Fibromyalgia
1. Introduction
Fibromyalgia is a condition causing chronic widespread muscular pain. Widespread pain can be difficult to fully measure and certain people may have good and bad periods, making it difficult to treat (1). The central nervous system (the spinal cord and the brain) regulates how we perceive pain. With fibromyalgia the central nervous system becomes sensitised, meaning people with fibromyalgia can experience pain with no obvious injury, or increase the expected levels of pain from an actual injury (1,2). The emotional symptoms associated with fibromyalgia can also mean that people with fibromyalgia develop more severe forms of worry, fear or low mood in response to chronic pain. It is now well known that pain is very closely related to emotional factors, and they can predispose and exacerbate flare-ups of pain in people with chronic pain (7, 13).
A diagnosis of fibromyalgia is often made by a rheumatologist (a doctor specialising in joint and soft tissue disorders) once other conditions causing similar symptoms are excluded. Blood tests and scans do not show fibromyalgia but are useful in ruling out other conditions (1,3, 4). Fibromyalgia was once thought to be a rheumatological condition, related to inflammation of the tissues. However, recent research has shown this is not necessarily the case, although people with other rheumatological conditions may be more susceptible to developing fibromyalgia (4).
Although there is no cure for fibromyalgia currently available, a diagnosis and management plan may help reduce the anxiety associated with the condition and enable patients to take a more active role in controlling their symptoms.
Frequently Asked Questions
- Fibromyalgia is a condition that causes chronic widespread pain in different areas of the body (1).
- Not common
- It affects less than 5% of the population (15).
- No.
- Fibromyalgia may be linked to several other health problems, such as depression, anxiety and osteoarthritis.
- It is rarely associated with any serious medical conditions.
- Although there is currently no cure for fibromyalgia, with the right treatment and lifestyle changes the symptoms can be well managed.
- Women are four times more likely to suffer from fibromyalgia than men (15).
- People who are classed as obese or those who are physically inactive are more at risk (11).
- There are higher rates of fibromyalgia diagnosed in those with significant childhood or emotional trauma (13).
- Pain in multiple parts of the body, such as the shoulders, low back, neck or arms (1).
- Difficulty getting to sleep or waking often with pain during the night (5-8).
- Issues with memory or feeling that you cannot concentrate for long (5-8).
- Pain that is leading to anxiety, depression or low mood (5-8).
- Other conditions such as irritable bowel syndrome may exist together with fibromyalgia (5-8).
- Making changes to your life and regular physical activity are two of the most important ways to help manage fibromyalgia.
- Weight loss and participating in regular physical activity is very important (1).
- Medication, such as pain killers or anti-inflammatories, are helpful but are not a long-term solution (18).
- Cognitive behavioural therapy (CBT) can be useful to help you cope with the physical and emotional aspects of chronic pain (17).
- Currently, there is no cure for fibromyalgia (1).
- Making appropriate lifestyle changes can help manage symptoms and prevent a flare-up of pain.
- Medication, exercise, healthier eating and sticking to a consistent sleep routine are all useful ways to prevent and manage, a flare-up of pain.
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk.
2. Signs and Symptoms
Fibromyalgia not only causes widespread pain but can also cause whole-body issues other than pain. Please note this is not an exhaustive list and each person may experience some, all or other symptoms not listed here (5-8).
- Long term widespread pain in multiple areas, such as the back, shoulders, legs and arms.
- An increased sensitivity to touch, temperature or normal movement.
- Pain negatively affects their quality of sleep.
- Difficulty concentrating on simple tasks.
- Conditions such as irritable bowel disease may coexist with fibromyalgia, leading to stomach cramps, loss of appetite or nausea.
- Emotional symptoms such as fear, worry or depression.
3. Causes
The cause of fibromyalgia is not yet fully understood, but changes in how our brain and central nervous system process pain signals are thought to be important (9). The onset of fibromyalgia has been linked to infection, especially when accompanied by prolonged bed rest, physical trauma affecting the spine (such as a road traffic accident) or the chronic pain associated with other conditions such as rheumatoid arthritis or ankylosing spondylosis (1,2). Fibromyalgia may also be triggered by psychological stressors, including childhood trauma, PTSD, anxiety or depression (1,2, 9). In some cases, there may be no psychological or physical trigger for fibromyalgia that can be identified.
