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Health & Wellness

Understanding Fibromyalgia

Fibromyalgia, or FMS, is a debilitating condition that causes people to experience pain all over their bodies. It has attracted a lot of attention recently, as in 2017 the pop star Lady Gaga canceled her European tour, citing the pain from fibromyalgia as one of the reasons. It is a condition that affects people of all ages and from all walks of life, and it is a condition that is still poorly understood and often conflated with other conditions such as arthritis or lupus.

What is Fibromyalgia?

Fibromyalgia is a chronic (long-term) condition that causes people a lot of pain.

Symptoms include: 1

    • Fatigue

    • Trouble sleeping

    • Headaches

    • Memory problems

    • Digestive troubles

    • Increased sensitivity to pain

    • Pain that is widespread and lasts for a long time

One of the more common diagnostic techniques for determining whether someone has fibromyalgia is to palpate 18 specific pain points. If the person reports pain and tenderness at 11 or more of those tender points, as noted in the American College of Rheumatology classification criteria and the pain continues for at least 3 months then they meet that diagnostic criteria. 2 There are other tests that are available which do not rely on those 18 sites. The 'chronic' part of the diagnosis is important, however. Pain that appears and then goes away again is not necessarily fibromyalgia. For someone to be diagnosed with the condition, the pain must be widespread and must last for a period of several months. By the time most people actually get a diagnosis, it is likely that they have been reporting pain in various parts of their body for a longer period of time than that.

woman in bed with aches and pain in back What Causes Fibromyalgia?

It is unclear what causes fibromyalgia. Some people develop it after an accident or a severe viral infection, or some other form of traumatic event. 3 Not everyone who suffers from fibromyalgia can point to such a clear, specific trigger, however.

One common link in fibromyalgia is that the people who suffer it typically struggle to get enough deep, restorative sleep. It is thought that people who have a deficiency in serotonin can create an imbalance of Substance P - the spinal fluid that manages the transmission of pain signals. This imbalance means that people experience pain when a healthy person might simply note a slight ache or some stiffness. There is some evidence that there is a genetic component to fibromyalgia as well. 4 At the moment, the risk factors are not well understood. Both men and women do suffer from the condition, but women appear to be at a greater risk for it, although there is not yet a clear understanding as to why that is.

The Prognosis for Fibromyalgia Sufferers

Fibromyalgia is a chronic condition, and it is typically lifelong. There is no single, known cure that is completely effective, although since 2007 the FDA has approved three new medications that are useful for the management of the condition. 5 The medical profession is investing a lot of effort into learning about the condition. At the moment, there is no single cure but with a multidisciplinary team and careful self-management techniques, it is possible to retain a good quality of life.

Most people who have fibromyalgia will find that even with treatment they will still experience some symptoms and that the symptoms will get worse when they are going through stressful times. 6 Managing depression and stress can be an important part of managing fibromyalgia. Fibromyalgia affects around two percent of the adult population, and while both genders can suffer from it, women seem to develop the condition more frequently than men. 7

Treatment for Fibromyalgia Treatment for Fibromyalgia

Fibromyalgia is a debilitating condition that is often overlooked, or that takes a long time to get diagnosed because there are so many other comorbid conditions. The good news, for those that get diagnosed promptly, is that it is possible to manage it with early intervention and stop the condition from becoming too disabling.

People who suffer from fibromyalgia often suffer from other conditions, including temporomandibular joint dysfunction, anxiety disorders, irritable bowel syndrome, and chronic fatigue. 8 Managing those conditions can be beneficial in terms of helping to reduce the symptoms of fibromyalgia, and can help people to remain as healthy as possible. Spontaneous recovery is not impossible but is very rare, although it is common for symptoms to improve over time with good management. 9

Most treatments for fibromyalgia are non-pharmacological. Drug-based treatments are typically only partially successful, while self-management, through coping skills, behavioral therapy, and lifestyle changes can be far more effective long-term. 10

Where pharmaceuticals are used, there are a few options. Antidepressants and antiepileptic drugs are popular, and there are some other drugs, including painkillers, that are selectively employed to treat certain symptoms.

The Use of Antidepressants to Treat Fibromyalgia

Low doses of amitriptyline are often used to treat the pain and the sleep disturbance that fibromyalgia sufferers experience. The evidence supporting the idea of this drug is limited, and there are some risks. Many patients develop a tolerance to the drug, and there is also the possibility of weight gain as a side-effect as well as other adverse effects. 11 However, for some people, it does offer the chance of long-term pain relief.

