What is Fibromyalgia?

Fibromyalgia is a chronic condition which causes widespread pain (pain all over the body) that can vary from mild pain to incapacitating. To be considered widespread, the pain must occur on both sides of the body as well as above and below the waist.

The condition can also cause sleep problems, fatigue and very often emotional and mental distress as well as memory issues. People with fibromyalgia may be more sensitive to pain than others, known as abnormal pain perception processing.

Researchers believe that the condition amplifies pain by affecting the way your brain and spinal cord processes painful and non-painful signals.

Anyone can be affected by fibromyalgia although it affects around seven times as many women as men and the condition usually develops between the ages of 30 and 50; however, it can occur at any age.

It is unclear exactly how many people are affected by fibromyalgia as it can be a difficult condition to diagnose, but some estimates suggest that 1 in 20 people in the UK may be affected to some extent.

What is the difference between polymyalgia and fibromyalgia?

Polymyalgia is a condition which causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips. Stiffness in your muscles that lasts longer than 45 minutes is a common symptom.

Other symptoms may include:

• Weight loss.
• Loss of appetite.
• Depression.
• Extreme tiredness and fatigue.

Both genetic and environmental factors are thought to be responsible for polymyalgia; however, the definite cause is unknown. It is estimated that 1,200 people develop the condition each year.

The condition is age related, therefore most people who develop the condition are over 70 years old and it is very rare in people younger than 50. The condition is more common in women than men.

Polymyalgia and fibromyalgia are similar in terms of their symptoms and the word myalgia means pain within the muscles. Both conditions are characterised by muscle pain; however, many other aspects of the two conditions differ.

Polymyalgia is an inflammatory disease of the muscle and it is believed to be an autoimmune disease where the connective tissues are attacked by the body’s own immune system. Aside from the symptoms of stiffness, people may also have flu like symptoms, including fever, weakness and weight loss. Less common in people with the condition is a potentially dangerous complication called giant cell arthritis, which is an inflammation of the arteries which supply the brain.

In contrast, fibromyalgia is not an inflammatory condition and instead is thought to be caused by an abnormal sensory processing in the central nervous system which makes you sensitive to pain and other painful sensations.

Both polymyalgia and fibromyalgia are more common in women than men. Polymyalgia rarely occurs in anyone under 50 years old, although fibromyalgia can occur at any age. Polymyalgia usually resolves itself within two years; however, fibromyalgia is usually chronic and does not usually disappear.

Treatment for polymyalgia also differs as medication is usually targeted towards treating the inflammation. Fibromyalgia is usually treated with analgesic medications, antidepressants, relaxation techniques and exercise.

What are the causes of fibromyalgia?

There is no known specific cause of fibromyalgia, although certain factors such as stress and genetics may predispose someone towards the condition. Fibromyalgia can often begin after an event, for example surgery, an infection, physical trauma, or a high level of psychological stress.

Sometimes the condition can occur gradually over time without being triggered by a single event.

Some researchers believe that repeated nerve stimulation can cause the brain and spinal cord to change, leading to an abnormal increase in certain chemicals in the brain that signal pain.

The brain’s pain receptors appear to develop a memory of the pain and can overreact to painful and non-painful signals.

There are likely to be several factors that can lead to these changes including:

• Infections – Some illnesses appear to trigger fibromyalgia.
• Genetics – Fibromyalgia appears to run in families therefore there may be certain genetic mutations that make you more susceptible to developing fibromyalgia. If a parent or sibling has the condition, it may mean that you are more likely to develop the condition yourself.
• Emotional or physical events which are traumatic – This could be a car accident or abuse. Prolonged psychological distress may also trigger the condition.
• Chronic poor sleep.
• Lack of exercise.
• Anxiety, depression and other mood disorders such as post-traumatic stress disorder (PTSD).

What are the signs and symptoms of fibromyalgia?

The most common symptoms of fibromyalgia are:

• Pain all over the body – This is often described as a constant dull ache which has lasted for at least 3 months. For the pain to be considered widespread, it must occur on both sides of your body and both above and below the waist.
• Anxiety and depression.
• Sleep problems.
• Tiredness and fatigue – Sleep can often be disrupted by pain and there are often other sleep disorders, for example sleep apnoea or restless legs disorder.
• Difficulties with memory and concentration.
• Headache and migraines.

Sometimes people also experience:

• Digestive problems, for example abdominal pain, bloating, constipation and IBS (irritable bowel syndrome).
• Tingling and numbness in hands and feet.
• Pain in the face or jaw.

The pain caused by the condition and poor sleep quality can affect your ability to function day to day at work or at home. As the condition can often be misunderstood and can go undiagnosed, this can be frustrating, leading to depression and anxiety for some people.

What are the risk factors for fibromyalgia?

Anyone can develop fibromyalgia; however, there are some risk factors which include:

• Lupus or rheumatoid arthritis – It is thought that having these conditions make it more likely for you to develop fibromyalgia. The Arthritis Foundation provide information about how support groups can help you cope with living with arthritis.
• Age – Although you can develop fibromyalgia at any age, it is more common between the ages of 30-50 and you are more likely to have the condition as you get older.

There are some other risk factors which have been associated with fibromyalgia, although more research is needed in order to evidence this.

