Everything You Need to Know About Fibromyalgia
Fibromyalgia is a long-term, or chronic, condition
It causes symptoms such as:
- musculoskeletal pain, or pain in the muscles and bones
- general fatigue
- sleep and cognitive disturbances
This condition can be hard to understand, even for healthcare professionals.
Its symptoms mimic those of other conditions, and there are no tests to definitively confirm a diagnosis.
As a result, fibromyalgia is often misdiagnosed
In the past, some healthcare professionals even questioned whether fibromyalgia was real.
Today, it’s much better understood.
Some of the stigmas that previously surrounded fibromyalgia have eased, but it can still be challenging to treat.
Medications, therapy, and lifestyle changes can help you manage your symptoms and improve your quality of life.
You may also experience remission-type periods in which your pain and fatigue improve.
Fibromyalgia causes what’s now referred to as regions of pain.
Some of these regions overlap with the areas of tenderness traditionally known as tender points or trigger points.
However, some of these previously noted areas of tenderness are not included in the regions of pain.
The pain feels like a consistent, dull ache.
A healthcare professional will consider a diagnosis of fibromyalgia if you’ve experienced musculoskeletal pain in four out of the five regions of pain outlined in the 2016 revision to the fibromyalgia diagnostic criteria.
Current diagnostic criteria refer to fibromyalgia pain as multisite pain.
In contrast, the 1990 fibromyalgia diagnostic criteria defined fibromyalgia pain as chronic widespread pain.
In addition, the diagnostic process now focuses on the severity of pain and the areas of musculoskeletal pain.
In the past, the duration of pain was the focal point of a fibromyalgia diagnosis.
Other symptoms of fibromyalgia include:
- trouble sleeping
- nonrestorative sleep, or sleeping for long periods of time without feeling rested
- trouble focusing or paying attention
- dry eyes
- pain or a dull ache in the lower abdomen
- bladder problems, such as interstitial cystitis
The condition can affect your emotions as well as your physical health.
Fibro fog or brain fog is a term some people use to describe the fuzzy feeling they get.
Signs of fibro fog include:
- memory lapses
- difficulty concentrating
- trouble staying alert
According to a 2015 literature review, some people find mental fogginess from fibromyalgia more upsetting than the physical pain.
There’s no cure for fibromyalgia at the moment.
Instead, treatment focuses on reducing symptoms and improving quality of life with medications, self-care strategies, and lifestyle changes.
In addition, you may wish to seek out support and guidance.
This may involve joining a support group or seeing a therapist.
Medications can relieve pain and help you sleep better.
Common medications for fibromyalgia include pain relievers, antiseizure drugs, and antidepressants.
Fibromyalgia pain can be uncomfortable enough and consistent enough to interfere with your daily routine.
Do not just settle for pain.
Talk with a healthcare professional about ways to manage it.
If your pain is mild, one option is to take over-the-counter pain relievers, such as:
- acetaminophen (Tylenol)
- ibuprofen (Advil, Motrin)
- naproxen (Aleve, Naprosyn)
These medications can lower your pain levels, reduce discomfort, and help you better manage your condition.
They may even help you sleep better.
Many of them bring down inflammation, too.
Though inflammation is not a primary symptom of fibromyalgia, you may experience it if you have a related condition such as rheumatoid arthritis (RA).
Please note that nonsteroidal anti-inflammatory drugs (NSAIDs) do have side effects.
Caution is advised if NSAIDs are used for an extended period, as is usually the case when you’re managing a chronic pain condition.
Opioids have also been prescribed for pain relief.
However, researchhas not shown them to be effective over time.
Also, the dosage for narcotics is typically increased rapidly, which can pose a health risk for people prescribed these drugs.
Tramadol (Ultram) is one of the opioids most closely associated with fibromyalgia relief.
However, some experts do not consider it a traditional opioid, and any possible benefits for fibromyalgia could be due to it also being a serotonin-norepinephrine reuptake inhibitor (SNRI).
According to a 2020 study, there’s not enough evidence to support or oppose the use of tramadol in fibromyalgia.
More research on opioids is needed.
Pregabalin (Lyrica), an antiseizure drug, was the first medication the Food and Drug Administration (FDA) approved for fibromyalgia.
It blocks nerve cells from sending out pain signals.
Gabapentin (Neurontin) was designed to treat epilepsy, but it may also help reduce symptoms in people with fibromyalgia.
Gabapentin has not been FDA-approved to treat fibromyalgia and is considered an off-label drug.
Antidepressants such as duloxetine (Cymbalta) and milnacipran (Savella) are sometimes used to treat pain and fatigue from fibromyalgia.
These medications may also work on rebalancing neurotransmitters and help improve sleep.
The FDA has approved both duloxetine and milnacipran for the treatment of fibromyalgia.
Other drugs that are not FDA-approved to treat fibromyalgia, such as sleep aids, can help with specific symptoms.
