Fibromyalgia Symptoms, Diagnosis & Treatment

Fibromyalgia is a chronic condition that causes pain, stiffness, and tenderness of muscles, tendons, and joints. These symptoms are often accompanied by restless sleep, chronic fatigue, anxiety, depression, and disturbances in bowel function. The cause and cure for fibromyalgia is unknown, but medications and alternative treatments can help reduce symptoms. Fibromyalgia is sometimes referred to as fibromyalgia syndrome.

Fibromyalgia is very real. However, there are no specific diagnostic tests for of fibromyalgia, which may cause doctors difficult challenges while trying to obtain a during diagnosis. Also, the symptoms of fibromyalgia can be similar to those of other conditions, which may lead to a misdiagnosis.

Fibromyalgia is not a form of arthritis (a disease of the joints), but rather a muscle disorder. Fibromyalgia and arthritis can cause significant pain and fatigue as well as interfere with a person's ability to carry on daily activities. However, the symptoms of fibromyalgia do not typically worsen over time, unlike the symptoms of arthritis. It is common for fibromyalgia to be associated with another joint disease, such as systemic lupus or rheumatoid arthritis.

Fibromyalgia is a condition that is more prevalent in women than in men. Up to 90% of all people with fibromyalgia are women. It is possible that hormones are responsible for this huge gender difference, but the exact reason is unknown.

There is no clear cause of fibromyalgia, but there are many theories to explain possible causes. It is believed that fibromyalgia results from a combination of many physical and emotional stressors, as opposed to one single event. In some fibromyalgia patients, there are elevated levels of a nerve chemical signal, called substance P, which amplifies pain signals.

Levels of serotonin in the brain have also been reported as relatively low in patients with fibromyalgia. Serotonin is a brain chemical messenger (neurotransmitter) that is associated with a calming, anxiety-reducing effect. Patients with fibromyalgia have an impaired non-rapid eye movement, or NREM, sleep phase, which prevents deep sleep and often causes them to wake up fatigued. The onset of fibromyalgia has been associated with psychological distress, trauma, and infection.

The universal symptom of fibromyalgia is pain. Patients have an increased sensitivity to many different sensory stimuli and an unusually low pain threshold. The pain of fibromyalgia is generally widespread, involving both sides of the body. Pain usually affects the neck, buttocks, shoulders, arms, the upper back, and the chest. Pain can cause aches all over the body, including painful tender points, deep muscle pain, chronic headaches, unending back pain, or neck pain. Pain of fibromyalgia can be aggravated by noise, weather change, and emotional stress. Fibromyalgia pain may be caused by reduced blood flow to parts of the brain that normally help the body cope with pain.

Fibromyalgia tender points are localized areas of the body that are tender to light touch. Even touching these areas lightly can cause pain. Fibromyalgia tender points are commonly located around the elbows, shoulders, knees, hips, back of the head, and the sides of the breastbone. Tender points are often the size of a penny and their cause is currently unknown. Doctors initially thought tender points were located in areas of inflammation, but there have not been any particular signs of inflammation in the corresponding tissue when a tender point is it examined closely.

As we know, women are more likely than men to develop fibromyalgia. Women have described fibromyalgia pain as a dull ache that starts in the muscles. Women may also have trouble remembering and concentrating or they may jumble up words when they speak. These symptoms have been called “fibro fog” because their minds often feel foggy.

Fibromyalgia Symptoms List

Women may also experience the following symptoms:

• Migraines
• Painful periods
• Pain during sexual intercourse
• Irritable bowel and bladder
• Restless leg syndrome
• Sensitivity to loud noises and bright lights

Fatigue occurs in 90% of fibromyalgia patients and it can be described as crippling, exhausting, and flu-like. Patients may even feel fatigued after hours of bed rest. Fatigue may be related to abnormal sleep patterns. Normally, there are several levels of sleep and getting enough of the deeper levels of sleep may be even more important than the total hours of sleep. Patients with fibromyalgia lack the deep, restorative level of sleep, called non-rapid eye movement (NREM) sleep. Consequently, patients with fibromyalgia often awaken in the morning without feeling fully rested, even though they seem to have had an adequate number of hours of sleep time.

