FIBROMYALGIA

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue,

sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by
affecting the way your brain and spinal cord process painful and nonpainful signals.

Symptoms often begin after an event, such as physical trauma, surgery, infection or significant
psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering
event.

Women are more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also
have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and
depression.

While there is no cure for fibromyalgia, a variety of medications can help control symptoms. Exercise,
relaxation and stress-reduction measures also may help.

SYMPTOMS

The primary symptoms of fibromyalgia include:

 Widespread pain. The pain associated with fibromyalgia often is described as a constant dull ache that
has lasted for at least three months. To be considered widespread, the pain must occur on both sides of
your body and above and below your waist.
 Fatigue. People with fibromyalgia often awaken tired, even though they report sleeping for long periods
of time. Sleep is often disrupted by pain, and many patients with fibromyalgia have other sleep disorders,
such as restless legs syndrome and sleep apnea.
 Cognitive difficulties. A symptom commonly referred to as "fibro fog" impairs the ability to focus, pay
attention and concentrate on mental tasks.

Fibromyalgia often co-exists with other conditions, such as:

 Irritable bowel syndrome

 Chronic fatigue syndrome
 Migraine and other types of headaches
 Interstitial cystitis or painful bladder syndrome
 Temporomandibular joint disorders
 Anxiety
 Depression
 Postural tachycardia syndrome

CAUSES

Many researchers believe that repeated nerve stimulation causes the brain and spinal cord of people with
fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the
brain that signal pain.

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 In addition, the brain's pain receptors seem to develop a sort of memory of the pain and become
sensitized, meaning they can overreact to painful and nonpainful signals.

There are likely many factors that lead to these changes, including:

 Genetics. Because fibromyalgia tends to run in families, there may be certain genetic mutations that may
make you more susceptible to developing the disorder.
 Infections. Some illnesses appear to trigger or aggravate fibromyalgia.
 Physical or emotional events. Fibromyalgia can sometimes be triggered by a physical event, such as a
car accident. Prolonged psychological stress may also trigger the condition.

RISK FACTORS

Risk factors for fibromyalgia include:

 Your sex. Fibromyalgia is diagnosed more often in women than in men.

 Family history. You may be more likely to develop fibromyalgia if a parent or sibling also has the
condition.
 Other disorders. If you have osteoarthritis, rheumatoid arthritis or lupus, you may be more likely to
develop fibromyalgia.

COMPLICATIONS

The pain, fatigue, and poor sleep quality associated with fibromyalgia can interfere with your ability to
function at home or on the job. The frustration of dealing with an often-misunderstood condition also can
result in depression and health-related anxiety.

DIAGNOSIS

In the past, doctors would check 18 specific points on a person's body to see how many of them were
painful when pressed firmly. Newer guidelines from the American College of Rheumatology don't require
a tender point exam.

Instead, the main factor needed for a fibromyalgia diagnosis is widespread pain throughout your body for
at least three months.

To meet the criteria, you must have pain in at least four of these five areas:

 Left upper region, including shoulder, arm or jaw

 Right upper region, including shoulder, arm or jaw
 Left lower region, including hip, buttock or leg
 Right lower region, including hip, buttock or leg
 Axial region, which includes neck, back, chest or abdomen

Tests
Your doctor may want to rule out other conditions that may have similar symptoms. Blood tests may
include:

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 Complete blood count
 Erythrocyte sedimentation rate
 Cyclic citrullinated peptide test
 Rheumatoid factor
 Thyroid function tests
 Anti-nuclear antibody
 Celiac serology
 Vitamin D

If there's a chance that you may be suffering from sleep apnea, your doctor may recommend an overnight
sleep study.

TREATMENT

In general, treatments for fibromyalgia include both medication and self-care strategies. The emphasis is
on minimizing symptoms and improving general health. No one treatment works for all symptoms, but
trying a variety of treatment strategies can have a cumulative effect.