Duloxetine is another antidepressant that is sometimes used to treat fibromyalgia, although it is not approved for that use in all countries. Australia, for example, does not support its use because the benefit of the core symptoms of the condition is quite marginal. 12

Milnacipran is approved in some countries, and it has been found to be moderately effective. It is particularly useful for managing fibromyalgia in obese patients because unlike some other antidepressants it is found to have potential weight-loss promoting effects, instead of being a common cause of weight gain. 13

Antiepileptics for Fibromyalgia

People who suffer from fibromyalgia have a higher concentration of substance P and glutamate in their central nervous system. It has been found that using antiepileptics such as pregabalin can help to modulate pain and promote sleep. Pregabalin has the potential to benefit sleep in particular, but it is contraindicated in a lot of cases because weight gain is a side effect. 14

Other Drugs that Can Treat Fibromyalgia

Other drugs that have been tested for fibromyalgia include non-steroidal anti-inflammatories, opioid receptor agents, and other painkillers. Researchers have decided that opioid-related drugs such as codeine and oxycodone should not be used, because of the poor clinical response, and the risk of side effects such as opioid-induced hyperalgesia. 15

aromatherapy in bowls Complementary Medical Treatments for Fibromyalgia

It's clear, then, that it is difficult to treat fibromyalgia with medication. For this reason, doctors are encouraging patients to look at other ways of managing the condition, including complementary therapies. Exercise, meditation, cognitive behavioral therapy, aromatherapy , physical therapy, and even counseling and peer support can all help with the condition.

When a person is first diagnosed with fibromyalgia, the doctor is likely to recommend that they look at managing the symptoms, and improving their lifestyle as the first stages of treatment, including:

    • Improving sleep hygiene and treating comorbid issues such as sleep disorders

    • Getting regular exercise, including aerobics, strength training, and stretching

Those who do not respond to those initial treatments may be given some drug-related therapies. Those who struggle with getting even very minor amounts of exercise may be given physical therapy to help themselves get mobile. Someone with severe fibromyalgia may need a team of people to help them, including:

    • Specialist pain consultants

    • Physiotherapists

    • Psychologists

    • Occupational therapists

    • Social workers

    • Employment advisors

Those who are able to go about their normal lives most of the time, in spite of the pain that they are in, are more likely to have a good prognosis in the long term. The team that you work with will help you to come up with a management plan. 16 That plan could include:

Learning about your condition: Each person is different in how they respond to the condition. Some people have flare-ups if they don't sleep enough. Some people experience more pain and fatigue when they are stressed. Learning what does and does not affect you will go a long way towards making it easier to cope with the condition.

Physical activity: Exercise can help people to sleep better, and this can help with serotonin levels, and with fatigue. 17 The overall improvements in fitness and strength can be invaluable too.

Pain management: Rather than relying on painkillers which could lead to dependency or have other side effects, it can be useful to learn alternative methods of pain management, such as cold packs to reduce inflammation, gentle movement or yoga to relieve tension, or soaking in a warm bath. Talking to others who also suffer from fibromyalgia could help you to learn potential techniques to help with your condition. Many have found essential oils to be helpful in dealing with pain.

Stress management: Stress can make the symptoms of fibromyalgia worse, and stress management techniques can help you to cope with the condition more effectively. Stress can impact your serotonin levels, and reducing stress through meditation, changes to your work schedule, and even aromatherapy can often help to reduce the likelihood of flare-ups. 18 Studies show that essential oils such as lemon, bergamot, and lavender can help to relieve stress and anxiety and treat mood disorders which could be comorbid with fibromyalgia. 19

Work around your condition: Retaining your independence is an important thing when you have a chronic condition. Finding ways to keep up with your work and social life can be good for your mental health, and also improve your physical quality of life as well. You may not be able to keep up with the same working hours or the same physical workload, but doing what you can and staying engaged socially or at the office or at school can be invaluable.

Focus on nutrition: A well-balanced diet is a must, and it is important for people who have fibromyalgia to try to maintain a healthy weight. Weight gain is a common side effect of fibromyalgia medication, and weight gain can put unnecessary strain on the joints. 20 Eating a filling, nutritious but calorie-controlled diet can help to stop weight gain, giving the medication the chance to work properly.

Join a support network: There are support networks for people who are suffering from fibromyalgia, and these networks can offer advice about complementary and alternative therapies, new options in terms of medications, adaptations that can be made to the workplace to support those with limited mobility, and also just a kind, friendly listening ear. If you are struggling with fibromyalgia then it is worth finding a local support network to help you.

Common Misconceptions About Fibromyalgia

Fibromyalgia is a surprisingly common condition, but it is also misunderstood. Let's take a look at some common misconceptions about the condition:

Myth: If You Have Fibromyalgia You Will Not Be Able to Exercise

A lot of people who suffer from fibromyalgia will find that their first instinct is to rest as much as possible. They may feel that because they're in pain, the last thing that they should do is try to exercise. A lack of exercise can lead to secondary problems, however, as it leads to muscle weakness and stiffness. 21

Moderate intensity aerobic exercise and weight-bearing exercise that is done with an emphasis on the form are useful for people who are looking to stay mobile. If you have fibromyalgia and are looking to start exercising for the first time, try to do so slowly and gently.

