The 2021 Ultimate Guide to Fibromyalgia
Fibromyalgia is one of the most common chronic pain conditions. According to the Centers for Disease Control and Prevention (CDC), the condition affects about 4 million U.S. adults. The majority of that number is made up of women. The American Chronic Pain Association (ACPA) estimates that nearly as many women live with fibromyalgia as there are living with diabetes.
Despite its prevalence, there are a lot of misconceptions about fibromyalgia. Because much of the condition is medically unexplained, some people don’t even believe the condition is real. Even those who think it exists, even those living with it and healthcare professionals, may still find it hard to understand. This guide will help clear up those misunderstandings by walking you through the basics, like what fibromyalgia is, how it is diagnosed, and how it’s treated.
What is Fibromyalgia?
Fibromyalgia is a chronic condition characterized by widespread pain in the muscles and bones. This is typically a consistent dull ache or tenderness in multiple “regions of pain” throughout the body. Fibromyalgia can also cause a range of other symptoms that often mimic those of other conditions. It is not yet completely understood. Unfortunately, because of this, many people with fibromyalgia are misdiagnosed at first.
Those with fibromyalgia typically experience many different symptoms at once. Some common symptoms include:
- Widespread pain
- Trouble sleeping or not feeling rested after sleeping
Fibromyalgia also commonly causes what is known as “fibro fog” or a “brain fog.” Fibro fog can make it difficult to concentrate and stay alert and may cause memory lapses.
Some less common symptoms may include:
- Digestive issues
- Belly pain, nausea, or bloating
- Muscle spasms
- Low-grade fever
- Dry eyes, nose, or mouth
- Sensory sensitivity (such as to sound or light)
- Ringing in the ears
- Widespread itching
All symptoms of fibromyalgia may fluctuate between flare-ups and periods of symptom relief. Often, a particularly bad period of pain and other symptoms is followed by a period of relief.
What Causes Fibromyalgia?
It has been found that fibromyalgia develops due to a malfunction of the body’s neurotransmitters. Neurotransmitters are chemical messengers that help the nerve cells communicate with each other and with other cells in the body. When they work correctly, the body can function properly.
In the case of fibromyalgia, neurotransmitter production is altered, and the body perceives stimuli more strongly than usual. This results in the widespread pain experienced with the condition.
The altered production of neurotransmitters impacts more than just the body’s perception of pain, too. Malfunctioning neurotransmitters can also disturb the body’s other functions. This is what causes fibromyalgia’s other symptoms, like headaches, fatigue, and brain fog.
What causes this malfunctioning to occur, and what specifically causes fibromyalgia to develop, is still unknown.
Fibromyalgia Risk Factors
Although the specific cause of fibromyalgia is unknown, a few factors are generally believed to put you more at risk of developing the condition. These factors include:
- Genetic predisposition: If someone in your close family has fibromyalgia, you may be more at risk of developing it. According to the Fibromyalgia Awareness Association, in many cases, multiple members of the same family are affected by fibromyalgia, and specific genes may be linked to the condition.
- Sex: If you are a woman, you may be more at risk. Approximately 90% of all people with fibromyalgia are women. According to the CDC, women are twice as likely than men to develop the condition.
- Age: According to the CDC, you are more likely to develop fibromyalgia as you get older. However, children can also develop fibromyalgia.
- Disease: Having lupus or rheumatoid arthritis is thought to increase your risk of developing fibromyalgia. Additionally, other illnesses such as a viral infection may cause the condition to flare up in those genetically predisposed.
- Stressful triggers: High stress at home or work, or trauma such as a car accident or an assault can also trigger a fibromyalgia flare-up in those predisposed to the condition.
How do You Diagnose Fibromyalgia?
Before we get into how fibromyalgia is diagnosed, it should be acknowledged that many people with the condition are first misdiagnosed with other conditions. This is because many fibromyalgia symptoms mimic or appear alongside those of other conditions, so some symptoms may initially be seen as their own issues rather than as clinical manifestations of one disorder.
