Pain Management

An In-Depth Look at Fibromyalgia

WHAT IS FIBROMYALGIA?

Fibromyalgia affects 5 million Americans age 18 or older. Around 80-90% of those diagnosed with fibromyalgia are women, however, men and children are also susceptible to the condition. In other words, fibromyalgia is known to affect 2-8% of the world’s population. In comparison to males, females have a rate of susceptibility of 7:1.

Fibromyalgia is a condition of the central nervous system and is believed to occur as a result of neurobiological abnormalities that cause physiological pain and cognitive impairment. The pain of fibromyalgia is described as “musculoskeletal,” meaning there is pain found in the muscles, as well as the bones and joints. Sufferers of fibromyalgia describe the pain as a constant, chronic impairment that troubles them on a daily basis. Long-term pain isn’t just “uncomfortable,” but can also be damaging to your body and brain. In 2008, a study was published in the Journal of Neuroscience which stated that those who suffer from chronic pain can represent signs and symptoms of insomnia and depression. Anxiety is another factor that many sufferers deal with. It is believed that the anxious feelings arise from the fact that the pain from fibromyalgia is never ending and incurable.

According to the California Arthritis Partnership Foundation and The Arthritis Foundation, fibromyalgia is considered a form of arthritis. Arthritis, as most know, is inflammation of the joints. While fibromyalgia does not cause inflammation or damage to the joints or muscles, it is similar to arthritis because it impairs the joints and disrupts the sufferer’s ability to perform daily tasks due to chronic muscle soreness, fatigue, lack of concentration, and a series of other painful elements.

WHAT CAUSES FIBROMYALGIA?

Fibromyalgia is often clouded in a sort of mysterious identification because of its relation with multiple symptoms that affect the body in different ways. The exact cause of Fibromyalgia is still widely debated and includes different aspects such as psychology, genetics, and neurobiological and environmental factors. The following list contains many of the supposed causes of fibromyalgia:

Factors such as an infectious illness, physical/emotional trauma, or sudden hormonal changes may possibly lead to developing fibromyalgia.
There are other theories that include hormonal disorders, everyday stress, and even possible genetic reasons, which is why most physicians believe fibromyalgia to be a balance of physical and emotional stress.
Fibromyalgia is also often linked to deficiencies or ineffectiveness of neurotransmitters in the brain; complications with normal serotonin and dopamine excretion may be directly related to the cause and the symptoms of the condition.
There is also the theory that low levels of the neurotransmitter, Serotonin, can lead to lower pain thresholds and can increase sensitivity and pain. Serotonin is responsible for giving us calm feelings and reducing our anxiety. Studies show that the less sleep we receive, the brain produces lower amounts of Serotonin. Since it is common for fibromyalgia sufferers to experience insomnia or non-restorative sleep, many believe that this is a valid factor for the development of fibromyalgia.
Some research has shown that current, sudden trauma to the brain and spinal cord increases pain sensitivity and may have a link to fibromyalgia.
Stress or poor physical conditioning may be factors that cause fibromyalgia.
Research also suggests that muscle “microtrauma” (slight damage) can lead to chronic pain and fatigue.
Depression and anxiety have their place in trying to describe the cause of fibromyalgia. Depression is commonly correlated with serotonin levels, as well as anxiety. It’s hard to know which one is the culprit causing the disorder. As with the chicken and the egg riddle, it’s hard to determine if fibromyalgia is causing your depression and anxiety, or if the anxiety and depression are causing your fibromyalgia.

As of today, experts do not classify mental health as a cause of fibromyalgia but understand that chronic pain can lead to feelings of anxiety and depression, which can exacerbate fibromyalgia symptoms.

WHAT ARE THE SYMPTOMS OF FIBROMYALGIA?

Many patients are diagnosed during their “middle-age,” but some symptoms can be present earlier in life. The symptoms of fibromyalgia are fairly recognizable. Even though they can differ from person to person, there are a multitude of symptoms that seem to be universal including:

chronic muscle pain, spasms, and tightness that occur day and night
moderate to severe fatigue and lack of energy
morning stiffness
insomnia or non-restorative sleep (when fibromyalgia patients do get sleep, they tend to wake up just as tired as before they fell asleep)
abdominal pain, nausea, bloating, and irritable bowel syndrome
“fibro fog” which refers to difficulty remembering things, concentrating, or performing mental tasks
tension headaches, migraines
irritability
jaw and facial tenderness
anxious and depressed feelings
sensitivity to loud sounds
dry, burning eyes
a strong sensitivity to taste and odors
sensitivity to cold temperatures
feeling as though there is swelling or inflammation in the muscles and/or bones, even though there isn’t
numbness/tingling in the extremities
burning of the skin (like a sunburn, but without visible redness)

Image result for fibromyalgia symptoms

Research from the University of Michigan shows that the pain levels of fibromyalgia are linked to these other “annoying” sensory symptoms. Patients with a greater number of physical symptoms and severity of sensory symptoms tend to predict higher pain scores during research, as well as reduced functional capacity. Since the pain signals are amplified in fibromyalgia, so are all of the other sensory inputs for touch, sight, sound, and smell. This means that whatever is amplifying the pain is also connected to the amplification of other sensory symptoms. Basically, the more sensory/pain symptoms that become amplified, the worse your fibromyalgia may be: “Fibromyalgia patients are often sensitive to odors, loud noises, bright lights, some foods, and prescription medications.” Due to this sensitivity, fibromyalgia sufferers may also experience chest pain, shortness of breath, dizziness, nasal congestion, palpitations, profuse sweating, and difficulty in focusing the eyes. With all of this evidence, many researchers have come to the conclusion that: “Treatments geared at dampening the sensory amplification process may be more effective than tending to each annoying symptom individually.”