Start with short bursts of exercise and push yourself, but not too hard. Try to do a little bit more each day. It's good to get out of breath and to work up a bit of a sweat, but do not risk injury. Swimming is a good starting exercise, alternatively, you can work with a personal trainer that understands the condition and that can help you to work up to harder and more intense exercise.

Yoga and pilates are good exercises too. Make sure that you find a yoga instructor that has experience in working with people with pre-existing conditions, that can help you to modify the poses around your abilities and injuries.

Myth: Fibromyalgia Makes You Gain Weight

Fibromyalgia will not directly make you gain weight. Some of the medications that are prescribed for fibromyalgia have weight gain as a side effect, but even then the amount of weight that most people gain is only in the 10 to 15-pound range. The medications may increase your appetite, or lead to some water retention. You can limit their impact by watching what you eat and trying to be more active. Fibromyalgia symptoms are usually lessened if a person who is overweight is able to get back to a healthy weight.

Myth: Fibromyalgia I

s Imaginary

Fibromyalgia can be difficult to diagnose, and it often takes repeated trips to the doctor over a period of years to get diagnosed. By the time the diagnosis happens, the patient may feel like a hypochondriac because they have been back and forth to the doctor about pain in their elbow, knee, etc. Once the doctor says "You have fibromyalgia, the pain is being caused by your brain" it can feel like the doctor is telling you that the pain is in your head. This is not the case. The pain is real, and while the nerves may be healthy in other ways, they are still responding to 'pain' triggers in an excessive way, and the pain that the patient feels is genuine. 22

Myth: Fibromyalgia Is Just Arthritis

Fibromyalgia and arthritis are related, but they are not the same condition. Fibromyalgia affects soft tissue and muscles, while arthritis affects the joints. People with fibromyalgia find that there are certain triggers such as time of day or even the weather that will affect the condition, while those with rheumatism tend not to have those triggers. 23 In arthritis, the pain comes from the inflamed joint. With fibromyalgia, the pain comes from the nervous system.

Myth: Complementary Treatments Won't Help Because the Pain Is in the Brain

Complementary and alternative therapies have always been controversial, but there is an increasing movement towards accepting the idea of aromatherapy for the management of chronic pain. 24 While the treatments may not cure the condition directly, they can mitigate some of the things that make it worse, and can also improve a person's quality of life.

Meditative movements - such as yoga or tai chi - can help to improve the symptoms of fibromyalgia according to some recent studies, and treatments that can improve a person's sleep patterns can be hugely beneficial as well. 25

For a long time, complementary and alternative medicine was controversial because a lot of the therapies that were promoted promised cures, or detracted from traditional treatments. It would not be wise for someone with a treatable but progressive condition to turn to the use of alternative medicine when there are documented conventional cures available. when it comes to palliative care or the management of chronic pain, however, the landscape is rather different.

The effects of aromatherapy and massage on anxiety, mood, and mental health are well documented. For someone that is feeling constant pain, unable to sleep, and unable to imagine any respite from their condition it can be invaluable.

Explaining the Condition to Those Who Don't Understand

One of the biggest challenges of fibromyalgia is explaining it to people who do not have it. Fibromyalgia is an invisible disability, and because of this, it can be hard for people to recognize that it is a real condition. Sufferers tend to have good days and bad days. Sometimes they feel physically OK but have severe brain fog. Sometimes they are in so much pain that even walking around is difficult.

One way of explaining this is to use the 'spoon theory'. This explanation comes from a story that a well-known blogger gave to describe what it is like to live with lupus - a condition that is similar to fibromyalgia in that it causes chronic pain. Essentially, someone with lupus (or fibromyalgia, or other similar conditions) wakes up each day and is given a number of "spoons". On a good day, they may get 20 "spoons" on a bad day they may get only five. Every activity, from getting out of bed and taking a shower, to finding the focus to send some work emails, or walking to the shops, or answering the phone. Every little activity costs a spoon.

Someone who is generally healthy doesn't have to think about the little things. They'll be able to get up and make breakfast on autopilot. They'll reply to emails without having to think too hard. Maybe, if they're introverted, they'll feel like they're spending a lot of their "spoons" to go to a work's night out. In general, though, day to day activities aren't stressful for them. For someone who is sleep deprived and constantly in pain, even small tasks are a lot harder.

Fibromyalgia May Not Be Curable, But It Can Get Better

Studies which track fibromyalgia patients over long periods of time show that sufferers do not tend to show spontaneous recovery, but in some cases, the condition does show some improvement. One study which was published in 2016 tracked patients over a two year period. There were 76 people who took part in the whole study and of those, 14.5 percent reported a noticeable improvement in their pain. 26 There were 11 patients that no longer screened positive for chronic widespread pain in the second part of the study. This shows that it is worth practicing pain management techniques and trying to maintain a positive outlook because while some people are burdened with long-term pain , there is the possibility of recovery to some degree.

Aromatherapy can be an effective supplement to manage pain, and managing your pain is a crucial part of a relaxed life.

Photo credits: fizkes/, zerbor/, marilynbarbone/, maroke/

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