What is fibromyalgia?

Witten by Carolina Vaccari

Fibromyalgia syndrome (FMS) is a long-term condition that causes diffuse musculoskeletal pain and muscular stiffness usually associated with other symptoms. These can include:

• Sleeping troubles.
• Intense general fatigue and increased sensitivity to pain.
• Mood issues such as anxiety and depression.
• Problems with memory and concentration.
• Migraine and other types of headaches.
• Digestive problems such as Irritable Bowel Syndrome (IBS).
• Bladder problems such as cystitis or painful bladder syndrome.
• Temporomandibular joint disorders.

Fibromyalgia seems to affect more women than men. The average age range at which it is diagnosed is 35 to 45 years old, but most people have had symptoms already earlier in life.

Overall, Fibromyalgia is likely to be connected to alterations in levels of specific chemicals in the brain, which affect the way the central nervous system perceives and manages the pain around the body. The brain’s pain receptors develop a sort of memory of the pain and they become hyper-sensitized and they overreact to painful and non-painful signals.

The onset of Fibromyalgia’s symptoms is usually associated with traumatic events, such as:

• Physical traumas such as surgery or infection.
• Significant psychological stressful event (e.g mourning).

However, in other cases, symptoms can gradually build up over time without a specific triggering event.

Diagnosing fibromyalgia can be complicated because there is no specific test to diagnose the condition. Moreover, its symptoms can vary and be similar to other severe conditions that might need a different diagnostic and medical approach. These conditions may include:

• Multiple sclerosis (MS) – a degenerative condition of the central nervous system that affects movement and balance.
• Chronic fatigue syndrome (also known as ME) – a condition that can also cause long-term tiredness and general muscle pain.
• Rheumatoid arthritis – a condition that causes pain and swelling in the joints.

Further testing in the form of a blood test will help to rule out other conditions. Your doctor may send you for a blood test to check:

• Erythrocyte sedimentation rate
• Cyclic citrullinated peptide test
• Rheumatoid factor
• Thyroid function tests
• Antinuclear antibody
• Celiac serology
• Vitamin D level

Overall, diffuse pain throughout your body for at least 3 months is the main criteria needed for a Fibromyalgia diagnosis. The pain should be reported in at least four of these five areas:

• Left upper region, including shoulder, arm or jaw.
• Right upper region, including shoulder, arm or jaw.
• Left lower region, including hip, buttock or leg.
• Right lower region, including hip, buttock or leg.
• Axial region, which includes the neck, back, chest or abdomen.

It is also possible to have other conditions alongside diffuse pain throughout the body, such as depression, anxiety or irritable bowel syndrome (IBS). It is important to do further tests to diagnose these and approach them with specific therapies if needed.

Fibromyalgia is a complex condition and it often requires a multi-disciplinary approach. It has numerous symptoms and a single treatment will not be enough for treating all of the symptoms. Moreover, specific treatments are effective for some people, but they might not work for others. It is therefore important to try and combine a variety of therapies and lifestyle changes that suit the patients individual needs.

The prescription of medication plays a key role in the treatment of FMS. They can include:

• Pain relievers (such as ibuprofen or naproxen). They help to manage and relieve the pain.
• Antidepressant. They boost the level of specific neurotransmitters, which might have a key role in the widespread pain associated with
• Fibromyalgia. They also seem to reduce the fatigue associated with FMS and promote sleep.
• Anti-epileptic drugs. They seem to help reduce specific types of pain.
• Antipsychotics. They are sometimes used for treating chronic pain.
• Medication to help with sleep. If you sleep better you may find other symptoms become less severe.
• Muscle relaxants. They help reduce muscles stiffness or spasms.

