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Fibromyalgia

Fibromyalgia is a long-term (chronic) condition that causes pain in different places in your body. It can also cause tiredness as it affects your sleep. Around two in 100 people have fibromyalgia, but it could well affect more people than this as it can be difficult to diagnose.

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  • About Who does fibromyalgia affect?

    Most people with fibromyalgia start to get symptoms between 20 and 60. It’s more common with increasing age. But children can get fibromyalgia too – some people who are diagnosed with fibromyalgia as adults are found to have had it since childhood.

    Fibromyalgia is 10 times more common in women than men.

  • Symptoms Symptoms of fibromyalgia

    The main symptom of fibromyalgia is widespread pain in your body. How this feels to you will vary. It may feel like a deep ache in your muscles, or you may feel a burning, throbbing, intense and persistent pain all over your body. Your joints might feel sore too. The pain may be worse at some times than others and move about to different areas of your body. Fibromyalgia can often make you more sensitive to pain – you might find that even the slightest touch is painful.

    Fibromyalgia can cause other symptoms too, which include:

    • feeling stiff, especially when you wake up
    • feeling tired
    • sleeping badly
    • problems with your memory or thinking clearly
    • changes in your mood

    If you’ve had these symptoms for at least three months, go and see your GP to get some help.

    Other symptoms and health conditions can be associated with fibromyalgia. These include:

  • Diagnosis Diagnosis of fibromyalgia

    Your GP will ask about your symptoms and examine you. They may also ask about both you and your family's medical history.

    Your GP will see how widespread the tenderness is in your muscles and joints. If you have lots of 'trigger points' without symptoms of any other joint or muscle disease, you're more likely to have fibromyalgia.

    There are no blood tests, X-rays or scans that can diagnose fibromyalgia. But your GP may do some blood tests to rule out other conditions with similar symptoms to fibromyalgia.

    Your GP may refer you to see specialists for further tests and treatment. These specialists might include:

    • a pain specialist
    • a rheumatologist (a doctor who specialises in identifying and treating conditions that affect the muscles and joints)
    • a neurologist (a doctor who specialises in identifying and treating conditions that affect the central nervous system)
    • a psychologist (a doctor who specialises in mental health and psychological treatments)
    • a physiotherapist
  • Self-help How to help yourself

    Pacing

    One way of coping with the symptoms of fibromyalgia involves looking at how you do things and finding ways to make tasks more manageable. One way to do this is by ‘pacing’. This means working within your limits to do what you can without aggravating the pain or making yourself even more tired. On a good day, you may feel you can catch up on many things you didn’t feel able to do on a bad day. But be careful that this doesn’t lead to a cycle of doing too much in one go, followed by being able to do very little. Pace yourself.

    Heat treatment

    Heat may help to ease your pain. A hot bath or shower might help, or soak your hands or feet in warm water. Using heat pads on painful areas may reduce pain and stiffness too.

    Relaxation

    You might find it helpful to learn a relaxation technique and do this before you go to bed to help you sleep. Ask your GP to direct you to information on how to learn these techniques. It's important to take steps to improve your sleep as your body needs it to stay healthy. See our information on The science of sleep to learn more about why we need sleep and how much. We also have information on How to get a good night's sleep.

    Mindfulness

    Practising mindfulness may be helpful, as it might ease pain and improve your quality of life. See our blogs on Mindfulness for tips and advice about how to integrate it into your life.

  • Treatment Treatment of fibromyalgia

    There isn’t a cure for fibromyalgia, but there are treatments to help you to manage the symptoms. A key part of treating fibromyalgia is to educate yourself about the condition and to work with your doctors to find treatments that help you. Often you’ll need to use a combination of treatments to ease your symptoms.

    Many people with fibromyalgia who get treatment can manage their symptoms and live a full life. The condition doesn't damage your joints or affect your lifespan.

    Physical therapies

    Doing some exercise every day is really important if you have fibromyalgia. It can help relieve pain and stiffness, increase your strength and how easily you can move around. You’ll get an increased sense of wellbeing too.

    Starting to exercise when you’re in pain and feeling exhausted may, at times, seem like an impossible task. But help is out there. You can get advice from your doctor, or see a physiotherapist to get tips on how to exercise safely and effectively. This may mean starting with a few minutes of gentle stretching and gradually building up the time you spend doing this each day.

    Walking or water-based exercises are both good forms of exercise to start with. Aim to exercise every day to start with, and then work on increasing how long you exercise for. You could start by walking for five minutes for the first week and then increase this by one minute for each subsequent week. Make a future target of exercising for at last half an hour every day.

