Fibromyalgia

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There are three main symptoms of fibromyalgia, which are:

Widespread pain

The pain caused by fibromyalgia will be felt on both sides of your body, as well as above and below your waist, and is most commonly described as a constant dull ache that lasts for a prolonged period of time. Everyone experiences pain in a slightly different way, so your fibromyalgia pain might differ to someone else's.

It could be that you feel a burning pain or pins-and-needles sensation, a deep aching throughout the body, an electric stinging sensation, or feeling like you've got sunburn. The pain can be triggered by something small, like the wind, a handshake, or certain fabrics passing over your skin, and may go from mild to debilitating in a short space of time. Sometimes there will be no trigger for episodes of pain.

Fatigue

If you have fibromyalgia, it is possible that you will feel tired when you wake up, despite sleeping for long periods of time. Your sleep may also be disrupted by pain, headaches, restless leg syndrome (an overwhelming urge to move your legs), or sleep apnoea (when your breathing stops and starts while you're sleeping). It is thought that fibromyalgia causes fatigue because of your body constantly working extra hard to deal with your pain. This constant reaction to pain signals being sent across the nerves can make you feel tired. You might also have difficulty sleeping due to your fibromyalgia (insomnia).

Cognitive issues

Another common symptom of fibromyalgia is known as 'fibro fog' where your ability to focus, pay attention, and concentrate on mental tasks becomes compromised. You may also have trouble with remembering certain details, be less alert, struggle with holding a conversation, along with issues relating to your decision making, planning, and abstract thinking.

The cause of 'fibro fog' is unclear, but some suggest that it is due the chronic pain taking up too much mental exertion, while others point to the fact that the problem originates in your brain means that certain neurological pathways and neurotransmitters (small circuits in the brain that transfer and receive information) are negatively affected. Another theory is that the poor sleep and subsequently low energy levels caused by fibromyalgia diminishes your ability to think as clearly as normal.

Other symptoms of fibromyalgia may include:

• Irritable bowel syndrome
• Chronic fatigue syndrome
• Migraines and headaches
• Dry eyes
• Rashes
• Interstitial cystitis (a bladder condition that causes long-term pain and problems urinating)
• Temporomandibular joint disorders (a condition affecting jaw movement)
• Anxiety and/or depression
• Digestive issues (abdominal pain, bloating, constipation, etc.)
• Postural tachycardia syndrome (abnormal increase in heart rate, typically after sitting or standing)

Despite extensive research, it remains unclear what causes fibromyalgia, although there are certain factors that seem very likely to be involved.

Nerve signal issues

When you experience an injury, nerve signals travel from the affected area on your body through your spinal cord to your brain, which picks up these signals as pain. Once the area is no longer experiencing the initial cause of the injury (e.g., you remove a ring on your finger that was too tight), your brain no longer picks up these signals.

In the case of fibromyalgia, on the other hand, you may experience pain all over your body, even when there is no apparent illness or injury. It is thought that this happens because of an abnormal processing of pain signals in your brain and spinal cord. So, if you have fibromyalgia, you might have more cells that carry pain signals than normal, or fewer cells that slow pain signals down. This essentially means that your pain volume is always turned up. A consequence of this is that minor bumps or scrapes hurt considerably more than they should, and you might feel pain from something that usually wouldn't hurt at all (e.g., putting on a t-shirt).

Genetics

Although fibromyalgia is not passed directly from parents to their children, the condition can cluster within family groups. Research has shown that the chances of developing fibromyalgia are several times higher in the immediate families of people with fibromyalgia compared to families where no one has fibromyalgia.

Studies of DNA in families containing people with fibromyalgia have shown a number of genes that play a role in your nervous system's response to pain and could be responsible for why you have developed the condition.

Significant trauma

If you experience a serious injury, such as a car accident, it can lead to you developing the symptoms associated with fibromyalgia, even after the initial affects of the injury have passed. In the same way, a major operation can lead to fibromyalgia developing. You might also be at risk of developing fibromyalgia if you encounter a severe emotional trigger, such as serving in armed forces during a war or experiencing prolonged physical abuse.

Rheumatoid arthritis

Although it has not been demonstrated that having rheumatoid arthritis causes fibromyalgia, the two conditions share certain symptoms. Rheumatoid arthritis is an autoimmune condition, which means your immune system attacks healthy tissue on your body, usually your joints, leading to pain, swelling, and fatigue – all symptoms of fibromyalgia. So, having an inflammatory form of arthritis, or any condition that causes your joints to swell, can increase the risk of fibromyalgia. This is possibly due to the chronic pain itself, leading to your brain becoming particularly sensitive to not just things that hurt but also things that aren't typically painful.

Gender

According to studies, fibromyalgia is twice as likely to occur in women as it is in men, although it has been claimed in response that diagnosis rate with women is simply higher. However, the symptoms of fibromyalgia are generally more severe in women than men. Women tend to have more widespread pain, experience irritable bowel syndrome more often, and have higher chances of morning fatigue. The transition to menopause could also potentially increase the affect of fibromyalgia.

There are other possible causes of fibromyalgia, which include but are not limited to:

• Ankylosing spondylitis (pain and swelling in parts of your spine)
• Obesity
• Depression and/or anxiety
• Systemic lupus erythematosus (a condition that affects your immune system and causes problems with skin, joints, kidneys, and organs)
• Infections

Exercise

If you have fibromyalgia and don't exercise, your symptoms could become worse, so having an exercise programme is important for improving your general quality of life. Your physiotherapist may give you a programme that you can follow, taking care to adapt the exercises to what you enjoy and feel comfortable doing on a long-term basis. This may involve:

Walking

Start by talking short walks, maybe five times a day, working up to a total of 30 minute's worth of walking every 24 hours. If you start to feel uncomfortable, you can decrease this amount.

