Understanding Fibromyalgia: A Patient Guide to Chronic Pain Symptoms
“… I feel pain all throughout my body and I can’t tie it back to an accident or injury.”
“Every day I wake up feeling like I ran a marathon, even though I didn’t…“
The National Fibromyalgia Association estimates that 10 million people in the U.S. suffer from this chronic pain condition. And while historically symptoms were often dismissed as being “all in your head,” leading research has shown that this condition is anything but imagined.
What is Fibromyalgia and What Causes It?
Fibromyalgia, or “fibro” for short, is a chronic pain condition characterized by widespread pain and fatigue symptoms throughout the body. This pain is often experienced from the waist up and the waist down and can be described as a constant dull ache, or by some as “like a constant flu.”
Although the root cause of fibromyalgia has yet to be determined, research suggests that possible events such as physical injury, a traumatic emotional event, or an underlying autoimmune disease can serve as a trigger to fibromyalgia symptoms.
Is it all in your head? The answer is NO, but it does start in your BRAIN.
Imagine you bump your elbow on the kitchen counter. In a typical situation, there will be an immediate burst of pain when your brain signals your nervous system. Shortly after, the brain will assess the situation, and the pain signals will begin to taper off.
With fibromyalgia, pain is a result of miscommunication between the brain and the spinal cord. So, in a case like this, the brain may not communicate that the pain should wear off, creating an indefinite pain signal. When the brain continues to send pain signals well after the initial injury subsides, this type of pain is called nociplastic pain.
With so few external symptoms and an unknown root cause, many fibromyalgia patients experience symptom dismissal or misdiagnosis. Fortunately, with emerging neurobiological and genetic studies, alongside neuroimaging and microbiome research, the perception of how fibromyalgia is understood and treated is changing.
Could I Be Experiencing Fibromyalgia?
If you or a loved one has been experiencing chronic pain for at least three consecutive months and has yet to uncover a possible cause, you may be experiencing fibromyalgia. Fibromyalgia can affect anyone; in fact, you may recall some of your favorite singers or actors (such as Lady Gaga or Morgan Freeman) who have been diagnosed with this condition.
Generally, fibromyalgia is more likely to occur in the following groups:
- Women are ten times more likely to develop fibromyalgia, especially in middle age
- Middle aged individuals between 20 and 50 years old
- Patients with preexisting chronic conditions such as rheumatoid arthritis, lupus, and more
- Genetically predisposed individuals who have a family history of fibromyalgia
Many of the symptoms associated with fibromyalgia are also related to other conditions and diseases, so to accurately diagnose this condition, your neurologist or physician may first review your symptoms in detail to rule out any possible comorbidities before making an official diagnosis. Fibromyalgia can be best described as a diagnosis of exclusion, meaning that once you have ruled out all other potential causes, then you may have fibromyalgia.
Signs & Symptoms of Fibromyalgia
If pain and discomfort are a part of your day-to-day life, and you have any of the following symptoms for several months without any clear explanation, it is recommended to seek an evaluation with your neurologist, so that pain symptoms can be managed and treatment options can be tailored to you.
Common symptoms of fibromyalgia include:
- Widespread pain throughout the body
- Constant fatigue and exhaustion
- Sleep disturbances and difficulty sleeping
- Cognitive difficulties, often called “fibro fog”
- Increased sensitivity to touch, temperature, or pressure
- Frequent headaches and migraines
- Stiffness in muscles and joints, particularly in the morning
- Depression and anxiety (30-40% of fibromyalgia patients have co-occurring depression)
- Digestive problems such as IBS (irritable bowel syndrome)
- Numbness or tingling in the hands and feet
Fortunately, with advances in neurological testing, we now have more success in diagnosing fibromyalgia and identifying pain sources in our patients.
Conditions Commonly Mistaken for Fibromyalgia
Because fibromyalgia shares symptoms with many other conditions, it’s essential to undergo the appropriate testing necessary to rule out similar diagnoses. The following conditions are often confused with fibromyalgia:
Rheumatoid Arthritis (RA): While both conditions cause widespread pain and fatigue, RA is characterized by joint inflammation and can be detected through blood tests and imaging that identify joint damage.
Lupus: Like fibromyalgia, this autoimmune disease can cause fatigue and body pain; however, lupus typically presents with additional symptoms such as skin rashes and fever, which can be identified through blood work showing specific antibodies. However, sometimes laboratory markers may not appear for many months or years, and patients can easily be confused with having fibromyalgia.
Hypothyroidism: An underactive thyroid can cause fatigue, muscle aches, and cognitive difficulties that mirror Fibromyalgia symptoms. However, thyroid function can be easily assessed through blood tests measuring thyroid hormone levels.
