What is Fibromyalgia?
Put simply, Fibromyalgia is a chronic pain syndrome that affects multiple parts of the body for no apparent reason, but it isn’t just a pain syndrome as there are other effects throughout the body, ranging from fatigue, digestive problems and more. In today’s article, we are going to look, in-depth, at Fibromyalgia but be warned, nobody fully understands it or the best ways to treat it. This being said, we will see what the current research has to say on the subject.
How many people suffer from Fibromyalgia?
This is a difficult question to answer accurately because it is often left undiagnosed. For example, in a population survey by Vincent et al (2013), they found that 7.7% of women and 4.9% of men could be considered to have Fibromyalgia according to ACR 2010 criteria for Fibromyalgia, but, only 27% of the people who met the criteria had actually been formally diagnosed Fibromyalgia! This means that diagnosed Fibromyalgia is as low as 2% in women and only 0.15% in men but this is likely much higher in reality.
Why is Diagnosed Fibromyalgia lower than the true amount?
The reason may be due to the presence of incidental findings on scans being considered to be the cause of the symptoms and yet they may not be symptomatic problems and in fact, Fibromyalgia may be the true cause. Another reason is that some people don’t pursue the diagnosis, as you essentially rule out all other conditions first and people essentially bail out of the process because it is so lengthy. Another reason could be that people may feel silly because they have a condition with no real cause or reason and this would be more likely true in men than women.
Click the image below to find out more about misdiagnosis in general:
What are the symptoms of Fibromyalgia?
The big problem for sufferers of Fibromyalgia is that there are no outward signs of the condition, meaning they may look well but feel awful.
This creates a stigma as people may not believe them and people don’t understand how they can have the problems they have. The symptoms are very individual and often vary from day to day, the pain level and can be mild or very severe at random times for no apparent reason.
Fibromyalgia is often permanent or at least very long-standing. The common list of symptoms are aching or burning pain in various areas of the body. These locations can change but are more severe in areas of the body that you use the most. Fatigue is also very common in Fibromyalgia and this fatigue can be extreme in some people.
Other symptoms are below:
Diarrhoea and abdominal pain
Feeling an urgent need to urinate
Poor circulation to your hands and feet
Depression or anxiety
Forgetfulness or confusion
Obviously, these symptoms could be from another cause so it is advisable to get checked out by your G.P to clear other conditions first.
What causes Fibromyalgia?
No-one really knows!
Yes, we still don’t know! Welcome to the human body! However, we have some theories about what causes fibromyalgia, but the issue as always, is it a cause or an effect?
Abnormal pain messages
The first theory is one of the main ones and it is that people with fibromyalgia have become hypersensitised in their central nervous system. This effectively relates to the sympathetic nervous system, which is your fight or flight response part of your central nervous system. When this fight or flight is over-activated then you will get responses that relate to fight or flight and protection responses such as, increased pain, poor sleep, poor digestion etc. Think about it, this is what your body is meant to do in an acute stress response but the problem with fibromyalgia is that this isn’t short term, it is long term and this is a problem.
The problem with this theory is we don’t know why exactly this occurs but it could be the result of changes to chemicals in the nervous system that trigger from something like chronic stress for example.
This theory is based on research that has found that people with fibromyalgia have low serotonin, noradrenaline and dopamine in their brains. Once again this could be a cause but equally could be an effect but these chemicals are important for normal function and if they are low then it will negatively affect the following:
Response to stress
Perception of pain
Another chemical that is not at the correct level is the stress hormone, cortisol, which has been found to be raised in fibromyalgia. This again adds to the stress fight or flight response more in fibromyalgia.
Even though poor sleep is a symptom of fibromyalgia it may be possible that disturbed sleep patterns may, in fact, be a cause of fibromyalgia but this is again unknown. What we do know is that fibromyalgia can prevent you from sleeping deeply and cause extreme tiredness in some sufferers.
We also know that poor sleep affects pain itself and this is seen in the fact that people with fibromyalgia who sleep badly, often have higher levels of pain. Check out the video below on how pain is affected by lack of sleep:
It would seem that people get fibromyalgia after a trigger and some research has suggested genetics may be why some people develop it after a known trigger of fibromyalgia and some don’t.
So what are the possible triggers of fibromyalgia?
Fibromyalgia is often triggered by some form of stress, such as physical or emotional or psychological stress.
The known triggers for fibromyalgia include:
After a virus
After an injury
After having an operation
After giving birth
Following the breakdown of a relationship
Being in an abusive relationship
Sometimes the trigger may not be obvious and most people won’t realise that there was a trigger and even looking back people can occasionally say, “well, it didn’t happen after any of these” or “non of these triggers have happened to me.” Either way, you can’t do anything about it after the fact.
How do you diagnose Fibromyalgia?
This is challenging because symptoms vary so much from person to person and there is no actual test for fibromyalgia. One ‘test’ is to apply pressure to various places on your body to see if they are tender. The rest is based on having symptoms for longer than 3 months that haven’t changed overall with you either having severe pain in 3 to 6 different areas of your body, or milder pain in 7 or more spots and you have ruled out other potential reasons for the symptoms.
So to rule out other causes you will need X-rays and blood tests and be assessed by multiple disciplines such as neurology, rheumatology, orthopaedics etc. Things that they will be checking for, can be the following:
Osteoarthritis or Rheumatoid arthritis
Multiple sclerosis (MS)
Systemic lupus erythematosus
Chronic fatigue syndrome (ME)
Under or overactive thyroid
Irritable bowel syndrome (IBS)
How do you treat Fibromyalgia?
