Understanding Fibromyalgia

You may not have heard or known about fibromyalgia, but if you have you’ll know it can often be a very difficult condition to live with. Even if you have heard of it, or have been diagnosed with fibromyalgia you may not understand it completely; let’s break it down and look at what you can do to help your pain and discomfort, and what you can do to manage some of your symptoms.

First off, what is fibromyalgia?

Fibromyalgia (FM) is defined as a chronic or widespread musculoskeletal pain syndrome (tenderness in and around the body, sensitivity to touch). People with FM often experience tenderness, amplified pain and severe fatigue, but each person will experience symptoms differently.

The pain severity can fluctuate and can present as a different pattern throughout the year, FM is more common in Northern Hemisphere countries where their Winters are longer.

There are two key symptom groups, central and amplified sensations -

• Central symptoms include:
  • Bad sleep, fatigue, cognitive fog, poor memory/concentration, emotional distress, mood disturbances
• Amplified sensations:
  • Pain & sensory symptoms, e.g - noise, ringing in ears, light sensitivity, bowel/bladder issues, nausea w/ food & medications, peripheral dysaesthesia
• Other syndromes - IBS & bladder issues, restless legs, regional pain syndrome, hypotension, chronic fatigue, chemical insensitivity

It is (currently) thought that FM is caused by a trigger or stressor in a person’s life that brings about an onset of psychological symptoms. These symptoms cause changes in the brain due to the psychological effects and create different activity of the stress pathways i.e poor coping skills, catastrophization. The alteration of stress pathways causes pain related networks within the brain to not work well, linking emotion and stress to the body. This causes spinal cord alteration, creating a central sensitisation - meaning, the spinal nerve centre becomes too sensitive and normal low level sensation (movement, touch, posture) access the pain systems and can cause pain. Muscle tissue tightens as pain chemicals are released, causing pain and changes in the small nerves.

Getting diagnosed:

A FM diagnosis can often come with other conditions - there is typically a 30-50% overlap with other conditions in people who have fibromyalgia.

There are no blood tests that can be completed to diagnose FM, although blood tests are completed to rule out other conditions such as rheumatoid arthritis, hypothyroidism and menopausal hormones.

Fibromyalgia will be diagnosed by a rheumatologist, using a set of criteria questions that will identify and rate the severity of your symptoms and pain. This helps to understand if your pain is widespread or generalised.

With those who have FM, pain will be found within each four quadrants of the body (think of a line that divides your left and right, and another that divides your top and bottom half of your body at your abdomen, these are your four quadrants).

Where to from here? (Treatments)

Well, there is no current cure or medication directly for fibromyalgia.The focus is on managing symptoms and their severity.

When treating fibromyalgia, a holistic combination of approaches needs to be looked at:

Education and understanding - It’s important to understand pain and how it impacts the body, as well as the condition itself (hopefully this blog has been of some help). Ensure you gain an understanding of the symptoms you experience so that the right resources and help can be enlisted to manage symptoms effectively and to ensure you have the right understanding around the condition.

Support - often people with fibromyalgia may find it difficult to work and socialise not only due to the pain and discomfort, but people with FM may also experience depression and anxiety which can be isolating. It’s important to try and maintain a good social support network, a team of people by your side to help and support you.

Medications - there are no direct medications that help treat fibromyalgia so it’s important to consider medication carefully. However some medications may assist with managing symptoms, such as helping to improve sleep and/or emotional state, it’s important to speak to your Doctor about these.

Psychology & Management -

Managing stress, emotional distress and catastrophisation is important in managing symptoms. Heightened stress may cause an increase in severity of symptoms. It may be helpful to seek professional help in identifying the main stressors in your life that may be impacting your emotional wellbeing and enlisting strategies to manage and prevent a heightened emotional state. Manage stress = manage fibromyalgia.

Exercise - Exercise may be the most important management strategy of them all. Regular exercise has been found to be one of the most effective ways to help manage fibromyalgia and its umbrella symptoms. There are a variety of exercises that are recommended and include Pilates, aerobic exercise (low impact - walking, swimming, cycling, etc), resistance training, tai chi and yoga (basically anything to get the body moving).

Evidence has shown exercise to have positive effects on global wellbeing, depression, physical function, pain and tender points in those who have fibromyalgia. It’s important to find your optimal type of exercise to avoid exercise-related pain, musculoskeletal injury and fatigue.

You may also find it helpful and relieving to enlist a Physiotherapist or Massage Therapist to treat local pain generators by loosening tight muscles and addressing trigger points.

Written by Kisani Hutton - Remedial Massage Therapist

References:

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003786.pub2/full

https://link.springer.com/article/10.1007/s11916-011-0214-2

https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1756-185X.2012.01767.x