Medications
Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:

 Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen
(Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful. Opioid medications are not
recommended, because they can lead to significant side effects and dependence and will worsen the pain
over time.
 Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue
associated with fibromyalgia. Your doctor may prescribe amitriptyline or the muscle relaxant
cyclobenzaprine to help promote sleep.
 Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of
pain. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin
(Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia.

Therapies
A variety of different therapies can help reduce the effect that fibromyalgia has on your body and your
life. Examples include:

 Physical therapy. A physical therapist can teach you exercises that will improve your strength, flexibility
and stamina. Water-based exercises might be particularly helpful.
 Occupational therapy. An occupational therapist can help you make adjustments to your work area or
the way you perform certain tasks that will cause less stress on your body.
 Counseling. Talking with a counselor can help strengthen your belief in your abilities and teach you
strategies for dealing with stressful situations.

SELF CARE
Self-care is critical in the management of fibromyalgia.

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 Stress management. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself
time each day to relax. That may mean learning how to say no without guilt. But try not to change your
routine completely. People who quit work or drop all activity tend to do worse than do those who remain
active. Try stress management techniques, such as deep-breathing exercises or meditation.
 Sleep hygiene. Because fatigue is one of the main components of fibromyalgia, getting good quality sleep
is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed
and getting up at the same time each day and limiting daytime napping.
 Exercise regularly. At first, exercise may increase your pain. But doing it gradually and regularly often
decreases symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics.
A physical therapist can help you develop a home exercise program. Stretching, good posture and
relaxation exercises also are helpful.
 Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have
more bad days. Moderation means not overdoing it on your good days, but likewise it means not self-
limiting or doing too little on the days when symptoms flare.
 Maintain a healthy lifestyle. Eat healthy foods. Do not use tobacco products. Limit your caffeine intake.
Do something that you find enjoyable and fulfilling every day.

ALTERNATIVE MEDICINE

Complementary and alternative therapies for pain and stress management aren't new. Some, such as
meditation and yoga, have been practiced for thousands of years. But their use has become more popular
in recent years, especially with people who have chronic illnesses, such as fibromyalgia.

Several of these treatments do appear to safely relieve stress and reduce pain, and some are gaining
acceptance in mainstream medicine. But many practices remain unproved because they haven't been
adequately studied.

 Acupuncture. Acupuncture is a Chinese medical system based on restoring normal balance of life forces
by inserting very fine needles through the skin to various depths. According to Western theories of
acupuncture, the needles cause changes in blood flow and levels of neurotransmitters in the brain and
spinal cord. Some studies indicate that acupuncture helps relieve fibromyalgia symptoms, while others
show no benefit.
 Massage therapy. This is one of the oldest methods of health care still in practice. It involves the use of
different manipulative techniques to move your body's muscles and soft tissues. Massage can reduce your
heart rate, relax your muscles, improve range of motion in your joints and increase production of your
body's natural painkillers. It often helps relieve stress and anxiety.
 Yoga and tai chi. These practices combine meditation, slow movements, deep breathing and relaxation.
Both have been found to be helpful in controlling fibromyalgia symptoms.

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 DIETARY MANAGEMENT

Aim for a well-rounded diet

Eating a balanced diet is a good idea for anyone, regardless of whether they have fibromyalgia.

However, getting the right mix of nutrients is particularly important to people with fibromyalgia,
according to a 2018 literature review.

Diets that are rich in antioxidants and provide adequate amounts of nutrients such as vitamin B12 can
help lead to reduced symptoms.

A balanced diet should include:

 fresh fruits and vegetables

 whole grains

 healthy fats

 low fat dairy

 lean protein, such as chicken or fish

Try to avoid foods that are low in nutritional value, which are more likely to negatively affect your health,
including excessive amounts of saturated fats and anything processed or fried.

Also limit the amount of salt and sugar in your diet.

Eat for energy

Fibromyalgia can make you feel tired and worn out. Eating certain foods can give you more energy to get
through your day.

