Fibromyalgia: A Patient’s Guide to Understanding and Managing Chronic Pain
Fibromyalgia is a chronic condition characterized by widespread pain, fatigue, and sleep disturbances. It’s more common than you might think, affecting about 1 in 20 primary care patients, with women being ten times more likely to be affected than men. The typical age of presentation is between 20 and 50 years, but it can occur in children, adolescents, and older people.
What Causes Fibromyalgia?
The exact causes are still unclear but are believed to involve a combination of environmental factors (like trauma or illness) and genetic factors. People with a family history of fibromyalgia are more likely to develop it. It’s also linked to factors like not finishing education, low income, being female, and divorce. Some consider it a psychogenic or psychosomatic condition, but research points to it being a disorder of pain regulation, specifically a form of central sensitization. This means the brain amplifies pain signals.
What are the Symptoms?
The main symptoms include:
- Chronic widespread pain: Pain in multiple areas of the body.
- Fatigue: Persistent tiredness.
- Sleep disturbance: Difficulty sleeping.
Other common symptoms include:
- Muscle pain and tenderness
- Forgetfulness or trouble concentrating
- Morning stiffness
- Paraesthesia (numbness or tingling)
- Headaches
- Dizziness
- Weight fluctuations
- Anxiety and depression
Symptoms often worsen with cold, humid weather and stress.
How is Fibromyalgia Diagnosed?
Diagnosis is primarily clinical, based on a doctor’s evaluation. There are criteria from the American College of Rheumatology (ACR) that include a symptom survey to assess pain locations, fatigue, sleep issues, and mood. To meet the ACR criteria, certain conditions must be met:
- A widespread pain index (WPI) and symptom severity score must meet specific thresholds.
- Symptoms must have been present at a similar level for at least three months.
- Other disorders that could explain the pain must be ruled out.
Note: Fibromyalgia is not a diagnosis of exclusion.
While lab tests aren’t usually needed to diagnose fibromyalgia, they can help rule out other conditions.
Associated Conditions
Fibromyalgia can occur alongside other conditions like:
- Anxiety and depression
- Irritable bowel syndrome
- Rheumatoid arthritis
- Lupus
- Restless leg syndrome
- Chronic fatigue syndrome
Treatment Options
The best approach involves managing symptoms to improve quality of life through both medication and non-medication methods.
Non-pharmacological treatments:
- Patient education: Understanding the condition is crucial.
- Exercise: Regular aerobic and strength training can be helpful.
- Sleep hygiene: Improving sleep habits.
- Cognitive-behavioral therapy (CBT): Helps manage psychological aspects and stressors.
Pharmacological treatments:
- Pain relievers: Paracetamol, NSAIDs, and tramadol can help manage pain.
- Antidepressants: Can reduce pain, fatigue, and sleep disturbances.
- Other medications: Pregabalin and gabapentin may help reduce pain in some patients.
Important Note: Corticosteroids and strong opioids are not recommended.
Living with Fibromyalgia
Fibromyalgia is a chronic condition, and managing it can be challenging. Working closely with your doctor to find the right combination of treatments and support is essential for living well with fibromyalgia.
