Fibromyalgia is a chronic condition that causes pain all over the body. The condition affects the muscles, tendons and ligaments (bands of tissue that connect bone to bone), resulting in widespread pain, fatigue and extreme sensitivity to pain.
The name fibromyalgia comes from the Latin word 'fibro', meaning fibrous tissues (tendons, ligaments), 'my' meaning muscles, and 'algia' meaning pain.
Fibromyalgia used to be known as fibrositis, which literally means inflammation of the muscles and soft tissue. However, the condition was renamed fibromyalgia after studies found that there is no inflammation or nerve injury
Who is affected by fibromyalgia?
Anyone can develop fibromyalgia, although the condition affects more women than men. In most cases, fibromyalgia occurs between 35-60 years of age, but it can develop in people of any age, including children and the elderly.
The number of people with fibromyalgia has never been measured, but it is thought that between 2 and 4.5% of people in the UK have the condition.
There is no cure for fibromyalgia, but treatment aims to ease the symptoms. The condition can be treated using a combination of medicines, complementary therapies and lifestyle changes.
There are many symptoms of fibromylagia and they tend to vary from person to person. The symptoms can also come and go over time, although it is unlikely that they will ever disappear altogether. The main symptoms of fibromyalgia are outlined below.
Pain
If you have fibromyalgia, one of your main symptoms is likely to be widespread pain, which you may feel from 'head to toe'. This pain may feel like an ache, or a burning sensation, or it may be more like a sharp stabbing pain.
You may also find that your pain is worse in the areas of your body that you use the most, such as your back, neck, shoulders and feet.
Extreme sensitivity
Fibromyalgia can cause you to become extremely sensitive to pain all over your body, and you may find that even the slightest touch is very painful. If you hurt yourself - for example, if you stub your toe - you may find that the pain continues for much longer than it normally would.
If you have fibromyalgia, you may find that you are very sensitive to other things as well, such as smoke, certain foods and bright lights. Being exposed to something you are sensitive to can cause your other fibromyalgia symptoms to flare up.
Fatigue and trouble sleeping
Fatigue as a result of fibromyalgia can range from a mild, tired feeling to the exhaustion that is often experienced during a flu-like illness. Sometimes, severe fatigue may come on very suddenly and can drain you of all your energy. If this occurs, you may feel too tired to do anything at all.
Fibromyalgia can also affect your sleep, and you may find that you often wake up tired even when you have had plenty of sleep. This is because fibromyalgia can sometimes prevent you from sleeping deeply enough to refresh you properly. The muscles in your legs may also spasm at night which can also interfere with a restful night's sleep.
Stiffness
If you have fibromyalgia, as well as causing you pain, you may find that your muscles, tendons and ligaments become stiff and prone to spasm. The stiffness may be most severe when you have been in the same position for a long period of time.
Cognitive problems ('fibro-fog')
Cognitive problems refers to problems with mental processes, such as thinking and learning. If you have fibromyalgia, you may have trouble remembering and learning new things, problems with attention and concentration, and slowed or confused speech.
Headaches
If you have pain and stiffness in your neck and shoulders from fibromyalgia, you may also have frequent headaches. The headaches can vary from being quite mild to very severe migraines.
Irritable bowel syndrome (IBS)
If you have fibromyalgia, you may also develop irritable bowel syndrome (IBS) as well. IBS is a common digestive condition that causes pain and bloating in your gut. It can also cause constipation and diarrhoea.
Other symptoms
Other symptoms of fibromyalgia can include:
•facial pain, often as a result of neck, shoulder, or jaw muscle stiffness,
•tingling, numbness, prickling, or burning sensations in your hands and feet (paresthesia),
•dry eyes, skin, or mouth,
•unusually painful periods (in women),
•anxiety, and
•depression.
Your symptoms may sometimes get better, or worse, depending on factors such as changes in the weather, stress levels, and how physically active you are.
If you have fibromyalgia, it is unlikely that your condition will ever resolve permanently, although there may be long periods of time when your symptoms disappear completely. Most people have to learn to live with the condition long-term. However, fibromyalgia is not life-threatening and does not reduce life expectancy.
