Dr. Maggie Cadet, Board Certified Rheumatologist and Director of The Bone and Joint Health and Osteoporosis Center at the Spine & Pain Institute, explains Fibromyalgia.
Fibromyalgia is a chronic health condition that can cause widespread musculoskeletal pain. Contrary to popular belief, it does not cause systemic inflammation and it is not considered an autoimmune disease. Individuals may have a chief complaint of symptoms such as tenderness to touch/pressure (for at least 3 months), severe fatigue, sleep disturbance or waking unrefreshed from sleep, impaired memory or a reduced ability to think clearly (“foggy state”). In the clinical history, an individual may also report a personal history of conditions including: Migraine or tension headaches, anxiety and/or depression, irritable bowel syndrome (IBS) or gastroesophageal reflux disease (GERD), irritable or overactive bladder, pelvic pain, temporomandibular jaw pain or sleep disorders (restless leg syndrome, sleep apnea).
Diagnosis is dependent on a subjective clinical history. There may be specific tender points on the body that are present on a physical exam. There is no specific blood test or imaging to diagnose Fibromyalgia but often these are used to rule out other conditions with a similar presentation, like hypothyroidism (underactive thyroid), rheumatoid arthritis and lupus.
Remember, rheumatoid arthritis and lupus can cause inflammation in joints and various organs.
There is no known direct cause of Fibromyalgia, however certain factors are believed to increase the risk of development
- Gender: Women have a higher prevalence than men
- Genetics: Certain genetic mutations may increase your risk of developing Fibromyalgia – but genes alone do not cause fibromyalgia
- Existing conditions: People with autoimmune disease including Lupus, Rheumatoid Arthritis are thought to be at an increased risk of developing Fibromyalgia. Osteoarthritis (“wear and tear arthritis” may also be a factor)
- Stress/trauma: Physical trauma, like a car accident; emotional or psychological stress such as a bereavement may also trigger Fibromyalgia
A healthcare professional may monitor for depression and anxiety in individuals with fibromyalgia due to the chronic pain and sleep disturbance that may be experienced with Fibromyalgia.
Although there is no cure for Fibromyalgia, medication, lifestyle modifications and alternative therapies may help relieve symptoms and improve quality of life.
- Physical Activity and exercise: low-moderate impact aerobic activity such as walking, cycling swimming, yoga and tai-chi can be beneficial in improving one’s quality of life. Low impact exercise is not harmful, although some pain may be experienced initially. A patient should consult with a physician and or physical therapist to confirm what exercise regimen is best for the individual.
- Cognitive behavioural Therapy (CBT) may help an individual better comprehend how specific thoughts and behaviours may impact pain. CBT may result in stress and tenderness reduction.
- Diet and Nutrition: Lifestyle modifications such as avoidance of excess alcohol, caffeine, and sugar and ensuring a diet rich with nutrients and adequate hydration can help improve symptoms by improving self-care.
- Recognizing and identifying triggers for fibromyalgia as well as participating in activities that reduce stress and anxiety such as meditation, mindfulness, and deep breathing exercises are crucial.
- Correcting and enhancing sleep patterns can help reduce sleep disturbances and encourage relaxation.
- Medications: There are some approved drugs to help treat Fibromyalgia and reduce pain. These drugs can include duloxetine (Cymbalta), milnacipran (Savella), Lyrica (pregablin) or gabapentin (Neurontin), however your doctor will determine the best course of treatment depending on your individual presentation. Other medications such as acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs (NSAIDS) or cyclobenzaprine (Flexeril) may be useful to treat other causes of pain that can be seen with fibromyalgia such as arthritis and muscle pain. Opioid narcotic medications and sleep medications such as benzodiazepines should be avoided.
A rheumatologist specializes in the treatment of musculoskeletal and autoimmune disease. As symptoms of fibromyalgia often mimic some autoimmune diseases, it is often a rheumatologist who will evaluate the patient for other autoimmune diseases such as rheumatoid arthritis. A primary care physician in addition to other specialists such as a physiatrist, sleep medicine doctor, psychiatrist or therapist may be involved in creating a treatment plan aiming to help the patient self-manage their fibromyalgia long term and continue monitoring an individual’s progress.
This information is for educational purposes only, not as medical advice or as a diagnosis. Please see your physician should you have any questions, symptoms or any concerns. For more information: www.rheumatology.org, www.mayoclinic.org, www.fmaware.org.