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Fighting the Fight: Fibromyalgia Explained

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Aug 22, 2022.

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 exact cause of fibromyalgia is unknown. Brain imaging studies have shown that a difference in the way the brain and spinal cord process pain messages may lead to fibromyalgia symptoms.
  • Your doctor will usually rely on a group of symptoms to make a diagnosis.
  • Inflammation does not typically occur with fibromyalgia, and common NSAID pain relievers such as ibuprofen and naproxen have not been proven effective.

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, and symptoms may vary from person to person.

Common symptoms of fibromyalgia include:

  • muscle pain
  • joint pain
  • stiffness
  • fatigue.

Fibromyalgia is difficult to diagnose because the symptoms mimic other disorders and there are no visible signs or definitive laboratory tests.

Main Symptom of Fibromyalgia

The one symptom experienced by everyone with fibromyalgia is pain. The pain is felt throughout and on both sides of the body; it can move from one part of the body to another.

This pain can be described in various ways, such as:

  • an ache
  • a sharp pain
  • a throbbing sensation
  • a burning feeling.

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.

Updated Diagnostic Guidelines: ACR

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
  • 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).

Previously, a fibromyalgia diagnosis was made when a patient had 3 previous months of unexplained body-wide pain and at least 11 of 18 tender points in specific locations. Today, doctors do not follow the tender point guidelines because symptoms can come and go. In addition, doctors are often uncertain about how much pressure to apply to tender points during an exam.

Diagnostic guidelines from the American College of Rheumatology (ACR) still include widespread pain throughout your body for at least 3 months.

Is Fatigue Common in Fibromyalgia?

Fatigue, a state of mental and/or physical exhaustion, 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.
  • 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 conditions that occur with fibromyalgia and can interfere with sleep.

Staying Active with Fibromyalgia

Stiffness of muscles and joints is most noticeable in the morning and after a period of rest. This level of stiffness 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. Aerobic exercise is often recommended for patients with fibromyalgia.

A study published in BMJ found that tai chi is another, possibly better, option to aerobic exercise to ease chronic pain with fibromyalgia.

  • The study evaluated 226 adults, primarily women, with an average age of 52 who had fibromyalgia for roughly 9 years. None of the participants had engaged in tai chi or any other type of alternative therapy for the past six months.
  • The patients were randomly assigned to either aerobic exercise therapy or tai chi for up to 24 weeks. Researchers found that all patients experienced some relief of their symptoms, but the improvements were much greater among those in the tai chi groups at the end of 24 weeks.

What is Fibro Fog?

An inability to focus, pay attention and concentrate on mental tasks is a symptom referred to as “fibro fog”. Mental and emotional disturbances are common and affect around 50% of fibromylagia sufferers. Memory can be affected, too.

What causes these symptoms is not exactly known. While it seems plausible that lack of sleep could contribute to these symptoms, experts have not found a cause-and-effect relationship between lack of sleep and these symptoms.

Up to one third of fibromyalgia patients also suffer from other mental health issues, such as:

List of Fibromyalgia Symptoms

Other symptoms that can be experienced by people with fibromyalgia include:

  • Migraine and tension headaches
  • Recurrent abdominal pain
  • Diarrhea
  • 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.

Most people with fibromyalgia have symptoms of widespread pain for at least 3 months that is not explained by other conditions. The requirement of 11 out of 18 tender points is no longer required for diagnosis, as noted by the American College of Rheumatology.

Instead, the main factor needed for a fibromyalgia diagnosis is widespread pain throughout your body for at least three months.

To meet these newer criteria, you must have pain 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 neck, back, chest or abdomen

Other indicators doctors will look for include:

  • chronic fatigue and unrefreshing sleep
  • cognitive symptoms including poor memory and lack of concentration
  • numbness
  • dizziness
  • nausea
  • irritable bowel syndrome
  • 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.

A combination of these strategies may deliver the best outcome in fibromyalgia.

  • patient education
  • stress management
  • regular exercise
  • diet focus
  • medication.

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 common medications used to treat fibromyalgia:

  • Amitriptyline
  • Milnacipran (Savella)
  • Pregabalin (Lyrica)
  • Cyclobenzaprine
  • Fluoxetine (Prozac)
  • Duloxetine (Cymbalta)
  • Gapapentin (Neurontin)

Follow along to learn more about these medications.

Medications for Fibromyalgia

The goal of 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.

