Fibromyalgia – what’s the best way to treat it?
Fibromyalgia is often looked at as a mystery or, in some cases, as a garbage diagnosis people get when no one knows what’s wrong with them. Some look at it as if you’re doomed when you get it and say “there’s no cure for fibromyalgia”. When you’ve been in pain for quite some time, that’s reasonable. Everything usually does feel hopeless by then, but it doesn’t have to be. I do think there might be hope and treatment worth looking into, but it might not be what you expect, since it’s not particularly magical…
It has been known for quite some time, where we’re counting hundreds of years, and throughout the years, we’ve called it different things. Fibrositis, polymyalgia rheumatic or “rheumatism in the muscles”, simply myalgia or myofascial pain syndrome, similar to what trigger points have been called.
Many patients have been looking for help with this throughout the years, and most of them seem to be women. Some numbers point to 85% of patients being women. Other numbers say women are twice as likely to get it, that it’s hereditary and that people usually get it when they are middle-aged.
It is often ignored as the women are told they are whining – or the physician might explain it as something psychological or psychosomatic and do nothing. Which… isn’t a lousy deduction, I’d say, but the solution won’t be to ignore the person looking for help and tell them things are in order. The fault might very well be psychosomatic. Long-term pain is always more or less psychosomatic. If fibromyalgia is more, less, or entirely psychosomatic is a mystery where I’m open for input, as always, if you’ve got any…
Unfortunately, being more or less ignored or handled in an ignorant way is not uncommon when it comes to pain. But even though it might feel as if it is, the situation is rarely entirely hopeless. If you are handled as so, feeling misunderstood, and sad is nothing but reasonable.
That shouldn’t make you quit looking. Pain is pain regardless of what we call it or why it’s there – and it’s a highly subjective feeling with a lot of psychology involved, rather than just the pure physical parts, even though you might think the body is all that matters when it comes to pain. The physical parts are what hurts, right? It is, but the brain is everything when it comes to interpreting the signals and making something out of them.
Symptoms
The most common symptom of fibromyalgia is the deep, throbbing, diffuse kind of pain that often moves around. Neck, shoulders, and the back are the most common complaints, but it might be more or less everywhere, including joints. Plenty of pain and the long-term pain symptoms to go with it meaning you’ll get more pain; bigger areas, pain that moves around, and you’ll be more sensitive to pain, as you’ve become a pro at feeling it. Muscle aching often contributes to stiffness, numbness, and poor motor control as well.
With the pain comes stress and a lower mood. That is entirely natural, though extremely debilitating and annoying. As if the pain itself wasn’t enough… If these troubles arise, you might get far LESS pain if the stress and depression symptoms GET BETTER. Treat those to increase your quality of life and decrease your pain.
Gastrointestinal troubles are common. Some get swelling hands and feet, and some get irrationally cold – a symptom I often see among stressed patients. The chilly hands ought to match how we redirect blood when we get stressed.
As with all long-term pain, fatigue commonly comes with it, both mentally and physically. Being in pain is brutal. It takes its toll and drains you of energy.
The fatigue and depressive troubles, and the stress over time often cause cognitive issues like memory problems or difficulty focusing.
I evaluate about symptoms and the complications of long-term pain in the series that begin with “What is long-term pain?”.
How do we get a diagnosis?
There are no specific lab-test to “find fibromyalgia”.
We practically diagnose it by excluding everything else and still have a fitting case. Lab tests don’t detect the widespread pain of fibromyalgia, but they can detect many other things, so we could use them to do just that. We want to exclude everything related to rheumatism since it could give similar symptoms. We want to ensure it’s not a lack of vitamins, hypothyroidism, infection, or anything degenerative. However, with Lupus or rheumatoid arthritis, it’s even more likely to get fibromyalgia. One thing doesn’t necessarily exclude the other.
When “everything else is excluded” and you still have enough symptoms – this is what we ought to be left with.
In short, the fibromyalgia network tells us that an exam to get a diagnosis is as easy as a physical exam, where you’re poking pressure points, which takes about five minutes.