Muscle relaxers, which were once used, are no longer recommended.
Researchers are also investigating a few experimental treatments that may help people with fibromyalgia in the future.
Natural remedies for fibromyalgia
If medications do not relieve your symptoms entirely, you can look for alternatives.
Many natural remedies focus on lowering stress and reducing pain, and they can help you feel better both mentally and physically.
You can use them alone or together with traditional medical treatments.
Natural remedies for fibromyalgia include:
occupational and physical therapy, which improves your strength and reduces stress on your body
- massage therapy
- yoga, which you should approach with caution if you have hypermobility
- tai chi
- stress-reduction techniques
- a balanced, nutrient-rich diet
- 5-hydroxytryptophan (5-HTP), an amino acid
Therapy can potentially reduce the stress that triggers fibromyalgia symptoms.
Group therapy may be the most affordable option, and it can give you a chance to meet others who are going through the same issues.
Individual therapy is also available if you prefer one-on-one help.
Cognitive behavioral therapy (CBT) is one approach for managing stressful situations.
It’s important to note that most alternative treatments for fibromyalgia have not been thoroughly studied or proven effective.
Ask a healthcare professional about the benefits and risks before trying some of these treatments.
Healthcare professionals and researchers do not know what causes fibromyalgia.
According to the latest research, the cause appears to involve a genetic disposition complemented by one or more triggers (such as infection, trauma, or stress).
Experts do not fully understand what causes the chronic widespread nature of fibromyalgia pain, either.
One theory is that the brain lowers the pain threshold. Sensations that were not painful before become very painful over time.
Another theory is that the brain and nerves may misinterpret or overreact to normal pain signals.
They become more sensitive, to the point where they cause unnecessary or exaggerated pain.
This may be due to a chemical imbalance in the brain or an abnormality in the dorsal root ganglion, which is a cluster of neurons in the spine.
Fibromyalgia often runs in families.
If you have a family member with this condition, you’re at a higher risk for developing it.
Researchers think certain gene mutations may play a role.
They’ve identified a few possible genes that affect the transmission of chemical pain signals between nerve cells.
A past illness could trigger fibromyalgia or make its symptoms worse.
Infections that have possible links to fibromyalgia include:
- Epstein-Barr virus
- gastrointestinal infections, such as those caused by the bacteria Salmonella and Shigella
People who go through severe physical or emotional trauma may develop fibromyalgia.
The condition has been linked to post-traumatic stress disorder (PTSD).
Like trauma, stress can have long-lasting effects on your body.
Stress has been linked to hormonal changes that could contribute to fibromyalgia.
Fibromyalgia tender points
In the past, a person was diagnosed with fibromyalgia if they had widespread pain and tenderness in at least 11 out of 18 specific points around their body.
Healthcare professionals would check to see how many of these points were painful by pressing firmly on them.
Common tender points, or trigger points, included the:
- back of the head
- tops of the shoulders
- upper chest
- outer elbows
For the most part, tender points are no longer a part of the diagnostic process.
Instead, healthcare professionals may diagnose fibromyalgia if you’ve had pain in four out of the five areas of pain as defined by the 2016 revised diagnostic criteria, and you have no other diagnosable medical condition that could explain the pain.
Pain is the hallmark symptom of fibromyalgia.
You’ll feel it in various muscles and other soft tissues around your body.
The pain can range from a mild achiness to an intense and almost unbearable discomfort. Its severity could dictate how well you cope day to day.
When fibromyalgia pain is in your chest, it can feel similar to the pain of a heart attack.
Chest pain in fibromyalgia is centered in the cartilage that connects your ribs to your breastbone.
The pain may radiate to your shoulders and arms.
Fibromyalgia chest pain may feel:
- like a burning sensation
- as if you’re struggling to catch your breath, which is also a symptom of a heart attack
Your back is one of the most common places you’ll feel pain.
Most people have low back pain at some point in their lives.
If your back hurts, it may not be clear whether fibromyalgia is to blame or if it’s another condition such as arthritis or a pulled muscle.
Other symptoms such as brain fog and fatigue can point to fibromyalgia as the cause.
It’s also possible to have a combination of fibromyalgia and arthritis.
The same medications you take to relieve your other fibromyalgia symptoms can help with back pain, too.
Stretching and strengthening exercises can help support the muscles and other soft tissues of your back.
You may feel fibromyalgia pain in the muscles and soft tissues of your legs.
Leg pain caused by fibromyalgia can feel similar to the stiffness of arthritis or the soreness of a pulled muscle.
The pain can be described as deep, burning, or throbbing.
Sometimes fibromyalgia in the legs feels like numbness or tingling.
You may have a creepy-crawly sensation.
An uncontrollable urge to move your legs is a sign of restless legs syndrome, which can overlap with fibromyalgia.
