Fibromyalgia is a collection of symptoms, sometimes called a syndrome. It is a very common problem. It typically affects women, but is sometimes seen in men too. It is not a disease but is a physiologic response of the nervous system to a set of circumstances. That response is to increase the sensitivity of the nerves throughout the body. Things that typically would not cause pain do. Things that typically would cause pain cause worse pain. The symptoms of fibromyalgia (joint/muscle pain, memory problems, fatigue, poor concentration, etc.) are not caused by inflammation or a damaging process of deterioration in the body.
Occasionally, people will be told that this problem is “all in your head” or that it is not real. Such statements are not reasonable, are not supported by scientific evidence, and should not be taken seriously. Fibromyalgia is like major depressive disorder, migraine headaches, and several other medical problems in that there is no test to diagnose it, but the diagnosis can be made on the basis of expert opinion.
The major factors causing the symptoms of fibromyalgia are:
SLEEP PROBLEMS – Most people report several years of having poor quality sleep or less than adequate quantity of sleep or both. Many people with fibromyalgia have underlying sleep apnea which is part of the problem. People who are intentionally kept from sleeping as part of studies often develop the symptoms of fibromyalgia. Sleep is a physiologic need for the body and a person cannot feel well if chronically deprived of quality sleep. For many, this becomes a vicious cycle of pain leading to worse sleep leading to more pain. People often need help breaking this cycle.
DEPRESSION/ANXIETY/STRESS– Most people with fibromyalgia have one or more of these problems and they find that their symptoms of pain and fatigue are worse during times of stress. The pain symptoms of fibromyalgia can be extremely difficult to treat if depression or anxiety are not treated, or if stress is out of control. Often, controlling these problems requires the help of a mental health professional.
DECREASED RECREATIONAL ACTIVITY – Many people with fibromyalgia pains are active only when they must be, such as doing dishes or working. In part this is because activity seems to make them feel worse. People will often decrease their activity level with it. Unfortunately, this leads to short term improvement but long term worsening of symptoms. Like a person at the end of a long airplane or car ride who has been sitting for many hours, people with fibromyalgia are stiff and achy. Daily habits of activity that are relaxing are an important part of improving the symptoms of fibromyalgia. Such activities may include Tai Chi, going for a stroll, or swimming. Vigorous exercise such as running, while good for overall health, is not necessary to help with the symptoms of fibromyalgia.
There are medications which can help with the symptoms of fibromyalgia, but their effect is typically modest and most people find that if they do not address the issues listed above, they will see symptoms worsen with time. Opiate medications, such as Percocet and morphine, are typically not good choices for this problem as they tend to cause some worsening of problems when used long term. On the other hand, those who focus on addressing sleep problems, stress/depression/anxiety problems, and recreational activity problems find that they see gradual improvement. Input from health care providers can help with management of these issues.
By: Dr. Daniel Kreutz, M.D., Rheumatologist