Other abnormalities that can be related to symptoms include immune system dysfunction, sleep disturbances, and hormonal irregularities. Fibromyalgia also includes pain in a series of “trigger points.” These trigger points, (or “myofascial trigger points”) are described as sensitive and irritable spots in the fibrous tissue that surrounds the skeletal muscle. They are related to palpable nodes in stretched bands of muscle fibers. These “trigger points” are often unexplained. Pain often emerges from these points to broader areas of the body. Some specialists in fibromyalgia have identified patterns, meaning that pain in one location is associated with trigger points in another location.
Fibromyalgia can be confused with sleep disorders. Some fibromyalgia patients can have an associated sleep disorder called the alpha-EEG anomaly. This condition was discovered in a sleep lab with a machine that recorded brain waves during a patient’s sleep. It was also discovered that most fibromyalgia patients can fall asleep without hesitation, but their deep level (or “delta” wave) sleep is constantly interrupted by “bursts” of “awake” brain activity. Fibromyalgia has also been linked to “jerking” or spastic muscle movements during sleep and may produce symptoms of restless leg syndrome.

HOW IS FIBROMYALGIA DIAGNOSED?

For now, there is no single test or exam that can accurately diagnose fibromyalgia and there is a considerable debate among the science community as to whether or not an “objective” diagnosis is even possible. The most widely accepted classification for research purposes was constructed in 1990 by the Multicenter Criteria Committee of the American College of Rheumatology. They established the criteria for fibromyalgia as follows:

A history of widespread pain lasting more than three months and affecting all four quadrants of the body, (i.e., both sides, and above and below the waist).
The other criteria involves “tender points.” There are around 18 “designated” tender points in the body (although a person with the disorder may feel pain in other areas as well). A person with fibromyalgia will feel pain in at least 11-18 of these tender points.

In cases of fibromyalgia, most patients have to work closely with their doctor for long periods of time until they finally receive their diagnosis. This is typically the best way to receive an accurate diagnosis because many of the symptoms emulate certain rheumatic disorders. After your doctor is positive that you have fibromyalgia, you and your physician should construct an effective treatment plan. There are doctors who specialize in fibromyalgia and these “specialist” will be able to correctly identify and diagnose fibromyalgia. Finding a doctor that specializes in fibromyalgia might take a while and require a lot of research, but you can always find out if a doctor is “board certified” as a specialist in fibromyalgia. You can also find out whether or not your doctor has extensive experience in pain management, which is a major factor when it comes to dealing with fibromyalgia. “Pain specialist” are typically board certified anesthesiologist, neurologist or psychiatrist who have received specific training in pain management. They should have credentials from the American Board of Anesthesiology, as well as other types of credentials from associations related to the medical practice of fibromyalgia. It is not uncommon for a patient with fibromyalgia to seek the opinion of a neurologist and even an orthopedist who specializes in the treatment of pain in tendons, ligaments, muscles, cartilage, and other joint issues. A lot of individuals who believe they suffer from fibromyalgia can visit their doctor to have a laboratory test performed; however, it is worth knowing that this test often produces inconclusive results because it can come back as normal despite finding out later that the patient does indeed have fibromyalgia.

Fibromyalgia may at times be classified as a mental disorder, such as depression and anxiety, or a stress related disorder, such as PTSD. When sufferers of fibromyalgia feel as if they are informed that their condition is “all in their head,” it is not only offensive, but with what we know now, is a “backwards” way of thinking when it comes to treating fibromyalgia.

HOW IS FIBROMYALGIA MANAGED?

Fibromyalgia isn’t treated as a single disease, but more as a collection of symptoms that are treated individually and managed by a series of treatment options. These options are not considered as a “cure” but more as a management technique. Pain management is a constant factor for those who suffer from fibromyalgia. Sometimes the disease requires extreme lifestyle modifications, such as eating and everyday habits. The Feldenkrais method is regarded as a primary technique for treating and managing the pain of fibromyalgia. The exercises in the Feldenkrais method have a way of “re-educating” the brain and nervous system to develop new ways of moving or perceiving the body during movement. Proprioception is a big factor in the Feldenkrais method, which involves becoming aware of the movements your body is making in comparison with other parts of your body. During the Feldenkrais method, the goal is to teach movements that are more efficient and to discover the quality of positive change that is happening within your body. Other treatment options for fibromyalgia include: acupuncture, massage, aerobics, stretching, and other forms of light movement exercises. Tai Chi and Yoga have research to support their efficacy in managing the pain of fibromyalgia. Aromatherapy is also providing qualitative results in easing the pain of fibromyalgia. Nutrition also plays a major role in dealing with fibromyalgia. Eating the right kinds of foods can help bring your system to its optimal healing level and reduce the onset of fibromyalgia symptoms. Keeping your body healthy is a great way to strengthen your immune system and increase your energy levels.