    Other activities that combine exercise and relaxation, like yoga and t’ai chi, might also help with some of the symptoms of fibromyalgia, particularly difficulty sleeping. T’ai chi is a mind–body practice that originated in China as a martial art. It combines meditation with slow, gentle, graceful movements, as well as deep breathing and relaxation, to move vital energy through your body. It’s shown promise for fibromyalgia in small studies. It has reduced symptoms such as pain, sleep quality, depression, and improved the quality of life of patients with the condition. The next steps are to test it in greater numbers of people to prove it works. In the meantime, it’s probably worth giving these types of exercise a go to see if they help you.

    See Related information for more tips and advice about exercise.

    Talking therapies

    A talking therapy called cognitive behavioural therapy (CBT) may help if you have fibromyalgia. It helps to challenge negative thoughts, feelings and behaviours, and how you manage pain. You can either see a CBT therapist or access the treatment online.

    Medicines

    Medicines can be very helpful in some people with fibromyalgia. But they don’t work for everybody, and some people can’t cope with the side-effects. Your GP will talk you through your options and what’s best for you. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or GP for advice.

    You may find over-the-counter painkillers, such as paracetamol and ibuprofen, help to relieve pain caused by fibromyalgia. But these don’t work for everyone. If they don’t work for you, your GP may refer you to a pain clinic, or consider stronger medicines.

    Your GP, or the doctors at the clinic, will give you advice about how to manage pain. And they might prescribe you a stronger pain medicine, such as tramadol. Tramadol works best if you take it just for a short time.

    Other medicines, such as ones called pregabalin and gabapentin, may help with both pain and tiredness. These medicines work by blocking the activity of nerve cells involved in transmitting pain. You’ll need a prescription for these.

    Your doctor may prescribe you a low dose of an antidepressant, such as amitriptyline or fluoxetine. This is because the nerve cells involved in transmitting pain are the same as those involved in depression. Antidepressants block the action of these and will, therefore, help to control pain from fibromyalgia. Some antidepressants can also improve your sleep. When doctors prescribe antidepressants for fibromyalgia, it’s called off-label use. This means the medicine is being used to treat a condition that it hasn’t been licensed for. So, you won’t see anything about fibromyalgia in the patient information leaflet that comes with the medicine. A doctor can legally prescribe outside the licence if they feel the medicine will benefit you.

    Complementary therapies

    You might find that complementary therapies such as acupuncture or hydrotherapy help to ease pain, stiffness and tiredness, and improve your quality of life. There isn’t strong scientific evidence that they work but you might decide to give them a try.

  • Causes Causes of fibromyalgia

    Doctors don’t know the exact reasons why you may develop fibromyalgia yet. They’re currently investigating a number of theories to try to pinpoint the cause so that they can develop treatments for it. So far, they’ve found that people with fibromyalgia have high levels of certain pain chemicals in their nervous system. They also have low levels of chemicals that can damp down a pain response. For these reasons, it seems possible that, if you have fibromyalgia, you have a heightened sense of pain that lasts longer than usual.

    Fibromyalgia may run in families. You’re more likely to get fibromyalgia at some time in your life if one of your relatives has it.

    Some people with fibromyalgia have been through a traumatic event before the condition begins, such as a car accident or serious illness. It’s possible that events like this might trigger the start of fibromyalgia.

  • Prompt access to quality care

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  • Living with fibromyalgia Living with fibromyalgia

    Your family, friends and work colleagues may be able to help you live more easily with fibromyalgia in various ways. If they offer help, encourage them to learn more about fibromyalgia with you so they understand what you’re dealing with. They may be able to help you with tasks that you find too painful or tiring sometimes or support you with your exercise goals. It’s much more fun to exercise with friends than on your own, so it may keep you going to reach your targets.

    In some people, the symptoms of fibromyalgia can make you feel isolated and depressed, so it’s important to maintain your social circle. Although the last thing you might feel like doing is going out, it can really help to improve your wellbeing.

    Fibromyalgia and work

    Work can be challenging for some people with fibromyalgia. If you need help at work to deal with the pain, have a chat with your employer to discuss what your options are. You may be able to keep working if you make some adaptations to your workplace. An occupational health adviser can help you with this.

    If your symptoms are really bad, you may feel that you have to stop working. But it’s important not to rush into this decision. Work can be a good thing for many reasons – keeping up your physical abilities, self-esteem, confidence and social relationships. It may increase your awareness of the pain and tiredness if you have fewer things to focus on. It’s a good idea to take a short period of sick leave first to see how you get on before you make your decision. Your GP or specialist doctor can help you make this decision. Support groups are a wealth of information too.

    If you do give up work, it’s a good idea to build other things into your life such as taking up a new hobby. These could be a distraction from the pain of your condition, and will keep you active and may even expand your social life. After all, your quality of life is key.

  • FAQ: Welfare benefits Can I apply for any welfare benefits?

    It can be challenging to continue working if you’re often in pain and tired from having fibromyalgia. If you feel your only option is to stop working, you may be able to apply for welfare benefits. You’ll need to meet certain criteria to be eligible, based on how much fibromyalgia affects your ability to work and take care of yourself.

