Fibromyalgia
- Dr Sundeept Bhalara, Consultant Rheumatologist and Physician
Fibromyalgia is a long-term (chronic) condition that causes widespread pain in your body. You may also have trouble sleeping, feel tired, and have problems with your memory.
There’s no cure for fibromyalgia but there are ways to manage the condition and help ease your symptoms.
About fibromyalgia
In fibromyalgia, there seems to be a problem with the way your brain and nervous system process pain. This means that you feel pain all around your body, even when there isn’t any damage to your muscles or other tissues. Although there may not seem to be any obvious reason for your pain, the pain you feel is still very real. The same changes in your brain that affect how you process pain can also affect your memory, mood, and sleep patterns.
Fibromyalgia is a common condition – it’s thought to affect up to 1 in 20 people. It’s much more common in women than in men. Most people with fibromyalgia start to get symptoms between the ages of 20 and 60. You’re more likely to get it as you get older, but children can get it too.
Causes of fibromyalgia
It’s not clear exactly why some people develop fibromyalgia, but there are certain things that seem to increase your risk.
Fibromyalgia runs in families. You’re more likely to get fibromyalgia at some time in your life if one of your relatives has it. It’s linked to other chronic pain disorders too, such as irritable bowel syndrome (IBS) and temporomandibular joint disorder. So, if you or someone in your family has one of these conditions, you may be more likely to get fibromyalgia.
It’s thought that certain things may trigger symptoms of fibromyalgia. These can include:
- traumatic events such as a car crash
- having major surgery
- having a serious infection such as the Epstein–Barr virus (EBV) that can cause glandular fever
Sleep problems may also play a role in triggering fibromyalgia symptoms. Lack of sleep can affect nerve pathways that control pain, and this can make your symptoms worse.
Symptoms of fibromyalgia
The main fibromyalgia symptoms include:
- widespread pain in your body, which often affects your neck and shoulders or your lower back
- oversensitivity to touch, light, sounds or smells – even a slight touch may seem painful
- feeling stiff, especially when you wake up – it may get worse by the end of the day too
- feeling very tired and lacking energy
- sleeping badly and waking up unrefreshed
- problems with your memory or thinking clearly (sometimes called ‘fibro fog’)
- changes in your mood
- ‘pins and needles’ or tingling feelings
- headaches
These symptoms may get worse in cold weather or if you’re feeling stressed. If you’re getting these symptoms on a regular basis, contact your GP for advice.
Other health conditions can be associated with fibromyalgia. These include:
- irritable bowel syndrome (IBS)
- anxiety and depression
- an irritable bladder, which can make you want to pee a lot
- restless legs syndrome
- premenstrual syndrome (PMS)
- Raynaud’s phenomenon
Nearly one in three people who are diagnosed with fibromyalgia have symptoms of depression. If you’re finding it difficult to manage pain or lack of sleep, this can make you feel depressed. It’s also possible that fibromyalgia and depression can come about in the same way – through changes to chemicals in your brain.
Diagnosis of fibromyalgia
Your GP will usually be able to diagnose fibromyalgia based on your symptoms, and by ruling out other potential causes for your pain. They’ll ask you about your symptoms, your general health, and your medical and family history. They may check different parts of your body to find exactly where you’re getting pain. Your GP may also ask you how severe other symptoms are, including tiredness, sleep problems, and memory problems. The more parts of your body that are affected and the more severe your symptoms are, the more likely you are to have fibromyalgia.
Your GP will also examine you to check for signs of other conditions that could be causing your pain.
There’s no specific fibromyalgia test. But your GP may do some blood tests to rule out other conditions with similar symptoms to fibromyalgia.
Sometimes, your GP may refer you to a specialist for further tests or treatment. These may include one or more of the following.
- A pain specialist, who may be based in a pain clinic.
- A musculoskeletal (MSK) specialist such as a physiotherapist or MSK physician (health professionals who specialise in treating conditions that affect muscles and joints).
- An occupational therapist, who can help you manage your everyday activities.
- A rheumatologist (a doctor who specialises in identifying and treating conditions that affect the muscles and joints).
- A psychologist (a doctor who specialises in mental health and psychological treatments).
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Self-help for fibromyalgia
A big part of managing fibromyalgia is learning to understand your condition and what you can do to help yourself. Different things work for different people. But the following tips may help.
- Learn about fibromyalgia and the ways you can manage it. It may help to share this information with your family and friends so they can support you.
- Pace yourself. Work within your limits and break up tasks into smaller sections if that helps.
- Do some exercise every day if you can, even if it’s just a little. For more information about exercise for fibromyalgia, see our section on treatment.
- Try to get into a good sleep routine to help with tiredness.
- Learn some relaxation techniques. Try to do something you find relaxing each day, especially before bedtime.
- Have a warm bath or apply heat with a hot water bottle to help ease pain and stiffness.
- Practising mindfulness may help.
- Keep to a healthy weight. Early research suggests that your symptoms can be worse if you’re very overweight and treatments might not work as well.