4. Risk Factors
This is not an exhaustive list. These factors could increase the likelihood of someone developing fibromyalgia. It does not mean everyone with these risk factors will develop symptoms.
- A family history of fibromyalgia, such as a parent or another relative (10).
- Obesity (11).
- Physical inactivity or increased sedentary behaviour (11).
- Emotional or physical childhood trauma (13).
- Low socioeconomic status (12).
- Associated mental health conditions such as depression, anxiety or PTSD (13).
- Poor sleep quality (14).
- Previous diagnosis of a rheumatological condition such as rheumatoid arthritis (12).
5. Prevalence
Fibromyalgia can be difficult to diagnose, but it is estimated between 2%-4% of people have a fibromyalgia diagnosis (1,15). However, up to 75% of people with a fibromyalgia diagnosis do not meet the diagnostic criteria, meaning that the literature suggests that the condition is often over-diagnosed (16).
Women are up to 4 times more likely to develop fibromyalgia than men. The prevalence of fibromyalgia increases with age, with most people being diagnosed between 40 and 60 years of age (1,15).
6. Assessment & Diagnosis
Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.
Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made. Blood tests and imaging studies like an MRI may be used to rule out other conditions that may present similarly to fibromyalgia (1).
7. Self-Management
As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help the management of your fibromyalgia. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference.
Other frontline treatments for fibromyalgia such as cognitive-behavioural therapies, including acceptance and commitment therapy and mindfulness, can improve pain, mood, function and sleep, whilst reducing stress and helping to cope with chronic pain (17).
8. Rehabilitation
Rehabilitation for fibromyalgia will look different for everyone, but it should always focus on reducing any risk factors, e.g. losing weight, eating a healthier diet, promoting a healthy lifestyle and general exercise (1).
Below are tw0 rehabilitation programmes created by our specialist musculoskeletal physiotherapists targeted at improving general function and decreasing pain associated with fibromyalgia. However, these programmes are only a starting point and may need to be adapted to meet your specific needs and goals.
9. Fibromyalgia
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
These are some simple, total body exercises that help promote the movement of multiple joints. Depending on the location of your pain, you can choose to make these movements more specific to that area, such as gentle movement of the neck, shoulders or low back. The aim of these exercises is to encourage natural movement, promote muscle and joint range of motion, and reduce pain and stiffness. Pain should not exceed 5/10 on your perceived pain scale whilst completing this exercise programme.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
These exercises include some additional, bodyweight strengthening exercises, particularly around the low back and lower limbs. They can help improve functional tasks such as walking speed, getting in and out of bed, and going up and down stairs by mobilising and building strength in different parts of the body. These could be performed once or twice per day, as required. Pain should not exceed 2/10 on your perceived pain scale whilst completing this exercise programme.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
10. Return to Sport / Normal life
For patients wanting to achieve a high level of function or sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from a further assessment to ensure you are making progress and establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.
11. Other Treatment Options
Many people with fibromyalgia will have tried a variety of different pain-relieving medication(s). These may have a good effect initially, but their effectiveness may reduce over time. Anti-depressant medications may be recommended as these increase serotonin levels which can improve mood and reduce pain. Other forms of medication, including tricyclic anti-depressants (such as amitriptyline), also improve sleep, decrease fatigue and may have a better pain-relieving effect (18).
12. Links for Further Reading
References
- Häuser, W., Ablin, J., Fitzcharles, M.A., Littlejohn, G., Luciano, J.V., Usui, C. and Walitt, B. (2015). Fibromyalgia. Nature reviews Disease primers, 1, 1-16.
- Phillips, K. and Clauw, D.J. (2013). Central pain mechanisms in rheumatic diseases: future directions. Arthritis and rheumatism, 65, p.291.
- Eich, W., Häuser, W., Arnold, B., Jäckel, W., Offenbächer, M., Petzke, F., Schiltenwolf, M., Settan, M., Sommer, C., Tölle10, T. and Üçeyler, N. (2012). Fibromyalgia syndrome. general principles and coordination of clinical care and patient education [English version of “Das fibromyalgiesyndrom, 26.
- Clauw, D.J. (2014). Fibromyalgia: a clinical review. Jama, 311, 1547-1555.