Fibro fog, fibromyalgia fog and brain fog, is a symptom of fibromyalgia. Fibro fog is a term used to describe the cognitive difficulties brought on by fibromyalgia. Patients experiencing fibro fog have felt as if they had been taking cold medicine constantly. Fibro fog could be related to the patient’s sleep quality, but the definite cause of fibro fog is still undetermined.

Fibro Fog Symptoms List

Fibro fog symptoms may include the following:

• Short term memory loss
• Misplacing objects
• Becoming easily distracted
• Forgetting plans
• Difficulty carrying on conversation
• Inability to remember new information

It can be challenging for doctors to diagnose fibromyalgia patients because their symptoms are common in many other conditions. Many patients have been misdiagnosed as having depression, inflammatory arthritis, chronic myofascial pain, or systemic exertion intolerance disease. Ultimately, the diagnosis of fibromyalgia is made purely on clinical grounds based on the doctor's history and physical examination.

In patients with chronic widespread body pain, the diagnosis of fibromyalgia can be made by identifying point tenderness areas. Fibromyalgia patients typically have at least 11 of the 18 classic fibromyalgia tender points. Doctors may also inquire about a patient’s level of fatigue, sleep disturbances, and stress levels. According to the American College of Rheumatology, before the diagnosis of fibromyalgia can ultimately be confirmed, muscle pain must be present for longer than three months.

There are no blood tests or X-rays that specifically point the doctor to the diagnosis of fibromyalgia. Tests are often done to exclude other possible diagnoses. Other lab tests may be performed to rule out other possible conditions. Once a doctor completes diagnostic tests, the following criteria will be used to determine if a fibromyalgia diagnosis is appropriate:

• Pain has been widespread in all four quadrants of the body
• Pain has been present for at least three months
• There is no other disease that would be causing these symptoms

Since no simple blood test or X-ray can tell you if you have fibromyalgia, symptoms may be similar to those of other conditions. Many medical conditions can cause pain in different areas of the body and your doctor may still want to do blood tests or X-rays to rule out illnesses that mimic fibromyalgia. The following conditions can mimic fibromyalgia:

• Low thyroid hormone levels (hypothyroidism)
• Vitamin D insufficiency
• Arthritis
• Chronic fatigue syndrome
• Depression
• Irritable bowel syndrome
• Lupus
• Parathyroid disease
• Muscle diseases
• Bone disease
• Elevated blood calcium (hypercalcemia)
• Infectious diseases
• Cancer

Although there is no cure for fibromyalgia, treatment can relieve some of the symptoms. Since symptoms are diverse and vary among patients, treatment programs must be individualized for each patient. Treatment programs are most effective when they combine patient education, stress reduction, regular exercise, and medications. There are also alternative remedies and lifestyle habits that may help ease fibromyalgia symptoms. Ultimately, the physician, physical therapist, and patient may all play an active role in the management of fibromyalgia.

Patient education is an important first step in helping patients understand and cope with their diverse symptoms. Unfortunately, not all physicians are intimately acquainted with the variations of this illness. Community hospital support groups and the local chapters of the Arthritis Foundation have become important educational resources for patients and their doctors.

Many fibromyalgia patients admit feeling anxious, nervous, and even panicked during a fibromyalgia flare-up. Therefore, stress may play a very important role in triggering fibromyalgia symptoms. It is extremely difficult to measure stress levels in different patients because people react differently to certain events. Stress reduction in the treatment of fibromyalgia must be individualized. This might include simple stress modification at home or work, biofeedback, relaxation tapes, psychological counseling, and/or support among family members, friends, and doctors.

Sometimes, changes in environmental factors (such as noise, temperature, and weather exposure) can exacerbate the symptoms of fibromyalgia, and these factors need to be modified. Stress management in fibromyalgia patients may lead to less anxiety, depression, and fatigue. Patients may also experience better sleep and an increased quality of life.

