Are you or a loved one suffering from chronic and unexplained muscle aches and pain throughout the body? A syndrome called fibromyalgia might just be the culprit. It’s the third most common musculoskeletal condition, and while there is not yet a cure, symptoms can be managed. Let’s dive in! 

What is fibromyalgia?  

Fibromyalgia is known for widespread pain and tenderness. Something as simple as a hug can be painful for patients suffering from it. It most commonly begins in middle adulthood but can occur in the teen years and in old age as well and is most common in women. 

Unlike arthritis and other conditions, the pain and tenderness tend to affect the whole body and not specific joints, so if joints aren’t swollen or warm, this is usually a key sign that it is fibromyalgia and not RA. It’s important to make the distinction between the two since they are treated differently. 

It is extremely common for patients with rheumatic diseases like osteoarthritis, lupus, rheumatoid arthritis, or ankylosing spondylitis, as well as gastrointestinal conditions like irritable bowel syndrome (IBS), to also have fibromyalgia. 

Common symptoms of fibromyalgia

• Fatigue
• Sleep disorders like insomnia
• Brain fog
• Memory trouble
• Mood issues
• Depression or anxiety
• Migraine or tension headaches
• Digestive problems: irritable bowel syndrome (commonly called IBS) or gastroesophageal reflux disease (often referred to as GERD)
• Irritable or overactive bladder
• Pelvic pain
• Temporomandibular disorder – often called TMJ (a set of symptoms including face or jaw pain, jaw clicking, and ringing in the ears)

Causes and triggers of fibromyalgia

This topic is heavily debated, and the condition may be different depending on the individual. Research says the involvement of the nervous system, particularly the central nervous system, which includes the brain and spinal cord is involved. It’s not thought to be an autoimmune, inflammation, joint, or muscle disorder, but the new findings suggest that it is caused by immune issues that increase antibodies, triggering the activity of pain-sensing nerves in the body. 

While genes alone are not thought to cause it, fibromyalgia does potentially run in families, making them more prone to getting it. Distress is also thought to be a trigger. A car accident causing spine injuries, any sort of chemical imbalance in the brain, or other physical and emotional stress are thought to be triggers that impact how our bodies interact with our brain and spinal cord. 

Fibromyalgia is also described as a Central Pain Amplification disorder, meaning the volume of pain sensation in the brain is powered up, amplifying the way patients feel pain. Although fibromyalgia can affect the quality of life, it is still considered medically benign and does not cause heart attacks, stroke, cancer, physical deformities, or loss of life.

Diagnosing fibromyalgia

If you’ve followed along for a while, you know that rheumatologists like myself sometimes act as medical detectives. Since I’ve been there personally with my autoimmune issues, I empathize with patients, and getting to the bottom of a mysterious health condition is one of the most rewarding parts of what I do. A diagnosis is the first step toward getting answers and taking action to remedy pain and suffering. 

Diagnosis is typically a process of elimination with fibromyalgia since there are no diagnostic tests, like x-rays and blood panels, that will point directly to it. Doctors might suspect fibromyalgia from the beginning, but they must first rule out lupus, rheumatoid arthritis, hypothyroidism (underactive thyroid gland), polymyalgia rheumatica, and other conditions that have similar symptoms. 

Initially, you’ll undergo a physical exam to detect tenderness and categorize the pain and will then undergo a series of blood tests to determine if it’s one of the conditions mentioned above. 

Treatment of fibromyalgia

There is no cure for fibromyalgia, and I have noticed that traditional treatments for the condition are hit or miss. Some patients don’t respond to them at all, and some experience side effects that outweigh the benefits. 

With all of this said, there is hope! I have always thought that there is something deeper happening when it comes to fibromyalgia, and we’re slowly gaining more insight into it. For now, however, we need to make do with what we do know. 

From an integrative standpoint, we can do so much for fibromyalgia, but from the allopathic side, there are only so many available options for treatment. Symptoms can be treated with medication, alternative therapies, and lifestyle changes. From what I’ve seen, the best outcomes are achieved by taking a multi-layered approach. Here are a few options: 

• Exercise – I probably sound like a broken record, but the solution to pain in the body is often movement, and this is definitely the case here. Aerobic exercises, a walk through the neighborhood, Tai Chi, yoga, and any other type of low-impact exercise will keep patients nimble and feeling much better. 
• Cognitive behavioral therapy – Our minds and bodies communicate back and forth, so addressing psychological barriers is extremely helpful for any chronic condition. CBT is used for treating IBS, IBD, and so many other ongoing health challenges to help patients fully understand their condition, identify behavior patterns that are triggers for flare-ups, and find ways to cope. I am here to treat the mind, body, and soul. There is no shame in addressing mental health, and I am here to help break the stigma around these treatment options. 
• Alternative therapies – Acupuncture, chiropractors, massage therapy, aquatic therapy, and other alternative treatments shouldn’t be overlooked. While there is not much data on their impact, at the very least, these options could relieve tension and stress in the body, which is always recommended. 
• A clean environment – While environmental factors are out of our control in a lot of cases, non-toxic cleaning products, detergents, cosmetics, etc. may be something to consider if you have fibromyalgia since heavy metals and chemicals could trigger a flare-up. 
• Medication – Medication is often an important piece of the puzzle. Even if a patient takes great care of themselves and does what they are supposed to, sometimes, medicine is necessary for recovery. Antidepressants are often prescribed, and Lyrica is the most common drug that is approved to treat fibromyalgia. Pregabalin and gabapentin (Neurontin) are also options, but all of these options often have side effects like dizziness, sleepiness, swelling, and weight gain. Depending on the situation, the benefits sometimes outweigh the symptoms. Narcotics are usually not advised because they are not effective in treating the condition, but sometimes Tramadol is used in specific cases. Over-the-counter medicines like Tylenol, aspirin, Advil, and Motrin are typically not effective either, but they can sometimes help with the pain triggers of the condition. 

Like any health issue, getting to the root cause is the goal when treating fibromyalgia. This often takes a great deal of trial and error to determine a patient’s response to treatment options and causes of flare-ups. 

A note to fibromyalgia patients: have hope 

We’ve come a long way in the medical field, so if you have recently been diagnosed with fibromyalgia or a similar condition, my main message is to have hope. This life is a journey, and we’re sometimes faced with challenges, but stay strong! 

While it is a difficult condition to be faced with, and chronic pain is never pleasant to deal with, the good news for my fibromyalgia warriors out there is that you do not have to worry about damage to your organs and other life-threatening impacts as a result of your condition. Focusing on self-care, managing your pain, and keeping a positive mindset should be your main mission. 

Develop a solid relationship with your doctor, be open-minded with treatment options, and advocate for yourself. While it might feel extremely hard now, it is possible to reduce your pain and take back your life.