Fibromyalgia

Symptoms

Fibromyalgia is a common, chronic condition characterised by widespread pain, and

• extreme fatigue
• sleep disturbance
• cognitive problems e.g. problems with memory and concentration

These symptoms make it difficult to undertake activities of daily living (ADLs).


The location, type and severity of pain may change over time. There may be muscle pain (myalgia), nerve pain (neuralgia) and/or joint pain (arthralgia), but these can overlap and be difficult to separate.

Fibromyalgia often causes a combination of the following, but each affected person will have their own set of symptoms:

• burning or dull aching pain
• increased sensitivity to pain and various other sensory stimuli (e.g. heat, cold, light, odours)
• muscle twitching or jerking (myoclonic jerks), spasms, tightness, cramping
• Restless Legs Syndrome (RLS)
• tingling or numbness in hands and feet (paraesthesia)
• joint stiffness
• pain in the face or jaw, including temporomandibular joint syndrome
• costochondritis
• headaches

Additional symptoms may include:

• digestive problems, including Irritable Bowel Syndrome (IBS)
• pelvic or urinary issues, including endometriosis
• environmental sensitivities, including Multiple Chemical Sensitivity (MCS)
• dizziness

Diagnosis

Two formal measures are used in the diagnosis of Fibromyalgia.

1. Pain over the previous week, measured by the Widespread Pain Index (WPI), with a score between 0 and 19, for pain in up to 19 identified body parts.
2. Pain and other symptoms, such as fatigue, unsatisfactory sleep, and/or cognitive problems, measured by the Symptom Severity Scale (SSS).

Patients satisfy the diagnostic criteria for fibromyalgia if:

• symptoms have been present for at least three months
• WPI is ≥7 with an SSS ≥5; or WPI range is between 3‒6 with an SSS ≥ 9; and
• there is no other health problem that would explain the symptoms

Previously, ‘tender points’ were used to diagnose the condition. However, these are no longer used to diagnose FM.

Doctors may also want to check for related illnesses such as an underactive thyroid, different types of arthritis, lupus, and ME/CFS, which commonly occurs with FM.

Management

Gentle exercise is likely to be beneficial for people with Fibromyalgia if they do not have exertion intolerance caused by comorbid ME/CFS. Exercise may include a combination of aerobic activities and resistance or strength training. Hydrotherapy is sometimes recommended.

For people with ME/CFS, symptoms of Fibromyalgia are likely to worsen during post-exertional malaise (PEM), and pacing may reduce FM symptoms, including pain, sleep disturbance, cognitive problems and fatigue.

If there are concerns about safety or ability to carry out activities of daily living (ADLs), consider consulting an Occupational Therapist.

Fibromyalgia may flare in response to triggers. A diary may help to identify patterns for flares and possible triggers.

Triggers may include:

• food allergies and sensitivities
• air-borne substances, including those causing allergies and sensitivities
• medications
• environmental changes, including temperature and weather changes
• poor sleep quality
  
• hormonal changes
• physical or psychological stresses, including surgery, injury and overexertion

For some people, pain may be exacerbated by stimuli that would normally be tolerated, such as tight or uncomfortable clothing or heavy bedding.

Psychotherapy may assist in adapting to changes and losses that result from living with chronic illness.

Treatment for pain

Treatments will differ according to the type and severity of pain. Individual treatment plans can be developed in consultation with a clinician. These plans may include some of the following non-drug therapies and medications. Referral to a rheumatologist may also be helpful.

Non-drug therapies

Some of the following may be helpful.

• application of heat and cold
• compression garments
• magnesium
  • topical use as magnesium oil or Epsom Salts
  • oral magnesium, for example magnesium citrate, sulphate, glycinate. Different forms affect the body differently, with different benefits and side effects.
• transcutaneous Electrical Nerve Stimulation (TENS)
• transcutaneous Vagus Nerve Stimulation (tVNS)
• acupuncture
• chiropractic therapy
• massage
• physiotherapy or exercise physiology

Medications

A wide range of prescription drugs, over-the-counter (OTC) pain relievers and nutritional supplements may help reduce the various types of pain in fibromyalgia and improve sleep.
Many have a synergistic beneficial effect when used in combination.

Start medications at a low dose, as usual doses may be poorly tolerated.
Introduce one change at a time, so that the impact can be monitored.

• paracetamol

• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin
  • NSAIDS may have a synergistic beneficial effect on pain when combined with central nervous system-active medications, such as antidepressants or anticonvulsants
• low-dose antidepressants
• muscle relaxants
• anticonvulsants
• sleep medications

While opiate medications are not normally indicated, there is some evidence that short-term use of Tramadol may assist some people.

Recent research suggests that low-dose naltrexone (LDN) and medical cannabis may also be helpful.

Continued use of some medications may cause tolerance to or dependence. The prescribing clinician can advise on these and other safety matters.