Pain, Symptoms and Management of Fibromyalgia

What is fibromyalgia?

Fibromyalgia is an elusive condition. That is, there are no specific tests to diagnose the illness and the symptoms often differ from one individual to another. The original diagnosis criteria required a person to have pain on palpation of 11 out of 18 specific tender points but that has changed and the criteria is now based on widespread pain in certain body regions lasting more than three months and severity of that pain. It can and is often accompanied by other symptoms (see below). These symptoms vary in each indivudual.

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).

What causes fibromyalgia?

While causes of fibromyalgia are still largely unknown, the following explanations are under consideration:

• Genetic - Fibromyalgia seems to run in some families

• Trauma or environmental insult (chemicals)

• Stress and other mental health conditions (like stress, anxiety, and depression)

• Neurological disorder(s)

  
  

Symptoms that often accompany the pain of fibromyalgia

• Fatigue

• Joint stiffness

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

• Muscle throbbing, aching

• Excessive skin sensitivity/tenderness to touch

• Numbness or tingling, burning 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, especially IBS (irritable bowel symdrome)

• 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. For this reason, those diseases need to be ruled out before fibromyalgia can be ruled in. Clinching a diagnosis of fibromyalgia can be time-consuming and labor-intensive for both the patient and provider, And, because of all the factors involved, it can be difficult to diagnose. When fibromyalgia presents with other painful diseases, these can make the pain and suffering from fibromyalgia even worse.

Again, there are no scans or blood tests to diagnose fibromyalgia. However, several blood tests are often done to check for the 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

There is no cure. Treatment is targeted to managing the symptoms

• 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

  -Deep breathing exercises - This helps release endorphins in your brain, which are"feel good" hormones. This technique is practiced by taking a deep breath through your mouth using your diaphragm muscle located just beneath your lower ribs (instead of using neck, shoulder and upper chest muscles), pausing and then releasing the breath through the mouth. Repeat this several times.

  -Guided Imagery - Think of a relaxing situation or a place you have been and focus on only that - focusing on texture, smells and visuals.

  -Use Mindfulness - This is when a person focuses on the present moment, feeling and experiencing the moment with awareness and acceptance, not judgment. This reportedly helps the fronto-limbic area of the brain, which is responsible, in great part, for emotional regulation and processing.

  -Try Progressive Muscle Relaxation Exercises: This is done by tightening muscle groups for eight seconds then relaxing them for several seconds: Begin with facial muscles, with the face, moving to the scalp - tighten muscles eight seconds, then relax; then the neck, doing with each muscle group of the chest, back, pelvis, extremities and so on. This releases some tension and stress. If you do not have time to move through all of your muscle groups, do this with those muscles you believe have the most tension.

  -Analytical Meditation - This meditation involves focusing on an object or a concept and focusing on only that.

  -Body Scanning-Focus on a part of your body and feel relaxation, warmth, release of tension

• Yoga

• Tai Chi

• Counseling

• TENS (transcutaneous electrical nerve stimulation) blocks pain nerve transmission.

• ​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 offer 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.

• Relaxing Music

• For some, spirituality can contribute to a deeper sense of control, purpose, and connection, personal control, offering social support, and potentially improving overall health and well-being

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

• Fibromyalgia

  
  

​​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)

• Hypnotics for insomnia if present

• 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

Hopefully, this discussion about pain, symptoms and management of fibromyalgia has given you a starting point to relief. 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.