Elusive to diagnose, challenging to treat, and with no clearly identified cause, fibromyalgia affects an estimated 5 million adults in the U.S., according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The majority—between 80 and 90 percent—are women. Although the reason for the disproportionate incidence in women remains unclear, researchers have looked at hormones, immune response, brain chemistry, and genetics as possible reasons for the gender difference.
People with fibromyalgia experience pain in muscles, tendons, and ligaments that varies in intensity. The pain may come and go, which can make diagnosis difficult. Symptoms also include fatigue, sleep disturbances and, in some instances, difficulties with memory or concentration.
Usually, people are diagnosed in middle age, but fibromyalgia affects adolescents and children, too, although less frequently. No blood test or imaging exam can pinpoint fibromyalgia, so physicians rely on a combination of their patients’ history, the symptoms patients report, and a physical exam that includes pressing on specific “tender” spots on the neck, shoulders, back, hips, arms, and legs. Fibromyalgia is characterized by pain that endures for longer than three months.
The onset of fibromyalgia can follow a traumatic event, such as a car accident, or it may appear unrelated to any stress or illness. It can also build gradually and worsen with time. No specific cause has been identified, but research has focused on a possible genetic link.
The Role of Sleep
Insomnia, waking up at night, and fatigue are part of the constellation of symptoms experienced by people with fibromyalgia. The symptom known as “fibro fog”—feeling confused or finding it difficult to concentrate—resembles the signs of sleep deprivation. Whether sleep problems are a contributing factor or a result of fibromyalgia is under speculation. A recent study in Arthritis & Rheumatism described an association between sleep problems and increased risk of fibromyalgia in women. Further investigation would determine whether early intervention and treatment of sleep disorders would in fact lower fibromyalgia risk.
The Smoking Conundrum
Studies of patients with chronic pain conditions, including fibromyalgia, show an association between tobacco use and greater pain intensity. Smoking is also associated with greater functional impairment, measured by variables such as days missed from work, reported “good” days, fatigue, and interference with daily activities. Smokers with fibromyalgia have more severe symptoms including pain and depression than nonsmokers with fibromyalgia, says Toby Weingarten, M.D., associate professor of anesthesiology at the Mayo Clinic College of Medicine in Rochester, Minn. Patients that smoke report smoking does not ease pain, but may provide a way to cope.
Weingarten has studied chronic pain patients in four separate clinical settings, including one specifically for fibromyalgia. In a program where patients were weaned from opioid painkillers, offered physical therapy, and learned behavioral strategies for coping with pain, this combination was “very effective in turning patients’ lives around,” Weingarten says. Pain management and providing coping strategies that are healthier than smoking may be a better first-line approach for fibromyalgia patients than going straight to smoking cessation. Weingarten also observes that smoking cessation does not appear to make pain conditions worse. No studies have yet measured whether quitting improves pain.
Treating fibromyalgia may require a multidisciplinary approach. The best therapies are regular aerobic exercise, improved sleep habits, and behavioral therapy. “Regular physical activity is the best therapy for fibromyalgia,” Weingarten says. A consistent program of walking, yoga, tai chi or other gentle exercise can help ease pain, and helps lift the depression that often accompanies fibromyalgia. In some cases medications can be used, but often antidepressants and anticonvulsants rather than prescription pain medications are most effective.
Information and support are available from the National Fibromyalgia and Chronic Pain Association.
Have you been diagnosed with fibromyalgia? What has helped you deal with this condition? Tell us in the comments