Fibromyalgia: Causes, Management and Treatment

Fibromyalgia syndrome (FS) is a chronic and complex condition of unknown etiology, which is characterised by widespread musculoskeletal pain and multiple tender points.

Patients suffering from fibromyalgia often report high disability level and poor quality of life. There is no specific laboratory test to diagnose it but the accepted method for diagnosis is the 1990 American College of Rheumatology (ACR) criteria.

According to ACR patients deemed to have fibromyalgia, should have widespread pain for longer than three months duration, with pain on palpation of at least 11 of 18 specific tender points on body.

According to the latest research figures quoted by National Fibromyalgia Association, between 3-6% of world population suffers from the condition.

Classification of Fibromyalgia syndrome (FS)

It is classified based on psychological and autonomic nervous system profiles

1. “Fibromyalgia due to somatization” (may respond to psychotherapy)

2. “Fibromyalgia and comorbid, pain-related depression” (may respond to antidepressants)

3. “Depression with concomitant fibromyalgia syndrome” (may respond to antidepressants)

4. “Extreme sensitivity to pain but no associated psychiatric conditions” (may respond to medications that block the 5-HT3 receptor)

One of the most overlooked and under diagnosed debilitating health issue… 3.4% of females and 0.5% of males, complain of fibromyalgia symptoms.

My understanding of Fibromyalgia syndrome (FS)

In my years of experience, I have seen wondrous benefits of yoga and related modalities like asana, pranayama, breathing exercises and meditation on people afflicted with chronic fibromyalgia.

Of late, I have started noticing a few yoga centres and wellness retreats have started conducting specific health retreats for fibromyalgia,  chronic pain relief and and related pain management retreats. Please go attend them, if there is one happening in your area.

Also, being grossly misunderstood and under reported, people suffering from chronic fibromyalgia tend to get depressive. Most people/doctors, who do not understand this dreaded condition, can not comprehend the depth of fibromyalgia pain and how depressing & debilitating it can be.

What causes fibromyalgia?

Researchers suggest that being a complex syndrome it cannot be caused by a single event but from a combination of many physical and emotional stressors. Some researchers believe that it is caused by reduced level of serotonin (neurotransmitter) leads to reduced pain threshold and anxiety. Increased levels of substance P may cause increased pain sensitivity. Some studies also link fibromyalgia to sudden brain and spinal cord injury.

1/5. Stress

Chronic stress may be an important precipitating factor as fibromyalgia is frequently seen in people with stress related disorders such as chronic fatigue syndrome, irritable bowel syndrome, diverticulitis and depression.

2/5. Insomnia

Many people suffering from fibromyalgia experience insomnia or non-restorable sleep, which causes lower levels of serotonin, resulting in increased pain sensitivity.

3/5. Depression

Some researchers used to believe that low-grade depression causes fibromyalgia but recent studies negate this thought. However continuous pain can cause anxiety and depression, which can worsen the symptoms of fibromyalgia.

4/5. Genetics

Some scientists theorise that people suffering from fibromyalgia may have gene or genes inherited from their parents, which cause adverse reaction to some stimuli. When these people are exposed to certain emotional or physical stressors there is a change in the body’s response to that stimulus. This causes higher sensitivity of entire body to pain.

5/5. Gluten sensitivity

There is an association seen between fibromyalgia and gluten sensitivity. Also patients have seen improvements in their symptoms by eliminating gluten from their diet.

Fibromyalgia management and treatment

Although there is no cure, simple management and treatment can relieve most of its painful symptoms. A multidisciplinary pain management approach should include medications, patient education, yoga asana stretches, breathing exercises, regular gentle low impact exercise and cognitive behavior therapy.

1/10. Medications

1. Muscles relaxants like tizanidine is prescribed sometimes to relieve symptoms

2. Anti-seizure drugs – gabapentin is used sometimes to help relieve fibromyalgia symptoms

3. Antidepressants like Duloxetine and milnacpran may be used to relieve pain and improve sleep quality

4. Human growth hormone – addition of growth hormone to standard treatment is effective in reducing pain

5. Painkillers – Over the counter painkillers like acetaminophen, ibuprofenor naproxen sodium may be helpful. Some doctors prescribe opiods such as tramadol but in low doses only.

Fibromyalgia pain can be debilitating and what provides relief to one patient may not help other, so one should consider non drug treatment as they are generally safe and do not cause further harm.

2/10. Massage helps

It is another good way to reduce symptoms of fibromyalgia but one should go for an experienced therapist as patients may find it painful, as their muscle tissue is very sensitive. It should involve light force without triggering trigger points.

3/10. Practice Tai Chi

Tai Chi is a Chinese martial art, which involves mind body practice. It involves breathing techniques, various graceful movements and relaxation. A recent study compares Tai Chi with standard fibromyalgia treatment showed a significant improvement in quality of life and settlement of other symptoms.

4/10. Acupuncture helps

Acupuncture may not be gold standard treatment but it is worth trying. Accupunture increases blood flow to inflamed areas and promotes relief from stiffness and tension headaches.

5/10. Aromatherapy helps

Use of fragrant herbs and oils for skin or inhalation induce sleep, reduce muscle pain and calms the mind. Some patients may see improvement while for others symptoms may get worsen so it should be used carefully and under expert supervision.

6/10. Melatonin treatment

It is seen that patients suffering from fibromyalgia pain often have poor quality of sleep, which may be due to low levels of melatonin. Taking appropriate doses of melatonin may help to promote good sleep thereby reducing the pain effects.

7/10. Vitamin D and Vitamin B12

Vitamin D and B12 are virtually recommended for everybody and not just fibromyalgia patients. It can be taken by sun exposure or orally. Consult your Doctor for the recommended dosage of Vitamin D and B12, taken preferably taken with food, for better absorption. Please go to the respective pages for more on Vitamin D and Vitamin B12…

8/10. Cognitive behavior therapy (CBT)

CBT along with exercises has proved to be effective in some sufferers. It helps in improving mood and self-efficacy or coping with pain and fatigue.

9/10. Exercises benefit for Fibromyalgia

1. Decreased general pain
2. Reduced no. of tender points
3. Improved sleep and less fatigue
4. Decreased pain at tender points
5. Fewer feelings of helplessness & hopelessness
6. More frequent & meaningful social interactions
7. Lessened impact of the disease on daily activities.
8. Long term aerobic activity such as aqua therapy and cycling has been proven beneficial to relieve symptoms

10/10. Benefits of yoga for fibromyalgia

Yoga is a great antidote to stress, which can exacerbate fibromyalgia symptoms. Most of the hatha yoga posture involves stretching of muscle tissues and fascia, which improves circulation to the affected tissue thereby reducing tension, inflammation and pain.

Pranayama, meditation and various breathing techniques stimulate vagus nerve – reducing stress, tension and heaviness of affected muscle tissue; promoting good sleep and overall functioning of the body.

One should start with simple asanas and should not go in extreme yoga postures as it may worsen their symptoms. Asana such as Garudasan (eagle pose), which stretches muscles around shoulder blade, Bhujangasan (cobra pose) extend back while opening chest should be part of your rehabilitation program. Please consult your yoga teacher to personalise yoga for fibromyalgia to maximise the benefits.

A POINT TO NOTE… Sitting meditation can trigger ‘relaxation induced stress’ in people who suffer from fibromyalgia related stress, anxiety and depression. And if it does, discontinue the practice of sitting meditation. Consult your guide, for further guidance.

ALSO, I strongly suggest you to connect with others who have the issue, build up a community, share your thoughts, attend/conduct lectures, specific classes, workshops or sessions being offered in your area. All the Best.