Other options, such as antidepressants, sleeping aids, acetaminophen, and muscle relaxants may also be 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.

A Cochrane review reported on gabapentin use in fibromyalgia. In studies, the maximum gabapentin dose used was 2400 mg daily.

  • Patients reported a 30% or greater pain reduction compared to when treatment was started. This affect was achieved by 38 of 75 participants (49%) with gabapentin compared to 23 of 75 (31%) patients receiving an inactive placebo.
  • A patient global impression of change of "better" was achieved by 68 of 75 patients (91%) with gabapentin and 35 of 75 patients (47%) with placebo.
  • Researchers deemed the one randomized study they found to be of low quality, and felt their evidence was insufficient to support or refute gabapentin use in fibromyalgia.

Dizziness, weight gain, and sedation are noted as gabapentin side effects.

Antidepressants for Fibromyalgia

The main classes of antidepressants used for treating fibromyalgia are:

Doctors may prescribe antidepressants to improve sleep and relieve pain in non-depressed patients with fibromyalgia. SSRIs or SNRIs may be a better option in patients who cannot tolerate common tricyclic antidepressant side effects, such as tremors, dizziness, headache, dry mouth, constipation, nausea, drowsiness, and dizziness.

The antidepressant 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 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.

Learn More: Flexeril - How to Safely Use This Muscle Relaxant

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 or Opioids Effective for Fibromyalgia?

Pain relief is a major concern for patients with fibromyalgia. How can you safely address it without use of addicting opioids?

  • 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 bleeding risks may outweigh the benefits of using these drugs.
  • Opioids such as oxycodone (Oxycontin) or tramadol 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.

According to a Cochrane review, there is no randomized trial evidence that oxycodone (with or without naloxone) is of value in treating people with fibromylagia.

Does Capsaicin Work in Fibromyalgia?

Heat can feel good, right? 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, a research study found that topical capsaicin 0.075% (Capzasin-HP, Icy Hot, SalonPas, others) applied 3 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 capsaicin 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:

  • Acupuncture/acupressure
  • Homeopathy
  • Hot and cold packs, massage therapy
  • Nutritional supplements, vitamin D or dietary modifications
  • Herbal preparations
  • Yoga
  • Osteopathy or chiropractic treatment
  • Medical marijuana for fibromyalgia

Always check with your doctor before adding or starting an alternative therapy. Herbal supplements, vitamin D or medical marijuana can have drug interactions and may interfere with the effectiveness of other medicines.

Marijuana or Cannabinoids For Fibromyalgia: Effective?

Robust studies evaluating the use of cannabis or medical marijuana for fibromylagia are lacking. Larger, randomized studies of greater quality are needed to assess the use of marijuana for fibromylagia symptoms.

A small, retrospective study published in the Journal of Clinical Rheumatology looked at 26 fibromyalgia patients (19 female patients (73%), mean age 37.8 ± 7.6 years) and use of medical cannabis (MC).

  • The mean dosage of MC was 26 ± 8.3 grams per month, and the mean duration of MC use was 10.4 ± 11.3 months.
  • All the patients reported a significant improvement in every parameter on the questionnaire, and 13 patients (50%) stopped taking any other medications for fibromyalgia.
  • Eight patients (30%) experienced very mild adverse effects.
  • The authors concluded that medical cannabis treatment had a significant favorable effect on patients with fibromyalgia, with few side effects.

A questionnaire-type study enrolled 56 women with fibromyalgia; 28 women were users of marijuana and 28 were not. For the users, the route of administration was smoking (54%), oral (46%) and combined (43%). The use of cannabis was associated with significant benefit on some fibromyalgia symptoms such as reduction of pain and stiffness, enhancement of relaxation, and an increase in somnolence and feeling of well being.

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 but not pain in fibromyalgia patients, according to research found in a small study.

  • However, a 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.

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
  • improved mood
  • 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 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 TV, working or eating)
  • Ensuring the room is dark and a comfortable temperature when trying to sleep
  • Having a regular time for going to bed and awakening, even on the weekends
  • Stopping use of electronic devices and TV at least 30 minutes to one hour before bedtime.

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 Fibromyalgia Support Group, also. Here you can ask questions, share information, and learn from others that are also fighting back at fibromyalgia.

Visit the Fibromylagia Center to learn more about how to manage this chronic condition.

Finished: Fighting the Fight: Fibromyalgia Explained

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Further information

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