Fighting the Fight: Fibromyalgia Explained
Medically reviewed on May 22, 2017 by L. Anderson, PharmD.
What Causes Fibromyalgia?
The term 'fibromyalgia' literally means pain in your muscles and fibrous tissues (such as the tendons and ligaments). For many years it was thought that fibromyalgia was psychologically based but it is now recognized as a medical condition in its own right, as research into the condition has advanced.
The cause of fibromyalgia is unknown. There are indications that an injury, infection or illness may trigger the condition. There are also indications that hereditary factors are involved in the development of fibromyalgia as it can occur in several members of one family.
Tired and Achy: Signs and Symptoms of Fibromyalgia
A person with fibromyalgia can experience a wide range of symptoms. Common symptoms include muscle and joint pain, stiffness and fatigue, but symptoms vary from person to person.
Fibromyalgia is difficult to diagnose because the symptoms mimic other disorders and there are no visible signs or definitive laboratory tests.
The next several slides describe common symptoms which may occur intermittently and in different combinations.
Main Symptom of Fibromyalgia
The one symptom experienced by everyone with fibromyalgia is pain.
This pain can be described in various ways, such as an ache, a sharp pain, a throbbing sensation, or a burning feeling. The pain is felt throughout and on both sides of the body; it can move from one part of the body to another.
The amount of pain experienced can vary throughout the day and can also worsen with a change in weather, increase in stress, noise, activity and lack of sleep.
Tender Points in Fibromyalgia
People with fibromyalgia also have tender points, which are specific spots on the body that are painful to touch. Common tender points are found around the elbows, shoulders, knees, hips, back of the head, and sides of the breastbone.
The joints are not affected, although many patients feel like the pain starts in their joints. There are no lumps with the pain points, and no signs of inflammation (swelling).
A fibromyalgia diagnosis is often made when a patient has 3 months of unexplained body-wide pain and at least 11 of 18 tender points in specific locations.
Is Fatigue Common in Fibromyalgia?
Fatigue is experienced by up to 90% of people with the condition. The level of fatigue can vary from person to person, from being barely noticeable to severe.
Many patients complain that they can't get to sleep or stay asleep, and they feel tired when they wake up. It seems that people with fibromyalgia often lack the deep restorative stages of sleep. Some report that their fatigue is more distressing than their pain, and it interferes with their ability to enjoy life. Some experts believe that if a person does not have sleep problems, the condition may not be fibromyalgia.
Restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) are also common.
Is Stiffness Common With Fibromyalgia?
Stiffness of muscles and joints is most noticeable in the morning and after a period of rest. This can interfere with work and daily activities such as driving.
Staying active is the best way to prevent stiffness. If a person has to sit for long periods, they can reduce stiffness by regularly getting up to move around and stretch.
What is Fibro Fog?
Mental and emotional disturbances are common and affect around 50% of fibromylagia sufferers. An inability to focus, pay attention and concentrate on mental tasks is a symptom referred to as “fibro fog”.
Up to one third of fibromyalgia patients also suffer from other mental health issues, such as depression, anxiety, irritability or mood swings.
List of Fibromyalgia Symptoms
Other symptoms that can be experienced by people with fibromyalgia include:
- Migraine and tension headaches
- Recurrent abdominal pain
- Difficulty swallowing
- Irritable bladder leading to frequent or painful urination
- Numbness and tingling of the extremities
- Dry eyes and mouth
What Causes the Pain in Fibromyalgia?
It is thought that fibromyalgia may be due to a malfunction in the way the central nervous system processes pain signals. This leads to people with fibromyalgia experiencing pain from sensations that other people might perceive only as discomfort.
Two brain chemicals, serotonin and substance P, are thought to play a role in the condition. Serotonin is a neurotransmitter (a chemical that enables the transmission of nerve impulses) that influences a variety of functions. Studies have indicated that levels of this chemical are lower than usual in people with fibromyalgia.
Substance P, another neurotransmitter, is involved in transmitting pain sensations to the brain and also regulates the way we perceive pain. Some studies have found substantially elevated levels of this substance in people with fibromyalgia.
How is Fibromyalgia Diagnosed?
Fibromyalgia can be a difficult condition to diagnose as the symptoms of fibromyalgia are often similar to those of other conditions, such as rheumatoid arthritis, thyroid disease, vitamin D deficiency or chronic fatigue syndrome. Blood tests and x-rays usually return normal results in someone with fibromyalgia but they are often performed in order to rule out other conditions.
Doctors use certain criteria to help make a diagnosis. Most people with fibromyalgia have symptoms of widespread pain for at least 3 months that is not explained by other conditions, and tenderness in at least 11 out of 18 tender points. However, some people may still have fibromyalgia even without these symptoms.
Other indicators doctors will look for include chronic fatigue, unrefreshing sleep and cognitive symptoms including poor memory and lack of concentration. They may also look for numbness, dizziness, nausea, irritable bowel syndrome and depression.
