- Celiac disease or gluten sensitivity.
- Hypothyroidism/Hashimoto’s disease.
- Lyme disease and other tick-borne diseases.
- Rheumatoid arthritis.
- Chronic fatigue syndrome (myalgic encephalomyelitis)
- Myofascial pain.
- Fibromyalgia affects two-four percent of people, women more often than men.
- Fibromyalgia is not an autoimmune or inflammation-based illness, but research suggests the nervous system is involved.
- Doctors diagnose fibromyalgia based on all the patient’s relevant symptoms (what you feel), no longer just on the number of tender places during an examination.
- There is no test to detect this disease, but you may need lab tests or X-rays to rule out other health problems.
- Though there is no cure, medications can reduce symptoms in some patients.
- Patients also may feel better with proper self-care, such as exercise and getting enough sleep.
Fibromyalgia is a common neurologic health problem that causes widespread pain and tenderness (sensitivity to touch). The pain and tenderness tend to come and go and move about the body. Most often, people with this chronic (long-term) illness are fatigued (very tired) and have sleep problems. The diagnosis can be made with a careful examination.
Fibromyalgia is most common in women, though it can occur in men. It most often starts in middle adulthood but can occur in the teen years and in old age. You are at higher risk for fibromyalgia if you have a rheumatic disease (a health problem that affects the joints, muscles, and bones).
What causes fibromyalgia?
The causes of fibromyalgia are unclear. They may be different in different people. Current research suggests the involvement of the nervous system, particularly the central nervous system (brain and spinal cord). Fibromyalgia is not from an autoimmune, inflammation, joint, or muscle disorder. Fibromyalgia may run in families. There likely are certain genes that can make people more prone to getting fibromyalgia and the other health problems that can occur with it. Genes alone, though, do not cause fibromyalgia.
There is most often some triggering factor that sets off fibromyalgia. It may be spine problems, arthritis, injury, or another type of physical stress. Emotional stress also may trigger this illness. The result is a change in the way the body “talks” with the spinal cord and brain. Levels of brain chemicals and proteins may change. More recently, Fibromyalgia has been described as a Central Pain Amplification disorder, meaning the volume of pain sensation in the brain is turned up too high.
Although Fibromyalgia can affect the quality of life, it is still considered medically benign. It does not cause any heart attacks, stroke, cancer, physical deformities, or loss of life.
How is fibromyalgia diagnosed?
A doctor will suspect fibromyalgia based on your symptoms. Doctors may require that you have tenderness to pressure or tender points at a specific number of certain spots before saying you have fibromyalgia, but they are not required to make the diagnosis (see the Box). A physical exam can be helpful to detect tenderness and to exclude other causes of muscle pain. There are no diagnostic tests (such as X-rays or blood tests) for this problem. Yet, you may need tests to rule out another health problem that can be confused with fibromyalgia.
Because widespread body pain is the main feature of fibromyalgia, health care providers will ask you to describe your pain. This may help tell the difference between fibromyalgia and other diseases with similar symptoms. Other conditions such as hypothyroidism (underactive thyroid gland) and polymyalgia rheumatic sometimes mimic fibromyalgia. Blood tests can tell if you have either of these problems. Sometimes, fibromyalgia is confused with rheumatoid arthritis or lupus. But, again, there is a difference in the symptoms, physical findings, and blood tests that will help your health care provider detect these health problems. Unlike fibromyalgia, these rheumatic diseases cause inflammation in the joints and tissues.
|1. Pain and symptoms over the past week, based on the total number of painful areas out of 19 parts of the body plus level of severity of these symptoms:
b. Waking unrefreshed
c. Cognitive (memory or thought) problems plus a number of other general physical symptoms
|2. Symptoms lasting at least three months at a similar level|
|3. No other health problem that would explain the pain and other symptoms|
How is fibromyalgia treated?
There is no cure for fibromyalgia. However, symptoms can be treated with both non-drug and medication-based treatments. Many times the best outcomes are achieved by using multiple types of treatments.
Non-Drug Therapies: People with fibromyalgia should use non-drug treatments as well as any medicines their doctors suggest. Research shows that the most effective treatment for fibromyalgia is physical exercise. Physical exercise should be used in addition to any drug treatment. Patients benefit most from regular aerobic exercises. Other body-based therapies, including Tai Chi and yoga, can ease fibromyalgia symptoms. Although you may be in pain, low-impact physical exercise will not be harmful.
Cognitive-behavioral therapy is a type of therapy focused on understanding how thoughts and behaviors affect pain and other symptoms. CBT and related treatments, such as mindfulness, can help patients learn symptom reduction skills that lessen pain. Mindfulness is a non-spiritual meditation practice that cultivates present moment awareness. Mindfulness-based stress reduction has been shown to significantly improve symptoms of fibromyalgia.
Other complementary and alternative therapies (sometimes called CAM or integrative medicine), such as acupuncture, chiropractic, and massage therapy, can be useful to manage fibromyalgia symptoms. Many of these treatments, though, have not been well tested in patients with fibromyalgia.
