Fibromyalgia, also called fibromyalgia syndrome or FMS, is a disorder in which one experiences chronic pain and tenderness to touch. It is sometimes described as oversensitivity to sensations such as touch, light, or sound. Fibromyalgia pain and tenderness may come and go and are usually felt throughout the body.
Fibromyalgia is common in the United States, with the National Fibromyalgia and Chronic Pain Association reporting approximately 10 million Americans with the condition. Fibromyalgia may occur in men and women, though it most often occurs in women. The onset of fibromyalgia may happen at any point. Sometimes the onset of symptoms occurs as early as the teen years. It may also occur during adulthood or into old age.
Fibromyalgia Risk Factors
Those who already have an existing rheumatic disease are at greater risk of developing fibromyalgia. The American College of Rheumatology defines rheumatic diseases as conditions which affect the joints, muscles, and bones.
Rheumatic diseases often cause inflammation, swelling, and sometimes damage to the muscles, joints, and bones. Many rheumatic diseases are considered autoimmune diseases in which the body’s immune system attacks its own healthy joints, muscles, tissue, and bones. While fibromyalgia is not considered an autoimmune disease, it may accompany autoimmune diseases such as lupus or rheumatoid arthritis.
What Causes Fibromyalgia?
Fibromyalgia is called a disorder or condition and not a disease because the exact cause of fibromyalgia is unknown. When someone is diagnosed with a disease, the origin and progression of the disease can usually be identified. For example, when someone is diagnosed with cancer, physicians know the patient has a disease because they have found the source of the disease in the cancer cells. Similarly, with autoimmune diseases, there will often be antibodies or other factors present in the patient’s bloodwork to pinpoint the source of the disease and symptoms. With fibromyalgia, however, there is no way to pinpoint what exactly causes the condition, how it progresses, or how to reverse or cure it.
What triggers fibromyalgia is different from what causes it. Triggers are injuries or circumstances that may initiate the onset of symptoms even though they are not responsible for the disorder itself. Common triggers include:
- Spinal injury
- Physical injury or physical stress
- Emotional stress
- Sleep disorders such as sleep apnea
- Mood problems such as anxiety, panic disorder, and depression
While these triggers commonly lead to fibromyalgia symptoms and a diagnosis, the underlying cause of the condition remains unknown.
The American College of Rheumatology describes fibromyalgia as a neurologic condition, suggesting that the nervous system plays a role in the disorder. A study published in the Journal of Neuroscience Research indicates that fibromyalgia pain is the result of abnormal pain processing in the central nervous system. This means that the way the body communicates with itself is disrupted or altered in some way. This disruption may cause the patient to experience sensations such as touch, light, or sound at an amplified level, resulting in pain. The amplification of these sensations is why fibromyalgia is sometimes referred to as Central Pain Amplification Disorder.
Fibromyalgia can be difficult to diagnose given that the symptoms may mimic those of other conditions, such as rheumatoid arthritis, which also cause pain throughout the body. No test can diagnose or rule out fibromyalgia, which is another reason it is difficult for patients to get a diagnosis.
Fibromyalgia causes pain but it does not cause inflammation or deterioration of joints, and it cannot be detected on X-rays or ultrasounds. If a physician suspects that a patient’s pain is fibromyalgia pain, he or she will perform a physical exam. The doctor will evaluate tender points and trigger points throughout the body.
Tender points are intensely sensitive areas on the body that cause pain when approximately 10 pounds of pressure are applied. A trigger point, however, causes pain to radiate to other areas of the body when pressure is applied. Trigger points are often characterized by painful muscle knots.
The physician will diagnose based on the results of the physical exam along with the patient’s other symptoms. Additionally, the physician may perform blood tests and other assessments to rule out other conditions that may present similarly to fibromyalgia.
Is Fibromyalgia Physical or Mental?
Some physicians think fibromyalgia could be classified as a mental disorder. This is for a couple of reasons. The first reason is that there is no diagnostic test, such as blood work, that can identify fibromyalgia. Since there is no physiological way to know exactly when or how the disorder started or what specifically caused it, doctors look to possible mental causes.
A 2017 study published in the International Journal of Behavioral Medicine concluded that in many cases fibromyalgia may be diagnosed as a mental disorder. This is because 82% of the individuals diagnosed with fibromyalgia who participated in the study fulfilled the criteria for Somatic Symptom Disorder (SSD). SSD means there is a strong link between a mental focus on physical symptoms and actually experiencing the physical symptoms. For example, an individual with SSD may experience physical symptoms, often widespread pain, with no medical explanation.
