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what is fibromyalgia?

 

 

  Fibromyalgia means widespread pain in the muscles, but this syndrome causes many other symptoms. Lab tests seldom validate your condition and the results often make you feel like a hypochondriac. Pressing on tender points can diagnose fibromyalgia, but the exam still does not explain all of your symptoms.

People with fibromyalgia often describe their symptoms as a flu-like infection that doesn’t go away. It leaves you exhausted and unable to think or find the right words (symptoms of fibro fog).  With fibromyalgia, you have trouble sleeping and wake up stiff and achy. Your symptoms can be debilitating and you probably feel as though you have to push yourself to get anything done.

What Makes Fibromyalgia Symptoms Worse?

 

   Certain aggravating factors can make your symptoms come and go, or change without reason. Other conditions may also make you feel worse. Learn what these factors are so that you can work with your doctor on more effective treatment strategies.

 

Factors that Aggravate Fibromyalgia

 

Weather (especially cold climates and changes in barometric pressure), cold or drafty environments, hormonal fluctuations (premenstrual and menopausal states), poor quality sleep, stress, depression, anxiety, and over-exertion can all contribute to fibromyalgia symptom flare-ups.

 

Other Situations that Make Fibromyalgia Worse 

 

Fibromyalgia patients are often sensitive to odors, loud noises, bright lights, some foods, and prescription medications.  You may also experience:

• chest pain unrelated to the heart

• shortness of breath

• dizziness

• nasal congestion

• painful periods

• palpitations

• irritable bladder/interstitial cystitis

• profuse sweating

• tingling/numbness sensations

• chemical sensitivities

• vulvodynia (vulvar pain)

• difficulty focusing eyes

• the feeling of swollen extremities

• dry/burning eyes and mouth

 

Most Common Fibromyalgia Symptoms

 

Pain All Over – People describe fibromyalgia pain as deep muscular aching, throbbing, shooting, stabbing, or intense burning. Muscle groups used the most may hurt more.1 In addition, the severity of regional pains can make your fibromyalgia symptoms worse.

 

Fatigue – Exhaustion can be one of the most incapacitating fibromyalgia symptoms. You may feel as though your arms and legs are weighted down by concrete blocks and your body may be so drained of energy that every task requires great effort.

 

Sleep Difficulties – It’s not just about falling asleep. Repeat arousals prevent you from reaching deep, restorative sleep, so you wake up feeling as though you have been hit by a Mack truck.  An overnight sleep study may show symptoms of repeat arousals, but a specific sleep disorder may not be found.

 

Brain Fog – Trouble concentrating, retaining new information, and word-finding are common fibromyalgia symptoms that seriously interfere with daily functioning.6 You may be easily distracted and this symptom appears to correspond to the severity of pain (as though the brain is consumed by the pain, limiting your ability to perform cognitive tasks).

 

Morning Stiffness – You may wake up to enhanced muscle soreness with fibromyalgia, but you probably also feel more stiff than usual. The cause of these muscle symptoms is unknown, but warm water and gentle stretching usually help alleviate them.

 

Muscle Knots, Cramping, Weakness – No matter how much you try to relax your muscles, they may feel tense. Many contain rope-like knots called myofascial trigger points, making you more susceptible to muscle cramping and weakness.8 The pain of fibromyalgia may also be a source of muscle weakness.

 

Digestive Disorders – Constipation, diarrhea, abdominal pain, gas and bloating, irritable bowel, and nausea are found in roughly 40 to 70% of fibromyalgia patients.9 Acid reflux and a slowed digestion are also common.

 

Headaches/Migraines – Recurrent tension headaches or migraines are present in 50 to 70% of fibromyalgia patients. Headache symptoms are usually rated as severe, occur at least two times per week, and often have a migraine component.  This head pain is partly due to trigger points in the shoulder, neck, and head muscles.

 

Balance Problems – Balance confidence is greatly reduced in people with fibromyalgia.  Walking patterns are altered and the odds of falling are increased.

 

Itchy/Burning Skin – Your skin may look normal or it may have itchy red bumps similar to hives.  Burning pain, similar to a bad sunburn, is also common in fibromyalgia patients.

 

Other Strange Symptoms? – Do bright lights, sounds, or odors bother you? These symptoms could be part of your fibromyalgia. 

 

Diagnosis

 

If you hurt all over and feel worn out, you may have fibromyalgia or chronic fatigue syndrome. Both are serious chronic illnesses that have specific criteria for diagnosis, but may be overlooked because blood tests are typically normal. Also, the distinction between fibromyalgia and chronic fatigue syndrome is rather fuzzy, with up to 70 percent of patients meeting the diagnosis for both.

 

Fibromyalgia Tender Points

 

Routine lab tests do not detect the widespread pain of fibromyalgia. Instead, the diagnosis is made by a physical exam of pressure points that takes about five minutes. When light pressure is applied to the surface of the muscles throughout the body, patients with fibromyalgia find this painful, especially at the specific tender point areas used for diagnosis.