Treatments for Fibromyalgia
While there is no cure for fibromyalgia, the condition can be managed using a variety of measures. Treatment usually involves not only relieving symptoms, but also changing people's attitudes about their disease, and teaching them behaviors that help them cope.
Combinations of patient education, stress management, regular exercise, diet focus and medication may deliver the best outcome.
Since all patients are different it is important that treatment plans are tailored to the individual. Treatments usually involve trial and error, and a combination of medications and lifestyle adjustments.
Fibromyalgia Medication List
Here's a list of medications used to treat fibromyalgia:
- Milnacipran (Savella)
- Pregabalin (Lyrica)
- Cyclobenzaprine (Flexeril)
- Fluoxetine (Prozac)
- Duloxetine (Cymbalta)
- Gapapentin (Neurontin)
- Tramadol (Ultram, ConZip)
- Ibuprofen (Advil, Motrin)
- Acetaminophen (Tylenol)
Medications for Fibromyalgia
The goal of fibromyalgia medication treatment is to help reduce the pain of fibromyalgia and improve sleep and quality of life. There is no one best medication for fibromyalgia - each treatment is individualized.
Pregabalin (Lyrica), duloxetine (Cymbalta), and milnacipran (Savella) are all FDA-approved specifically for treating fibromyalgia. However, many other drugs, including antidepressants, sleeping aids, pain relievers, and muscle relaxants are also used to treat the condition.
There is no consensus over which treatment is most useful, or whether a combination of treatments works best. Patients may receive drug treatments in combination with exercise, patient education, and behavioral therapies.
Anti-Seizure Medications for Fibromyalgia
Pregabalin (Lyrica), an antiepileptic medicine, was the first medicine to be approved by the FDA in 2007 to treat fibromyalgia. Pregabalin is thought to work directly on the pain pathway by blocking nerve pain. Research has shown that it may improve sleep quality, fatigue and pain.
Learn More: Lyrica: 12 Things You Need to Know
Research also suggests that another antiepileptic, gabapentin (Neurontin), relieves pain in some people with fibromyalgia and improves sleep quality and fatigue, although this drug is not specifically FDA approved for fibromyalgia. Dizziness, weight gain, and sedation were noted gabapentin side effects.
Antidepressants for Fibromyalgia
The main classes of antidepressants used for treating fibromyalgia are:
- Tricyclics such as amitriptyline (Elavil)
- Selective serotonin-reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), citalopram (Celexa), and paroxetine (Paxil)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) including duloxetine (Cymbalta), milnacipran (Savella) and venlafaxine (Effexor)
Doctors may prescribe them to improve sleep and relieve pain in non-depressed patients with fibromyalgia. These may be a better option in patients who cannot tolerate tricyclic antidepressant side effects, too.
The dosages used for managing fibromyalgia are generally lower than dosages prescribed for treating depression. If a patient has depression in addition to fibromyalgia, higher doses may be required. It's important to note that many antidepressants used in fibromyalgia are used "off-label", meaning they have not been FDA-approved specifically for fibromyalgia.
Other Medications for Fibromyalgia
Cyclobenzaprine (Flexeril) is a muscle relaxant which works by blocking nerve impulses (pain sensations) sent to the brain and helps some patients with fibromyalgia. Cyclobenzaprine, structurally similar to tricyclic antidepressants, has been shown to help with sleep and pain, but not fatigue or tender points, and side effects like dizziness and dry mouth can be very common.
Pramipexole (Mirapex), a drug used to treat Parkinson's disease and restless leg syndrome (RLS), stimulates the production of a brain chemical known as dopamine. Pramipexole may help relieve pain in people with fibromyalgia. In a small 14-week study of 60 patients treated with pramipexole, over 40% of patients had a 50% or more reduction in their pain score, compared with 14% of patients taking placebo.
Is Ibuprofen Effective for Fibromyalgia?
Pain relief is a major concern for patients with fibromyalgia. Common pain relief medications such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Advil, Motrin) may have a limited effect because their pain relief mechanism does not affect the pain mechanisms that occur centrally (in the brain) with fibromyalgia. NSAIDs should be used with extreme caution in older adults because the cardiovascular and gastrointestinal risks outweigh the benefits of using these drugs.
Some people may find relief with stronger medications such as tramadol (Ultram), but caution is also required due to the possibility of intolerable side effects, addiction and abuse.
Learn More: Tramadol: 9 Things You Should Know
Opioids such as oxycodone (Oxycontin) should be avoided for pain control in fibromyalgia because this class has been shown to worsen pain and mental ability, as well as lead to risks for addiction and overdose.
Does Capsaicin Work in Fibromyalgia?
Capsaicin is the active ingredient in hot chili peppers, and is used in medicated creams and lotions to relieve muscle or joint pain. Capsaicin reduces the amount of substance P in the body, a chemical that acts as a pain messenger.
There are not many over-the-counter medications shown to be very helpful for fibromyalgia. However, one study has shown that topical capsaicin 0.075% (Capzasin-HP, Icy Hot, SalonPas, others) applied three times daily for 6 weeks did have a short-term positive effect. The study in 135 patients with severe fibromyalgia showed that muscle pain and overall improvement scores were significantly better when capsaicin was added to treatment compared to the group using their standard fibromyalgia treatment without capsaicin.
