Pain and Approaches to Fibromyalgia

Fibromyalgia is more common than most people know. According to an NIH Publication, about 2% of people in the United States have a diagnosis of fibromyalgia. It is more common in females than males (about 2:1).

Fibromyalgia is chronic, widespread pain lasting more than three months. There are 18 specific points on the body that tend to be painful in fibromyalgia. The pain of fibromyalgia is often accompanied by other symptoms:

• Fatigue

• Joint stiffness

• Joint, muscle, and/or tendon pain and tenderness

• Excessive skin sensitivity/tenderness to touch

• Numbness or tingling of the extremities

• Headaches

• Insomnia

• Difficulty concentrating and sometimes brain fog (“fibro fog”)

• Increased sensitivity to environmental stimuli like light, temperature, noise, and odors.

• Digestive problems

• Pain sometimes refers to different parts of the body

• Anxiety and depression (both common co-occurrences)

As one might note, symptoms of fibromyalgia mimic those of many other disease processes like arthritis, chronic fatigue, migraines, IBS, depression, and others discussed above. For this reason, it can be very difficult to diagnose. It can also present with other painful diseases, which can make the fibromyalgia even worse than it typically is.

There are no scans or blood tests to diagnose fibromyalgia. However, several blood tests are often done to check for other causes. A good history and hands-on exam are essential. Palpating and counting the number of tender areas using the widespread pain index (WPI), in addition to using the symptom severity scale (SSS) are tools used to diagnose fibromyalgia. Typically, no inflammation is found in the area of pain.

General Approaches to Fibromyalgia

• Acupuncture

• Massage

• Yoga

• Hydrotherapy

• Mental health counseling

• See depression and anxiety

• Occasionally, there are “triggers” to painful episodes: For example, mental health problems and bouts of rheumatoid arthritis. It is important to try to control these underlying precipitants.

• Education about fibromyalgia is essential

• Exercise management (30 minutes of aerobic exercise at least three times/week)-Gentle exercise

• Sleep hygiene

• Warm moist heat, warm bath with Epsom Salts, hydrotherapy

• Anti-inflammatory foods

• Hydration

• Relaxation techniques (lots of instructions online - like deep breathing, meditation, guided imagery).

• Yoga

• Tai Chi

• Counseling

• ​Pain clinics help diagnose pain and take a holistic approach to treatment and care. They have providers who help diagnose painful conditions, prescribe medications, give injections, provide physical therapy, occupational therapy, and provide other approaches to pain like cognitive behavioral therapy (psych) to help alter the perception of and tolerance to pain. This is an ideal approach to hard-to-control chronic pain.

Over-the-Counter Treatment:

NSAIDS:  These include Ibuprofen (Motrin, Advil), Naproxen (Aleve), and Acetylsalicylic acid (common: Aspirin).In many cases, they are quite effective in decreasing pain. They are always good medications to start with if you are having pain,, especially pain from inflammation (almost all pain has some element of inflammation). BUT on a long-term basis, these medicines can cause gastric ulcers and bleeding as well as kidney and blood pressure issues, so beware - alternate your pain medications (NSAIDS) if possible - ibuprofen to Tylenol or a prescription medicine. Speak to your PCP about this and also consider taking a stomach acid-reducing medicine (common: omeprazole/Prilosec or famotidine/Pepcid and others) while taking NSAIDs. Remember: Aspirin thins your blood and can make you bleed more easily.

Acetaminophen (common: Tylenol), on the other hand, is not an anti-inflammatory but a pain reliever instead. This is also a good medication, but used long term, can cause liver problems. Again, consider alternating this with ibuprofen every few weeks or speak to your PCP about getting another prescription pain medication.

Topical Creams

• Capsicum (Pepper) Cream - Used topically as directed.

• Methyl salicylate (an anti-inflammatory related to aspirin) - Topical application

• Voltaren/diclofenac - Topical

Be sure to read labels and follow instructions for these medications.

Considered Natural Remedies

• Turmeric/Curcumin

• CoQ10

  
  

​​Prescriptive Treatment

• Antidepressants (tricyclics, serotonin reuptake inhibitors [SSRIs], Serotonin-norepinephrine reuptake inhibitors [SNRIs]) - duloxetine (Cymbalta) - an SNRI - is commonly used for pain.

• Antiseizure medicine (common: pregabalin, gabapentin)

• Tramadol

• Muscle relaxants

• Trigger point injections

• Topical lidocaine (anesthetic substance)

• Possibly THC/Cannabinoids

• Ibuprofen (high dose)-800 mg

• Narcotics/opioids are rarely used for fibromyalgia because of the risk of addiction and lack of evidence-based effectiveness. If given narcotics, it would likely be low-dose opioids such as oxycodone or hydrocodone (combo opioids with Tylenol: Lortab, Percocet,, and Vicodin) and Tramadol (i.e. Ultram). Because these are highly addictive, they are not the drug of choice for long-term pain.

  
  

A Woman With Pain

If you continue to have pain, pain clinics help diagnose pain and take a holistic approach to treatment and care. They have providers who help diagnose painful conditions, prescribe medications, give injections, provide physical therapy, occupational therapy, and provide other approaches to pain, like cognitive behavioral therapy (psych), to help alter the perception of and tolerance to pain. This is an ideal approach to hard-to-control chronic pain. consider going to a pain clinic. Otherwise, follow up with a healthcare provider until you have some degree of control over your pain.