Fibromyalgia is often misdiagnosed as:
- Irritable bowel syndrom
- Muscle spasm
- Subclinical hypothyroidism
- Restless leg syndrome
- Vertigo or dizziness
That said, a fibromyalgia diagnosis does not entirely rule out the possibility of additional conditions occurring.
Because there is no lab test or scan that can detect fibromyalgia, your doctor will mainly be considering your symptoms. The main sign required for a fibromyalgia diagnosis is widespread pain for at least three months. “Widespread pain” is considered to be pain in at least four of these five regions:
- 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, including neck, back, chest, or abdomen
If your symptoms overlap with other conditions, your doctor may also want to conduct blood tests to rule those conditions out. However, just like a fibromyalgia diagnosis does not rule out additional conditions, additional conditions do not entirely rule out the possibility of fibromyalgia.
Once you are diagnosed with fibromyalgia, you and your doctor will develop a treatment plan that works best for you. It’s important to note that treatment for fibromyalgia is not a cure, but instead focused on minimizing symptoms. Typically, most treatment plans will consist of medication and therapy.
There is a range of medications your doctor may suggest to help you manage fibromyalgia symptoms. These include:
- Pain relievers: Your doctor may recommend over-the-counter pain relievers, such as ibuprofen (Advil), acetaminophen (Tylenol), and naproxen sodium (Aleve). Opioid medication, on the other hand, is not recommended because it typically only worsens the pain over time.
- Antidepressants: Antidepressants like duloxetine (Cymbalta) and milnacipran (Savella) can reduce fibromyalgia fatigue and pain. Additionally, your doctor might prescribe antidepressants to treat depression and anxiety associated with the condition.
- Muscle relaxers: To help you sleep, your doctor may prescribe you with amitriptyline or a muscle relaxer like cyclobenzaprine.
- Anti-seizure drugs: Some anti-seizure medications can be used to treat fibromyalgia pain. These include gabapentin (Neurontin) and pregabalin (Lyrica).
Your doctor may also refer you to other professionals for various types of therapy for your fibromyalgia. These include:
- Psychological therapy: Psychological therapy or counseling is an essential aspect of fibromyalgia treatment. Fibromyalgia pain can cause stress and have other adverse effects on your mental health. Still, psychological factors can also increase your symptoms. A counselor or therapist can teach you coping skills and new behaviors that can help manage symptoms.
- Physical therapy: A physical therapist can teach you safe exercises to help relieve pain, strengthen your muscles, and improve flexibility and stamina. They may also be able to help you find ways to improve your posture and relieve stress off of your regions of pain.
- Occupational therapy: An occupational therapist can help you adjust how you work and conduct other tasks to reduce stress on your body.
- Group therapy: Group therapy can be affordable to reduce stress while also meeting others with the same condition. This resource by the National Fibromyalgia and Chronic Pain Association (NFMCPA) can help you find a support group near you. Additionally, online communities like the NFMCPA Online Support Community, Living with Fibro, and the Fibromyalgia Subreddit can also be helpful
Living with Fibromyalgia
In addition to treatments from medical professionals, there are a few things you can do in your daily life to manage your symptoms. This includes regular exercise, eating a healthy diet, improving your posture, and getting a good night’s sleep.
Although fatigue and pain can make you want to avoid exercise at all costs, exercising regularly can be beneficial (even when you’re having a flare-up). Not only can it reduce pain, but it can relieve stress, give you an energy boost, and make you feel more confident. On top of that, if you avoid exercise, you may lose functional capacity over time, which can end up causing more pain in the long run.
Before starting an exercise routine, talk to your doctor about what kind of physical activity would be right for you. Generally, though, it’s recommended to have at least 30 minutes of moderate-intensity aerobic exercise (such as walking or swimming) 3-5 days a week, muscle strengthening and balance exercises (such as yoga or Pilates) at least two days a week, and flexibility exercises (such as stretching) every day. Always avoid high-intensity exercises, and be sure to stay hydrated while you work out.