“When light pressure is applied to the surface of the muscles throughout the body, patients with fibromyalgia find this painful, especially at the specific tender point areas used for diagnosis.
To meet the fibromyalgia criteria for diagnosis, patients must have:
A. Widespread pain in all four quadrants of the body for a minimum of three months
B. At least 11 of the 18 specified tender points
The 18 sites used for the fibromyalgia diagnosis cluster around the neck, shoulder, chest, hip, knee, and elbow regions.
The finger pressure that your doctor must apply to these areas during an exam is just enough to cause the nail bed to blanch or become white.”
Check the PDF I’ve posted at www.mbdolor.com/fibromyalgia to get some further information. Two pages with a few criteria for you to see if you match a diagnosis.
Why do we get it?
We’re not entirely sure why it’s developed; there seems to be no known pathology, and we’ve got no tests to “find fibromyalgia,” as far as I know. It could very well be nothing but long-term pain going haywire. If that’s the case, it’s not at all impossible to combat it and get free entirely with enough change.
Some seem to get it from too much psychological stress for too long. Some get it after something specific, like a traumatic event like surgery or an injury. Others get it when they’ve been in too much pain for too long. All of these support the long-term pain theory decently, which is why I think that could be a good reason why.
If it develops like any other long-term pain and got the same symptoms, why not? That would likely be in our favor. We do have a decent clue about long-term pain, while the underlying cause of fibromyalgia is more of a mystery. If it’s the same mechanism, we suddenly do have a decent clue about fibromyalgia.
Some do, however, reason that there is a local reason to get the pain. Some even point to specific skin- and muscle biopsies that could show a difference compared to “healthy” ones. The temperature when looking at people with heat cameras is another topic. Some reason about microcirculation.
Is the pain nociceptive?
Is it psychosomatic?
The fibromyalgia network that created the criteria to get a diagnosis refers to trigger points themselves. Is that the answer, or is it something else? For a diagnosis, you poke a bunch of tender points, and I quote them: “90 percent of the 18 predetermined tender points are actually myofascial trigger points.”
As I often think when it comes to my depressed and stressed clients, is it a mix of both? A sensitive, tired brain and trigger points for various reasons. Could long-term pain with central sensitization and trigger points be the reason, or is there something more?
Could a constant tension of the muscles contribute to decreased circulation and, through that, the dull, throbbing pain some would recognize as lactic acid? That lack of oxygen here and there could lead to worse performance and physical fatigue.
Could it cause swelling because it restricts blood flow?
Could the same trigger points refer pain to other places? They can indeed, and sometimes quite far. Which could make large areas hurt, but it doesn’t really hurt there, so poking around that area doesn’t help. The referred pain is also known for being fuzzy and hard to pinpoint. Even if you do feel the pain, it can be hard to pinpoint exactly WHERE.
Could the constant tension and the trigger points cause the pain people experience in their joints and muscle insertions? Definitely.
If the long-term pain theory is right, which it is, the question is just if there’s more to it or not – I explain why we get long-term pain in the chapter “Why do we get long-term pain?”
Treatment
The treatment usually recommended is the multimodal one – an eclectic approach – to get the best results. Toss everything you can at the situation to make it as good as possible! That even goes for Swedish healthcare, even though it’s rarely offered. It’s just recommended.
Movement is essential, and learning the pain science and understanding pain is crucial. Minding your pacing is vital, and CBT, ACT, and caring for psycho-social aspects can make a major difference. Mindfulness seems to help a great deal. Some use pain killers, and if they work – they’re great. In some cases, anti-depressants can make a difference too. Opiates are less spot-on for long-term pain, though some do get enough effect to keep opiates around. Some use gabapentin and some use SNRIs, hoping for decreased pain.
To treat pain short-term, there’s always the usual heat or ice, painkillers, massage, TENS, and other passive therapies, and whatever else you might find – just distraction could make a difference.
Dry needling with the needles could treat the trigger points. To then add some electricity could decrease the immediate pain.