    There are different types of benefits, and they all have different criteria to meet. These include:

    • personal independence payment
    • employment and support allowance
    • attendance allowance (if you're 65 or over)

    For more information about welfare benefits, see the GOV.UK website, your local job centre or Citizens’ Advice Bureau.

  • FAQ: Fibromyalgia and depression Can I get both depression and fibromyalgia?

    Yes, you may find you feel depressed if you have fibromyalgia because these two conditions may be linked.

    Fibromyalgia has a range of symptoms, which can affect different aspects of your health and wellbeing. If you find it difficult to manage your symptoms and are in pain, or don't get much sleep, you may feel depressed. It’s also possible that whatever is causing your fibromyalgia also causes depression, such as low levels of certain brain chemicals.

    It can be difficult to stay positive when you’re in pain and feeling tired. You may find a short course of antidepressants helps to bring back some balance. But it's important to make some changes so that you can manage your fibromyalgia better in the long term. You might find that cognitive behavioural therapy (CBT) helps you to achieve this. This helps to challenge negative thoughts, feelings and behaviours, and how you manage pain.

    Go and see your GP to get some advice, or get in touch with a support group to learn how others cope best.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis 2017; 76(2):318–28. doi: 10.1136/annrheumdis-2016-209724
    • Fibromyalgia. BMJ Best Practice. bestpractice.bmj.com, last updated 12 August 2016
    • Patient booklet. Fibromyalgia Action UK. www.fmauk.org, published 19 April 2010
    • Fibromyalgia. Medscape. emedicine.medscape.com, updated 31 July 2016
    • Fibromyalgia (fibrositis). PatientPlus. patient.info/patientplus, last checked 24 November 2014
    • What treatments are there for fibromyalgia? Arthritis Research UK. www.arthritisresearchuk.org, accessed 8 March 2017
    • Participant information for pain management programmes. The British Pain Society. www.britishpainsociety.org, published November 2013
    • Rheumatology. Oxford handbook of clinical medicine (online). Oxford Medicine Online. oxfordmedicine.com, published January 2014
    • Insomnia. BMJ Best Practice. bestpractice.bmj.com, last updated 26 January 2017
    • Geneen LJ, Moore RA, Clarke C, et al. Physical activity and exercise for chronic pain in adults: an overview of Cochrane reviews. Cochrane Database of Systematic Reviews 2017, Issue 1. doi: 10.1002/14651858.CD011279.pub2
    • Busch AJ, Webber SC, Richards RS, et al. Resistance exercise training for fibromyalgia. Cochrane Database of Systematic Reviews, Issue 12. doi: 10.1002/14651858.CD010884
    • Wang C, Schmid CH, Rones R, et al. A randomized trial of tai chi for fibromyalgia. N Engl J Med 2010; 363(8):743–54. doi: 10.1056/NEJMoa0912611
    • Cognitive behavioural therapy. Royal College of Psychiatrists. www.rcpsych.ac.uk, updated July 2013
    • Derry S, Cording M, Wiffen PJ, et al. Pregabalin for pain in fibromyalgia in adults. Cochrane Database of Systematic Reviews 2016, Issue 9. doi: 10.1002/14651858.CD011790.pub2
    • Opioid analgesics. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, reviewed April 2017
    • Cooper TE, Derry S, Wiffen PJ, et al. Gabapentin for fibromyalgia pain in adults. Cochrane Database of Systematic Reviews 2017, Issue 1. doi: 10.1002/14651858.CD012188.pub2
    • Gabapentin and pregabalin. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, reviewed February 2017
    • Off-label or unlicensed use of medicines: prescribers’ responsibilities. GOV.UK. www.gov.uk, published April 2009
    • Deare JC, Zheng Z, Xue CCL, et al. Acupuncture for treating fibromyalgia. Cochrane Database of Systematic Reviews 2013, Issue 5. doi: 10.1002/14651858.CD007070.pub2
    • Bidonde J, Busch AJ, Webber SC, et al. Aquatic exercise training for fibromyalgia. 2014, Issue 10. doi: 10.1002/14651858.CD011336
    • Self-help and daily living for fibromyalgia. Arthritis Research UK. www.arthritisresearchuk.org, accessed 8 March 2017
    • Workplace health: long-term sickness absence and incapacity to work. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, 25 March 2009
    • Questions and answers about fibromyalgia. National Institute of Arthritis and Musculoskeletal and Skin Diseases. www.niams.nih.gov, published July 2014
    • Personal independence payment (PIP). GOV.UK. www.gov.uk/pip, last updated 7 March 2017
    • Employment and support allowance (ESA). GOV.UK. www.gov.uk, last updated February 2017
    • Attendance allowance. GOV.UK. www.gov.uk, last updated 27 February 2017
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    Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, May 2017
    Expert reviewed by Dr Sundeept Bhalara, Consultant Rheumatologist and General Physician
    Next review due May 2020

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