Fibromyalgia pain can cause you to ache all over, affecting your muscles, skin, and joints. It can make it difficult to move or to rest. Certain medications do not affect it, and some days it seems like the pain will not ever go away. Fibromyalgia used to be understood as a systemic inflammatory disease, chiefly characterized by full-body pain and tenderness.
However, more research has led specialists to believe that fibromyalgia is primarily tied to the central nervous system and how our brain and spine register pain – it is not an inflammatory disease. While it may connect to certain autoimmune conditions such as lupus and rheumatoid arthritis, it is not considered an autoimmune illness.
It is a painful disease, chiefly characterized by increased pain perception, sensitivity, fatigue, and tenderness around specific body points. Fibromyalgia can co-occur with other similar illnesses and a host of physical and mental health conditions and can have a vast impact on the overall quality of life. To understand how fibromyalgia may be best treated, it is essential to explore why it occurs.
What Is Fibromyalgia?
Fibromyalgia is a chronic pain condition currently believed to be linked to the brain’s perception of pain, with potential hereditary and environmental factors leading to its development. When the brain usually processes noxious stimuli – i.e., painful events – specific nerves send signals to the brain to trigger the sensation of pain, which primarily acts as a warning system to stave off further danger.
However, fibromyalgia affects how often that system is tripped, and it diminishes the brain’s capacity to regulate and stop pain signals from occurring. More accurately, fibromyalgia enhances the brain’s pain sensitivity, effectively boosting incoming calls. Research has also shown that patients with fibromyalgia are less likely to produce their opioid release after feeling pain, as most people do to dull incoming signals.
At least some of the symptoms experienced by fibromyalgia patients are related to the excessive release and availability of stress hormones such as cortisol. These combined issues can be further exacerbated by some of the fibromyalgia comorbidities, including mood disorders such as major depressive disorder and other physical conditions such as chronic fatigue syndrome and irritable bowel syndrome.
How Does Fibromyalgia Progress?
Fibromyalgia is currently understood as a long-term, lifelong condition – but it is not a progressive disease, which means it does not worsen over time. It may decline in response to aging, or lifestyle choices that are not conducive to treatment and pain management, or because of a physically demanding job or sudden change in environment.
But on its own, fibromyalgia does not seem to progress into something worse than when it is first diagnosed. Diagnosis is not simple, and many Americans may be underdiagnosed and unknowingly living with fibromyalgia. There was doubt surrounding fibromyalgia in the not-so-distant past, and health professionals considered it a fake illness.
That stigma has mostly gone away as better brain imaging research helps point towards fibromyalgia existence and pathology, but its remnants linger. Furthermore, because there is no cure, and treatment plans are usually tailored to an individual, it can be challenging to treat and manage fibromyalgia pain.
Identifying Fibromyalgia Pain
Modern-day diagnosis of fibromyalgia is based on ruling out other causes of widespread pain. Blood count, thyroid function, rheumatoid factor, and other tests may be performed to rule out other causes of pain such as potential inflammatory conditions, bacterial or viral infection, autoimmune diseases, neurological disorders such as multiple sclerosis, and more.
Because fibromyalgia can co-occur with other conditions, evidence of potential rheumatoid arthritis, for example, may not necessarily rule out fibromyalgia. Other symptoms that doctors look out for include:
- Sleep disturbances
- Tingling or numbness
- Brain fog and measurable cognitive decline
- Jaw pain
- More frequent anxious or depressed thoughts
- Painful urination
- Irritable bowel symptoms
- Tender points
- Fibro fog and fatigue
Pain specialists rely on 18 pressure points to pinpoint and diagnose fibromyalgia (by testing for excessive sensitivity in at least 11 points). This old diagnostic method may be inaccurate because pain sensitivity in specific body areas can come and go. A more comprehensive and holistic view of a patient’s symptoms is necessary today. If you suspect that you might have undiagnosed fibromyalgia, consult your physician or another doctor.
Fibromyalgia Pain and Brain Fog
One of the fibromyalgia characteristics aside from pain is diminished cognitive function or a “brain fog.” This generally means that patients may regularly experience periods where they cannot think straight, are easily distracted, or struggle with memory problems. There may be a link between fibromyalgia and ADHD, as the two commonly co-occur. However, the so-called “fibro fog” is separate from ADHD and refers explicitly to episodic lapses in memory and concentration, as well as sudden and overwhelming fatigue.
Gender Differences Among Patients With Fibromyalgia Pain
Fibromyalgia is overwhelmingly more common in women, but this may be due to underdiagnosis of men’s condition. More research is needed to understand whether there are significant gender differences in fibromyalgia pain onset and severity. For now, prevalence is more common among female patients with psychiatric comorbidities and other forms of pain.
Common Fibromyalgia Comorbidities
While fibromyalgia is a standalone condition, some medical researchers believe it may be part of a group of related psychiatric and medical conditions referred to as effective spectrum disorder (ASD), some of which include:
- Irritable bowel syndrome
- Chronic fatigue syndrome
- Major depressive disorder
- Dysthymic disorder
- Premenstrual dysphoric disorder
- Eating disorders
- Post-traumatic stress disorder
- Generalized anxiety disorder
- Social phobia
These conditions are linked via similar hereditary abnormalities. This means patients with fibromyalgia are, as far research shows, more likely also to develop one or more of these conditions. Aside from these conditions, patients with autoimmune diseases such as rheumatoid arthritis and lupus are more likely to develop fibromyalgia pain.
Treatment for Fibromyalgia Pain
Treatment for fibromyalgia pain is varied and may depend significantly on comorbidities and symptom severity. For example, patients with psychiatric comorbidities (such as depressive and anxiety disorders) were far more likely to experience severe physical symptoms and lower functioning. The relationship between depression and chronic pain is well known, and psychiatric treatment can reduce both symptoms. Some effective medications include (but is not limited to):
- Antidepressants are useful when fibromyalgia is co-occurring with mood disorders, such as major depressive disorder and premenstrual dysphoric disorder.
- Non-benzodiazepine sedatives may help patients with fibromyalgia who are struggling with severe sleep issues.
- NSAIDs and anti-inflammatory medication does not help address fibromyalgia pain but can help address comorbid pain conditions such as arthritis. Opioids do not seem to help with fibromyalgia pain.
Doctors find that a combination of pharmacological and non-pharmacological treatments work best. Thus, the medication should be combined with an appropriate diet and exercise plan tailored to a patient’s abilities, pain levels, and circumstances and a focus on psychosocial support at home and elsewhere. Talk therapy, such as CBT, may help address psychiatric comorbidities and reduce overall pain perception.
Fibromyalgia is a challenging condition to live with. It can significantly impact energy levels, make sleep miserable, and affect both mood and mental functioning. However, a tailored treatment and pain management plan and family support can go a long way towards improving life quality.