It is important to address risk factors and triggers for fibromyalgia including sleep disorders, such as sleep apnea, and mood problems such as stress, anxiety, panic disorder, and depression. This may require the involvement of other specialists such as a Sleep Medicine doctor, Psychiatrist, and therapist.
Medications: The U.S. Food and Drug Administration has approved three drugs for the treatment of fibromyalgia. They include two drugs that change some of the brain chemicals (serotonin and norepinephrine) that help control pain levels: duloxetine (Cymbalta) and milnacipran (Savella). Older drugs that affect these same brain chemicals also may be used to treat fibromyalgia. These include amitriptyline (Elavil) and cyclobenzaprine (Flexeril). Other antidepressant drugs can be helpful in some patients. Side effects vary by the drug. Ask your doctor about the risks and benefits of your medicine.
The other drug approved for fibromyalgia is pregabalin (Lyrica). Pregabalin and another drug, gabapentin (Neurontin), work by blocking the overactivity of nerve cells involved in pain transmission. These medicines may cause dizziness, sleepiness, swelling, and weight gain.
It is strongly recommended to avoid opioid narcotic medications for treating fibromyalgia. The reason for this is that research evidence shows these drugs are not of help to most people with fibromyalgia and will cause greater pain sensitivity or make pain persist. Tramadol (Ultram) may be used to treat fibromyalgia pain if short-term use of an opioid narcotic is needed. Over-the-counter medicines such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (commonly called NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve, Anaprox) are not effective for fibromyalgia pain. Yet, these drugs may be useful to treat the pain triggers of fibromyalgia. Thus, they are most useful in people who have other causes for pain such as arthritis in addition to fibromyalgia.
For sleep problems, some of the medicines that treat pain also improve sleep. These include cyclobenzaprine (Flexeril), amitriptyline (Elavil), gabapentin (Neurontin) or pregabalin (Lyrica). It is not recommended that patients with fibromyalgia take sleeping medicines like zolpidem (Ambien) or benzodiazepine medications.
Living with fibromyalgia
Even with the many treatment options, patient self-care is vital to improving symptoms and daily function. In concert with medical treatment, healthy lifestyle behaviors can reduce pain, increase sleep quality, lessen fatigue and help you cope better with fibromyalgia. With proper treatment and self-care, you can get better and live a more normal life. Here are some self-care tips for living with fibromyalgia:
- Make time to relax each day. Deep-breathing exercises and meditation will help reduce the stress that can bring on symptoms.
- Set a regular sleep pattern. Go to bed and wake up at the same time each day. Getting enough sleep lets your body repair itself, physically and mentally. Also, avoid daytime napping and limit caffeine intake, which can disrupt sleep. Nicotine is a stimulant, so those fibromyalgia patients with sleep problems should stop smoking.
- Exercise often. This is a very important part of fibromyalgia treatment. While difficult at first, regular exercise often reduces pain symptoms and fatigue. Patients should follow the saying, “Start low, go slow.” Slowly add daily fitness into your routine. For instance, take the stairs instead of the elevator, or park further away from the store. As your symptoms decrease with drug treatments, start increasing your activity. Add in some walking, swimming, water aerobics, and/or stretching exercises, and begin to do things that you stopped doing because of your pain and other symptoms. It takes time to create a comfortable routine. Just get moving, stay active, and don’t give up!
- Educate yourself. Nationally recognized organizations like the Arthritis Foundation and the National Fibromyalgia Association are great resources for information. Share this information with family, friends, and co-workers.
- Look forward, not backward. Focus on what you need to do to get better, not what caused your illness.
Massage for Fibromyalgia
- Keeping a log of triggers. Share on Pinterest Keeping a log of daily activities and routines may help to identify triggers of fibromyalgia flare-ups. …
- Reducing stress and relaxing. Stress makes symptoms of fibromyalgia worse. …
- Getting enough sleep. …
- Exercising regularly. …
- Not doing too much. …
Do you remember the last time you had the flu? With it came aches, pains, stiffness, headaches, lethargy, disturbed sleep, inability to concentrate, and discomfort. These symptoms no doubt went away after a few days or a week at most.
Now imagine having the flu all the time.
For the fibromyalgia client, flu-like symptoms, with the exception of fever, can persist for weeks, months or years.
Some people live with these symptoms every day and night of their lives.
Because fibromyalgia is a syndrome or a collection of symptoms and conditions, not everyone who has it possesses the same symptoms.
Although fibromyalgia’s characteristics are numerous, it usually includes widespread, chronic musculoskeletal pain, fatigue, sleep disturbances, depression, and stiffness.
Massage therapy is particularly beneficial for the fibromyalgia client, as it can reduce heart rate, relax muscles, improve range of motion and increase the production of the body’s natural painkillers.
One recent study showed massage therapy decreased pain, improved quality of sleep, and eased depressive symptoms in fibromyalgia sufferers.
About 10 million people in the U.S. suffer from fibromyalgia, according to the National Fibromyalgia Association (NFA, www.fmaware.org), and 75 to 90 percent of those with the syndrome are female.
The cause of fibromyalgia is unknown, although brain imaging and neurosurgery have indicated fibromyalgia may be caused by “an interpretative defect in the central nervous system that brings about abnormal pain perception,” according to the NFA.