To work exercise into your daily routine, try to create a regimen that is both accessible and something you enjoy. For example, sign up for a supervised activity at a recreation center near you, or create a fun exercise routine you can do at home.
It’s never too late to start exercising, but be sure to start slow, and don’t let tiredness, pain, or soreness after a workout stop you. That’s normal, even for people without fibromyalgia! That said, try to keep a healthy balance and rest when you need to.
A nutritious, balanced diet is key to managing fibromyalgia. It keeps you at a healthy weight to minimize strain on the muscles and tendons. Eating the right foods and avoiding others can also help reduce symptoms of the condition.
The key to a healthy diet is to eat nutritionally balanced meals. The easiest way to do this is to consider the Healthy Eating Pyramid by Harvard University. The Pyramid notes a few essential things to remember:
- The majority of your daily intake should be whole grains (like whole-wheat bread and whole-grain pasta), healthy oils (like olive oil), and fruits and vegetables.
- A moderate daily serving of healthy proteins like chicken, fish, nuts, beans, or tofu.
- A moderate daily serving of dairy products, such as milk, yogurt, and cheese
- Only consume red or processed meat, refined grains (like white bread and rice), and sweetened products on an occasional, moderate basis.
- Drink mainly water each day.
Foods to Eat to Reduce Symptoms
In addition to an all-around healthy diet, some foods, in particular, can help reduce some symptoms. These include:
- For fatigue: Almonds, broccoli, beans, tofu, oatmeal, avocado, and dark leafy greens like spinach
- For constipation: Fresh fruit (prunes, in particular, can help), vegetables, whole grains, water, and orange juice with pulp
- For diarrhea: Lactose-free or dairy-free (like rice or oat) milk, white meat and fish, boiled ham, carrots, apple juice, baked apples, very ripe bananas, potatoes, rice, pasta without sauce, and toast
- For dry mouth: Puree, jelly, soup, sorbet or ice cream, popsicles, mints or other sugar-free candy, and plenty of water
- For menstrual pain: Fish and herbal teas (lavender, mint)
- For disturbed sleep: Whole grains and leafy green vegetables
Foods to Avoid to Reduce Symptoms
There are also some foods you will want to avoid or eat sparingly to help keep your symptoms at bay. These include:
- For fatigue: Sugary foods, as they will only give you a short boost before causing you to crash
- For constipation: Sugar and refined grains like white rice and bread
- For dry mouth: Dry, hard to swallow foods like those that are toasted or fried
- For headaches and migraines: Processed meats and foods with additives. Some other foods that may be causing headaches include onions, oranges, chocolate, cheese, wine, beer, coffee, and tea
- For menstrual pain: Red meat, butter, margarine, and pastries
- For disturbed sleep: Coffee, tea, energy drinks, chocolate, alcohol, and spicy foods
In general, you should be avoiding food additives and food chemicals such as MSG and aspartame, as well as processed and sugary foods. You may also consider reducing your gluten intake, as one study showed that non-celiac gluten sensitivity could be an underlying cause of fibromyalgia.
Having poor posture can overload your locomotor system and harm your overall well being. To reduce pain and other fibromyalgia symptoms, do your best to improve your posture throughout the day with the following tips:
- Standing: Avoid standing for long periods and change positions often. When doing standing activities, such as ironing, brushing your teeth, or putting makeup on, avoid leaning forward. Instead, rest one foot on a box or stool and alternate feet every so often.
- Sitting: Avoid slouching forward, and be sure to sit in a seat with a backrest for support. Keep your back straight and both of your feet touching the floor. A support cushion for your lower back can also help improve sitting posture.
- Sleeping: Avoid sleeping on your stomach, as it can strain your lower spine. The fetal position (on your side with your hips and knees slightly bent) or your back with a pillow supporting your knees is the best position to sleep in.
