Center for Pain Management

Fibromyalgia

Fibromyalgia is a common yet often misunderstood and misdiagnosed painful muscular condition which affects many Americans. Unfortunately for many individuals suffering from Fibromyalgia there is no easy solution. There are however strategies proven to improve the quality of life for these individuals.

If you take the name apart, fibro is a medical term for connective tissue, myo is a medical term for muscle, and algia is a medical term for pain. Literally then the name means pain in the muscle and connective tissue. This syndrome is characterized by pain, both above and below the waist and to the left and right side of the body; stiffness; fatigue; sleep disturbance; and in some cases depression. There are two diverging schools of thought about this as a diagnosis. Some experts believe that Fibromyalgia is a name given to a pattern of complaints that are really symptoms of an undiagnosed condition. This can be a hormonal or nutritional deficiency or an undiagnosed infection often of the sinuses, urinary tract or intestines. Other experts view Fibromyalgia as a distinct clinical entity diagnosed by the presence of the symptoms described above and the presence of pain at 11 out of 18 distinct points identified by the American College of Rheumatology in the presence of otherwise normal lab, x-ray, and electrodiagnostic studies. In clinical practice both scenarios are seen, and in addition there are patients who have diffuse myofascial pain or trigger points associated with degenerative spinal processes or following trauma. For this reason physicians who treat individuals with Fibromyalgia must both perform a thorough diagnostic evaluation to rule out underlying conditions and provide treatment options to manage the symptoms of Fibromyalgia when a correctable cause can not be found.

In the absence of a correctable condition, there is no cure for primary Fibromyalgia. There are however strategies which can lessen the pain and disability associated with the condition. There is no cure for Diabetes, but individuals with diabetes can lessen the impact of the disease by taking their medications as prescribed, following their diet, and exercising according to their doctor’s instructions. In the same way there are things that an individual with Fibromyalgia can do to control the symptoms and lessen the pain and fatigue.

The first and perhaps the most important is activity pacing. This means finding an optimal activity level for each person on each given day. For individuals with Fibromyalgia too little activity will cause an increase in stiffness and debilitation, while too much activity will cause an increase in pain and fatigue. Individuals will feel their best at an optimal amount of activity including work, leisure, home and exercise activities. Finding this is however much easier said than done. Most individuals feel poorly for so long that on the first day they feel better, they overdo to catch up. This often results in an increase in pain and fatigue that requires a period of recovery. Many individual spend their lives in this endless cycle of overdoing followed by inactivity. It takes discipline and practice to learn to do a little even on really bad days and not to overdo on good days.

The second critical factor is sleep. Common sense suggests that people in pain will not sleep well, but it may in fact be the opposite. Many experts feel that people who do not sleep well will be in pain. Poor or inadequate sleep is considered to be one of the possible causes of Fibromyalgia, and in clinical practice it is obvious that people who do not have adequate sleep have a much more difficult time managing their pain. Sleep management is a continuum. It may be as simple as improving sleep behaviors such as providing a dark, quiet environment, going to bed the same time each night, not reading or watching TV in bed, and going to bed neither hungry or too full. If these strategies are not enough to improve a person’s sleep, there are medications which can be prescribed. In some cases consultation with a sleep specialist or even an overnight sleep study may be required. Many individuals with Fibromyalgia have been found to have an underlying sleep disorder. Several area hospitals have sleep disorder centers and several area pulmonologists and neurologists practice in the field of sleep medicine.

Cardiovascular exercise is another critical factor in the management of Fibromyalgia. Cardiovascular exercise is any exercise that raises the heart rate for a period of time including walking, bicycling, swimming, and low impact or water aerobics. Multiple quality research studies have found that a good cardiovascular exercise program will lessen both the pain and fatigue associated with Fibromyalgia. It is interesting that several studies concluded that moderate cardiovascular exercise improved symptoms, but too much exercise made the pain and fatigue worse. For this reason it is important to start slowly with as little as a few minutes at a time. Starting too aggressively can result in increased pain and the misconception that all exercise will make the condition worse. Exercising under the supervision of a physical therapist or trainer who understands Fibromyalgia may be helpful. All individuals should check with their family physician before beginning any new exercise program.

Specialists in various areas of medicine are placing increasing importance on the role of nutrition in the management of Fibromyalgia. As stated earlier a deficiency in certain vitamins or minerals is identified as one of the possible causes of Fibromyalgia. While supplements should be taken only under the direction of a physician, individuals with Fibromyalgia should be careful to eat a well balanced diet. A variety of fruits and vegetables should be included as these are a primary source of vitamins and minerals. The FDA food pyramid is a simple guide to healthy eating and many area hospitals offer outpatient nutritional counseling. In addition to these well accepted strategies, other modifications including increasing water intake and limiting caffeine and nicotine may be helpful.

Medications also have a role in the management of Fibromyalgia. Pain medications are helpful to some individuals; and can be appropriate if they allow the person to participate more fully in work, family, and leisure activities. Medications may also be used to manage poor sleep or depression, both of which if left untreated make the symptoms of Fibromyalgia more difficult to control. Anti-inflammatory and muscle relaxant medications are also helpful to some people.  It is important to seek out a physician with experience in treating Fibromyalgia for medication management.

For more information or to schedule an appointment call the Center for Pain Management at (317)706-7246.