The Mayo Clinic lists the following symptoms of SSD:
- Shortness of breath
- Single, multiple, or varying symptoms
- Symptoms that range from mild to moderate or severe
- Excessive thoughts, feelings, or behaviors related to symptoms including:
- Constant worry about possible illness
- Fear of serious complications without any evidence of such
- Viewing normal physical sensations as threatening or harmful
- Fear of physical activity and what it might do to your body
- Constantly checking your body for abnormalities
- Frequent health care visits that produce no results
- Being unresponsive to medications and treatments
According to the American College of Rheumatology, the most common symptoms of fibromyalgia include:
- Tenderness to touch affecting the muscles, joints, or skin
- Severe fatigue or chronic fatigue
- Sleep problems such as waking up feeling unrested
- Brain fog or “fibro fog” such as memory problems or difficulty focusing and thinking clearly
Other signs of fibromyalgia may include:
- Depression or anxiety
- Migraines or tension headaches
- Irritable bowel syndrome (IBS) or gastroesophageal reflux disease (GERD)
- Overactive bladder
- Pelvic pain
- Temporomandibular disorder (TMJ) which includes jaw pain, jaw clicking, and ringing in the ears
The symptoms of fibromyalgia often affect the quality of life for those who live with this chronic pain condition. However, fibromyalgia has not been shown to lead to additional health problems such as heart attack, stroke, or cancer and has not been shown to cause physical problems like the deterioration of muscles, joints, or bones, or physical deformities.
Types of Pain
Just as there are many different types of fibromyalgia triggers, there are different kinds of pain, which are commonly distilled into seven types:
- Hyperalgesia (pain amplification)
- Allodynia (pain from non-painful stimuli)
- Paresthesia (pins and needles pain)
- Muscle pain (low back pain, neck pain, chest pain)
- Joint pain (hip pain, knee pain)
- Abdominal pain
While there is no fibromyalgia cure, there are a variety of fibromyalgia treatments available to help ease symptoms and provide an improved quality of life for those who live with the condition.
One of the most important forms of treatment is physical exercise. A study published in BioMed Research International revealed that aerobic exercises and muscle-strengthening exercises were effective means of reducing pain and improving quality of life for fibromyalgia patients. It may be difficult at times for fibromyalgia patients to engage in physical activity due to pain.
Low-impact exercise therapies such as tai chi and yoga have also proven to be beneficial to fibromyalgia patients by easing symptoms.
The U.S. Food and Drug Administration has approved three drugs for the treatment of fibromyalgia:
These three drugs help to reduce fibromyalgia pain by affecting chemicals in the brain that impact communication within the body. It is thought that the nervous system plays a role in fibromyalgia and affects the body’s ability to communicate sensations like touch and pain properly. These drugs may help correct that miscommunication within the body.
Patients may also find relief from the pain of fibromyalgia by treating the triggers that cause the fibromyalgia symptoms to flare. Additional medications may be given to patients to help with certain triggers like other diseases, disorders, or health conditions. Common medications for pain management and to treat fibromyalgia triggers include:
- Sleep aids
- Muscle relaxers
- Anti-seizure medication
Some fibromyalgia patients have found relief from symptoms through amino acids. Amino acids help the body form protein, which is needed to maintain a healthy, properly functioning body. According to University Health News Daily, some amino acid supplements may contribute to easing symptoms of fibromyalgia.
It is believed that a key factor in fibromyalgia pain is an imbalance of serotonin in the brain. The essential amino acid L-tryptophan plays an important role in creating serotonin. Serotonin is made from 5-hydroxytryptophan (5-HTP), which is made from L-tryptophan. L-tryptophan acts as the foundation for building 5-HTP and serotonin.
A study published in the Journal of International Medical Research showed that patients treated with 5-HTP showed improved fibromyalgia symptoms. Although research suggests that L-tryptophan may contribute to relief from fibromyalgia symptoms, it is always best to take a balanced mixture of all essential amino acids. A balanced mixture will help ensure that the blood concentration of amino acids is optimal.
There are a variety of complementary and alternative therapies and relaxation techniques that may bring relief for fibromyalgia patients alongside physical activity and drug-based treatments. These therapies include:
- Chiropractic care
- Massage therapy
Some fibromyalgia patients have benefited from reduced symptoms by revamping their diets. Research has shown that when certain foods are avoided or consumed, they can affect fibromyalgia symptoms. For example, a 2017 study published in Nutricion Hospitalaria revealed that fibromyalgia patients who consumed a low-FODMAP diet experienced a reduction in symptoms.
FODMAP stands for fermentable oligosaccharide, disaccharide, monosaccharide, and polyols. FODMAPS are carbohydrates and different types of sugar that do not get fully absorbed. Since they do not get completely absorbed, they end up becoming fermented and causing distress for sufferers of irritable bowel syndrome (IBS). Those with IBS are encouraged to follow a low-FODMAP diet. Studies, such as the one published in Nutricion Hospitalaria, have shown that a low-FODMAP diet may also benefit fibromyalgia patients. Additional studies have shown that following a vegan or vegetarian diet may also help alleviate symptoms associated with fibromyalgia.