“An increasing number of scientific studies now show multiple physiological abnormalities in the [fibromyalgia] patient, including increased levels of substance P in the spinal cord, low levels of blood flow to the thalamus region of the brain, [hypothalamic-pituitary-adrenal] axis hypofunction, low levels of serotonin and tryptophan and abnormalities in cytokine function,” a statement on the NFA’s website noted.
Medical experts believe a genetic predisposition to fibromyalgia is possible.
Many fibromyalgia clients also believe a traumatic experience—either physical or psychological—can be a trigger.
More research must take place before an official cause can be determined.
Muscle aches and pains are the most predominant symptoms a fibromyalgia sufferer may experience on a daily basis.
Pain levels can change from day to day and from morning to evening.
Changes in weather, level of stress, and how much sleep we receive all affect this.
Fibromyalgia sufferers also have difficulty with activities of daily living and suffer from muscle weakness.
The worst part of fibromyalgia is not knowing what symptoms may present the next day.
Muscle pain and stiffness are not the only symptoms of fibromyalgia.
Overexertion is the fibromyalgia sufferer’s enemy, but inactivity can cause just as much pain.
The adage uses it or lose it fits perfectly.
The client with fibromyalgia might hear buzzing from neon lights and sometimes have itchy skin for no apparent reason.
She might suffer from mouth ulcers; restless legs; tingling or numbness in extremities or face; mood swings; panic attacks; lower-than-average body temperature; and sensitivity to odors, noise, medications, food, and cold.
Some of the more annoying conditions that occur with fibromyalgia include yeast infections of the tongue and mouth, dry mouth—although this could be caused by medications—and “fibro fog,” or confusion and memory challenges.
Fibro fog happens at the most inconvenient times.
Trying to remember a word or name you should know, directions to a place you frequent, or why you came into a room are all part of everyday life for fibromyalgia sufferers.
Flares, or periods of time when pain and aches are at their worst, are common with fibromyalgia.
Memory tends to worsen during a flare, so it’s always helpful to call and remind a fibromyalgia client about her massage appointment.
A Difficult Road
In the past, people sometimes suffered for years not knowing what was wrong with them.
Families grew tired of hearing how bad they felt while appearing to be perfectly healthy.
Many physicians did not recognize fibromyalgia, instead of believing it was all in the patient’s mind.
People with fibromyalgia were often labeled hypochondriacs, and often began to question their own sanity.
Today there still isn’t anyone reliable medical test to diagnose fibromyalgia; instead, diagnosis is often a process of elimination.
A physician will check for thyroid, kidney, and liver problems, and anemia, and other blood disorders that can cause fatigue.
Another blood test, called FM/a, identifies markers produced by immune system blood cells in people with fibromyalgia, according to WebMD.
The physician should listen to the patient’s history, and perform a tender-point test based on American College of Rheumatology criteria.
Some physicians still question the validity of a fibromyalgia diagnosis.
According to the NFA, it can take up to five years for someone with fibromyalgia to receive a diagnosis.
By the time a fibromyalgia client finds a massage therapist, she may have run out of people who will listen to her.
Massage therapists can make a big difference in how the sufferer feels about herself.
A sounding board provided without diagnosis or advice might be exactly what she needs.
Massage is effective for fibromyalgia clients because it can break up muscular restrictions, knots, and tightness.
Gentle effleurage in the direction of muscle fibers tends to be tolerated better, whereas acupressure can exacerbate pain.
Working easefully, layer by layer will loosen muscles.
The shoulders, neck, hips, and gluteal muscles tend to be most troublesome for clients with fibromyalgia.
Addressing those areas with a light initial touch works best, and then you can begin to work knots out slowly by lifting and palpating.
You do not have to do everything at once.
Massage is accumulative; it builds on itself.
People with fibromyalgia often take medication prescribed for pain or depression.
If a client receives massage or other complementary therapies concurrently with Western medical treatment, she usually experiences much better results than with allopathic care alone.
Along with massage, other beneficial therapies might include gentle exercise or stretching, chiropractic, myofascial release, cranial-sacral therapy, hydrotherapy, homeopathy, guided imagery, heat therapy, manual lymphatic drainage, energy work, and biofeedback.
One research study showed 12 weeks of thermal therapy, which consisted of time in a sauna and underwater exercise in a heated pool, resulting in a significant decrease in pain and symptoms, along with a significant increase in quality of life, among women with fibromyalgia.
Another study indicated a multidisciplinary approach of massage, pressure on tender points, thermal therapy, and aerobic exercise produced pain relief for the fibromyalgia client.
Contraindicated therapies include high-impact exercise, cold water, and deep-tissue massage unless the client has received it in the past with desirable effects.
The next time you hear a client say she hurts all over, stop and listen to her.
It may very well be true, and she may live in pain every day.
A kind ear and talented touch could make a big difference in her life.
A referral to a physician, if the client hasn’t already seen one for a diagnosis, would be appropriate.
Clients with fibromyalgia frequently present for massage therapy, and a better understanding of the syndrome is needed.
Massage therapists can help clients have a better quality of life.
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