The most important therapy for muscle pain is regular low-impact exercise. Keeping muscles conditioned and healthy by exercising regularly decreases the amount of discomfort. Low-impact aerobic exercises, such as swimming, cycling, walking, and stationary cross-country ski machines can be effective fibromyalgia treatments. Exercise regimens are most beneficial when performed on an every-other-day basis, in the morning. Exercise is the body’s way to create natural painkillers, endorphins, which can also boost one’s mood. Exercise may exert its beneficial effect by promoting a deep level of sleep (NREM sleep). Sometimes physical therapy can be helpful to optimally guide the exercise plan.

Even though research hasn't shown specific foods that can reduce fibromyalgia symptoms, some patients have found that they feel better when eating certain foods. Patients may find it helpful to keep a food diary and record their symptoms after eating. This will allow them to recognize any foods that may reduce or worsen fibromyalgia symptoms or be related to another illness. As you make changes to your diet, keep in mind that people with fibromyalgia tend to benefit most from taking a variety of approaches to managing their symptoms.

A well-rounded diet is always a great idea for anyone. However, there are certain diets or foods that patients have said reduce their symptoms. Vegetarian or vegan diets are two diets that may help. In order to fight fatigue, avoid sugary foods and stick to foods that will give you energy, such as almonds, broccoli, beans, tofu, oatmeal, and whole-grain bread. Avoiding alcohol and caffeine before bedtime can help promote a more restful sleep. When patients have accompanying irritable bowel syndrome, the diet should be adjusted to prevent aggravating the bowels. Likewise, when patients have accompanying interstitial cystitis, foods that irritate the bladder should be avoided.

Traditionally, the most effective medications for the treatment of fibromyalgia have been the tricyclic antidepressants, medications often used in treating depression. Tricyclic antidepressants appear to reduce fatigue, relieve muscle pain and spasm, and promote deep, restorative sleep in patients with fibromyalgia. Examples of tricyclic antidepressants commonly used in treating fibromyalgia include amitriptyline (Elavil) and doxepin (Sinequan).

Duloxetine (Cymbalta), milnacipran (Savella), and venlafaxine (Effexor) are also antidepressants that treat fibromyalgia. Studies have shown that adding fluoxetine (Prozac), or related medications, to low-dose amitriptyline further reduces muscle pain, anxiety, and depression in patients with fibromyalgia. The combination is also more effective in promoting restful sleep and improving an overall sense of well-being.

Fibromyalgia pain may be reduced with the injection of local anesthetic (such as lidocaine or Marcaine). The medication can be injected into peripheral tissues, such as muscles in the shoulders or buttocks or at the tender-points. Tender-point injections involve a doctor inserting a small needle directly into a tender point and injecting anesthetic. Tender point injections are sometimes called trigger point injections.

Alternative treatments work well for some fibromyalgia patients. Holistic therapies influence one’s total being, which may reduce chronic pain and stress. Alternative remedies may allow patients to reduce their medications and increase normal activities. Doctors can help patients find an acceptable way to blend conventional medicine with alternative treatments or natural remedies. Alternative treatments may also be able to increase restful sleep and reduce fibromyalgia pain.

Alternative Treatments List

Alternative treatments for fibromyalgia may include the following:

• Tai Chi and qi gong
• Herbal remedies- Echinacea, black cohosh, lavender, milk thistle, and B vitamins
• Natural dietary supplements- 5-HTP, melatonin, L-carnitine, SAM-e, and probiotics

Before using alternative treatments, discuss their use with your doctor. Additional alternative treatments are presented in the following slides.

Acupuncture may help treat fibromyalgia because it can alter brain chemistry and help increase pain tolerance. During treatment, a practitioner inserts one or more dry needles into the skin and underlying tissues at specific points. Gently twisting or otherwise manipulating the needles causes a measurable release of endorphins into the bloodstream.