To slow down the absorption of carbohydrates, combine them with protein or fats. Choose fresh, whole
foods high in fiber and low in added sugars, such as:

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  nuts and seeds, like almonds

 broccoli

 beans

 tofu

 oatmeal

 dark leafy greens

 avocado

Avoid sweets, which only give you a quick sugar boost. Your body will burn right through them, and then
you’ll crash, or immediately lose that high-energy feeling.

Go vegetarian

A few older studies have looked at how eating certain diets affects fibromyalgia.

A small 2000 study concluded that eating a raw and vegan diet might offer some relief from symptoms
such as stiff joints and poor sleep.

A small 2001 studyTrusted Source published in BMC Complementary and Alternative Medicine (now
BMC Complementary Medicine and Therapies) found that people who ate mostly raw
and vegetarian foods had less pain.

Their diets included items such as salads, carrot juice, nuts, and fruits.

More recent research has also touted the benefits of a raw and vegetarian diet.

According to a 2019 literature review, people who adopted this type of diet for a few months reported
improvements in parameters such as:

 pain

 sleep quality

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  morning stiffness

 emotional health

While meat-free diets are typically healthy and high in plant antioxidants, raw food diets are very
restrictive and aren’t for everyone.

Consider speaking with a healthcare professional or a nutrition expert before adopting a mostly or
completely raw diet.

Avoid foods that trigger symptoms

While there’s no single “fibromyalgia diet,” research does indicate that certain ingredients or types of
food may cause problems for some people with fibromyalgia.

These include:

 fermentable oligosaccharide, disaccharide, monosaccharide, and polyols (FODMAPs)

 foods containing gluten

 excitotoxins, a category of food additives

Some people feel better when they eat — or avoid — certain types of foods. You may need to keep a food
diary to find out which foods seem to trigger or improve your symptoms.

Fermentable oligosaccharide, disaccharide, monosaccharide, and polyols (FODMAPs)

FODMAPs are certain carbohydrates that are fermented by gut bacteria in the digestive tract. They may
promote symptoms in some people.

Foods high in FODMAPs include:

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  dairy products

 beans

 bread

 pasta

 barley and rye

 cruciferous vegetables such as broccoli, Brussels sprouts, and cauliflower

 fruits such as apples, peaches, and pears

A 2017 studyTrusted Source found that those with fibromyalgia had improved symptoms and quality of
life when following a low-FODMAP diet. They also lost weight.

Gluten

A 2014 study reported that non-celiac gluten sensitivity may be an underlying cause of fibromyalgia.

People with fibromyalgia who tested negative for celiac disease still saw significant improvements in pain
or quality-of-life indicators when following a gluten-free diet.

Excitotoxins

Excitotoxins are substances that stimulate the tongue’s taste receptors. Examples include monosodium
glutamate (MSG), aspartame, and altered proteins — like those found in protein isolates and hydrolyzed
protein.

In a 2012 study, people with both fibromyalgia and irritable bowel syndrome (IBS) reported significantly
improved pain symptoms after eliminating excitoxins for 1 month. When the study participants added
MSG back into their diets, their symptoms returned or worsened.

On the other hand, a 2013 study concluded that eliminating MSG and aspartame from the diet for a few
months had no effect on fibromyalgia symptoms.

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Larger studies are still needed.

Avoiding excitotoxins might not benefit everyone. However, you can try eliminating these compounds
from your diet and seeing whether that helps relieve your individual symptoms.

Maintain a moderate weight

Another benefit of eating a healthy diet is that it can help you manage your weight.

One 2012 study published in the journal Clinical Rheumatology found that people with fibromyalgia who
also have obesity enjoyed a better quality of life once they lost weight.

They experienced less pain and depression, had fewer tender points, and slept better after taking off a few
pounds. This study suggests that weight loss can be an important part of fibromyalgia treatment.

A 2019 literature review also suggests that weight loss and eating a low calorie diet can contribute to less
pain and inflammation and an improved quality of life.