NATIONAL FIBROMYALGIA AWARENESS DAY - 12 May 2020

Fibromyalgia

What is Fibromyalgia?

Fibromyalgia (also known as FM or FMS) is a condition that is characterised by persistent, widespread musculoskeletal pain. Fibromyalgia is a syndrome, which means that many symptoms tend to occur together, though each person may experience them differently or not at all. Because many of these symptoms overlap with other conditions, diagnosis can be difficult. Common symptoms include:

  • Widespread joint and muscle pain

  • Fatigue 

  • Cognitive difficulties or “fibro fog”

  • Pins and needles/numbness 

  • Unrefreshing/disturbed sleep or insomnia

  • Headache/migraine 

  • Increased sensitivity to stimuli e.g. heat, cold, sound, smells

  • Temporomandibular (jaw) pain

  • Food intolerances/digestive upset

  • Allergies/sensitivities

  • Anxiety

  • Depression

Other conditions are commonly associated with and can co-exist with Fibromyalgia, including:

  • Chronic Fatigue Syndrome (CFS/ME) -  see our post on CFS/ME here

  • Irritable Bowel Syndrome (IBS)

  • Thyroid Dysfunction

  • Restless Leg Syndrome

  • Autoimmune conditions - including Lupus and Sjogren’s Syndrome 

  • Dysautonomia -  including orthostatic intolerance and Postural Orthostatic Tachycardia Syndrome (POTS).

Often fibromyalgia symptoms can vary from day to day, and may go through periods of “flare up” or increased intensity. These flare ups are often linked to certain triggers, for example: over-exertion, being unwell, weather changes, increased stress, or caffeine/alcohol intake.

Fibromyalgia is generally classed as a lifelong condition, however symptoms can be managed, and in some cases symptoms may even disappear completely (go into remission). A good way to explain this is by using the example of a person with Type 2 Diabetes - they may control their Diabetes extremely well with diet and exercise, and as a result their blood sugars may be in a completely normal range. However, the diagnosis acts as a flag for medical professionals that the patient is more prone to high blood sugar than another person might be, and the patient needs to keep up healthy habits to self manage and monitor their condition (and may need to access further treatment at different times in the future to keep themselves on track).

What causes Fibromyalgia?

In some cases, fibromyalgia may start suddenly following a single incident - for example, after an infection, surgery, trauma or significant psychological/emotional distress. In other cases symptoms accumulate gradually with no one identifiable trigger. There are also suggestions that there are possible genetic and hormonal links, though these aren’t yet clear.

The exact causes/mechanisms of fibromyalgia are not yet fully understood. Current research suggests that symptoms are driven by changes in the sensitivity of the nervous system, which alters the way that our brain processes information from the body, leading to an amplified pain output. There are also effects on our endocrine (hormonal) and immune systems that can cause the wide array of symptoms above. It is important to understand that while the pain experienced can be severe, it is not associated with structural tissue damage in the painful area.

How common is Fibromyalgia?

It is estimated that Fibromyalgia affects between 2-5% of the population. Fibromyalgia is much more common in women than in men - between 75-90% of cases are female. It is most commonly diagnosed in adulthood, though can affect people of any age. 

How is Fibromyalgia diagnosed?

Unfortunately, there isn’t a specific test that can confirm a diagnosis of fibromyalgia. Diagnosis is made based on whether your symptoms fit with certain clinical criteria, and by ruling out any other possible causes of those symptoms. This can mean that receiving a diagnosis of fibromyalgia can take time, because your doctor often will need to perform various investigations/ tests to rule other conditions out.

How is Fibromyalgia treated?

Given that symptoms may vary from person to person, management should be planned around your own specific circumstances. Research has shown that holistic care is much more effective than medication alone. Your treatment plan may include:

  • Medications - including non-opioid analgesics, anti-inflammatories, antidepressant or anti-epileptic medications. 

  • Education - the more you understand your condition and your triggers, the more you can do to self manage your symptoms

  • Exercise - depends on your ability and preferences. Hydrotherapy or aquatic exercise can be a good, low impact option to start with (though currently this is tricky due to COVID restrictions).

  • Trigger management and flare up strategies

  • Nutrition - maintaining a healthy diet and avoiding too much caffeine or alcohol

  • Strategies to improve sleep

  • Stress management and relaxation techniques

  • Engaging in meaningful and enjoyable activities where possible

  • Support from a psychologist or counsellor for symptoms of depression and anxiety

  • Adjunctive treatments like acupuncture, dry needling and massage may help with short term relief from symptoms. However, research has shown that these treatments alone have little long term benefit, though can be helpful for some people when used in conjunction with other active strategies. 

How can Physiotherapy help me?

Physiotherapy treatment focuses on improving overall fitness, strength and function, as well as using exercise to desensitise and retrain your nervous system to reduce pain intensity.

While pain, fatigue and other symptoms can make exercising and everyday activities difficult, a physiotherapist experienced in treating fibromyalgia can help assess your abilities and provide you with appropriate options for exercise. Research has shown that even though exercising may be painful to start with, an appropriate physiotherapy program can lead to significant long term improvements in function, fatigue, quality of life and pain intensity. Physiotherapists can also provide adjunctive treatments like massage or dry needling, which may help reduce symptoms in the short term to allow you to more easily engage with exercise and other strategies. However, everyone is different and not all people tolerate hands on treatment.

Physiotherapists can also help provide you with education about your condition and other self management strategies and resources, including pacing of activity, self release/stretching techniques, improving sleep, lifestyle changes and relaxation/mindfulness activities. If you need more targeted assistance in these areas, your physiotherapist can also help link you with another appropriate health care professional (for example, a dietician or psychologist). 

How do I book an appointment?

Physiotherapy treatment can be accessed with or without a GP referral. However, you may be able to access a Medicare rebate if you have a GP Management Plan or EPC. You can book an appointment or chat to us for more information by contacting our clinic on 02 6926 7734

Where can I find additional information?

Fibromyalgia - Better Health Victoria 

Fibromyalgia Fact Sheet - Musculoskeletal Australia 

Pain, the Brain and Your Amazing Protectometer – Lorimer Moseley

Treating Pain using the Brain – David Butler

Post written by Soph Shephard (Physiotherapist) - Soph has a keen interest in treating persistent musculoskeletal pain, specific pain conditions, and other chronic conditions including fibromyalgia and chronic fatigue syndrome. She is actively involved in continuing professional development and coordination of the Murrumbidgee Pain Hub (a regular gathering of health professionals who work with clients with persistent pain). She has also been selected to undertake the Local Pain Educator Program through Pain Revolution, and is enrolled in post-graduate studies in Pain Science through University of South Australia.

References:

Andrade, A., Dominski, F. H., & Sieczkowska, S. M. (2020). What we already know about the effects of exercise in patients with fibromyalgia: An umbrella review. Seminars in Arthritis and Rheumatism. 

Araújo FM and DeSantana JM. (2019). Physical therapy modalities for treating fibromyalgia. F1000 Research 2019, 8(F1000 Faculty Rev):2030. https://doi.org/10.12688/f1000research.17176.1

Bair, M. J., & Krebs, E. E. (2020). Fibromyalgia. Annals of internal medicine, 172(5), ITC33-ITC48.

Jahan, F., Nanji, K., Qidwai, W., & Qasim, R. (2012). Fibromyalgia syndrome: an overview of pathophysiology, diagnosis and management. Oman medical journal, 27(3), 192–195. https://doi.org/10.5001/omj.2012.44

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Guest UserFibromyalgia, Wagga Wagga, Physiotherapy