According to acupuncturists, during this process, energy blocks are removed, which restores the flow of energy along the meridians, which are specific energy channels. The patient's brain chemistry is then altered by changing the release of neurotransmitters. These neurotransmitters stimulate or inhibit nerve impulses in the brain that relay information about external stimuli and sensations such as pain, which causes the patient's pain tolerance to increase. One acupuncture treatment may alleviate chronic pain for an extended period of time.

Electroacupuncture is another way of stimulating the acupuncture points. It uses a needle hooked up to small wires connected to very slight electrical currents. Heat (moxibustion) and massage (acupressure) can also be used during this electroacupuncture process. Laser acupuncture is another alternative treatment for fibromyalgia patients. During this treatment, low-intensity lasers are targeted at specific areas of the body to stimulate endorphins. The stimulated endorphins block transmission of pain signals to the brain, which offer relief to the patient.

Chiropractic care is another alternative treatment for fibromyalgia pain. It can treat pain of pressure points, back pain, neck pain, shoulder pain, headaches, and pain from musculoskeletal injuries. Chiropractic may be effective for fibromyalgia because it helps improve pain levels and increases cervical and lumbar ranges of motion.

Chiropractic is based on the principle that the body is a self-healing organism. To reduce pain and increase healing, the chiropractor uses spinal adjustments. The goal is to increase the mobility between spinal vertebrae, which have become restricted, locked, or slightly out of proper position. With gentle pressure or stretching, multiple gentle movements of one area, or specific high-velocity thrusts, the adjustments are said to help return the bones to a more normal position or motion. This treatment is said to relieve pain and better one’s health.

Massage therapy may can reduce muscle tension and ease pain in the muscles and soft tissue. Fibromyalgia patients can benefit from massage therapy because it can improve circulation and range of motion and boost production of natural painkillers. A deep tissue massage may stimulate circulation and release chronic patterns of muscle tensions. A neuromuscular massage combines the basic principles of ancient Oriental therapies (acupressure and shiatsu) with specific hands-on deep tissue therapy. The combination of these helps reduce chronic muscle or myofascial (soft-tissue) pain.

Massage therapy can also help fight depression and lessen the flow of chemicals associated with pain and stress while increasing production of serotonin. The increased serotonin will result in a better night’s sleep, which can help fight fibro fog.

During a biofeedback session, patients are able to monitor their stress levels and practice relaxation techniques. Certain techniques may work better than others and during the session the patient will be able to monitor how their body reacts to the techniques. This mind/body relaxation technique uses electronics to measure stress-related responses in the body.

Biofeedback may help patients learn how to relax tight muscles, which can relieve pain caused by fibromyalgia. The idea behind biofeedback is that people can use information about their body's internal processes to learn to control stressors that may cause pain. If learned properly, electronic biofeedback can help you control your heart rate, blood pressure, breathing patterns, and muscle tension, potentially reducing pain.

With meditation, you allow your thoughts to take a break from daily analytical routines and live in the moment. Meditation produces brain waves consistent with serenity and happiness, which help to relieve anxiety. Meditation may provide nourishment for your soul, satisfies inner spiritual hunger, and helps you develop your ability to pay attention to all areas of life without distraction. Fibromyalgia patients may also be able to control their flare-ups and reduce pain. Preliminary findings suggest that a meditation-based stress-reduction program is effective for some patients with fibromyalgia.

Meditation Benefits

Benefits of meditation include the following:

• Create a distraction from pain
• Hinder the central nervous system’s ability to recognize pain
• Encourage body deep muscle relaxation
• Reduce stress-related symptoms

The outlook for patients with fibromyalgia is generally quite good. It is important to note that fibromyalgia is not an organ-threatening illness. Those patients with an approach to treatment that involves optimal understanding of the condition, as well as sleep improvement, stress reduction, and exercise, tend to do best.

Try These Tips for Fibromyalgia

The following are tips to help cope with fibromyalgia:

• Take up yoga, meditation, or other activities to reduce stress
• Take notes; fibro fog may make it difficult to remember things
• Exercise regularly to decrease pain and stiffness
• Relax in the bath to soothe muscles and reduce pain
• Keep a daily journal to record diet and symptoms
• Join a support group to connect with people who are suffering from the same condition