- Daily activities: When picking things up or cleaning, squat, or kneel to avoid bending forward. Be sure always to keep your back straight. Also, avoid reaching above your head, as this can overload your spine. Instead, use a stool or step ladder to grab or clean things above you.
Good Night's Sleep
Fibromyalgia pain can cause an awful cycle when it comes to sleep. Pain makes it hard to sleep, but disturbed sleep can make the pain worse. Other factors like stress or depression may be keeping you up too.
To get a better night’s sleep, try to follow a bedtime routine, and keep a regular sleep schedule. Don’t exercise, eat, or drink caffeine or alcohol three hours before bedtime. It can also help to stay off electronic devices before bed and relax by meditating or having a hot bath instead. If this doesn’t help, talk to your doctor about what’s disturbing your sleep; they may recommend sleep medication.
Frequently Asked Questions
Is Fibromyalgia Real?
Yes, fibromyalgia is real, as are the symptoms experienced by those with fibromyalgia. It is not made up or “all in their head” as some may believe. Although it is not entirely medically understood yet, the experiences of those suffering from it should not be discounted.
Can You Get Disability for Fibromyalgia?
Yes, it is possible to claim disability for fibromyalgia successfully. However, it can be difficult. To be approved for disability by the Social Security Administration, you are required to have:
- Severe symptoms that have been present for at least three months
- At least 11 of the 18 “regions of pain” above and below the waist and on both sides of the body, or at least six ongoing symptoms of fibromyalgia
- Documented evidence that rules out other conditions, such as relevant medical records, laboratory testing, or a written opinion by your doctor
- Statements from you and friends, family, or coworkers about any limits fibromyalgia has on your daily activities
- Whether fibromyalgia prevents you from working
This guide by Healthline goes into more detail about how to apply for disability.
Can Fibromyalgia be Cured?
Unfortunately, there is no cure for fibromyalgia; all fibromyalgia treatment focuses on managing symptoms and reducing pain. Though they can’t cure the condition entirely, treatments such as medication, therapy, and lifestyle changes can make fibromyalgia easier to live with.
Can You Die from Fibromyalgia?
Fibromyalgia is not a degenerative disease, meaning it cannot progressively worsen to the point that it becomes deadly. However, fibromyalgia's chronic symptoms can lower one’s quality of life and cause anxiety and depression to develop, putting those with fibromyalgia at a higher risk of suicide than the general population.
It is crucial to seek psychological treatment in addition to physical treatment when you are diagnosed with fibromyalgia. If you are having suicidal thoughts, tell your doctor or psychologist as soon as you can.
What Experts Say About Fibromyalgia
We reached out to various health professionals including nutritionists, chiropractors, and physicians to get their insights, treatment methods, and best advice for handling Fibromyalgia.
My advice would be people get a food sensitivity test to see which foods are driving inflammation development in their body. Inflammation will drive fibromyalgia symptoms. I have helped clients navigate food sensitivities and I have seen 40-60% reduction in symptoms in the first 30 days of removing reactive foods.
The pain associated with fibromyalgia has seen some marked improvements through an anti-inflammatory diet. A diet low in refined carbohydrates, gluten, red meat and other inflammatory ingredients is ideal to mitigate the symptoms of an inflammatory disease, fibromyalgia included. This could look different for each individual as triggers can vary from person to person, but ideally removing processed convenience foods, sugar, and in some cases dairy, should significantly reduce flare-ups.
I am a gastroenterologist and many of my patients with irritable bowel syndrome also suffered from
fibromyalgia as these conditions often occur simultaneously. A significant contributing factor to symptoms in my patients was stress, trauma and repressed emotions linked to adverse childhood
experiences. A great screening question for these is:
If you learned that a child you care about was growing up exactly as you did, how would this make you feel?
If the answer to this is "Sad or Angry" then one or more of the resources on the website of the Psychophysiologic Disorders Association would likely be helpful.
