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Fibromyalgia basics: All you need to know

Dr. med. Andre Sommer

Dr. med. Andre Sommer

Fibromyalgia (also known as muscle fiber pain or fibromyalgia syndrome [FMS]) is a chronic, non-inflammatory pain disorder. Affected people suffer from muscle and limb pain, frequently with fatigue. The disease often occurs together with irritable bowel syndrome, chronic headaches, chronic fatigue syndrome, or chronic facial and jaw pain. Diagnosis is often time-consuming and involves many medical visits.

Once a diagnosis is made, various treatment options can be undertaken, consisting of drug therapy, behavioral therapy, and alternative healing methods. Unfortunately, many people cannot get rid of fibromyalgia symptoms, but most can lead a good life with the right treatment. The following text explains the most common fibromyalgia symptoms, how the diagnosis is made, and which therapeutic approaches can help.

What are common fibromyalgia symptoms?

Fibromyalgia is a disease that includes muscle pain, body aches, fatigue, fatigue, and sleep disorders. These complaints can be very diffuse; they do not all have to start at the same time, but can also appear slowly over months and years. Many sufferers describe the feeling as "feeling uncomfortable in their own body" or as if they had a very long-lasting flu.

In addition to sleep disorders, fibromyalgia can include restless legs syndrome, whereby legs feel restless shortly before bedtime, which can usually only be alleviated by walking. Another sleep disorder is sleep apnea (i.e. when breathing interruptions occur during sleep). These sleep disorders can be examined more closely in a sleep laboratory.

Muscle pain is often most severe in the neck and throat, but can also affect the arm, back and chest muscles. Those affected describe the pain as like “pulling” on sore muscles. The pain does not have to be the same at all times or in the same places. Muscle stiffness can also occur in the morning. In particular, the muscle-tendon transitions at the base of the bone can hurt - if these points react to pressure with pain, they are called “Tender Points”.

Fibromyalgia-affected joints may feel swollen in part, but should not be red, inflamed, or severely swollen—if so, alternative diagnoses should be considered.

Many sufferers also suffer headaches or mood swings, depression, or anxiety disorders.

Who is affected by fibromyalgia?

Fibromyalgia affects about 8 percent of the population up to the age of 70, the majority of which are women. Most of those affected develop symptoms between the ages of 30 and 55. If fibromyalgia has already been diagnosed in the family, the risk of developing it increases.

What causes fibromyalgia?

Scientists are still researching the causes of fibromyalgia. However, it seems certain that fibromyalgia is a chronic pain disorder. Pain is usually a warning signal from the body, for example because there is inflammation or an injury. In the case of chronic pain, however, these signals become independent - the pain is no longer a warning signal, but is passed on without an "externally recognizable" reason. This process arises from an extensive system of nerve fibers, messenger substances of the body, and the central nervous system (i.e. the brain and spine).

As a chronic pain syndrome, fibromyalgia can be triggered by various causes, for example psychological stress or physical illnesses such as inflammation. However, it is often the case that fibromyalgia sufferers do not necessarily remember such a triggering event and still suffer from fibromyalgia.

Is there a connection with other illnesses?

Fibromyalgia often occurs together with other diseases. These include, among others, irritable bowel syndrome, chronic headaches, chronic fatigue syndrome, chronic bladder pain, or chronic facial pain. It is assumed that all of these diseases have similar mechanisms of chronic pain development, and thus several conditions occasionally occur in one affected person.

Accordingly, constipation or diarrhea can occur in fibromyalgia patients, and abdominal cramps are not uncommon. Many sufferers suffer from headaches, migraines, or problems with the jaw’s temporomandibular joint (e.g. blockages, cracking or snapping).

How is fibromyalgia diagnosed?

The diagnosis of fibromyalgia is often troublesome, and many sufferers report a long journey to a correct diagnosis. This is due to the fact that fibromyalgia is an exclusion diagnosis, so all similar diseases in question must first be ruled out until the final diagnosis of fibromyalgia can be attributed to the patient. Diseases that need to be excluded include several bacterial and viral infections, autoimmune diseases, thyroid disease, muscular diseases, and diseases of the central nervous system.

An important criterion for fibromyalgia is that there is no noticeable damage or change to the muscle, tendons or ligaments. The disease can be diagnosed in some cases if the so-called “tender points” lead to pain when pressure is applied, but this pain does not occur when pressure is applied to other tendon points. However, there is no simple test that can diagnose the disease without excluding other diseases beforehand.

If there are other symptoms besides the muscle pain, additional tests may be necessary. For example, if the sufferer suffers from non-restorative sleep, a sleep laboratory can be used to determine whether the person may have breathing interruptions at night or suffer from restless legs syndrome. If there is depression or anxiety disorder at the same time, a psychological examination can also help.

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How is fibromyalgia treated with medication?

There are various approaches to treating fibromyalgia, based on the symptoms that those affected show.

