side effects include drowsiness and weight gain.
- Muscle relaxant
If symptoms of muscle stiffness or spasms are present a muscle relaxant may be prescribed to assist with this. This medication can also assist with sleep.
Physiotherapy
Techniques such as massage and heat treatment can be used to improve the feeling of muscle weakness or stiffness.
Psychology
The development of pain and symptom management strategies is essential and a Psychologist can assist with this. People with Fibromyalgia may be more prone to developing depression and anxiety. Pain management programmes and cognitive behavioural therapy (CBT) can be effective.
Exercise
Studies have shown that exercise, such as aerobic and strengthening exercise, can improve the symptoms of Fibromyalgia and improve quality of life. A physiotherapist, GP or healthcare professional with experience of Fibromyalgia should be involved in designing a personalised exercise programme which is individually suited to managing and promoting healing.
Relaxation and improving sleeping habits
It is important for people with Fibromyalgia to learn good relaxation techniques. This can assist in improving and reducing levels of stress which may aggravate the condition. Relaxation aids include deep breathing exercises, meditation, books, courses and CDs. Learning to relax will also aid sleep and it is important that people with Fibromyalgia learn to relax before bedtime which can assist with sleep.
Pacing
This involves balancing periods of activity with periods of rest. This means that periods of activity should be equalled by periods of rest. People with Fibromyalgia often find that their condition is better on some days than others. By pacing themselves to maintain a steady level of progress they are better able to manage the symptoms of Fibromyalgia. It is also important to avoid any activity that makes the symptoms of the condition worse and to take the time to slow down and take periods of rest when carrying out certain activities.
Support services
Arthritis Australia provides a support group for people with Fibromyalgia (arthritisaustralia.com.au).