Fibromyalgia is often described as an achiness or soreness deep within the muscles and joints, which is why some sufferers find relief in the use of topical analgesics. Topical ointments and other analgesic lotions are often advertised as pain reducers for muscle and joint afflictions. Products that contain Aloe Vera, Arnica, Capsicum, and Chondroitin are the types of topical analgesics that actually relieve pain from fibromyalgia instead of just masking the symptoms. Most advertised topical solutions have menthol as an ingredient. Menthol is known to create a soothing, cooling effect for inflammation and pain. Capsicum is a well-researched supplement for decreasing pain and inflammation in fibromyalgia sufferers. Some topical analgesics contain Emu oil which is known to permeate through the skin faster, bringing other beneficial ingredients along with it. There is a wide variety of topical creams on the market, so you may want to do a little research in choosing a brand that is individualistic for fighting your pain from fibromyalgia. Some topical creams have strong smells that can be offensive and since your Fibromyalgia is known to make you sensitive to smells it is good to know that some products are revered for having pleasant fragrances. Do not be afraid to try several different brands until you find the one that you love. Topical analgesics are perfect because they can be combined with other treatment options, and will not interfere with your medications or cause harmful side effects if used often. Basically, topical solutions allow you to tackle your pain in more ways than one!
Because fibromyalgia is often compared to a psychosomatic disorder, treatment for fibromyalgia may include Cognitive Behavioral Therapy (CBT) which is a type of therapy that assists in helping people identify and develop skills to change negative thoughts and behaviors. CBT states that individuals themselves create their own experiences and reality, not outside or external factors. By changing these negative thoughts and behaviors, people can alter their awareness of pain and develop more effective coping skills. Cognitive Behavioral Therapy relies on techniques that chemically alter the way our brain reacts and deals with certain situations and stressors. For many years now, research has been providing positive results for CBT because of its ability to make connections about the way we think to the way our brain works. Also, Neurotransmitters that control the way serotonin and norepinephrine are released during synaptic responses can be affected and ultimately changed with exercises and therapeutic activities that are included in CBT. These attributes of CBT involve changing the way we talk about ourselves, the way we see the world, and the way we perceive how events affect our lives. The popularity of CBT is rapidly rising due to its success in healing many different types of pain disorders and conditions. Mindfulness training and meditation are also a part of CBT which helps to reduce stress and treat symptoms of fibromyalgia. Yoga and Tai Chi are beneficial treatments for fibromyalgia because they divert attention away from the pain by using meditation and awareness techniques. This is all interrelated with proprioception and the body’s movements, such as those detailed in the Feldenkrais method.

PRESCRIBED MEDICATIONS FOR FIBROMYALGIA

There are two commonly prescribed medications for treating fibromyalgia, Cymbalta and Lyrica. Cymbalta (or duloxetine) is an antidepressant that is often prescribed to fibromyalgia patients who experience depression, generalized anxiety disorder, and neuropathic pain. Cymbalta is believed to ease pain signals by increasing the levels of serotonin and norepinephrine. Some patients have reported success with Cymbalta, while others have reported a ghastly variety of side effects. Some of these side effects include: nausea, dry mouth, sleepiness, loss of appetite, fatigue, and constipation. Certain studies (case-control and cohort design) have demonstrated an association between the use of drugs that interfere with serotonin re-uptake and the occurrence of gastrointestinal bleeding. Lyrica, the other commonly prescribed medication, is an anticonvulsant that helps to slow down signals in the brain, and is usually prescribed to treat seizures. Lyrica may be used while taking Cymbalta, and just like Cymbalta, comes with its’ own list of side effects that include: difficulty breathing, tightness in chest and surrounding area, blistering of the skin, chills, cough, dizziness, hives, itching, diarrhea, skin rash, swelling of the eyelids/face/lips/tongue, sores, and ulcers. Nervous system side effects can include dizziness, somnolence (extreme fatigue), ataxia (inability to control one’s bodily movements), tremors, and overall abnormal thinking. People taking Lyrica have also reported suicidal thoughts or suicidal behavior. Other side effects that are frequently reported include weight gain, Otitis media, and tinnitus. In controlled clinical trials of up to 13 weeks, weight gain of 7% or more over baseline was reported in 8% of pregabalin-treated patients. Every now and then, loss of taste and taste perversion are reported.

CONCLUSION

It may seem like a bleak future for fibromyalgia patients since treating their disease takes research and strong lifestyle changes by the patient. Sufferers of fibromyalgia are often forced to do their own homework, so they can find the right doctor, receive the correct diagnoses, discover the best treatment options, and start to manage their fibromyalgia in a routinely healthy way. Fibromyalgia IS manageable; however, it does require a great deal of effort by the patient and their physician.

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