Treatment of fibromyalgia
There isn’t a cure for fibromyalgia, but there are fibromyalgia treatments and things you can do to help ease your symptoms. Often a number of health professionals will be involved in your care, and your treatment will involve a combination of different fibromyalgia therapies. As you get to understand your condition better, you can work together with your doctors and therapists to find the best fibromyalgia treatments for you.
Exercise
If you have fibromyalgia, it can be really helpful to keep active with regular exercise. Exercise can help to provide fibromyalgia pain relief and help stiffness, increase your strength, and improve how easily you move around. It can improve your general wellbeing too.
Aim to do some exercise every day, incorporating the following types
- Aerobic exercise to get you breathing harder and faster.
- Resistance (strengthening) exercise to strengthen muscles and protect joints.
- Stretching exercises to increase flexibility.
Your doctor or physiotherapist may advise you on exercises for fibromyalgia and how to exercise safely and effectively. They may recommend an exercise programme for you. It’s usually best to start slowly, gradually building up the time you spend being active each day. Walking or swimming are both good forms of exercise to start with. Be patient – you may find your pain and tiredness get worse at first, but they should improve.
Other activities that combine exercise and relaxation – for example, yoga and t’ai chi – might also help with some of the symptoms of fibromyalgia.
Talking therapies
Your doctor may recommend a talking therapy called cognitive behavioural therapy (CBT). It helps to challenge negative thoughts, feelings and behaviours, and how you manage pain. You may be able to see a CBT therapist or access the treatment online.
Complementary therapies
Your doctor may suggest you try a course of acupuncture to see if this helps your symptoms. Acupuncture involves a therapist inserting fine needles into specific areas of your body to relieve pain. It should be delivered by a health professional with appropriate training in the therapy.
There isn’t enough evidence to support use of other therapies for fibromyalgia such as transcutaneous electrical nerve stimulation (TENS) machines or ultrasound.
Medicines
Doctors will usually recommend focusing on other fibromyalgia therapies before they suggest medicines to treat fibromyalgia. This seems to be better for managing fibromyalgia symptoms in the long term, and will avoid you depending on medicines. But if you’ve tried other options for managing your symptoms without success, your doctor may offer you fibromyalgia treatment with an antidepressant. Antidepressants are often used to help with sleep problems and pain, even if you don’t have depression. To help with sleep, your doctor may offer you a medicine that’s normally used to treat epilepsy.
Other types of medicine have previously been used in the treatment of fibromyalgia, including non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, and opioids. If you’re already taking one of these medicines for fibromyalgia, your doctor may talk to you about whether or not to continue taking it.
Living with fibromyalgia
It can be difficult to stay positive when you’re in pain and feeling tired. Long-term pain can make you feel isolated and lower your mood. It can help to stay connected with friends and family. You could also consider joining a support group. Ask your GP practice if they know of any local support groups.
If you find work challenging because of pain or tiredness, talk to your employer to discuss your options. Work can be a good thing for many reasons, such as keeping up your physical abilities, self-esteem, confidence, and social relationships. It’s worth exploring if you can make some changes that may allow you to keep working. You may be able to make some adaptations to your workplace. Or you may be able to work flexible hours or have rest breaks to cope with tiredness. An occupational health adviser or therapist may be able to help you with this.
If you’re not in work, it’s a good idea to build other things into your life – for example, taking up a new hobby. This could be a distraction from the pain of your condition and can help you to keep active and expand your social life.
Fibromyalgia runs in families so it may be linked to your genetic make-up. You’re more likely to get fibromyalgia at some time in your life if one of your relatives has it. If you go through a traumatic event, such as a car crash or serious illness, that may also trigger fibromyalgia.
For more information, see our section on causes of fibromyalgia.
There isn’t a specific test for fibromyalgia. Instead, your doctor will usually be able to diagnose it by asking about your symptoms. They’ll want to know which parts of your body are affected and how severe the pain is. They may do some blood tests to rule out other conditions.
You can find more details in our section on diagnosis of fibromyalgia.
Fibromyalgia won’t go away, but there are various therapies and things you can do to help ease your symptoms. An important part of managing fibromyalgia symptoms is to keep active with regular exercise. Getting good control of your fibromyalgia will help you to manage your symptoms and live a full life.
The symptoms of fibromyalgia are widespread pain that affects different parts of your body, as well as problems with sleep. You may feel very tired and not have much energy.
For more details, see our section on symptoms of fibromyalgia.
The part of the body that fibromyalgia affects the most is often your neck and shoulders, or your lower back. But you can feel pain all around your body.
For more details, see our section on symptoms of fibromyalgia.
Sometimes your symptoms of fibromyalgia can flare up, and you can suddenly feel worse. Symptoms such as pain will feel more intense during a fibro flare-up. It’s important to take care of yourself when this happens. Make sure you pace yourself and don’t do too much. And you might find relaxation techniques helpful.
Your symptoms can fluctuate over time and there may be times where you feel better than usual.
Benefits of exercise
Not only does regular exercise help you manage your weight and reduce your risk of developing diseases, it can help prevent and treat mental health problems
Other helpful websites
Discover other helpful health information websites.
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- Rachael Mayfield-Blake, Freelance Health Editor
