You ache all over. You’re not sleeping well. You seem to be forgetting things, and your overall mood matches the Grinch who stole Christmas. And you’ve been feeling this way for months. Is it the stress at work? Blood sugar ups and downs? Or something more chronic? While there are many reasons for your symptoms, don’t rule out a condition called fibromyalgia.
Fibromyalgia is a chronic disorder that is associated with pain in the muscles and bones, areas of tenderness, and fatigue. It’s a condition that affects anywhere from 5 to 10 million Americans, but it’s also tough to diagnose because the symptoms are subjective — meaning, there are no tests that can accurately diagnose this disorder.
As mentioned above, symptoms include:
• Areas of pain or tenderness at certain places on the body (often called trigger points or tender points
• Difficulty sleeping or sleeping for long stretches at a time without feeling rested
• Memory issues (“fibro fog”)
• Sensitivity to light or sound
• Trouble focusing or paying attention
• Pain in the abdomen
Fibromyalgia can go hand-in-hand with other chronic conditions, too, including:
• Irritable bowel syndrome
• Interstitial cystitis
• TMJ (temporomandibular joint problems)
• Rheumatoid arthritis
Experts aren’t exactly sure what causes fibromyalgia. In fact, until more recently, fibromyalgia was often brushed off by the medical community because it’s so difficult to diagnose and it’s challenging to treat. Fortunately, fibromyalgia is now being taken more seriously.
Factors that may “trigger” this condition include:
• Physical or emotional trauma (it’s linked with post-traumatic stress disorder, or PTSD)
• Infections, such as the flu
• Genetics (the condition may run in the family)
• Stress (physical or psychological)
When your body is under any kind of stress, your nervous system jumps into “fight-or-flight” mode. Your muscles and connective tissue tense up to provide more strength (so that you can do battle or run away). Once the “stress” is gone, the nervous system relaxes and goes back to normal. Not so with fibromyalgia. It stays stuck in fight-or-flight mode. Over time, this can lead to widespread muscle pain and tender spots, and lead to the other symptoms mentioned above.
Certain factors may predispose you to getting fibromyalgia. These factors include:
• Family history: There seems to be a genetic component to this condition
• Gender: Women are eight to nine times more likely to get this condition than men, likely because of rising and falling levels of estrogen (and this condition is more common in women going through menopause). However, men and even children can have this disorder.
• Age: According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), fibromyalgia mostly affects people over the age of 18; most people are diagnosed between the ages of 20 and 50.
• Rheumatic disease: Someone with rheumatoid or osteoarthritis, lupus, or ankylosing spondylitis may have a higher risk of fibromyalgia
• Diabetes: A meta-analysis published in the journal Rheumatology International in September 2017 looked at data from more than 3.5 million people. This data showed that fibromyalgia seems to be more common in people with certain diseases including Type 2 diabetes. More specifically, almost 15% of people with Type 2 diabetes also had fibromyalgia. A separate study done in Israel found fibromyalgia to be common in people with Type 1 diabetes.
There’s no lab test or x-ray that diagnoses this condition. And because symptoms of fibromyalgia are similar to other conditions, it can take a frustrating amount of time to diagnose. Plus, symptoms of this condition can wax and wane.
The American College of Rheumatology guidelines for diagnosing fibromyalgia list widespread pain throughout the body for three months as a criterion. Widespread refers to pain on both sides of the body, and pain both above and below the waist. And, you need to have other symptoms besides the pain, such as fatigue, trouble sleeping, etc. Finally, other conditions that could be causing the symptoms, such as rheumatoid arthritis, depression, or multiple sclerosis must be ruled out; you’ll likely need to have a physical exam, blood tests, and x-rays to exclude other issues.
If you have fibromyalgia, you’ll likely need a multi-pronged approach to treating it. Treatment may include:
Medication: Over-the-counter pain relievers, such as ibuprofen and naproxen can help with muscle pain. Antidepressants, such as duloxetine (brand name Cymbalta) and milnacipran (Savella) can also help with pain and fatigue (and lift your mood, too). Also, anti-seizure medicines, including gabapentin (Neurontin) and pregabalin (Lyrica) can provide pain control. The FDA has approved Cymbalta, Savella, and Lyrica for the treatment of fibromyalgia.
Massage therapy: Massage in areas of pain, such as the shoulders, can provide relief and improve mobility. In addition, massage helps promote relaxation, which, in turn, can give you a level of control over your condition. However, it’s best to find a massage therapist who has experience treating people with fibromyalgia to avoid worsening pain. Check out www.ncbtmb.org to find a qualified therapist in your area.
Acupuncture: Acupunture has had mixed reviews in its ability to help with fibromyalgia. However, it may be worth trying. If you aren’t finding relief after a number of sessions, it probably isn’t going to be helpful for your symptoms.
Physical activity: Being active may be the last thing you feel like doing if you’re tired and in pain. But more than 400 studies have shown that exercise is very effective in reducing pain — even more so than medication. Focus on more gentle types of physical activity, such as walking, tai chi, or yoga for symptom relief.
Nutrition: There’s no “fibromyalgia diet,” but eating healthfully can fuel your body and help provide symptom relief. Foods containing vitamins C and D, magnesium and omega-3 fatty acids, for example, may be helpful. It can help to pay attention to certain foods that may be triggering your symptoms. For example, some people find that dairy foods or foods that contain gluten or monosodium glutamate (MSG) may worsen symptoms. Consider working with a dietitian to help you pinpoint possible trigger foods and develop an eating plan that works for you.
Stress relief: Taking steps to reduce stress is important. In addition to being physically active, you may find that getting help to sleep better, meditating, or even working with a mental health specialist are ways to reduce your symptoms.
Do your best to keep an open mind about trying various approaches to provide you with relief. If one approach doesn’t seem to help, try something different. And, if you have diabetes, keep checking your blood sugars and working with your diabetes care team to help you manage your diabetes.
Want to learn more about fibromyalgia? Read “What Is Fibromyalgia?” and “Fibromyalgia Treatments.”
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