Kirana Kefalos, MD, LLC
Internal Medicine from a Holistic Perspective (Board certified)
I am an MD (Board Certified Internist) and have been practicing Energy Medicine for several years. (I had 4 years of training in Energy Medicine.)
Before I got my Energy Medicine training, I found it challenging and depressing to work with FM patients, since there was so little to offer. Now, with my knowledge of Energy Medicine, I find I can help people.
A few easy things to do:
- Get your energies moving in the right direction. Kidney 27 is a very important junction point on the acupuncture meridian system. When it is out of balance, the energy in your meridians can actually be running backwards. This is the body's way of slowing you down, so that you can rest and heal. But in today's world, most folks simply don't have the time to rest; we just push through day to day. Working these points regularly, for 15-20 seconds 1-4 times/day will get your energies moving forward.
This point invariably needs correcting in my FM clients.
Find the acupuncture point Kidney 27 (K27) located just under the collar bones, next to the breast bones (one on each side of the body). It will be in the first indentation under the collar bone. You can google an image of it for clarification. Rub on it with very firm pressure and /or tap on it. If it is tender to firm pressure this means it certainly needs to be worked with. It will become less tender over time, as you rub on it. By the way, I work my K27 points daily, before even getting out of bed!
- Get your energies crossing over again. There are many cross over patterns in a healthy body and aura. Examples include: the right side of your brain controls the left side of your body; Your optic nerves cross in your head; Even down to the molecular level, our DNA is 2 strands of a double helix which make figure 8's, one strand crossing over the other strand.
These crossover patterns allow for integration of the information in your body and brain. When you aren't "crossing-over" the hemispheres of your brain aren't communicating optimally, nor is the brain communicating well with the body.
Most people who I've seen with FM have very few crossover patterns in their energy. Simply put, things work better when there is good communication (whether it be a business, a relationship or a body).
Here is a simple way to get your energies crossing over: Take one hand and trace an infinity sign around both eyes, making a horizontal figure 8. This can be done as you touch the body, or just off the body. Do that for 20-30 seconds at least once/day.
I would recommend the ELISA/ACT LRA test. Here is a case study on the ELISA/ACT LRA (food and chemical) testing helped a 44 year-old woman with Fibromyalgia.
Soak in a warm bath to relax tense muscles and reduce pain as moist heat increases endorphins which blocks pain signals.
Opt for decaf as caffeine can increase nervousness and anxiety.
Take some 'me' time daily with a hobby of some sort to unwind and fight stress.
Dr. Jesica Mills, PharmD, MBA, RPh, ND
Pharmacist, Naturopath, Owner of Owensboro Family Pharmacy and Wellness
We recommend specific vitamins (B vitamins mostly) with amino acids, trace minerals, bioenergetic testing, PEMF treatments, dietary advice like avoiding nightshades, and even emotional balancing for those who had symptoms appear after trauma.
Patients with fibromyalgia will typically present with trigger points - tender spots in muscles - that when pressed on will be painful and can radiate the pain into other areas. Therefore in my practice I teach patients self massage in the form of ischemic compression - direct finger or thumb pressure on painful points for 30 seconds. This will activate the pressure point and upon release will increase blood flow to the area to assist with healing. This patient centered approach to healing will assist muscle fibers to relax and ease pain.
Acupuncture is a fantastic tool to add into a holistic treatment plan for fibromyalgia. It increases circulation of blood and reduces inflammation- causing a reduction in pain.
Home care help for fibromyalgia includes using heat therapies like hot showers, baths, heating pads and hot water bottles. This will also increase circulation and cause a reduction in pain. Adding Epsom salts to soaks reduces inflammation as well.
Exercise, like tai chi, works with the intrinsic muscles, or the small muscles that attach to large ones, and is an exercise anyone can do. Fibromyalgia patients should consider learning tai chi, which can also be a great community building activity.
About the Author
Stephanie Schwarten is a freelance writer and editor with a Bachelors degree in Professional Writing. She specializes in content marketing as well as both developmental and copy editing.
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