Some of these risk factors include:

• Being a woman makes it more likely that you will develop fibromyalgia.
• Repetitive injuries.
• Stressful or traumatic events, for example a car accident.
• Obesity.
• Illness, such as viral infections.
• A family history of the condition.

How is fibromyalgia diagnosed?

If you think you have fibromyalgia, you should visit your GP. Diagnosing fibromyalgia can be difficult as there is no specific test for the condition, and the symptoms can mirror symptoms from other conditions.

The symptoms can also vary quite widely amongst patients, therefore presenting further challenges in diagnosing the condition.

Doctors will usually diagnose fibromyalgia by using physical examinations, X-rays, taking blood samples and reviewing a patient’s medical history. Blood tests are usually recommended in order to rule out other causes of fatigue, for example anaemia or thyroid disease.

It will be important to rule out other conditions first before making a diagnosis.

Other conditions which may be causing symptoms similar to the symptoms of fibromyalgia are:

• Rheumatoid arthritis – A condition which can cause swelling of the joints and associated pain.
• Multiple sclerosis (MS) – A condition affecting the central nervous system (spinal cord and brain) which affects movement and balance.
• Chronic fatigue syndrome (ME) – A condition that causes chronic tiredness.

People with fibromyalgia tend to be deeply sensitive to pain that wouldn’t cause any pain in most people. Your healthcare professional may assess the number of painful areas or tender points on your body that are sensitive to touch.

In order to make a diagnosis, widespread pain should have been present for at least 3 months along with fatigue and some of the other symptoms, such as poor sleep quality, memory difficulties, concentration difficulties and symptoms of depression.

What is the best treatment for fibromyalgia?

Although it can sometimes be difficult to diagnose fibromyalgia, it can be treated and managed well with medication and self-help strategies.

Treatment can include:

• Exercise and muscle strengthening exercise.
• Stress management techniques, which can include yoga, meditation and massage.
• Improving quality of sleep.
• Education about the condition and how to manage it.
• Cognitive behavioural therapy (CBT) to treat any underlying depression. CBT is a type of talking therapy that can help you manage your problems by changing the way you think and behave. It is most commonly used to treat anxiety and depression but can be used to treat other mental and physical health problems.
• Medications including over the counter pain relief and prescription drugs.

Most people see improvements in their condition when they take steps to manage stress, improve sleep, exercise and eat healthier.

You should call your healthcare provider if you are experiencing:

• Depression or suicidal thoughts.
• Severe headaches or migraines.
• Ongoing sleep problems or severe fatigue.
• Increased pain.
• Memory problems.

You can also have what is known as a fibromyalgia attack. Certain things can bring on fibromyalgia symptoms (a flare up of the condition) especially things that increase stress levels.

These include:

• Hormone fluctuations.
• Lack of sleep.
• Changes to your diet or a poor diet.
• Changes in daily routine.
• Emotional stress.
• Work related stress.
• Medication or treatment changes.

Can fibromyalgia be prevented?

As experts don’t know what causes fibromyalgia, steps cannot really be taken to prevent it.

However, it is always good to:

• Have a good quality of sleep.
• Minimise stress.
• Maintain a healthy weight.
• Eat a nutritious diet.
• Stay active and exercise regularly as part of your routine.
• Seek help and manage depression.
• Manage arthritis.

All of these things support general health and would be recommended for any health condition.

How to improve quality of life

In addition to medical intervention, people can manage their fibromyalgia with self-management strategies. These are proven to reduce pain and disability.

Some of these include:

• Self-management education classes – This can help you in being more confident in controlling your symptoms and learning how to enjoy a good quality of life.
• Be physically active – All people should be physically active and should aim for 150 minutes per week according to experts. This can include walking, running, swimming, cycling or any other activity which involves movement for 30 minutes per day, 5 days per week. 30-minute sessions can be separated into smaller sessions, for example 10 minutes 3 times per day. Keeping active can also reduce the risk of other long-term diseases such as diabetes and heart disease.
• Attend physical activity programmes specifically aimed at how to safely exercise whilst living with a condition such as arthritis and fibromyalgia. The classes are aimed at reducing pain and adapted for disability related exercise. You can access these types of classes at local community centres.

The NHS provide some helpful tips about how to live with and manage chronic pain.

What are the complications of fibromyalgia?

Fibromyalgia is not a life-threatening condition in itself; however, it can cause a lower quality of life due to ongoing pain or disability.

Fibromyalgia can cause complications such as:

• Increased hospitalisations.
• Higher death rates from injuries or suicide.
• Increased rates of other rheumatic conditions such as arthritis and rheumatoid arthritis.
• Lower quality of life.
• Increased rates of depression. For further reading about the signs and symptoms of depression, please see our knowledge base.

Complications arising from fibromyalgia can interfere with your ability to function at home or in the workplace.

This may be due to the pain, fatigue or poor quality of sleep. Most people can ease symptoms with medication and lifestyle changes. Sometimes symptoms reduce or disappear after reducing stress and symptoms may return during a stressful time.

A small number of people with the condition experience pain or fatigue so severe that they are unable to work.

Fibromyalgia is also sometimes a misunderstood condition and this can cause frustration in people who suffer with the condition. The most important thing to remember is that fibromyalgia may be poorly understood, but it is very real when you are living with the condition.

By getting to know your condition and being more aware of the signs and symptoms, you can help your healthcare provider to help you identify fibromyalgia and access appropriate treatment which can greatly improve your quality of life.