Fibromyalgia

Fibromyalgia is a common condition in which people experience symptoms that include widespread pain and tenderness in the body, often accompanied by fatigue and problems with memory and concentration.

Fibromyalgia affects 2% to 5% of the population, mainly women, although men and adolescents can also develop the condition. It tends to develop during middle adulthood.

Symptoms of fibromyalgia

The symptoms of fibromyalgia can vary from mild to severe. Each person with fibromyalgia will have their own unique set of symptoms. The most common symptoms are:

• increased sensitivity to pain due to a decreased pain threshold
• increased responsiveness to sensory stimuli such as heat, cold, light, smell
• extreme fatigue (tiredness)
• problems with memory and concentration (fibro fog)
• problems with sleep.

Less common symptoms may include:

• irritable bowel syndrome
• irritable or overactive bladder
• headaches
• numbness or tingling in the arms and legs
• anxiety and depression.

The symptoms of fibromyalgia can vary from day to day. Symptoms may disappear for extended periods of time, perhaps even years.

Causes of fibromyalgia

No one knows what causes fibromyalgia. It’s thought that it may be the result of genetic (inherited) and environmental factors (such as exposure to a virus or illness).

It’s also believed that physical or emotional stress can trigger the start of fibromyalgia symptoms. However, fibromyalgia may also appear without any obvious cause.

Fibromyalgia is more common in people with:

• lupus or rheumatoid arthritis
• an illness such as a virus (or a recent illness or infection)
• pain from an injury or trauma
• emotional stress and depression
• family history of fibromyalgia
• previous pain syndromes
• mood disorders
• substance abuse.

There is no cure for fibromyalgia, but treatment can help you manage your symptoms.

Triggers for fibromyalgia flares

At times the symptoms you experience as a result of your fibromyalgia (such as pain or fatigue) will become more intense. This is called a flare. Flares can be triggered or made worse by several factors including:

• weather changes
• overexertion
• mental stress
• illness or injury
• travelling
• hormonal changes
• changes in treatment.

Triggers vary from person to person. Understanding the things that cause your fibromyalgia to flare means that you can be prepared and take steps to lessen the effect they will have on you and your life.

Diagnosing fibromyalgia

Fibromyalgia can be difficult to diagnose as the symptoms are common to many other conditions. This means that it may take some time to establish a diagnosis of fibromyalgia, which can be very frustrating.

Your doctor will take your medical history and description of your symptoms, and do a physical examination. According to the most recent assessment guidelines, they’ll also consider:

• widespread pain or tenderness lasting three months or more
• cognitive symptoms such as memory problems
• waking unrefreshed and experiencing fatigue.

You may also have tests, including blood tests, x-rays or scans. While these tests cannot diagnose fibromyalgia, your doctor may use them to rule out other conditions.

Signs that suggest a diagnosis of fibromyalgia are:

• widespread pain for 3 months or longer
• abnormal tenderness at particular points around the neck, shoulder, chest, hip, knee and elbow
• disturbed sleep patterns.

Treating fibromyalgia

While there is no cure for fibromyalgia, your symptoms can be effectively managed. This starts with a correct diagnosis. A management program will then be designed to meet your specific needs.

Generally, management of fibromyalgia will involve a combination of:

• education – you need to understand your condition in order to manage it well. The more you know about your condition (for example, what triggers flares, how to manage pain and fatigue) the more control you’ll have. Understanding your fibromyalgia means you’ll be able to make informed decisions about your healthcare and play an active role in its management
• exercise – evidence has shown that regular exercise improves symptoms of fibromyalgia such as pain, fatigue and quality of sleep. There is no one form of exercise that is better than another, but you’ll need to choose something that you enjoy so you’ll keep doing it. Many people find a hydrotherapy pool a good starting point because the water is warm and supportive. The key is to start exercise slowly and build it up very gradually. Talk to a physiotherapist or exercise physiologist to work out the best program for you
• pain management – there are many things you can do to manage pain, and different strategies will work for different situations. For example, heat packs can help ease muscle pain, cold packs can help with inflammation, gentle exercise can help relieve muscle tension. Try different techniques until you find what works best for you
• stress management and relaxation – stress may aggravate your symptoms. Things you can do to manage stress include planning your day and setting priorities, using relaxation techniques such as going for a walk or listening to music and avoiding people and situations that cause you stress
• balancing rest and activity – plan your activities to make the most of your energy by alternating periods of activity with rest. Break large jobs down into small achievable tasks so that you don’t overdo things
• pacing yourself – keep an eye on your energy levels throughout the day and make sure you take regular breaks as needed. Plan your days ahead of time and try to break up larger tasks into smaller, more manageable jobs
• cognitive behaviour therapy (CBT) – CBT is a short-term, task-based approach used by psychologists to challenge and change unhelpful ways of thinking. Evidence suggests that CBT can help reduce pain and disability in fibromyalgia
• staying at work – it’s good for your health and wellbeing. Talk to your doctor occupational therapist or social worker about ways to help you to get back to or to stay at work
• sleep – it’s important to get a good night’s sleep when you have fibromyalgia. Poor sleep, both quantity and quality, can aggravate your symptoms. Having fibromyalgia can affect your sleep, so getting a good night’s sleep can sometimes be difficult. If you're having problems sleeping, talk with your doctor about ways you can manage this
• massage – can help with muscle relaxation and stress management
• mindfulness – mindfulness-based therapies (MBT) can help you break away from negative thought patterns. When used in the management of fibromyalgia, studies have shown that MBT can help to reduce pain and depression, and establish better coping strategies for an improved quality of life
• transcutaneous electrical nerve stimulation (TENS) – a TENS machine is a small battery powered device with leads that connect to sticky pads on your body. It delivers very small electrical currents to your skin that stimulate nerves to relieve pain. While there is not enough high-quality evidence to say if TENS is effective for treating fibromyalgia symptoms or not, there is evidence to suggest that some people do find it helpful in reducing pain and fatigue. If you are thinking of trying a TENS machine, speak with your doctor to see if it’s a suitable option for you. You can often hire one from your physiotherapist, local pharmacy or local hospital
• acupuncture – there’s low to moderate-level evidence that acupuncture improves pain and stiffness in people with fibromyalgia. However, the effects are shown to be short-lived (up to a month). This means you would need to have repeated sessions to maintain any potential benefit
• nutrition – eating a healthy, balanced diet can help provide you with better energy levels, help to maintain your weight, and give you a greater sense of wellbeing
• support from others – contact Musculoskeletal Australia for information about peer support group locations and contact details.

Medication for fibromyalgia

Combined with other strategies, medication may be used to manage pain, reduce stress or promote sleep. There are different types of medication that your doctor may recommend:

• pain-relievers (analgesics) – medications such as paracetamol can provide temporary pain relief
• non-steroidal anti-inflammatory medications– for temporary pain relief
• anti-depressant medications – may be used in small doses to reduce pain and help you sleep
• anti-epileptic medications – may also be used to help reduce pain and promote sleep.

You may need to try some medications for 6 weeks or more to see if they work for you. Not everyone will benefit from such medications, but you can discuss your options with your doctor.

Fibromyalgia research

Fibromyalgia research is growing, and it is believed that scientists are finally making progress towards understanding this complex condition. It’s still early days but scientists are excited by their findings and the knowledge that they are moving ever closer to understanding this disease.

Where to get help

• Your GP (doctor)
• Rheumatologist
• Physiotherapist
• Psychologist
• Exercise physiologist
• Musculoskeletal Australia National Help Line Tel. (03) 8531 8000 or 1800 263 265