Fibromyalgia

Fibromyalgia is a condition that I see and treat often in my pain management practice. In this post, I will discuss an overview of fibromyalgia, including common symptoms and how it is diagnosed. I will also talk about different treatment options including lifestyle modifications, medications, other modalities and interventional procedures.

Fibromyalgia is a condition that is characterized by widespread pain and is associated with other symptoms such as fatigue, poor sleep, and poor concentration. We are still not exactly sure what causes fibromyalgia, but it is likely that there is an interplay of genetics, physical and emotional stressors that combine to cause the symptoms of fibromyalgia. There is probably an alteration in the way that the brain processes pain signals which leads to increased frequency and intensity of painful sensations.  

Fibromyalgia is more common in women, and is associated with other conditions including anxiety, depression, TMJ disorders, and irritable bowel syndrome. I treat a lot of pelvic pain in my practice, and I have found that there is significant crossover with this condition as well.

In the past, we used to diagnose fibromyalgia by putting a specific amount of pressure over various points of the body. If more than a certain number were painful, this was considered positive. Now, we use a Widespread Pain Index, which is a way of assessing for diffuse pain that occurs for more than three months. The pain cannot be caused by another diagnosis, and is associated with other symptoms like fatigue, poor sleep, and poor concentration. We will often do blood tests to rule out other disorders before fibromyalgia can be diagnosed.

Some of the most important treatment options for fibromyalgia are lifestyle modifications. This is really hard to do because it involves changing habits, but it is also probably the most important aspect of a fibromyalgia treatment plan. Evidence shows that regular cardiovascular exercise is helpful in controlling the symptoms of fibromyalgia. I usually tell my patients that they may feel a little worse after each episode of exercise, but that the overall trajectory of their long-term pain patterns is one of improvement. It is also totally fine if the exercise is gentle walking for 20-30 minutes! Sometimes it can feel overwhelming to think that good exercise is something intense like running a marathon. Small steps are more achievable and just as good for the symptoms of fibromyalgia. I also discuss sleep hygiene measures like a regular bedtime, no screens one hour before bed and trying to limit alcohol before bedtime.

Medications that are helpful for fibromyalgia are typically taken daily as a preventative measure, and they include some anti-depressants such as Cymbalta and Savella. Lyrica is another medication that is approved for use in patients with fibromyalgia, and Gabapentin is an older cousin of Lyrica that I often use if patients can’t get Lyrica approved by their insurance company. I also discussed in another post the use of low dose naltrexone, which isn’t formally approved yet for fibromyalgia, but I think likely will be in the future.  

I try to manage breakthrough symptoms with anti-inflammatory medications and muscle relaxants as needed, but these medications are not intended for daily use as they can have side effects. Opioids are not a good option for fibromyalgia because they can actually worsen pain over time.

I am very supportive of patients trying other modalities to control their pain from fibromyalgia including acupuncture and mindfulness based therapies (see my other post about mindfulness).  Sometimes starting therapy can be helpful too, because the stress of a chronic illness like fibromyalgia can be really challenging to manage alone.

As far as interventional treatment options, I typically will offer patients trigger point injections if they have severe areas of spasm. You can find a discussion of trigger point injections in this old post. Unfortunately, there isn’t one fibromyalgia injection that fixes the all the symptoms of this disorder.

If you are worried that you might have fibromyalgia, the best thing to do is get evaluated in person by a pain management physician so that you can be assessed. If you do have fibromyalgia, a pain management physician can help to develop an individualized treatment plan for you.