Chronic Fatigue Syndrome (CFS): CFS, also known as myalgic encephalomyelitis, shares many symptoms with fibromyalgia, particularly severe fatigue. The key difference is that fibromyalgia is primarily characterized by widespread pain, while CFS is dominated by exhaustion that doesn’t improve with rest.
Multiple Sclerosis (MS): MS can cause fatigue, pain, and cognitive issues, but it’s a progressive neurological disease that affects the central nervous system differently than fibromyalgia. Patients are often considered” hysterical” because they have such a wide variety of symptoms. MRI scans can typically identify lesions characteristic of MS; spinal fluid evaluation can be very helpful.
Lyme Disease: This tick-borne illness can cause muscle pain, fatigue, and cognitive problems that resemble fibromyalgia, but Lyme disease has a specific infectious cause that can be detected through blood tests.
Is There a Cure for Fibromyalgia?
While there is no definitive cure for fibromyalgia, many treatment options exist to minimize pain and depressive symptoms for patients suffering from this condition. Through a thorough review of the patient’s medical history, physical examination, laboratory tests, and psychological evaluation, a diagnosis can be the first step in creating a treatment plan that can offer symptom relief.
With fibromyalgia, symptoms may be general, but treatment is unique to every individual patient. To further refine the most effective treatment option for each patient, treatment may include additional monitoring of individual symptoms once medication and therapies have been introduced.
Once a diagnosis has been completed, comprehensive treatment plans may include:
Prescription Medication
Pain relievers, such as ibuprofen or acetaminophen, can provide relief for mild to moderate pain. For more severe cases, prescription medications such as Lyrica (pregabalin) or Cymbalta (duloxetine) may be prescribed to reduce pain signals. Muscle relaxers may also be prescribed to help with stiffness and improve sleep quality.
Antidepressants have also shown effectiveness in treating fibromyalgia. In certain patients, antidepressants have been very effective in relieving pain, improving sleep quality, and enhancing overall mood.
Lifestyle Changes
Whether it’s yoga or walking, gentle exercises combined with an anti-inflammatory diet, all can make a significant difference in improving your health and helping your body work for you instead of against you. Yoga, tai chi, and Pilates can be extremely beneficial for this group of patients. Eliminating stimulants like caffeine and alcohol before bed can improve sleep quality. Simple lifestyle changes can take pressure off the body and help limit pain. Often, these changes, when combined with medication, can bring lasting relief.
Exercise & Physical Therapy
Low-impact aerobic exercise and strength training can significantly reduce symptoms when done consistently and under the guidance of a trained professional who understands the unique needs of fibromyalgia. Activities like swimming, water walking, gentle cycling, and water aerobics are excellent choices.
Physical therapy can help reduce pain and improve overall quality of life by building strength, improving posture, and providing education on how to navigate daily activities.
Psychological Therapy
Cognitive Behavioral Therapy, or CBT, may be recommended to help relieve some of the emotional symptoms, such as depression and anxiety, that often accompany fibromyalgia. With the use of coping strategies for distress, patients can work to develop healthier responses to pain and stress.
Acupuncture & Massage Therapy
Many fibromyalgia patients find symptom relief with acupuncture and therapeutic massage for reducing pain and muscle tension. Regular treatment has been shown to promote lower stress hormones (cortisol), improve sleep quality, and provide temporary relief from the widespread pain associated with the condition. Note: It’s important to work with a therapist who understands chronic pain conditions and can adjust their techniques accordingly.
Living Well with Fibromyalgia
While fibromyalgia presents unique challenges, many patients successfully manage their symptoms through a comprehensive, personalized treatment approach. The key is working closely with your healthcare team to find the right combination of treatments that work for you. Remember, what helps one person may not help another, so patience and persistence are essential as you and your physician work together to find the optimal treatment plan for you.
A Message From Dr. Kandel
“Living with the chronic pain of fibromyalgia can be quite stressful. Working hard to develop a positive attitude can play a huge role in the overall treatment of this condition. Exercising the mind, exercising the body can be two steps in moving forward. Like with all other neurologic conditions, adequate hydration is essential, as well as avoiding all caffeine products.
I tell my patients that this condition and its treatment are more like a marathon than a sprint; slow and steady movement in the right direction is how the solution is best obtained. While there is no “quick fix” for this, sticking to a comprehensive treatment plan is the best way for patients to reach their goals of improved health and reduce discomfort.”
Joseph Kandel, MD
For additional Neurology Insights, feel free to visit the following resources below:
A Patient Guide to Managing Chronic Stress in Health Conditions
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