Aerobic exercises

Sometimes, walking can place too much pressure on your joints, causing you pain. If you find that this is the case for you, your physiotherapist may suggest doing certain stretching exercises in a pool. This is easier on your joints, relaxes your muscles, and allows for better stretching.

Range of motion exercises

You might struggle to have full range of motion when you have fibromyalgia, which is why your physiotherapist might recommend gentle stretching exercises. Flexing out certain muscle groups &- e.g., rotation of your arms and legs as you sit on a chair - can keep your joints looser, making general movement throughout the day slightly easier.

Medications

Due to the fact that depression and anxiety often accompany your fibromyalgia, your consultant may prescribe a series of antidepressants that relieve your discomfort by improving your sleep, emotional health, and overall quality of life. These medications are usually only recommended when you are over 18 and have lived with your symptoms for a long time, and may not be suitable for some antidepressants if you're taking other medications at the same time. Some of the antidepressant medications that may be prescribed are:

• Amitriptyline
• Citalopram
• Duloxetine
• Fluoxetine (Prozac)
• Paroxetine
• Sertraline

Talking therapies

Often, talking therapies are used to reduce the levels of pain caused by your fibromyalgia, the most common being cognitive behavioural therapy (CBT).

CBT

Cognitive behavioural therapy is a generally short-term form of talking therapy - usually between eight and 16 sessions - that focuses on changing the way you think about yourself, with an ultimate view towards identifying negative thought patterns and interpretations that contribute to your low mood, ahead of replacing these thoughts with more compassionate modes of thinking.

When it comes to fibromyalgia, your CBT therapist will focus on the way you 'catastrophise' - namely, believing that something is much worse than it actually is. Holding this belief can keep you in a loop of expecting, and then experiencing, high levels of pain. By making a note of this automatic process, you can then notice it when it arises and use mental techniques to prevent yourself from spiralling into 'catastrophising' mode, allowing you to relax, which in turn can improve sleep, reduce anxiety, increase functioning, and potentially ease your fibromyalgia symptoms.

Alternative medicines

If none of your prescribed treatments make any difference to the symptoms of your fibromyalgia, it could be that alternative medicinal practices may provide some relief. These are often known as holistic modalities, which involve therapies that don't target a specific part of your body but activate your nervous system as a whole by your practitioner using specialised touch techniques designed to activate your nervous system and send circulation throughout your body, which in turn unblocks any areas of pent-up tension and leaves you feeling more rested, lighter on your feet, and more positive overall. Some of these modalities include:

• Acupuncture
• Yoga
• Reiki
• Tai chi
• Massage therapy

Please note that these modalities cannot claim to cure, diagnose, or prescribe any conditions.

Assessing your pain

Your consultant will start by asking you to describe your pain - where you feel it, how long it's been going on for, and what your pain feels like (burning, aching, tingling, etc.). It is important for them to identify pressure or tenderness on specific parts of your body, so they will most likely conduct a physical examination that involves checking different pressure points on your body. These will be:

• Your left upper region (shoulder, arm, and jaw)
• Your right upper region (shoulder, arm, and jaw)
• Your left lower region (hip, buttock, and leg)
• Your right lower region (hip, buttock, and leg)
• Your axial region (neck, back, chest, and abdomen)

To meet the criteria for fibromyalgia, your consultant will need to confirm that you have pain in at least four of these five areas. However, this test alone is not sufficient for confirming that you certainly have fibromyalgia.

There aren't any lab tests that can confirm whether you have fibromyalgia. What your consultant may do instead is perform a series of tests that can show if you have any other conditions whose symptoms mirror that of fibromyalgia. This may involve:

Blood tests

Other conditions such as hypothyroidism (when your thyroid gland isn't producing enough hormones) and polymyalgia rheumatica (an inflammatory disorder causing muscle pain and stiffness, particularly in your shoulders and hips) can sometimes mimic fibromyalgia. Blood tests allow your consultant to see if either of these conditions are present, along with helping them check for antibodies to gluten, which is a sign of celiac disease - a condition in which the body develops an immune reaction to gluten (a protein found in wheat) and has similar symptoms to fibromyalgia. If these blood tests don't show that you have any of these conditions, you might have fibromyalgia.

Testing for rheumatoid arthritis

Rheumatoid arthritis can feel extremely similar to fibromyalgia, so your consultant will most likely do tests to see if this condition is what explains your symptoms. Blood tests can measure the rheumatoid factors in your blood (proteins that the immune system creates when it starts to attack healthy tissue). Along with blood tests, some imaging tests may be done as well, such as a musculoskeletal ultrasound (MSUS) or an MRI test, which can both detect inflammation and bone erosion that isn't picked up on X-rays.

Your consultant may also order further tests to rule out other conditions that can cause symptoms similar to fibromyalgia, including:

• Anaemia
• Chronic fatigue syndrome
• Depression and/or anxiety
• Myofascial pain syndrome
• Multiple sclerosis (a condition that affects the brain and spinal cord)
• Myasthenia gravis (a long-term condition that causes muscle weakness)

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If you would like to learn more about fibromyalgia and how we can help, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in November 2022. Next review due November 2025.

1. Fibromyalgia, Mayo Clinic
2. What does fibromyalgia feel like?, Very Well Health
3. Fibro fog, Creaky Joints
4. Is fibromyalgia hereditary?, Mayo Clinic
5. Fibromyalgia, CDC
6. Fibromyalgia exercise, WebMD
7. Cognitive behavioural therapy for fibromyalgia: think differently, feel better, Everyday Health