Overview and Frequently Asked Questions
Fibromyalgia presents with symptoms of chronic diffuse muscle and joint pain, poor sleep, and fatigue. Some patients also describe stomach ailments and have history of headaches. The symptoms may often be vague, but can be debilitating to patients with it.
Fibromyalgia can be difficult to diagnose, as there is no one test to confirm it. However, after more serious conditions have been ruled out, usually by taking a good history and physical exam, an expert in fibromyalgia can confidently diagnose this condition.
While there are a number of different medications which are used in the treatment of fibromyalgia, a more conservative approach should be tried first, including: exercise, sleep hygiene & education.
A slow but progressive increase in aerobic exercise (Examples: swimming, walking) can be very helpful. While the results are not immediate, exercise can reduce pain, and improve everyday functional mobility and quality of life.
Good sleep hygiene remains important. If there are any medical conditions disturbing your sleep, it is important to discuss these with your doctor. Otherwise, it is important to have a regular time to go to sleep, a comfortable bed and no regular disturbances.
Education is equally important. Speak to your physician about fibromyalgia education programs in your area.
What is Fibromyalgia?
Fibromyalgia a chronic diffuse pain syndrome. Patients describe diffuse musculoskeletal pain, although some areas can be worse than others. Phrasing like “I hurt all over” or “I have head to toe pain” is not uncommon, but there are many different ways patients with fibromyalgia will describe pain.
Is pain the only problem with fibromyalgia?
No. Patients also commonly describe poor sleep or still feeling tired when they wake up in the morning. Severe fatigue and morning stiffness are also common. People with fibromyalgia may also have difficulties with headaches, irritable bowel syndrome, or mood.
Who gets fibromyalgia?
Anyone can have fibromyalgia. It affects approximately 4% of the population. Females account for the majority of patients. The most common age is between 30-55, but is seen in the pediatric population too.
Why does fibromyalgia happen?
While there is much research going on the area, it remains unclear why fibromyalgia occurs. We believe it is a problem of how the body perceives pain, rather than a problem with the muscles, joints, or nerves themselves. In fact, if you took a biopsy of these areas, they would be perfectly normal.
Are there any triggers for fibromyalgia?
For some patients, they can identify a specific event that seemed to be associated with the start of their pain. Examples include trauma, either physical or emotional, or an illness. Many patients however cannot identify such a trigger.
Are there any other diseases associated with fibromyalgia?
Patients with rheumatoid arthritis and other disorders can also have fibromyalgia. In fact, it is important that these other conditions are ruled out.
What is the difference between rheumatoid arthritis & fibromyalgia?
Rheumatoid arthritis is an autoimmune inflammatory condition which affects specific joints in the body. If not treated aggressively, it can progressively worsen, affect organs such as the heart, lungs and eyes and shorten life-span. Fibromyalgia is a pain syndrome; It is not an autoimmune disease and it is does not cause objective signs of inflammation.
How is fibromyalgia diagnosed?
Fibromyalgia can be diagnosed by your physician by discussing your medical history and a proper physical examination.
Are there any blood tests or x-rays that can confirm the diagnosis?
No, fibromyalgia is a diagnosis of exclusion. In fact, it is reassuring that any investigations your physician may do return normal. This suggests there is no other serious reason for the symptoms.
How is fibromyalgia treated?
Treatment of fibromyalgia requires a multi-disciplinary approach. The best evidence for successful treatment include:
Good night’s sleep: Better sleep improves fatigue and pain. Treating any underlying sleep disorders, and learning about good sleep hygiene is important.
Education: Learning more about fibromyalgia and different mechanisms to cope with pain is part of the treatment strategy. Patients with fibromyalgia must learn not to let the pain take over their lives. Speak to your rheumatologist about educational opportunities that may exist.
Exercise: Slow progressive increase in aerobic exercise has been shown to be very effective in treating fibromyalgia. It is important to start slowly, as too much exercise at the beginning will only increase pain and cause discouragement. Any type of exercise will do; there is good evidence to suggest water exercise is helpful including swimming or aquasize, but regular walks, Yoga or Tai-Chi are all good examples. Once you’re comfortable at your exercise level for a few weeks, add to it by about 10% in intensity or duration. By keeping to this plan, patients describe improvement in pain and fatigue over the long term.
I have heard about a number of different medications that have been used to treat fibromyalgia. Do they work?
There are more and more medications being researched and approved for use with fibromyalgia. While some of them have been shown to be effective, there are only short term studies. The methods described in the answer above are long term solutions and do not carry the additional risk of adverse medication effects. However, for some people, medications may be necessary in combination with lifestyle changes to bring improvement.
Strong pain medications such as narcotics should be avoided. While they may work initially, their effect wears off and there is a slow dose escalation over time. If you need medications for fibromyalgia, discuss non-narcotic options with your physician. If you are already on a narcotic pain medication, discuss with your physician how you can safely stop it.
I have been reading about natural products that are used to treat fibromyalgia. Do they work?
Because there is no cure for fibromyalgia and its cause is poorly defined, there are many different products on the market which claim to treat fibromyalgia. Unfortunately, these products have usually not been studied well, so it is difficult for your physician to recommend them. If you want to consider these products, you should still discuss them with your physician to ensure they are a safe option for you.
What is the long term prognosis for fibromyalgia?
Patients with fibromyalgia who are able to improve their exercise regime and sleep hygiene, as well as learn strong coping mechanisms can do very well over time. It does take time to improve however and it can be difficult to stay with these changes when you do not see improvement initially. It is this lack of immediate feedback and the difficulty starting non-pharmacologic treatment which makes improvement difficult for some patients. Fibromyalgia is not associated with a shorter life span or the development of future diseases, such as heart disease, stroke, dementia, or cancer.