There is no cure for fibromyalgia, but treatment aims to ease your symptoms as much as possible and to improve your quality of life.
The symptoms of fibromyalgia tend to vary widely from person to person, so you may be treated for your condition by several different healthcare professionals. For example, you may be treated by your GP, a rheumatologist (a specialist in conditions that affect the muscles and joints), or a neurologist (a specialist in conditions of the central nervous system).
Fibromyalgia can be treated in several different ways, and it is likely that you will need more than one kind of treatment to ease your condition. However, all types of treatment may not be effective for everyone with fibromylagia.
In most cases, fibromyalgia is treated using a combination of medicines, complementary therapies and lifestyle changes.
You may also find that joining a fibromyalgia support group can be a tremendous source of comfort and support.
Medicines for fibromyalgia
You may need to take several different types of medicines for fibromyalgia, including painkillers, antidepressants, and medicines to help you sleep.
Painkillers
If you have fibromyalgia, you can treat your pain using simple painkillers, such as paracetamol.
If paracetamol is not effective in easing your pain, your GP, or healthcare professional, may prescribe a stronger painkiller, such as codeine.
You may also be prescribed a painkiller called tramadol, or one called nefopam. Both of these painkillers have been found to be effective in treating pain that is caused by fibromyalgia.
In some cases, in addition to your main painkiller, you may also be prescribed a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen. However, you should avoid taking NSAIDs if you have asthma, high blood pressure, or kidney, or heart, problems. They are also unsuitable for you if you have, or have had, a stomach problem, such as a peptic ulcer.
As well as easing pain, NSAIDs help to reduce inflammation. However, as fibromyalgia does not cause inflammation, they are not effective in treating the condition when taken on their own.
Antidepressants
Antidepressant medicines for fibromyalgia are not prescribed specifically to treat depression.
They are used to boost the levels of certain hormones, such as serotonin, noradrenaline (also known as norepinephrine), and dopamine.
It is thought that low levels of these hormones may be a factor in causing fibromyalgia, and that raising their levels may help to treat the condition and ease the pain of your symptoms. See the 'causes' section for more information about fibromyalgia and hormones.
If you have fibromyalgia, there are many different types of antidepressant medicines that you may be prescribed. The choice of medicine may depend on the type of fibromyalgia that you have, and severity of your symptoms, plus any side effects that the medicines may cause.
Antidepressants used to treat fibromyalgia include:
•Tricyclic antidepressants (amitriptyline, nortriptyline and dosulepin) - these are usually the first choice of antidepressant and raise levels of serotonin and noradrenaline (norepinephrine) in order to ease pain and help you sleep.
•Serotonin-norephinephrine reuptake inhibitors (venlafaxine and duloxetine) - which raise levels of serotonin and noradrenaline (norepinephrine). Venlafaxine also raises levels of dopamine, as well as serotonin and noradrenaline.
•Selective serotonin reuptake inhibitors (citalopram, fluoxetine and paroxetine) - these only raise serotonin levels, so they are not often used.
There are also two other types of medicine that affect the levels of hormones which are sometimes used to treat fibromylagia - a dopamine agonist called pramipexole, and a serotonin 5-HT3 receptor antagonist called tropisetron.
Muscle relaxants and medicines to help you sleep
If you have stiffness, or spasms, in your muscles as a result of fibromyalgia, your GP or health professional may prescribe a muscle relaxant to help ease your symptoms.
Muscle relaxants that are often used for fibromyalgia include medicines called tizanidine and carisoprodol. Tricyclic antidepressants (see above) can also help to relax your muscles.
Muscle stiffness and spasms can also affect your ability to sleep, but even if you sleep all night, you may find that you still wake up feeling tired. This is because fibromyalgia can prevent you from sleeping deeply enough to fully refresh you.
