Fibromyalgia is a condition characterised by widespread pain, sensitivity to touch and unexplained fatigue. It often interferes with daily activities, hobbies and work. Fibromyalgia is often classified as a pseudo-arthritis condition, as there is no actual damage or inflammation to the joints, cartilage, muscles or tissues.

The nervous system of fibromyalgia sufferers functions abnormally, causing normal stimulus such as pressure to be perceived as pain.

Who gets Fibromyalgia?

Fibromyalgia can affect children as well as adults, however women are twice as likely to develop fibromyalgia compared to men. It affects 2-8% of the population.

Causes

The individual cause of fibromyalgia is not always clear. Environmental factors as well as genes that regulate the way the body processes painful stimuli have been linked with an increased likelihood of developing fibromyalgia. Sometimes a physically or emotionally stressful event such as a motor vehicle accident, repetitive injuries, surgery or illness can trigger the onset of fibromyalgia. It is also possible for fibromyalgia to develop spontaneously, especially in those who already suffer from chronic pain.

Signs and symptoms:

• Generalised muscle and joint stiffness, especially in the mornings
• Deep, dull ache throughout the body
• Headaches
• Sensitivity to temperatures (hot and cold)
• Sensitivity to loud noises or bright lights
• Sleep disturbances
• Numbness and tingling of the hands and feet
• Restless legs syndrome
• Jaw pain and clicking
• Depression or anxiety
• Cognitive (thinking) and memory difficulties
• Irritable bowel syndrome
• Painful menstrual periods
• Persistent fatigue

Diagnosis

There are no diagnostic markers for fibromyalgia, however investigations such as X-rays, MRIs, CT scans and blood tests may be useful to exclude other potential causes of your symptoms. A physical exam will be required to detect tenderness and to exclude other causes of muscle pain. Your doctor may use the clinical criteria established by the American College of Rheumatology (2011) to diagnose fibromyalgia. These include:

1. Widespread pain at different areas of your body, severity of fatigue, cognitive problems
2. Symptoms or pain of similar intensity for at least 3 months
3. No history of medical condition(s) that would explain the pain and symptoms
4. Headaches, pain or cramps in the lower abdomen and depression in the last 6 months

Treatment

Treatment should include a combination of non-pharmacologic and pharmacologic therapy. Medication can aid in reducing severity of symptoms, however active self-management strategies directed at improving function are required for a long term solution. The aim of treatment should be to identify and address the specific triggers of your pain as everyone is unique. Discuss your treatment options with your doctor or physiotherapist.

Pharmacological treatment

Medications may play a role in the management of fibromyalgia to assist you in being active, participating in the things you enjoy and reducing your pain hypersensitivity.

Common medications for fibromyalgia include anti-depressants and anti-epilepsy drugs. Paracetamol and anti-inflammatory medications are not made specifically for fibromyalgia, however they can help to reduce pain. Seek advice from your doctor about any medication to ensure you know the risks, benefits and evidence for it’s use.

Non-pharmacological treatment

Physiotherapy treatment techniques including trigger point therapy, dry needling, massage, strengthening and stretching exercises have been shown to be effective in reducing pain for fibromyalgia sufferers.

Other important treatment options include:

• Improving sleep hygiene
• Having a balanced diet
• Graded exercise
• Strategies to cope with stress, anxiety and depression (eg. cognitive behavioural therapy, meditation, relaxation)

As experts in movement and exercise, physiotherapists can develop a graded exercise program specific to your needs and pain levels.

Helpful Websites/Resources:

1. Fibromyalgia Support Network (Western Australia) http://www.fibronetwork.org.au/
2. Arthritis Australia http://www.arthritisaustralia.com.au/
3. Pain Management (Western Australia) http://painhealth.csse.uwa.edu.au/further-assistance.html

References:

1. Clauw, D. J. “Fibromyalgia: a clinical review.” JAMA, J. Am. Med. Assoc., 2014, 311(15): 1547-1555.
2. Wolfe, F., et al. “Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia.” J Rheumatol, 2011, 38(6): 1113-1122.