Fibromyalgia: Causes, Symptoms, Trigger points & Treatments

What is Fibromyalgia

Fibromyalgia syndrome affects the muscles and soft tissue. Symptoms include chronic muscle pain, fatigue, sleep problems, and painful tender points or trigger points, which can be relieved through medications, lifestyle changes and stress management.

Causes of Fibromyalgia

The exact cause of fibromyalgia is unknown, but it’s thought to be related to abnormal levels of certain chemicals in the brain and changes in the way the central nervous system (brain, spinal cord and nerves) processes pain messages carried around the body.

It’s also suggested that some people are more likely to develop fibromyalgia because of genes inherited from their parents.

In many cases, the condition appears to be triggered by a physically or emotionally stressful event, such as:

  • an injury or infection
  • giving birth
  • having an operation
  • the breakdown of a relationship
  • the death of a loved one

Symptoms of Fibromyalgia

Symptoms of fibromyalgia include:

  • Widespread pain. The pain associated with fibromyalgia often is described as a constant dull ache that has lasted for at least three months. To be considered widespread, the pain must occur on both sides of your body and above and below your waist.
  • Fatigue. People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is often disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea.
  • Cognitive difficulties. A symptom commonly referred to as “fibro fog” impairs the ability to focus, pay attention and concentrate on mental tasks.
  • Other problems. Many people who have fibromyalgia also may experience depression, headaches, and pain or cramping in the lower abdomen.

Trigger points of Fibromyalgia

A person used to be diagnosed with fibromyalgia if they had widespread pain and tenderness in at least 11 of the known 18 trigger points. Doctors would check to see how many of these points were painful by pressing firmly on them.

Common trigger points include:

  • back of the head
  • tops of shoulders
  • upper chest
  • hips
  • knees
  • outer elbows

Trigger points are no longer the focus of diagnosis for fibromyalgia. Instead, doctors may make a diagnosis if you report widespread pain for more than three months and have no diagnosable medical condition that can explain the pain.

Fibromyalgia Treatment

Fibromyalgia can be hard to treat. It’s important to find a doctor who has treated others with fibromyalgia. Many family doctors, general internists, or rheumatologists can treat fibromyalgia. Rheumatologists are doctors who treat arthritis and other conditions that affect the joints and soft tissues.

Treatment often requires a team approach. The team may include your doctor, a physical therapist, and possibly other health care providers. A pain or rheumatology clinic can be a good place to get treatment. Treatment for fibromyalgia may include the following:

  • Pain management. Three medicines have been approved by the U.S. Food and Drug Administration (FDA) to treat fibromyalgia. These are pregabalin (Lyrica), duloxetine (Cymbalta), and milnacipran (Savella). Other medications are being developed and may also receive FDA approval in the future. Your doctor may also suggest non-narcotic pain relievers, low-dose antidepressants, or other classes of medications that might help improve certain symptoms.
  • Sleep management. Getting the right amount of sleep at night may help improve your symptoms. Here are tips for good sleep:
    • Keep regular sleep habits. Try to get to bed at the same time and get up at the same time every day — even on weekends and vacations.
    • Avoid caffeine and alcohol in the late afternoon and evening.
    • Time your exercise. Regular daytime exercise can improve nighttime sleep. But avoid exercising within 3 hours of bedtime, which can be stimulating, keeping you awake.
    • Avoid daytime naps. Sleeping in the afternoon can interfere with nighttime sleep. If you feel you cannot get by without a nap, set an alarm for 1 hour. When it goes off, get up and start moving.
    • Reserve your bed for sleeping. Watching the late news, reading a suspense novel, or working on your laptop in bed can stimulate you, making it hard to sleep.
    • Keep your bedroom dark, quiet, and cool.
    • Avoid liquids and spicy meals before bed. Heartburn and late-night trips to the bathroom do not lead to good sleep.
    • Wind down before bed. Avoid working right up to bedtime. Do relaxing activities, such as listening to soft music or taking a warm bath, that get you ready to sleep. (A warm bath also may soothe aching muscles.)
  • Psychological support. Living with a chronic condition can be hard on you. If you have fibromyalgia, find a support group. Counseling sessions with a trained counselor may improve your understanding of your illness.
  • Other treatments. Complementary therapies may help you. Talk to your physician before trying any alternative treatments. These include:
    • Physical therapy
    • Massage
    • Myofascial release therapy
    • Water therapy
    • Light aerobics
    • Acupressure
    • Applying heat or cold
    • Acupuncture
    • Yoga
    • Relaxation exercises
    • Breathing techniques
    • Aromatherapy
    • Cognitive therapy
    • Biofeedback
    • Herbs
    • Nutritional supplements
    • Osteopathic or chiropractic manipulation

Alternative medicine of Fibromyalgia

Complementary and alternative therapies for pain and stress management aren’t new. Some, such as meditation and yoga, have been practiced for thousands of years. But their use has become more popular in recent years, especially with people who have chronic illnesses, such as fibromyalgia.

Several of these treatments do appear to safely relieve stress and reduce pain, and some are gaining acceptance in mainstream medicine. But many practices remain unproved because they haven’t been adequately studied.

  • Acupuncture. Acupuncture is a Chinese medical system based on restoring normal balance of life forces by inserting very fine needles through the skin to various depths. According to Western theories of acupuncture, the needles cause changes in blood flow and levels of neurotransmitters in the brain and spinal cord. Some studies indicate that acupuncture helps relieve fibromyalgia symptoms, while others show no benefit.
  • Massage therapy. This is one of the oldest methods of health care still in practice. It involves use of different manipulative techniques to move your body’s muscles and soft tissues. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body’s natural painkillers. It often helps relieve stress and anxiety.
  • Yoga and tai chi. These practices combine meditation, slow movements, deep breathing and relaxation. Both have been found to be helpful in controlling fibromyalgia symptoms.
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