Use caution and start with low doses; some patients find topical application to be slightly painful at first. Also, be sure to use a glove to apply the cream and avoid getting it near your eyes, mouth, or other mucous membranes.
List of Alternative Therapy for Fibromyalgia
The following alternative therapies have shown to be effective for some people in managing the symptoms of fibromyalgia:
Can Medical Marijuana Help Fibromyalgia?
Nabilone (Cesamet), a synthetic cannabinoid drug derived from cannabis, is approved for the treatment of chemotherapy-induced nausea and vomiting. The active ingredient, THC, may help to improve sleep quality and pain in fibromyalgia patients. However, a 2016 review published by Cochrane found "no convincing, unbiased, high quality evidence suggesting that nabilone is of value in treating people with fibromyalgia." In addition, the tolerability of nabilone was low in people with fibromyalgia, with side effects such as dizziness, nausea, dry mouth and drowsiness.
One study did show that roughly 1 in 10 patients use marijuana to ease fibromyalgia symptoms such as pain, fatigue and lack of sleep.
Does Exercise Help Fibromyalgia?
Exercise is highly recommended even though people with fibromyalgia may be reluctant to exercise because of their pain. Exercise is important to prevent the muscles from losing strength due to lack of use.
Other benefits of regular exercise include:
- sleep promotion
- enhanced digestion
- increased blood flow
- improved muscle tone.
It is best to start with small amounts of low impact exercise (such as walking) on a daily basis, and gradually increase this as tolerated and recommended by your physician.
Can Stress Worsen Fibromyalgia?
Stress reduction is important as increased stress can magnify fibromyalgia symptoms.
Finding methods of relaxation (such as reading or listening to music) that suit the individual with fibromyalgia can be helpful in stress reduction. Talking about the condition with friends and family can also be helpful.
Some people may find it helpful to work with a professional counselor or psychologist to develop relaxation techniques and strategies to cope with the pain.
Rest is Important for Fibromyalgia Patients
Rest is also important in managing fibromyalgia. People with fibromyalgia often feel exhausted after only small amounts of activity. Therefore, it is often helpful to rest regularly during the day and even during activity if it is needed. Even brief periods of rest (such as 5 to 10 minutes) can be helpful.
Sleep is often low in quality for people with fibromyalgia. It is not advisable to use prescription sleeping tablets unless they are absolutely necessary, and then only for brief periods of time. Some methods that may help to gain a more restful sleep include:
- Avoiding alcohol and coffee in the evening
- Using the bedroom only for sleep or sex (not for working or eating)
- Ensuring the room is dark when trying to sleep
- Having a regular time for going to bed.
How to Cope With Fibromyalgia
Although fibromyalgia is lifelong, it does not get worse and is not fatal. Some patients find that their fibromyalgia symptoms remain stable over the long term, while more than a quarter of patients see improvement in their pain over time.
Dealing with the pain and fatigue can be frustrating. It is important that you educate yourself and others around you about fibromyalgia. Organizations such as the National Fibromyalgia Association and the American Chronic Pain Association can help put you in touch with others who have had similar experiences.
Consider joining the Drugs.com Fibromyalgia Support Group, also. Here you can ask questions, share information, and learn from others that are also fighting back at fibromyalgia.
Finished: Fighting the Fight: Fibromyalgia Explained
- National Center for Complementary and Integrative Health (NCCIH). Fibromyalgia: In Depth. Accessed May 22, 2017 at https://nccih.nih.gov/health/pain/fibromyalgia.htm
- Dymon T. Fibromyalgia. ACSAP – Neurologic and Psychiatric Care. Accessed May 22, 2017 at https://www.accp.com/docs/bookstore/acsap/a15b1_m1sample.pdf
- Arnold L, Clauw D, Dunegan L, et al. A Framework for Fibromyalgia Management for Primary Care Providers. Mayo Clin Proc. 2012 May; 87(5): 488–496. Accessed May 22, 2017 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498162/
- Holman AJ, Myers RR. A randomized, double-blind, placebo-controlled trial of pramipexole, a dopamine agonist, in patients with fibromyalgia receiving concomitant medications. Arthritis Rheum. 2005 Aug;52(8):2495-505. Accessed May 22, 2017 at http://www.ncbi.nlm.nih.gov/pubmed/16052595
- Casanueva B, Rodero B, Quintial C, et al. Short-term efficacy of topical capsaicin therapy in severely affected fibromyalgia patients. Rheumatol Int. 2013 Oct;33(10):2665-70. Accessed May 22, 2017 at http://www.ncbi.nlm.nih.gov/pubmed/22842953
- Arnold LM, Goldberg DL, Stanford SB, et al. Gabapentin in the treatment of fibromyalgia: a randomized, double-blind, placebo-controlled, multicenter trial. Arthritis Rheum 2007;56:1336-44. Accessed May 22, 2017 at http://www.ncbi.nlm.nih.gov/pubmed/17393438.