Treat pain and fatigue symptoms associated with fibromyalgia

Do understand the history of fibromyalgia as a diagnostic entity

Fibromyalgia (FM) was first described in the mid-nineteenth century in France and England. By the end of the 20th century, doctors began to recognize FM as a real syndrome characterized by widespread muscle pain. FM is currently considered the most common cause of generalized musculoskeletal (MS) pain in women between the ages of 20-55 years. Interestingly, FM is 6 times more common in women than in men, and roughly half of patients who see their doctors for pain meet diagnostic criteria for fibromyalgia.

Do understand the symptoms of fibromyalgia

The most important symptom of FM is widespread musculoskeletal pain involving all 4 quadrants of your body (i.e., above and below your waist, right and left sides) for greater than 3 months duration. Often, your pain can begin more localized, commonly in the neck or back, and become more generalized with time. Your main complaint may be muscle pain, although your joints may hurt as well and can sometimes even be swollen, though not to the degree as in rheumatoid arthritis, for example. Other explanations for your pain such as other arthritic or muscle disorders, endocrine abnormalities, infections, neurological diseases, and/or autoimmune diseases need to be evaluated for and ruled out.

Do know the commonly associated symptoms of fibromyalgia

In addition to widespread MS pain, you may experience any or all of the following: numbness or tingling in your arms and legs, “creepy, crawling” sensations, or pins and needles. If these symptoms are more prominent than the pain itself, it is important to consult with your doctor about a referral to a neurologist to rule out carpal tunnel syndrome, for example. This example reinforces the point that fibromyalgia is diagnosed when all other possible diagnoses have been entertained and ruled out: celiac disease, B12 or vitamin D deficiency, restless leg syndrome, in addition to the broader categories listed previously.

Do know that the universal symptom of fibromyalgia is fatigue

The fatigue you experience with fibromyalgia is also associated with non restful sleep; i.e., even though you may sleep for 10 hours, you still don’t feel well rested. Often, you may even feel like you have the flu, a common complaint among fibromyalgia patients. This fatigue can get in the way of your everyday life, including home and professional responsibilities. It is felt that abnormal sleep cycling is responsible for the disordered sleep seen in fibromyalgia.

Do know that you have a very real syndrome even though you may look normal

In spite of all the debate and controversy over the years, the diagnosis of fibromyalgia is well described and widely accepted in the rheumatology community. You need to find a physician who is familiar with the signs and symptoms of the disorder to get the best treatment.

Do not be discouraged if you feel mentally cloudy

A common symptom of fibromyalgia you may experience is called “fibro fog,” or cognitive fogginess. This may partly be a reflection of the poor sleep you are getting, but it is an almost universal symptom in fibromyalgia. You may feel not as sharp as you normally do or have some difficulty with memory. This, while frustrating, is normal and is not associated with progressive decline leading to problems in the workplace, etc.

Do not forget that fibromyalgia is a syndrome and that there are many other symptoms you may experience

For example, you may experience frequent headache, eye dryness, chemical sensitivities and TMJ pain. Additionally, you may have abdominal symptoms suggestive of irritable bowel syndrome, such as periods of diarrhea alternating with constipation, as well as pelvic and bladder pain (interstitial cystitis). Depression and anxiety are common, which are not the cause of your pain, but rather a coexistent symptom.

Do not assume a one-size-fits-all treatment approach

There are many, new effective therapies for fibromyalgia available today. Some of the drugs that your doctor may recommend are antidepressant medications pharmacologically (cymbalta for example), however, they are used to lessen the pain in FM. Other types of medicines your doctor could suggest are ones that act directly on the nerves (lyrica, neurontin). Depending on which of your symptoms is most prominent, the pain or the fatigue, your doctor may recommend one over the other or even a combination of the two.

Do not underestimate the value of a more holistic approach to management

It is possible that you may not respond to or tolerate some of the medications used to treat fibromyalgia because of side effects (fatigue versus insomnia, lightheadedness, and sweating, to name a few). In any case, you should also explore alternative and complementary medical approaches to your care. Studies are mixed, but have shown a benefit in doing tai chi, yoga, and acupuncture. These modalities can and should be used in conjunction with more conventional therapies for the best treatment outcome.

Do not neglect exercise because it hurts

Contrary to logic, exercising a painful muscle area will not make you worse. In fact, research suggests that once you achieve a higher level of conditioning, the benefits of regular exercise will profoundly improve your FM symptoms as well as your psychological health. So the point is: get out and exercise! Aside from the previous recommendations, you should engage in any type of exercise you enjoy. And mix it up – anyone will tire of the same activity day in and day out.