If this is the case, your GP or health professional may recommend, or prescribe, an over-the-counter (OTC) sleep medicine, or herbal supplement to help you sleep more deeply. If these medicines do not help, using one of the muscle relaxant medicines mentioned above may help you to sleep more deeply at night because they have a sedative (sleep-inducing) effect.
There are also stronger medicines, such as zopiclone and zolpidem, which can help you sleep. However, you may only be able to use one of these medicines for a short period of time because long-term use can end up disrupting your sleeping patterns even further.
Pregabalin
Pregabalin is an anti-seizure medicine that has been found to be effective in treating several fibromyalgia symptoms, including pain and sleeping problems. You may be able to take pregabalin as a brand called Lyrica.
However, pregabalin can cause a number of side effects, such as dizziness, blurred vision and weight gain, so it may not be suitable for everyone.
Complementary therapies for fibromyalgia
There are a number of complementary therapies which may help to ease your symptoms of fibromyalgia. However, it is important to remember that there is little medical evidence to back up the effectiveness of these therapies, and that they may not work for everyone.
Warm water therapy, such as swimming, gentle exercises in a warm pool, or simply having a warm bath, is a popular complementary therapy for people with fibromyalgia.
Some people also find that complementary therapies help to ease their pain, or fatigue, and help them to relax and manage their condition more effectively. Examples of complementary treatments that may help to ease symptoms of fibromyalgia include acupuncture (where thin needles are inserted into certain points around the body to help relieve pain), aromatherapy (where essential oils are used for a therapeutic effect), massage, and osteopathy (which aims to heal your body by applying pressure).
There are also complementary therapies for fibromyalgia that focus on the mental and emotional aspects of the condition. Relaxation therapy, anxiety management techniques, counselling, cognitive behavioural therapy (CBT), or other 'talking treatments', can sometimes help some people to cope better with pain, fatigue, or other symptoms.
If you decide to use a form of complementary therapy, always ensure that your therapist is a fully qualified and accredited member of the appropriate organisation - for example, the British Acupuncture Council (BAC).
If you have fibromyalgia, there are several ways that you can change your lifestyle in order to help relieve your symptoms and make your condition easier to live with.
Your GP, or healthcare professional, can also offer you advice and support about incorporating these changes into your everyday life.
Exercise
As fatigue is one of the main symptoms of fibromyalgia, you may find that you are often very tired and feel unable to exercise. However, an exercise programme that is specially suited to your condition can help to significantly improve your symptoms by reducing pain, boosting energy levels, and helping with regular sleep patterns.
Your GP, or a physiotherapist, can help you to design a personal exercise programme. The programme is likely to involve gentle exercises, such as stretching and warm water exercises, as well as low-impact aerobic exercises, such as walking, cycling, or swimming. However, you should take care not to push yourself too hard when exercising.
Relaxation
If you have fibromyalgia, it is important that you regularly take time to relax, or practice relaxation techniques. Stress can make your symptoms worse, cause them to flare up more often, and it can also increase your chances of developing depression, which is common among people with fibromyalgia.
There are many relaxation aids available, including books, tapes and courses, although deep breathing techniques, or meditation, can be just as effective. Try to find time each day to do something that relaxes you. Taking time to relax before bed may also help you to sleep better at night.
Anxiety management techniques, counselling, cognitive behavioural therapy (CBT), or other 'talking treatments' can also be helpful in combating stress and learning to deal with it effectively.
Diet
There is no specific diet that you should follow if you have fibromyalgia, but you should try to eat a healthy, balanced range of foods. Your diet should be high in fibre, fruit and vegetables, and low in fat, salt, and sugar.
You should only drink alcohol in moderation, and cut down on foods and drinks that are high in caffeine, such as coffee, tea, chocolate, and cola.
Pacing yourself
If you have fibromyalgia, it is likely that you will have some days when your symptoms are better than others. Try to maintain a steady level of activity at all times, without ever over-doing it. It is important that you always listen to your body, and that you slow down, and rest, whenever you need to.
You should avoid doing any exercise, or activity, that over-exerts you, or pushes you too hard because this can make your symptoms worse.
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