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What are the causes?
There is no definitive cause of FM, but genetics do play an important role as there is usually a strong family history of the condition. Infections such as mononucleosis and Lyme disease; chronic diseases such as osteoarthritis, rheumatoid arthritis, and diabetes; psychological stress (PTSD, depression, bipolar, ADHD); or trauma or injury to the body can act as triggers.
What are the typical symptoms?The most common symptom of FM is widespread pain, tenderness, and stiffness that affects both sides of the body, both above and below the waist. Most people with FM suffer from severe fatigue, cognitive or memory problems (“fibro fog”), trouble falling or staying asleep, and mood disturbances (anxiety or depression). Pain levels can vary from day to day. Some patients report occasional ringing in the ear, jaw pain/temporomandibular joint disorder (TMJ), dry eye, enlarged lymph nodes, nasal congestion, multiple allergies, irritable bowel syndrome (IBS), or difficulty digesting. Associated neurological symptoms include tension headaches or migraines or tingling/“pins and needles” sensations in the arms, hands, feet, or legs. Newly identified syndromes such as heart palpitations or a drop in blood pressure due to postural orthostatic tachycardia syndrome (POTS) have also been linked to FM.
How is it diagnosed?
Getting a diagnosis for fibromyalgia can be challenging because there is no individual test that will confirm that you have fibromyalgia. Many of the symptoms mimic other medical conditions, so FM becomes a diagnosis of exclusion. Your provider will review your symptoms and may order blood tests to rule out other conditions such as an auto-immune disorder, arthritis, or a thyroid imbalance. There are 18 designated tender points at the shoulders, legs, and back of the head that your physician will likely examine during your visit.
What types of treatment are available for fibromyalgia?While there is no cure for fibromyalgia, your provider will work with you to come up with a treatment plan that includes a combination of lifestyle changes and medication. Although the pain will likely never completely disappear, the goal is to ease the symptoms and improve the quality of life. The non-medication approach involves lifestyle changes that are vital for the improvement of symptoms. Medication alone will not help if one does not change their lifestyle.
Sleep - First, it's important to practice good sleep hygiene. If sleep apnea is suspected, it may help to see a sleep specialist and possibly have a sleep study.
Mental Health – It is important for those diagnosed with fibromyalgia to keep their stress levels at bay as stress can increase symptoms. Working with a mental health provider can help you address any psychological factors such as post-traumatic stress disorder (PTSD), depression, anxiety, or attention-deficit/hyperactivity disorder (ADHD).
Exercise - Exercise is a critical part of a treatment plan. Exercise helps to produce endorphins, which are our natural pain killers. You should aim to do some form of cardio/aerobic exercise for 30 minutes at least three times a week as well as strength training three times a week. Yoga and meditation are also helpful in decreasing anxiety while gently strengthening the muscles. Swimming in warm water is a great alternative form of low impact exercise. Tai Chi has also been shown to reduce pain.
Alternative Medicine – Acupuncture, massage therapy, physical therapy, and chiropractic manipulation have all shown benefits in improving symptoms of fibromyalgia.
Diet - Although there is still not enough data about diet, following an anti-inflammatory diet rich in fruits, vegetables, nuts, whole grains, fish, and healthy oils can be helpful. There is a hypothesis that small fiber nerve damage may come from too much sugar, causing insulin resistance without overt diabetes. Eliminating added and refined sugar in your diet can be helpful in many ways.
Supplements - Some vitamins may help with fatigue such as B complex and magnesium. Turmeric and glucosamine-chondroitin have little evidence but may help in relieving pain if there is underlying osteoarthritis. Cannabidiol (CBD) oil has analgesic properties as well; however, like any supplements, they are not FDA regulated. It’s hard to find a pure CBD without having some of the THC substance which gives the euphoria. More research is still needed in that field.
Medications - If symptoms of FM are not relieved by lifestyle changes, there are circumstances where prescription medications are appropriate.
- Insomnia or sleep apnea can amplify the perception of pain. Medications such as amitriptyline (Elavil®), gabapentin, or pregabalin (Lyrica®) can help to improve sleep. Cyclobenzaprine (Flexeril®), a muscle relaxer, can also help with both sleep and nerve pain.
- For pain, anti-inflammatory drugs such as ibuprofen may be suggested. Antidepressants called serotonin and norepinephrine reuptake inhibitors (SNRI) such as duloxetine (Cymbalta®) and milnacipran (Savella®) may also help to reduce pain.
- For localized pain, trigger or tender point injections and joint injections with corticosteroids and a numbing medicine like lidocaine may be suggested.
- Opioids are rarely recommended as they can lead to addiction and cause a rebound effect.