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Fibromyalgia Pain Management – What You Need to Know

Fibromyalgia Pain Management - National Pain & Spine

Fibromyalgia is a chronic pain disorder that causes widespread musculoskeletal pain, fatigue, and sleep problems. You can develop fibromyalgia after an accident, surgery, or infection. Similarly, psychological stress may trigger fibromyalgia. Sometimes symptoms simply add up over time, without a trigger.

People with fibromyalgia feel pain differently. Studies show that repeated nerve signaling causes the brain and spinal cord to amplify pain. This requires special treatment with medications such as anti-depressants.

Fibromyalgia pain management starts with a timely diagnosis from your doctor. It is also based on self care measures to increase your energy. Therefore, patient-initiated exercise and stress management are essential.

Facts

  • Fibromyalgia affects an estimated 10 million people in the U.S.
  • Eight percent of adults meet the American College of Rheumatology definition for this chronic pain disorder.
  • Fibromyalgia is more common in women. About 75% – 90% of the people affected are women. However, it also occurs in men and children of all ethnic groups.

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Main symptoms

Three symptoms are almost always present. Widespread pain is often present. You may feel a constant ache in different body points that are both on the left and right sides of the body, above and below the waist. Fatigue is another common symptom. You may lack focus and memory. This is described as “fibro fog”. Waking up tired is also typical. Although you need to rest for long periods of time, you wake up feeling tired.

Other complaints

Some complaints are due to other illnesses that can start at the same time as fibromyalgia.

Some examples:

  • Irritable bowel syndrome  –  stomach pain, nausea, diarrhea and constipation.
  • Migraines/other headaches  –  dizziness, increased sensitivity to light, odors, and sounds.
  • Interstitial cystitis  –  painful bladder, frequent and painful urination.
  • Temporomandibular joint pain  –   jaw pain and stiffness due to muscle tension and tooth grinding.
  • Depression  –  fatigue, sleep problems, trouble focusing.

New guidelines

In the past, doctors applied pressure to 18 points on a person’s body to see how many of them hurt. However, new guidelines were introduced in 2010. They don’t require a tender point exam. Therefore, it is up to your doctor to decide if he or she performs this exam.

A diagnosis for fibromyalgia requires widespread body pain. Ruling out other possible illnesses is also necessary.

The new definition involves more input from the patient. It uses two scales.

  • The Widespread Pain Index uses input from the patient to identify up to 19 body areas that hurt. For example, if you had pain in nine areas over the last week, your score is 9/19. Pain may be felt in body areas such as both shoulders, both hips, both upper leg areas, and others.
  • The Severity Scale uses input from the patient and the doctor. Four general areas are scored.
  1. Fatigue is scored by the patient.
  2. Waking from sleep unrefreshed is scored by the patient.
  3. Symptoms that interfere with your thinking (focus and memory problems) are scored by the patient.
  4. Body Symptoms (muscle pain, weakness, numbness, chest pain) are scored by the doctor.

Why the pain persists

Fibromyalgia is a centralized pain disorder. As such, it involves a change in the neurotransmitters (messenger chemicals) in your brain and spinal cord. Fibromyalgia has several key findings such as chronic fatigue and increased pain. These are most likely to improve with medications that act on the spinal cord and brain. Therefore, medications that treat depression work well for fibromyalgia.

Another medication that works for fibromyalgia is Naltrexone, a medicine that works at the opioid receptors. There is growing evidence that it can control fibromyalgia pain.  At the same time, opioids such as Oxycodone and Morphine make symptoms worse.

Risk factors

A number of risk factors work together to increase your risk for fibromyalgia.

These include:

  1. Gender affects your risk for fibromyalgia. Women are more likely to be diagnosed. However, the new 2010 guidelines have caused an increase in diagnoses for men.
  2. A Family history increases your risk. Fibromyalgia is often seen in women and children of the same family. You are more likely to develop it if a relative also has it.
  3. History of immune disorders. You have a higher risk if you suffer from diseases that affect the joints, muscles, and bones. Some examples are lupus and rheumatoid arthritis.
  4. Respiratory infections appear to trigger it.
  5. Physical trauma such as a car accident can trigger it.
  6. Psychological stress may also trigger it.

Diagnosis

Your primary care doctor, rheumatologist, or pain specialist can determine if you have fibromyalgia. There is no single test that guarantees a diagnosis. Therefore, reaching a diagnosis takes patience.

Your doctor will rule out other illnesses that cause fatigue and pain. If you have these symptoms it does not mean that you have fibromyalgia. Some illnesses may simply resemble it.

These include:

  • Arthritis causes joint pain throughout the body.
  • Polymyalgia creates pain or stiffness in the neck, shoulders, upper arms, and hips. You may have increased pain in the mornings.
  • Polymyositis is an inflammation and weakness of the muscles. It affects the muscles closest to your trunk. For example, your hip muscles may be weak. Therefore, you will have trouble standing.
  • Vitamin D deficiency increases the risk of depression.
  • Obstructive sleep apnea is a blockage in the nose or throat. It causes snoring and disrupts your sleep.
  • Hypothyroidism is a decrease in thyroid hormones that causes fatigue.

Fibromyalgia pain management

Medications, therapy, and self care measures are all treatments for fibromyalgia. The treatment that works best for you, depends on your symptoms.

Medications that help

  • Acetaminophen is a pain reliever that reduces muscle aches and stiffness.
  • Tramadol is a medicine that acts like opioids. Additionally, it increases certain brain chemicals that fight depression.
  • Antidepressants are medicines that increase certain chemicals in your brain. They treat depression and improve pain. Duloxetine (Cymbalta), Milnacipran (Savella), Amitriptyline (Elavil) are some examples.
  • Muscle relaxants relax your muscles and promote sleep.
  • Anti-seizure drugs are used to reduce certain types of chronic pain. Pregabalin (Lyrica) was the first drug approved for fibromyalgia.
  • Naltrexone is a medicine that acts at the same receptors where opioids work. When taken in low doses, it decreases the widespread pain of fibromyalgia.

Medications that are NOT as helpful

  • Anti-inflammatory medicines are not as helpful. Some examples are Aspirin and Ibuprofen (Motrin).
  • Opioids can lead to dependence and an actual increase in pain over time. Therefore, they should be avoided.
  • Steroids should not be used since fibromyalgia does not cause inflammation. However, they help with immune disorders if they exist alongside the fibromyalgia.
  • Anti-anxiety medicines improve sleep and relax muscles. However, they are habit forming. Their use is limited by concerns about dependence and dementia.

Therapy

Different therapies can help reduce the effects of fibromyalgia:

  • Physical therapy can improve your strength and flexibility. You should start with a gentle exercise. Pool therapy is ideal.
  • Occupational therapy can help you modify your work area in order to decrease strain on your body.
  • Counseling can help you deal with stress.

Self care

  • Exercise helps you reduce the widespread pain seen with fibromyalgia. You may feel tired after aerobic exercise. This is normal. It should not stop you from staying active. Start an exercise program slowly and continue it throughout your lifetime.
  • Stress increases symptoms. You can use a number of alternative treatments to reduce stress.

Click here to read about studies that support tai chi, yoga, and massage therapy.