Fatigue sometimes manifests in the legs too. Your limbs can feel heavy, as if they’re held down by weights.
Fibromyalgia risk factors
Available research still has not identified an exact cause of fibromyalgia.
Factors that may increase your risk of developing it include:
- Sex. Most fibromyalgia cases are currently diagnosed in females, but the reason for this disparity is not clear.
- Age. You’re most likely to be diagnosed in middle age, and your risk increases as you get older. Children can develop fibromyalgia too.
- Family history. If you have close family members with fibromyalgia, you may be at greater risk for developing it.
- A history of other conditions. Although fibromyalgia is not a form of arthritis, having rheumatoid arthritis (RA) may increase your risk of also having fibromyalgia. Fibromyalgia also affects around 30 percent of people with lupus.
Research continues to evolve to better understand this condition and its origin.
Fibromyalgia and autoimmunity
In autoimmune diseases such as RA and lupus, the body mistakenly targets its own tissues.
The immune system uses proteins called autoantibodies to attack the joints or other healthy tissues in the same way it would normally attack viruses or bacteria.
Having a small number of autoantibodies is normal, but high levels may indicate an autoimmune disease.
Autoimmune diseases and fibromyalgia have some overlapping symptoms, such as fatigue and trouble concentrating.
It can be hard for healthcare professionals to determine whether you have an autoimmune disease or fibromyalgia.
You can even have both types of conditions simultaneously.
The overlap in symptoms has led to the theory that fibromyalgia could also be an autoimmune disease.
This claim has been hard to prove, partly because there’s been little to no evidence that autoantibodies are involved in fibromyalgia.
Fibromyalgia does not traditionally cause inflammation, either. Inflammation is a common symptom of autoimmune diseases.
However, a small 2021 study found that autoantibodies may contribute to fibromyalgia after all.
In the study, researchers injected mice with autoantibodies from people with fibromyalgia or people without fibromyalgia.
The mice injected with autoantibodies from people with fibromyalgia began to experience fibromyalgia-like symptoms, such as reduced muscular strength and greater sensitivity to painful sensations (like cold).
The mice injected with autoantibodies from healthy people did not have any symptoms.
A different 2021 study from Taiwan has pointed to a link between fibromyalgia and the inflammatory autoimmune disease Sjögren’s disease.
People with fibromyalgia were twice as likely to develop Sjögren’s as people without fibromyalgia, according to data collected between 2000 and 2012.
More research is needed, but these study results are encouraging.
If fibromyalgia is an autoimmune disease, treatments for autoimmune diseases could potentially help treat fibromyalgia, too.
Fibromyalgia in females
According to the Centers for Disease Control and Prevention (CDC), fibromyalgia is twice as common in women as it is in men.
Research has traditionally concluded that at least 80 to 90 percentTrusted Source of fibromyalgia cases are diagnosed in women, according to a 2018 study on bias in fibromyalgia diagnosis.
Fibromyalgia may be underdiagnosed in men, though.
Fibromyalgia symptoms have generally been more severe in people who are female than in people who are male.
People assigned female at birth have more widespread pain, symptoms of irritable bowel syndrome (IBS), and morning fatigue than people assigned male at birth.
Painful periods are also common.
In addition, the transition to menopause could make fibromyalgia worse.
Complicating matters is the fact that some symptoms of menopause and fibromyalgia look almost identical.
Fibromyalgia in males
Males can have fibromyalgia, but they may remain undiagnosed because it’s viewed as a predominantly female disease.
When the 2016 diagnostic criteria are applied, more men are diagnosed, according to the 2018 study on bias.
The conventional wisdom is that at least 80 to 90 percent of fibromyalgia cases affect women.
When data from a German study were reanalyzed, researchers found that women comprised only 59.2 percent of the fibromyalgia cases.
This means men comprised 40.8 percent of the cases.
Males with fibromyalgia may have severe pain and emotional symptoms. The condition may affect their quality of life, career, and relationships, according to a 2018 survey.
Part of the stigma and difficulty in getting diagnosed stems from society’s expectation that males who are in pain should “suck it up.”
Those who do see a doctor can face emotional discomfort and the chance that their complaints will not be taken seriously.
A healthcare professional may diagnose you with fibromyalgia if you’ve had widespread pain for 3 months or longer in four out of five specific regions.
“Widespread” means the pain is on both sides of your body, and you feel it above and below your waist.
After a thorough examination, they must conclude that no other condition is causing your pain.
Healthcare professionals typically use a process of elimination to diagnose fibromyalgia.
There are no imaging scans that can detect it.
However, a healthcare professional may use imaging scans or various blood tests to help rule out other possible causes of your chronic pain.
The FM/a test is a blood test that may be used to diagnose fibromyalgia.
The manufacturers of the test claim that it’s definitive, but other experts are more skeptical of its usefulness.
It detects the presence of chemokine and cytokine proteins.