 

To meet the fibromyalgia criteria for diagnosis, patients must have:

 

A. Widespread pain in all four quadrants of the body for a minimum of three months

 

B. At least 11 of the 18 specified tender points (see diagram2)

The 18 sites used for the fibromyalgia diagnosis cluster around the neck, shoulder, chest, hip, knee, and elbow regions. The finger pressure that your doctor must apply to these areas during an exam is just enough to cause the nail bed to blanch or become white.

While many chronic pain syndromes mimic certain aspects of fibromyalgia, the 1990 American College of Rheumatology criteria identifies fibro patients with an 88 percent accuracy.

This is just as accurate as blood tests for other medical conditions, so you and your doctor should not view fibromyalgia as a wastebasket diagnosis.

 

Tender Points vs. Trigger Points

 

What is the difference between tender points and trigger points, and how will it impact your treatment? For starters, 90 percent of the 18 predetermined tender points are actually myofascial trigger points.4 Trigger points are firm nodules that you can often feel in your tight, rope-like muscles. Pressing on a trigger point hurts in the area and also shoots pain to other regions, while pressing on a tender point is believed to only cause discomfort to the local area.

The finding that most of your tender points are actually trigger points is good news because it opens up your treatment options. There are specific therapies for relieving the painful knots in the muscles where the trigger points are located, and research shows that relieving the pain of just one trigger point can have a significant on reducing your body-wide pain. One of the more popular approaches is therapeutic massage, which involves working out the trigger points to try to get the muscles to relax. In fact, anything that eases muscle tension, such as a hot shower or soaking in a hot tub, will reduce the impact of the trigger points. Unlike tender points, trigger points cause a restricted range of motion (muscle tightness) and they radiate pain to other areas of the body.

 

Is your tender point count under 11?

 

If you don’t quite meet the tender point criteria, the diagnosis of fibromyalgia may still apply to you. The tender point diagnosis was developed for selecting fibromyalgia patients for research studies. However, patients in the general community are often diagnosed with fibromyalgia using less strict guidelines.

 

New Fibromyalgia Criteria Proposed

 

In April of 2010, a group of rheumatologists acting on behalf of the American College of Rheumatology (ACR) published new preliminary criteria on how doctors should diagnose fibromyalgia. There are pros and cons of these new criteria. Tender points have been tossed out the window and they have been replaced with a symptom checklist. Learn more and take a survey that will tell you if you meet the fibromyalgia diagnosis.

 

Do you meet the diagnosis for fibromyalgia?

 

If the answer is yes, visit our Latest News section for information about drug and nondrug treatment options – we post new articles about studies that may be helpful for you. If you stay current on the latest news about fibromyalgia, you give yourself the best opportunity to return to a more enjoyable quality of life. Symptoms can be both frustrating and overwhelming when other people in your life cannot see your pain or trivialize your diagnosis. Find out more about the symptoms and learn about your treatment options, including various methods to relieve painful trigger points.

 

Could you have chronic fatigue syndrome?

 

Doctors usually order tests to make sure you don’t have an easy to treat condition or one that needs can destroy tissues so it needs to be caught early (such as rheumatoid arthritis or lupus). If nothing shows up on your tests and you really don’t have the widespread pain required of fibromyalgia, you and your doctor may want to consider the diagnosis of chronic fatigue syndrome.

 

 

Treatment

 

Fibromyalgia Treatment Strategies

 

The most effective treatment approaches for fibromyalgia symptoms use a combination of medications, nondrug therapies, and self-help strategies. The three FDA-approved fibromyalgia medications are not the only treatments available for patients; there are other over-the-counter meds, physical and body movement therapies, and alternative medicine options. You can also improve your quality of life by learning about your options, making changes and applying self-help strategies.

 

Medication Options

 

Doctors generally prescribe medications aimed at reducing pain and daytime fatigue and improving sleep. Patient responses to medications vary widely, and although the FDA has approved Lyrica, Cymbalta and Savella for fibromyalgia pain, your options should not be restricted to these drugs. There are many others on the market that could help ease your symptoms but have not been specifically approved for fibromyalgia.

Learn about your many medication options.

 

Nondrug and Alternative Therapies

 

Medications have the downside of side effects, which may limit what you can handle or the dose you can tolerate. Nondrug therapies are used to complement to your medication. Consider trying hands-on approaches (massage), movement therapies (Tai Chi), trigger point treatments (stretching sore muscles with heat), and nutritional supplements such as magnesium with malic acid and various anti-oxidants to protect your tissues.

Learn more about nondrug and alternative therapies.

 

Self-Help Strategies

 

You don’t have to rely upon a doctor or healthcare provider to feel better. There are many strategies you can use to ease your fibromyalgia symptoms that are inexpensive with few (or no) side effects. They can aid with  managing muscle tension, reducing painful knots in your muscles (i.e., myofascial trigger points), conserving energy, and improving sleep. If you use a variety of self-help approaches on an everyday basis, it will reduce your symptoms and give you a sense of control over your fibromyalgia.