Fibromyalgia

By Brad Czaszynski, DPT

Fibromyalgia is a common chronic neurological health condition that causes widespread musculoskeletal pain and sensitivity to touch.  The condition is also commonly associated with severe fatigue, problems with sleep, and problems with memory or thinking clearly.  Individuals with fibromyalgia may experience depression, anxiety, migraines, digestive issues, irritable or overactive bladder, and temporomandibular joint disorder (TMJD).  
The causes of fibromyalgia are unclear, and may vary from individual to individual.  Fibromyalgia is not caused by an autoimmune, inflammation, joint, or muscle disorder.  Research does suggest nervous system involvement, particularly the brain and spinal cord (central nervous system).  It is likely that there are certain genes that make individuals prone to getting fibromyalgia, however genes alone are not the cause of it.  Often times there are triggers that can set off fibromyalgia.  These can include emotional and physical stresses such as spine problems, arthritis, or injury.  Whatever the cause, the result is a change in the way the body communicates with the central nervous system, with research suggesting that fibromyalgia amplifies painful sensations.

Fibromyalgia currently affects around 10 million people in the United States, with 80-90% being women.  It is typically diagnosed in adults between the ages of 30 and 50 years old.  Individuals are more likely to develop fibromyalgia if a relative also has the condition.   There is also a higher risk for fibromyalgia when the individual has a rheumatic disease such as osteoarthritis, lupus, rheumatoid arthritis, or ankylosing spondylitis.  

There are no blood tests, x-rays, muscle biopsies, or other diagnostic tests that can be done to diagnose fibromyalgia.  Many other conditions, such as rheumatologic or infectious disease, Lyme disease, hypothyroidism, metabolic disease, or side effects due to medication, can cause pain and fatigue so it is important to rule out these as part of the diagnosis process.  In the past, doctors would perform a check of 18 specific points on the body to see if they are painful when pressed firmly, however nowadays doctors are looking for general widespread pain that has lasted more than three months with no other health problems that would explain the pain.

While there is no cure for fibromyalgia, individuals are able to get some relief of symptoms with both medication-based treatments and alternative treatments.  Several types of medication have been shown helpful in the treatment of the condition.  This includes drugs that alter the brain chemicals that help control pain levels (Cymbalta, Savella, Elavil, and Flexeril), antidepressant drugs, and drugs that work by blocking the activity of nerve cells involved in pain transmission (Lyrica and Neurontin).  The use of opioid narcotic medications is strongly discouraged in the treatment of fibromyalgia.  Along with medication, Cognitive Behavior Therapy (CBT), good sleep habits, stress management techniques (massage, yoga, meditation), education, and most important physical activity can help with reducing pain and disability.  Research has shown that the most effective treatment for fibromyalgia is physical exercise (aerobic and strengthening).  Despite this, many individuals with fibromyalgia are afraid to begin an exercise program due to fear of pain.  This is where a physical therapist can be a great resource.  A physical therapist should be able to help the patient interpret their pain while also teaching them how to manage and decrease the symptoms through a customized exercise program.  In order for an exercise program to be beneficial for these individuals it should: start slow, allow the individuals to pace themselves, have realistic goals, and be able to be modified in times of increased stress.

A physical therapist will use a combination of exercise, stretching, movement, and manual therapy techniques in order to manage symptoms and maximize functional abilities.  To reduce pain, the therapist should work on improving muscular flexibility through use of stretching and massage, as well as possibly using electrical stimulation, if appropriate.  Initially, as the individual begins an exercise-based program their pain may increase.  This is completely normal and should not be something to discourage them.  

Since the true mechanisms behind fibromyalgia are not fully understood, there is no way to predict or prevent the onset of the condition.  Despite this, early detection of signs and symptoms related to fibromyalgia can lead to early management and ultimately enhance long-term outcomes.


 

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