If you hurt all over, experience chronic fatigue, and feel so stiff you’re afraid to move, you may have fibromyalgia, also referred to as fibromyalgia syndrome (FMS). Fibromyalgia is one of the most common pain syndromes and a frequent cause of back and neck pain. Exactly how many people are affected by this condition is difficult to determine because it often goes undiagnosed. It is found more commonly in women, but this may be because men don’t go to the doctor as often and are less likely to report pain.

The American College of Rheumatology defines fibromyalgia as generalized pain (pain all over) that lasts for three months or longer. Additionally, there are specific tender points that are easily identified on physical examination. Patients may experience a variety of other symptoms including chronic fatigue, headaches, and intestinal problems such as cramping and diarrhea. However, muscle pain and joint stiffness are the most common complaints.

While the cause of FMS is unknown, it is likely that the condition results from abnormal pain processing by the central nervous system. In other words, the pain pathways in the nervous system get “wound up.” Because of this, fibromyalgia patients have roughly twice the pain sensitivity of normal subjects. To put this in perspective, think about the soreness you might experience after an especially strenuous activity, such as shoveling snow or a vigorous hike—then imagine doubling that pain. This is the sort of pain FMS patients experience much of the time. For this reason many FMS patients stop exercising and become deconditioned (they get out of shape).  It’s hard to get motivated to exercise when you know you’re going to hurt a lot afterward.

The onset of fibromyalgia is often related to a significant trauma, illness, or infection, but in many cases there is no precipitating event. One common denominator is that almost everyone with FMS has trouble sleeping. Specifically they have non-restorative sleep, meaning that they may fall asleep but still feel tired when they wake up. Fibromyalgia patients almost never feel well rested. We’re not sure if this is a cause or effect, but we do know that helping patients get a good night’s sleep is an important step in helping them get better.

Treatment

Before starting treatment, I provide patients with a copy of The Fibromyalgia Handbook by Harris McIlwain, M.D., and Debra Bruce, Ph.D., who have done an extraordinary job of describing this condition and outlining practical treatments.

After patients read the book, together we develop an individualized treatment program. If patients have a nonchalant attitude or are in denial about their diagnosis, I inform them that they need to deal with their fibromyalgia, or it will deal with them. If they allow the condition to go untreated, they will become progressively more deconditioned to the point where they won’t be able to do much of anything. In fact, it’s not unusual for people with FMS to become completely disabled. With a good physician to coach them and armed with knowledge from reading The Fibromyalgia Handbook, patients generally do very well and can return to leading productive lives.

Because most patients I see have had fibromyalgia for years, I tend to use a somewhat aggressive approach to get them on the path to wellness. If they’re not sleeping well, I may prescribe a sleeping pill or at least a sedating muscle relaxant at bedtime. Additionally, if they are not allergic to sulfa, I start them on Celebrex, which is the only anti-inflammatory that seems to significantly affect fibromyalgia pain. Generally, I avoid prescribing narcotics for fibromyalgia, but other pain medications—in particular, tramadol—can be just as effective with fewer complications.

FMS patients are almost always referred for physical therapy. If they are unable to tolerate land-based exercises, they are sent for aquatic therapy in a heated pool. If they are able to walk, they are put on a walking program. If they are really weak, I ask them to buy a treadmill, and they walk for just five minutes three or four times a day, gradually building up their strength and endurance. In short, FMS patients need to exercise, but they need to start very slowly. Medications often are required to help them overcome the pain they feel with even minimal activity. If they go to the gym and work out as they did in high school, they will almost certainly pay the price of increased pain for as long as two weeks afterward. A very gentle and consistent exercise program that includes lots of stretching will help fibromyalgia patients feel better and allow them to resume their normal activities.

Heat, especially moist heat, can play a major role in controlling the pain of fibromyalgia. I routinely recommend that patients buy a hot tub spa or at least take a couple of long, hot showers every day. Electric heating pads or the rice-filled wraps you warm up in the microwave work well, as do the heating pads that get warm when exposed to air. (ThermaCare is a popular brand.)  With any hot pack it’s possible to get burned, so be careful.

Many FMS patients and chronic pain patients in general have low levels of a neurotransmitter called serotonin—which can lead to depression. Even if you’re not depressed, a small dose of antidepressant can dramatically reduce fibromyalgia pain. I usually recommend a low dose of citaprolam (Celexa), since it is less likely to interact with other drugs and is generally well tolerated, but be careful of taking this with tramadol (Ultram or Ultracet) as it can slightly increase your risk of having a seizure.

Most fibromyalgia patients benefit from massage therapy and spinal manipulation—especially if these can be done at the same visit. I would encourage very gentle massage at first, because deep-tissue massage can increase the pain. For this reason I generally recommend against Rolfing, which involves applying very deep pressure to realign the fascia that surrounds the muscle. This almost always results in increased pain that may not start until a day or two after the treatment. You might look into the Alexander Technique and Feldenkrais. Both of these bodywork techniques are very gentle and focus on improving posture and allowing more efficient movement.

There is no cure for fibromyalgia, but the pain can almost always be reduced and managed. I have seen many people with this condition who experience almost complete resolution of their symptoms. If you think you have fibromyalgia, go to your doctor, develop a treatment plan, and get started on getting better.

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Author Biography: Pierre Angier is a board-certified osteopathic physician, a fibromyalgia patient and the author of Comfortable Sex—A Guide for Couples with Back and Neck Pain. For more information, visit www.comfortableSex.com

Disclaimer:  This article is provided for informational purposes only and is not intended as a substitute for the advice provided by your physician or other healthcare professional. You should not use the information in Dr. Angier’s Health and Wellness Newsletter (www.PierreAngier.WordPress.com) for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment.