Fibromyalgia is a common but often misdiagnosed and misunderstood disorder. This chronic condition causes widespread muscle pain, known as myalgia, and extreme tenderness in many areas of the body. Many people with fibromyalgia experience other symptoms in addition to musculoskeletal pain, including sleep disturbances, fatigue, headaches, and mood issues like depression and anxiety.
In the United States, fibromyalgia affects about 2 percent of people by age 20. That increases to about 8 percent of people by age 70. It’s the most common cause of generalized musculoskeletal pain in women 20 to 55 years old. Fibromyalgia is more common in women than men.
Many fibro patients report a life of chronic pain. Muscles and tendons are excessively irritated by various painful stimuli in people with fibromyalgia. “It can be anything sensory — touch, smell, light, sound, taste,” says Kevin Hackshaw, MD, a rheumatologist who specializes in treating patients with fibromyalgia at The Ohio State University Wexner Medical Center in Columbus.
“Any of these sensory nerves can lead to enhanced signaling or some form of discomfort,” says Dr. Hackshaw, who is also an associate professor in the division of rheumatology and immunology. This is thought to be due to a heightened perception of pain, called central sensitization.
It’s not clear why or how some people develop central sensitization, but it may have a genetic component, with some people predisposed to a heightened sense of pain. A lot of speculation exists as to why this is the case, says Dr. Hackshaw.
Quality of Life with Fibromyalgia
Quality of life varies for each person with fibromyalgia, says Tami Stackelhouse, a certified health coach who has fibromyalgia, founder of the International Fibromyalgia Coaching Institute, and author of Take Back Your Life: Find Hope and Freedom From Fibromyalgia Symptoms and Pain. For many fibro patients, the condition has a significantly negative impact on quality of life and ability to partake in and enjoy everyday activities.
Many fibro patients have constant pain and fatigue, though everything from parenting to chores must go on. “Activities that take a lot of energy are difficult,” says Stackelhouse. “Even standing in the shower and washing your hair can be difficult.”
That’s why you have to make adjustments, she says. Stackelhouse, for example, breaks up activities like showering, washing her hair one day and her body another day. “My fibromyalgia impacts every decision that I make from what I eat, to the things I do, to how I structure my day,” she says. “I do my best to stay well so I make certain choices.”
Dr. Hackshaw says that he has patients complete a fibromyalgia impact questionnaire at each visit. It surveys their ability to conduct daily activities like vacuuming, walking, driving, and shopping. It allows him to see how patients are doing with managing their symptoms and if medications have been effective.
You can use our ArthritisPower app to track your symptoms and share your results with your doctor.
Treatment for Fibromyalgia: The Big Picture
There’s not necessarily a straightforward or universal way to treat fibromyalgia, as the condition affects each patient differently and many fibro patients are also managing other co-occurring diseases at the same time, such as different kinds of arthritis. Many treatment options are available to address fibromyalgia’s various symptoms, so treatment for fibromyalgia should be multifactorial, individualized, and based on what specific issues and symptoms are affecting you most.
“Not everyone gets the same fibromyalgia treatment,” says Dr. Hackshaw. “We figure it out based on the symptoms that are most concerning for that patient.” He adds that doctors aim to use medications that treat multiple symptoms instead of prescribing multiple medications. “The key is that you need to find your ‘magic’ combination that works for you,” says Stackelhouse.
Medications for Fibromyalgia
Various medications can help reduce the pain of fibromyalgia and improve sleep. Common options include.
Anti-seizure drugs
Some medications used to treat epilepsy are often useful in reducing pain and improving sleep in fibromyalgia. These medications prevent sensitive nerves from sending too many pain signals to the brain. Gabapentin (Neurontin) may help lessen pain and fatigue and improve sleep. Pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia pain, fatigue, and sleep problems. These drugs are thought to relieve pain by blocking certain chemicals that increase pain transmission. Side effects include weight gain, swelling in lower legs, blurred vision, and dizziness.
Antidepressants
Several different classes of drugs that are used to treat depression can also effectively treat fibromyalgia. “These drugs work just as well in fibromyalgia patients who are not depressed as those who are,” says Daniel Clauw, MD, professor of anesthesiology, medicine (rheumatology), and psychiatry at the University of Michigan in Ann Arbor. “They work by changing levels of neurotransmitters, or brain chemicals, that are abnormal in people with fibromyalgia.”
Tricyclic antidepressants
Tricyclic antidepressants (TCAs) are often used first in treating fibromyalgia. Examples include amitriptyline (Elavil), nortriptyline (Pamelor), and cyclobenzaprine (Flexeril). Taking TCAs before you go to sleep may help alleviate muscle pain and promote deeper sleep. While doses used in fibromyalgia are lower than in depression, side effects are still common. They can include fluid retention, weight gain, drowsiness, constipation, dry mouth, and difficulty concentrating.
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
SNRIs can help particularly with fibromyalgia-related cognitive issues as well as well as pain, fatigue, anxiety, depression, and sleep problems. You may be prescribed duloxetine (Cymbalta) or milnacipran (Savella). Side effects include nausea, dizziness, dry mouth, headache, and sweating.
Selective serotine-reuptake inhibitors (SSRIs)
SSRIs may help with fibromyalgia-related cognitive issues as well as pain and depression. They increase the concentration of serotonin, a brain chemical that regulates the delivery of messages between nerve cells. You may be prescribed fluoxetine (Prozac) or paroxetine (Paxil, Pexeva). Side effects include nausea, vomiting, diarrhea, drowsiness, dry mouth, and effects on sexual desire and appetite.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Over-the-counter medications like ibuprofen (Advil) and naproxen (Alleve) may help relieve some fibro pain. “They may help relieve some of the pain of fibromyalgia, but in general these drugs do not help this type of pain as much as pain from other conditions [like arthritis],” says Dr. Clauw, who serves as director of the University of Michigan’s Chronic Pain and Fatigue Research Center. Even though many NSAIDs are available over the counter, they can have side effects such as stomach ulcers and kidney dysfunction.
Exercise for Fibromyalgia
Aerobic exercise
Exercise may be the last thing you want to do when you’re battling the fatigue, pain, and depression that come along with fibro, but many people find that once they begin exercising, it helps ease their fibromyalgia symptoms. Experiment to find the exercise routine that works best for you. You don’t need to spend hours in the gym to have an impact. Even walking for 10 minutes is a good start. Gentle, low-impact activity like walking, cycling, and swimming can help reduce muscle pain and improve muscle strength. A review that analyzed previous studies of aerobic exercise to treat fibromyalgia found that aerobic exercise can improve quality of life, stiffness and pain, and may improve muscle function.
Strength training
Strength training, which can include classes at a local gym or lifting weights at home, may help strengthen muscles and improve fibro symptoms. A study of women with fibromyalgia found that progressive resistance training was linked to greater overall health, pain relief, and muscle strength.
Tai chi
Some people with fibromyalgia may benefit from tai chi, a traditional Chinese exercise that combines mind-body practice with gentle, flowing movement exercises. Since tai chi promotes mind-body awareness, it may help with fibromyalgia’s physical and emotional symptoms. A study found that yang-style supervised tai chi could be as effective or more effective than aerobic exercise for managing fibromyalgia symptoms. Study participants got the most relief when they attended tai chi classes regularly. People who attended two classes a week for 24 weeks had the most significant symptom improvements.
Yoga
In yoga, you engage in gentle stretching and work on mind-body awareness. A study found that yoga may help with fibromyalgia symptoms including perceived disability, depression, and fear of movement. This study suggests that yoga might also serve as a bridge to other forms of exercise, such as aerobic exercise, for people whose fibro symptoms prevent them from doing higher-intensity exercise.
Regardless of what kind of exercise you do, it’s important to pace yourself and give yourself plenty of rest time between exercise sessions, says Stackelhouse. If you’re walking for exercise, for example, you might walk five to 10 minutes on Monday. Rest on Tuesday and maybe even Wednesday. Then increase your time by a few minutes the next time you walk. “Build that capacity. Start small and go slow,” she says. “I mean really small and slow.”
Diet for Fibromyalgia
There’s no one diet for fibromyalgia, but a healthy, balanced diet that includes combinations of whole grains, protein, and healthy fats at most meals and snacks can help maintain energy and combat fatigue. The components of anti-inflammatory diets like a Mediterranean-style diet work well for fibro patients. This includes eat more fruits, vegetables, legumes, and plant-based foods; getting more omega-3s; and reducing sugar, refined grains, and processed foods. In addition, experts advise keeping a food diary for a short period of time to identify potential food triggers that may make fibro symptoms worse, including dairy, MSG, caffeine, or artificial sweeteners.