To boost the effects of the treatment, medications can be combined with other therapies, such as:

• Osteopathy and Physiotherapy. This form of treatment will help to reduce muscle tension and improve joint mobility, aiding with easing the pain around the body. Moreover, the prescription of specific exercises will improve the general posture, strength and flexibility of the patient.
• Psychotherapy. Psychological support may be fundamental to help the patient to cope with their symptoms and deal with stress. In fact, the patient needs to develop strategies for avoiding or limiting overexertion and emotional stress. Cognitive Behavioural Therapy (CBT) seems to be largely used to help patients with Fibromyalgia.
• Exercise and relaxation techniques. This type of therapy is used to both help with patients sleep and to reduce muscle tension. Water-based exercises seem to be particularly helpful.
• Massages. This form of therapy is used to help relax and reduce muscle tension and stiffness.
  Acupuncture. Is used to help to reduce and manage different types of chronic pain, such as Fibromyalgia.
• Pilates

Finally, to cope with Fibromyalgia patients need to maintain a healthy lifestyle. They should eat healthy foods, avoid smoking, limit caffeine intake and do something that they find enjoyable and able to distract them from the pain awareness. Any treatment which helps the patient to relax and feel less stressed will help and allow them to cope better with their condition.

Fibromyalgia is a chronic disease and it is usually a lifelong condition. However, it is not a progressive disease (it will not get worse over time) and it does not cause damage to your joints, muscles, or organs.

Overall, flares-up are very common in Fibromyalgia. Symptoms temporarily increase in number or intensity and it can happen without warning. It is most likely to happen when the patient is overstressed or under a lot of pressure. Flares-up usually last from days to weeks.

Fibromyalgia cannot be prevented, but proper treatment and lifestyle changes can help reduce the frequency and severity of the symptoms, diminishing also the risk of flares-up. In general, to avoid a flare-up of the symptoms it is very important to minimize stress, take regular exercise, be consistent with the therapies and follow a healthy lifestyle.

Pain and intense tiredness and fatigue are the main symptoms of Fibromyalgia. Therefore, it might be difficult for the patient to exercise as much as they would like. It is therefore important to have an individualised exercise programme tailored to their condition.

Patients with Fibromyalgia need to find a balance between periods of activity and periods of rest. They should not overdo or push themself too much because this can be a cause of flares-up of the symptoms. Over time, patients will be gradually able to increase their period of activity, but it is important to balance them with the resting period and to make steady progress instead of trying to do as much as possible in a short time frame.

Fibromyalgia can make patients feel that some days are better than others and it is fundamental to listen to their body and to rest when it is needed.

Overall, different types of exercises can help in different ways:

• Stretching exercises. They can increase mobility and reduce muscles stiffness, decreasing the perception of the pain. These should always be part of the training routine.
• Resistance and strengthening exercises. This form of exercise is beneficial for improving muscle strength, physical disability, depression and quality of life. They help muscles to become stronger and to be able to better support the joints. As well as helping to reduce the fatigue perceived by patients. However, these types of exercise need to be part of a personalised exercise plan in order to avoid muscle stiffness and soreness to worsen.
• Aerobic exercises. They can improve patients’ stamina and endurance (how long you can keep going), aiding in increasing the patient’s breathing and heart rate. They help to release endorphins and serotonin which reduce muscle tension and improve sleeping patterns and mood.
• Low-impact aerobic exercises, such as walking, biking or swimming seem to be the best option for reducing symptoms of Fibromyalgia. In particular, water-based exercises appear specifically helpful because they reduce weight-bearing stress.
• Yoga and Pilates. These practices usually combine meditation, slow movements, deep breathing and relaxation, which all help in controlling fibromyalgia symptoms and reducing stress levels.

Patients might find it helpful to start with gentler forms of exercise, such as yoga or pilates, before attempting more intense training such as aerobic or strengthening exercises.

If you suspect to suffer from Fibromyalgia it is important to speak with your GP. The diagnosis of Fibromyalgia may be difficult and your GP will need to rule out other conditions. They will also suggest you the best therapy to manage the Fibromyalgia symptoms and they might refer you to other specialists such as a rheumatologist, neurologist or psychologist who might help you to better address your condition.

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