Needles could work for bigger things, like the back or tiny muscles in a fumbling hand that barely does its job but rather tends to drop stuff… We had pain, numbness, constant contraction of muscles, and horrible motor skills in this case. Treating with needles did a lot, but the long-term solution was found in treating LIFE and looking at the whole.
I love the eclectic approach, not just because it works so well, but it also makes things far more interesting. It’s not rare to see life get even better if that’s used than if we just removed the pain itself! Looking at the whole – and treating trigger points – ought to be an excellent approach to treat fibromyalgia as well as we possibly can.
If you’re curious of some more information how to treat pain this way you could move on to the chapter “Treat long-term pain”.
If you need help doing things straight away, reach out to me at www.mbdolor.com/contact. If you don’t – I sure hope I brought some new information, or gave you some new idea or perspective.
What is fibromyalgia?
Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by the typical symptoms that come with long-term pain, like fatigue, sleep, memory and mood issues. Long-term pain is stressful and comes with various consequences for good reasons. Treating it could be complex, but it’s not at all impossible, just because things are uncomfortable right now.
How is fibromyalgia treated?
Generally quite ignorantly. Not rarely with anti-depressants and opioids. I prefer to treat multimodally! If the pills work, that’s great; then we just add everything else. What else needs to improve? How can we relieve the suffering? What does life look like, and how can we make it better and more meaningful? How can we make things easier, more pleasant and lovely for you, your physical parts, your brain, and the pain?
How do you get a fibromyalgia diagnosis?
An exam to get a diagnosis is as easy as a physical exam, where you’re poking pressure points, which takes about five minutes.
When light pressure is applied to the surface of the muscles throughout the body, patients with fibromyalgia find this painful, especially at the specific tender point areas used for diagnosis.
To meet the fibromyalgia criteria for diagnosis, patients must have:
A. Widespread pain in all four quadrants of the body for a minimum of three months
B. At least 11 of the 18 specified tender points
The 18 sites used for the fibromyalgia diagnosis cluster around the neck, shoulder, chest, hip, knee, and elbow regions.
The finger pressure that your doctor must apply to these areas during an exam is just enough to cause the nail bed to blanch or become white.
What are the symptoms of fibromyalgia?
The most common symptom of fibromyalgia is the deep, throbbing, diffuse kind of pain that often moves around. Neck, shoulders, and the back are the most common complaints, but it might be more or less everywhere, including joints. Plenty of pain and the long-term pain symptoms to go with it meaning you’ll get more pain; bigger areas, pain that moves around, and you’ll be more sensitive to pain, as you’ve become a pro at feeling it. Muscle aching often contributes to stiffness, numbness, and poor motor control as well.
With the pain comes stress and a lower mood. That is entirely natural, though extremely debilitating and annoying. As if the pain itself wasn’t enough… If these troubles arise, you might get far LESS pain if the stress and depression symptoms GET BETTER. Treat those to increase your quality of life and decrease your pain.
Gastrointestinal troubles are common. Some get swelling hands and feet, and some get irrationally cold – a symptom I often see among stressed patients. The chilly hands ought to match how we redirect blood when we get stressed.
As with all long-term pain, fatigue commonly comes with it, both mentally and physically. Being in pain is brutal. It takes its toll and drains you of energy.
The fatigue and depressive troubles, and the stress over time often cause cognitive issues like memory problems or difficulty focusing.
Why do we get fibromyalgia?
We’re not entirely sure why it’s developed; there seems to be no known pathology, and we’ve got no tests to “find fibromyalgia,” as far as I know. It could very well be nothing but long-term pain going haywire. If that’s the case, it’s not at all impossible to combat it and get free entirely with enough change.
Some seem to get it from too much psychological stress for too long. Some get it after something specific, like a traumatic event like surgery or an injury. Others get it when they’ve been in too much pain for too long. All of these support the long-term pain theory decently, which is why I think that could be a good reason why.
If it develops like any other long-term pain and got the same symptoms, why not? That would likely be in our favor. We do have a decent clue about long-term pain, while the underlying cause of fibromyalgia is more of a mystery. If it’s the same mechanism, we suddenly do have a decent clue about fibromyalgia.