Unfortunately, there is no known cure so the key to treatment is to treat and manage your symptoms. Interestingly, very recently, there has been N.I.C.E. draft guidelines produced for chronic pain such as Fibromyalgia and there are some surprising recommendations in there.
“I can’t exercise because this just makes my pain worse.”
I hear this a lot, and it is true, but this is the difference between generic advice to exercise and a prescriptive progressive program of exercise that works in your tolerance and looks to build this tolerance up.
Is prescription exercise good for chronic pain syndromes such as Fibromyalgia?
In the current N.I.C.E draft guidelines from 2020, it makes recommendations based on evidence from 23 studies that found that exercise reduced pain and 22 studies improved quality of life compared with usual care in people with chronic primary pain. These benefits were found across different types of exercise and exercise affected both pain and quality of life in the short and long-term.
They are more in favour of supervised exercise rather than self-directed exercise. There is always an issue for continuing exercise independently after the initial supervised bout and so as the phrase goes:
“The best exercise is the exercise you can stick to!”
So you need to work out what works for you and fits with your lifestyle for the long term.
Here is a systematic review with meta-analysis of 50 studies with 3,562 participants, where they compared different exercise prescriptions for patients with chronic pain, such as fibromyalgia, chronic whiplash-associated disorders, and chronic idiopathic neck pain. For Fibromyalgia they found that both aerobic and strengthening exercises were found to be either similar or better than stretching exercises alone. They found that the exercises could be performed in 50 to 60 min supervised sessions, 2 to 3 times a week, for 13 weeks or more.
Overall, they found that low to moderate intensity global exercises performed for a long period in a session is best for non-specific pain such as Fibromyagia (Lenoir et al 2020).
Below are two videos on two pieces of research on the potential role that resistance training may have with Fibromyalgia patients. Now some people think that this is a crazy concept but the resistance can be super, super low and may have to be, to begin with. The aim is to find your rehab tolerance levels and work within this zone. Here is more information on this concept: What is the difference between injury rehab and normal training?
So if you are unsure about exercise and how to get started to help your Fibromyalgia then we can help at both our Physiotherapy clinics in Stoke-on-Trent.
This can be a sore subject as people can often think that because psychological treatment is recommended that Fibromyalgia is in your head but this isn’t why this helps. Essentially, these types of therapies can help you to cope with the symptoms better and lower the symptoms though the effect on things such as stress, anxiety, depression, which are well known to negatively affect pain.
Acceptance and commitment therapy (ACT)
This is a form of psychological therapy that is split into 2 main focuses the first part is acceptance and this is based on the idea of accepting our problems rather than focussing away from them. This is learning to make room for painful feelings, thoughts, and sensations, to allow them to exist in our minds, coming and going without us struggling against them. In essence not fighting them and saving emotional energy in the process.
The Commitment part is focused on learning to free yourself from the traps and barriers of life and to focus on what you really want your life to be. This also includes values, a value is a life direction, which guides us throughout our lives. The difference between a value and a goal is that a value hasn’t got an endpoint and it is almost like a mantra or something to that end. The aim is to give meaning and purpose to your life. Identifying and knowing our values will help us decide how to react to stress and distress so that we can still move in the direction of our values irrespective to what life throws at you.
The evidence is supportive of ACT with improved quality of life and sleep, reduced pain and psychological distress. but it may not be superior to cognitive behavioural therapy (CBT).
Cognitive behavioural therapy (CBT)
This is a psychological therapy that is based on the concept that your thoughts, feelings, physical sensations and actions are intertwined. So this means that negative thoughts and feelings can affect you physically and this then affects you psychologically and again in turn physically from this, a vicious cycle.
The aim of CBT is to help you to deal with overwhelming problems in a more positive way. This is done by breaking problems down into smaller chunks. You learn how to change negative patterns to improve the way you feel and this therapy focusses on the here and now not your past and so is more practical and easy to see the link. As for ACT, CBT is supported equally by the research and can improve pain and quality of life.
You want to stick needles in me!
Acupuncture has been around for a long time and is used for all sorts of things but how good is acupuncture for reducing pain? Here is a systematic review of 16 review articles and 11 randomized controlled trials published in the last 5 years on the clinical efficacy of acupuncture in adults with chronic musculoskeletal conditions. Among the conditions that they looked at was Fibromyalgia and they concluded that acupuncture does reduce pain in the short term in Fibromyalgia (Zhang et al 2020). The current draft N.I.C.E. guidelines concur with this and they do recommend acupuncture done for up to 5 hours of total treatment time over several weeks and months for conditions such as Fibromyalgia for up to 3 months pain relief.
The evidence for short term relief is there for massage therapy but more research is needed to find the most optimal type, intensity, duration and frequency. From my experience, gentle sports massage done within the individuals’ tolerance can work very well to reduce their tender points and general pain.
This is an area that has changed in recent times so the only medications advised by N.I.C.E are antidepressants, such as citalopram, sertraline, duloxetine, fluoxetine, paroxetine or amitriptyline as they have been found to improve pain and quality of life. Incredibly the latest guidance is to not offer any of the following at all:
Non-steroidal anti-inflammatory drugs
So, fibromyalgia is very complicated with lots of different symptoms. We know very little about its cause and unfortunately, there is no known cure. However, as you can see above, there are plenty of ways to manage the symptoms ranging from exercise, acupuncture, psychological treatment, massage and more. So if you are suffering, then Hawkes Physiotherapy can help you, so get in touch to see how we can help you to improve your quality of life.
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