Consultant in Pain Medicine

Fibromyalgia

FIBROMYALGIA

woman with fibromyalgia 2


What is
Fibromyalgia?

Fibromyalgia (sometimes known as ‘fibro’) is a distressing condition that causes you to feel unremitting pain and tenderness in their muscles and joints. 

It’s not an injury or arthritis that brings about the pain; rather, it’s thought that the muscles are in a state of constant tightness, and never get to relax, even when you’re asleep.

What are the symptoms of fibromyalgia?

  • Many people with fibromyalgia describe pain in their joints and their muscles, and sometimes throughout their body. Neck and spine pain is very common, along with aching and stiffness, and exercise may make things more uncomfortable.
  • You may have tight knots called ‘trigger points’ in your muscles are common.
  • Many people will also experience ‘allodynia’, which is the experience of pain upon light touch of the body, or body tenderness.
  • Disturbed sleep is also a key feature of fibromyalgia, and although a person with fibromyalgia may be able to get to sleep, they often wake feeling unrefreshed. 

  • Some people also experience restless legs at night-time.

  • Overwhelming fatigue affects many people who have fibromyalgia, along with ‘brain fog’; difficulty concentrating, and forgetfulness.

  • Irritable bowel symptoms (IBS), an overactive bladder, and painful menstrual periods are also common experiences.

  • Low mood, and feeling weepy or irritable is frequently reported by people with fibromyalgia.

How common is fibromyalgia?

Fibromyalgia is common. Around 2% of women in the UK may have fibromyalgia, although the actual number of men and women with fibromyalgia may be higher, as it is sometimes misdiagnosed as arthritis or other conditions.

Fibromyalgia often develops between the ages of 25 and 55, although children and teenagers can also suffer from fibromyalgia. It seems to affect women more frequently than men, and may even run in families, and is very often caused by long-term stress.

What causes fibromyalgia?

We don’t yet fully understand the cause of fibromyalgia, but one theory suggests that fibromyalgia results from abnormal processing of pain signals in the central nervous system.

The role of sleep in fibromyalgia

 Most patients with fibromyalgia report having disturbed sleep, or sleep that isn’t refreshing. 

Studies have shown that people with fibro are more likely to have light sleep, when they should be having a type of deep sleep known as ‘non-rapid eye movement’ (NREM), which is critical for body and mind restoration at night. 


This lack of restful sleep further exacerbates pain and tenderness, and brain fog experienced by people who have fibromyalgia.

There may also be factors that trigger the development of fibromyalgia, such as:

  • A traumatic event (such as an assault)
  • A physical injury
  • Undergoing surgery
  • Giving birth
  • An abusive relationship
  • A bereavement

Constant pain can also lead to anxiety and low mood, and feeling stressed can increase the severity of the pain experienced.

How is fibromyalgia diagnosed?

Fibromyalgia can be difficult to diagnose; there isn’t a simple test that can confirm it or rule it out, so it’s important to get expert help and a proper assessment.

In the past, a big emphasis was made on the presence of multiple trigger or tender points during an examination. Today, the diagnosis is arrived at by careful assessment, and consideration of the following:

  • Severe pain in at least 4 or 5 areas of your body
  • Symptoms that have been ongoing for three or more months
  • Other painful conditions have been excluded
  • Expert physical examination

Is fibromyalgia 'all in the mind'?

No. Nor is it a psychological condition. Fibromyalgia is recognised physical condition, and we know it can have an enormous impact on the quality of a person’s life. 

The pain of fibromyalgia is a nociplasitc type pain. In fibromyalgia, the brain and spinal cord process pain signals in an abnormal way, creating heightened sensitivity to pain, known as centralised pain. 

The way fibromyalgia is sometimes described to patients by clinicians may inadvertently give the impression that ‘it’s all in the mind’, i.e., that their symptoms are imagined. The pain experienced by a patient with fibromyalgia is very real, as is their suffering.

How is fibromyalgia treated?

While there isn’t a simple cure for fibromyalgia, there are many treatments that can help to manage the condition, and it’s not thought that fibro physically damages muscles or joints.

 Physical therapies

Physiotherapy can be very helpful in reducing the pain and stiffness experienced in fibromyalgia, as well as improving strength and fitness. If you’re suffering from fibromyalgia, you may feel that you are too tired to exercise, but we know from studies that exercise, particularly aerobic exercise, reduces pain, increases your ability to function well day-to-day, and improves mood. 

During physiotherapy, you will be guided to gradually increase your exercise which may include swimming, cycling and yoga.

Psychological therapy

Pain is distressing, and its emotional impact can be very taxing. It’s very understandable that many people with fibromyalgia develop low mood and symptoms of anxiety.

Psychological therapies, such as cognitive behavioural therapy (CBT) can help a person in pain to cope better, by understanding the connection between pain and emotions, and how we can influence how we feel, through our thoughts and reflections. 


Drug treatments

Sometimes it may be necessary to consider medical treatments to ease the symptoms of fibromyalgia.  Traditional painkillers don’t tend to be helpful, and in my experience many patients find traditional medications such as amitriptyline, citalopram and gabapentin, have unacceptable side effects.  

Duloxetine (a serotonin-noradrenaline reuptake inhibitor – SNRI) is an antidepressant medication which may help reduce abnormal pain signals by increasing naturally occurring chemicals in the nervous system called serotonin and norepinephrine. 

Duloxetine can be helpful for some patients in reducing their pain and elevating their mood.

 

There is increasing evidence to show that newly-legalised, prescribed medical cannabis medications can be very helpful in fibromyalgia, and there are medical publications to show this.

Improving your sleep

Poor sleep is a huge problem for many patients with fibromyalgia, so it’s important to do all you can to optimise your sleep. Clinicians refer to this as ‘sleep hygiene’, and to get as good a night’s sleep as possible, consider doing the following:

  • Having a regular bedtime, so that you go to bed at night, and get up in the morning, at the same time every day.

  • Make the bedroom dark and cool. Use blackout curtains if possible and remove clutter. Make your room as zen as possible.

  • Take a warm (but not hot) bath before bed, to relax your muscles and reduce stiffness.

  • Avoid drinking alcohol in the evening, or caffeine beyond midday. Reduce your overall caffeine consumption to a minimum.

  • Exercise is important, but not too close to bedtime. Leave at least two hours after exercising, to avoid being overstimulated when you’re trying to get to sleep.

  • Don’t watch TV in bed and put away smartphones and tablets that emit blue light, which interferes with the natural release of serotonin – a hormone that induces sleepiness.

  • Try listening to soothing music, or a meditation app to settle your mind and body.

How I can help you

Many patients suffer for years without the proper help they need, because their fibromyalgia has gone undiagnosed, or their symptoms have been misinterpreted. Just having the diagnosis confirmed can be very helpful.

If you are struggling with pain, or are looking for assistance in managing your fibromyalgia symptoms, I am here to help.