- Häuser, W., Zimmer, C., Felde, E. and Köllner, V. (2008). What are the key symptoms of fibromyalgia? Results of a survey of the German Fibromyalgia Association. Schmerz. 22,176-183.
- Henningsen, P., Zipfel, S. and Herzog, W. (2007). Management of functional somatic syndromes. The Lancet, 369, 946-955.
- Fietta, P. and Manganelli, P. (2007). Fibromyalgia and psychiatric disorders. Acta Bio-Medica: Atenei Parmensis, 78, 88-95.
- Atzeni, F., Sallì, S., Benucci, M., Di Franco, M., Casale, R., Alciati, A. and Sarzi-Puttini, P. (2012). Fibromyalgia and arthritides.
- Woolf, C.J. (2011). Central sensitization: implications for the diagnosis and treatment of pain. Pain, 152, S2-S15.
- Ablin, J.N., Cohen, H. and Buskila, D., 2006. Mechanisms of disease: genetics of fibromyalgia. Nature Clinical Practice Rheumatology, 2, 671-678.
- Mork, P.J., Vasseljen, O. and Nilsen, T.I. (2010). Association between physical exercise, body mass index, and risk of fibromyalgia: longitudinal data from the Norwegian Nord‐Trøndelag Health Study. Arthritis care & research, 62, 611-617.
- Wolfe, F., Häuser, W., Hassett, A.L., Katz, R.S. and Walitt, B.T. (2011). The development of fibromyalgia–I: examination of rates and predictors in patients with rheumatoid arthritis (RA). PAIN®, 152, 291-299.
- Häuser, W., Kosseva, M., Üceyler, N., Klose, P. and Sommer, C. (2011). Emotional, physical, and sexual abuse in fibromyalgia syndrome: a systematic review with meta‐analysis. Arthritis care & research, 63, 808-820.
- Mork, P.J. and Nilsen, T.I. (2012). Sleep problems and risk of fibromyalgia: longitudinal data on an adult female population in Norway. Arthritis & rheumatism, 64, 281-284.
- Queiroz, L.P. (2013). Worldwide epidemiology of fibromyalgia. Current pain and headache reports, 17, 356.
- Walitt, B., Nahin, R.L., Katz, R.S., Bergman, M.J. and Wolfe, F. (2015). The prevalence and characteristics of fibromyalgia in the 2012 National Health Interview Survey. PloS one. 10, e0138024.
- Perrot, S. and Russell, I.J. (2014). More ubiquitous effects from non‐pharmacologic than from pharmacologic treatments for fibromyalgia syndrome: A meta‐analysis examining six core symptoms. European Journal of Pain, 18, 1067-1080.
- Moldofsky, H., Harris, H.W., Archambault, W.T., Kwong, T. and Lederman, S. (2011). Effects of bedtime very low dose cyclobenzaprine on symptoms and sleep physiology in patients with fibromyalgia syndrome: a double-blind randomized placebo-controlled study. The Journal of rheumatology, 38, 2653-2663.
Other Conditions in
Neurological, Long Term Conditions, Rheumatology, Pain
Whiplash Disorders
An injury which typically occurs following a road traffic collision, often affecting the soft tissues of the neck.
Migraines
Often described as a moderate or severe headache felt as a throbbing pain on one side of the head.
Lumbar Spinal Stenosis
Narrowing of the spaces though which lower back spinal nerves travel which can result in weakness, pain and reduced function.
Low Back Pain and Sciatica
Sciatica is a symptom describing pain and/or pins and needles down the back of the leg.
Long Covid
A term to describe the effects of Covid-19 that continue for weeks or months beyond the initial illness.
Femoral Nerve Radiculopathy
This is where the nerve that supplies the front of the leg is irritated and causes pain/numbess.
Cervical Spinal Stenosis
Narrowing of the spaces through which the neck spinal nerves travel which can result in weakness, pain and reduced function.
Cervical Radiculopathy
Nerve pain originating from the neck and causing pain, altered sensation or weakness in the arm.
Cervical Disc Dysfunction
Disk/joint-related issues that can cause pain, weakness and altered sensation in the neck and arms.
Cauda Equina Syndrome
A rare but serious condition as a result of compression of the nerves at the base of your spine.
Carpal Tunnel Syndrome
Increased pressure irritating a nerve in the wrist, causing pain, loss of strength and tingling in your hand.