Two different groups of active ingredients are currently used as drugs: Pregabalin has long been used in the treatment of nerve pain and epileptic seizures and appears to have a soothing effect on the chronic pain associated with fibromyalgia. Duloxetine and milnacipran are both selective norepinephrine and serotonin uptake inhibitors. These agents are also used for depression and anxiety disorders and also appear to help fibromyalgia patients—regardless of whether the person is also depressed. Other antidepressants can also be used: For example, if you suffer from insomnia, the older antidepressant amitriptyline can help you become tired in the evening.

Although fibromyalgia does not involve inflammation, non-steroidal pain relievers and anti-inflammatories such as ibuprofen or naproxen can help in some cases. Even stronger pain relievers like tramadol seem to have an effect on fibromyalgia pain. Treatment with pain medication should always be coordinated with a doctor, otherwise severe kidney or liver damage, but also painkiller addiction may result.

For sufferers of restless legs syndrome, therapy with a dopamine preparation may be tried. In addition, iron levels should be checked as iron deficiency can occasionally lead to similar symptoms. If there is sleep apnea, ventilation with a mask at night can be helpful to ensure a more restful sleep.

Do alternative methods like homeopathy help against fibromyalgia?

Since fibromyalgia is a chronic pain syndrome, treatment should not only be single-track (e.g. with medication only). Although sports activity might be uncomfortable for a time, most of those affected report an improvement with moderate regular exercise, such as cycling, yoga, walking, or swimming.

Accompanying psychotherapy can also help in coping with chronic pain. In some cities, clinics also offer interdisciplinary programs for chronic pain patients. Here, for example, relaxation techniques are taught, such as the biofeedback technique, in which those affected learn to actively relax their bodies.

Alternative healing methods for fibromyalgia have also been investigated, although there are usually no sufficient clinical studies to guarantee successful treatment. Some sufferers benefit from acupuncture. Others would like to get homeopathic treatment. A homeopath seeks a holistic view of the person concerned, which is why there are no specific remedies that help in any case with fibromyalgia. Before going to a homeopath, all other possible diseases should be excluded.

Can nutrition affect fibromyalgia?

Since fibromyalgia is a multifactorial disease where psychological well-being has a strong influence on the symptoms , a change in diet can alleviate symptoms. However, there are no fixed regulations for this - sufferers should instead try out what diet they feel comfortable with, for example, through increased fruit consumption or increased fluid intake.

Obesity appears to exacerbate the symptoms of fibromyalgia, which is why weight reduction or regulation can be beneficial. In addition, the doctor should clarify whether there are any vitamin or trace element deficiencies that can be compensated for, either through diet or supplements.

Patients suffering from both fibromyalgia and irritable bowel syndrome should discuss with a doctor whether celiac disease or gluten intolerance have ever been excluded. Some patients report relief from their symptoms after starting a gluten-free diet. Others felt a subjective improvement after reducing the taste enhancer glutamate in their diet.

Is fibromyalgia an autoimmune disease?

Many tests that are carried out while possible fibromyalgia is being diagnosed are tests for so-called autoimmune diseases such as lupus erythematosus or dermatomyositis. This is because all of these diseases can have a relatively long and subtle course, have similar symptoms, and tend to affect women.

In contrast to fibromyalgia, however, autoantibodies can usually be detected in autoimmune diseases or, for example, inflammation of joints, muscles or tendon sheaths can be shown. Fibromyalgia does not show any of these signs and is therefore not to be regarded as an autoimmune disease. Nonetheless, in rare cases there can be sufferers who have both an autoimmune disease and fibromyalgia.

Is fibromyalgia the same as chronic lyme disease?

Fibromyalgia is not the same thing as chronic lyme disease. Scientists still disagree as to whether chronic lyme disease as a result of tick-borne lyme disease actually exists after the infection has been treated. But acute lyme disease as an inflammatory event can trigger fibromyalgia or at least cause it to “flare up.” However, this has no direct connection to lyme disease or to the lyme pathogens. Fibromyalgia exists without an infection “hiding” in the body.

Is fibromyalgia just a made-up disease?

Fibromyalgia is not a made-up disease. People often worry that the disease "only exists in their head" because there are no physical signs or changes in blood values. However, since the mechanisms of chronic pain development have been studied for a long time, it is known that they probably lead to complaints in fibromyalgia. Pain is always a subjective perception, which is why doctors rely on the detailed description and observations of their patients. Since the development of pain is a very complex process, mental states can also have both positive and negative influences on the course of the disease. For this reason, psychotherapeutic support can be useful to identify possible pain triggers and to work out measures for relief.

What is the prognosis with fibromyalgia?

Fibromyalgia does not result in permanent damage to the body, disability, or reduced life expectancy. Nevertheless, the symptoms can be perceived as very restrictive for those affected. However, there are various treatment concepts, so that most of those affected, even if the pain and tiredness may not completely disappear, can lead a full life.

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Dr. med. Andre Sommer

Dr. med. Andre Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara.

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