Read more here about following a healthy diet for fibromyalgia.
Therapy for Fibromyalgia
Occupational therapy
Occupational therapy can improve the quality of life, confidence, and functional abilities of people with fibromyalgia and other chronic pain conditions, according to a study published in the American Journal of Occupational Therapy. Occupational therapy focuses on restoring physical mobility as well as teaching coping skills to help you manage activities in your daily life, such as cooking, cleaning, and personal hygiene. “OT offers you different ways of doing things” to make life easier, says Stackelhouse.
Physical therapy
A physical therapist can tailor an exercise program to your needs, developing specific stretching and strengthening programs to help with your specific symptoms, including pain, stiffness, and fatigue. Physical therapists also turn to tools to help you use your muscles, stretch for flexibility, and move joints through range-of-motion exercises. Your physical therapist may try hydrotherapy, which uses moist heat or cold packs to stimulate healing and provide short-term pain relief. They may also use deep tissue massage, water aerobics, or TENS units (transcutaneous electrical nerve stimulation).
Cognitive behavioral therapy (CBT)
CBT is a type of psychotherapeutic therapy that aims to change how you think about pain and deal with illness more productively. It’s especially effective when you also learn about your disease and how to manage it. Other types of mental health counseling may also be helpful.
Complementary Treatments for Fibro
For some people, complementary treatments can help relieve fibro symptoms and improve quality of life.
Acupuncture
This ancient healing practice uses thin needles that are inserted into specific points on the body. Acupuncture is meant to balance your body’s natural energy flow. Its effects can ease your pain, increase a sense of calm, and improve digestion, to name a few possible benefits.
Chiropractic medicine
A chiropractor is a health care professional who focuses on the diagnosis and treatment of neuromuscular disorders, with an emphasis on treatment through manual adjustment and/or manipulation of the spine. A chiropractor can help ensure that your body is aligned properly, which may help alleviate certain aspects of fibro pain.
Hypnosis
With hypnosis, you’re put in a trance-like state of altered awareness and perception. Here, you may have heightened responsiveness to suggestions.
Biofeedback
During biofeedback, you use information about unconscious body functions like blood pressure or muscle tension to help gain conscious control over such functions.
Treating Fibromyalgia Fatigue
Persistent fatigue is one of the most challenging symptoms for many people with fibromyalgia. This fatigue doesn’t go away even after sleep or rest. It is different from regular tiredness. It is not just feeling tired from staying up too late or having a bad night’s sleep. It often includes physical exhaustion, depressed mood, and lack of energy or motivation.
While the above treatments should help address fibro fatigue, it’s important to treat fatigue as an important symptom with strategies specifically meant to reduce fatigue. A big part of this has to do with routines, pacing, and conserving energy.
Unrefreshing sleep, which is common when you’re experiencing chronic pain, can contribute to daytime fatigue. Look at your bedtime routine and “sleep hygiene” to make sure you’re creating a relaxing environment. Go to sleep and get up at the same time every day. Keep your room cool and dark. Turn off screens 30 to 60 minutes before bedtime.
Pacing your day is also important. You may not be able to do all thing things you once did or in the timeframe you used to be able to do them in. “Do less on good days so then you won’t crash so hard on bad days,” says Stackelhouse. “Learn to live within your ‘energy budget.’” She thinks of energy like a financial budget. “Live within a certain means. Keep a little energy so your body can use that to heal,” she says. “If you’re using energy all day, every day, then you will have nothing for the body to use for healing.”
If Fibromyalgia Treatment Isn’t Helping
Fibromyalgia is commonly misdiagnosed and other diseases can co-occur with fibromyalgia. If nothing you’re doing to treat fibromyalgia is helping, you may have a different or additional condition that requires its own treatment. “All these conditions can not only mimic fibromyalgia but people can have both at the same time,” says Dr. Hackshaw.
Diseases that commonly occur with fibromyalgia or that could be misdiagnosed as fibromyalgia include:
- Lupus
- Multiple sclerosis
- Rheumatoid arthritis
- Polymyalgia rheumatica
- Axial spondyloarthritis
- Thyroid disease
- Diabetes
- Anemia
- Chronic fatigue syndrome
Read more here about diseases that mimic fibromyalgia.
