What is Fibromyalgia?
Sometimes also called fibromyalgia syndrome, fibromyalgia causes a number of symptoms, the most common ones pain and tenderness in most areas of the body, as well as tiredness. It is a long-term – or chronic – condition that affects around 10 times as many women as men (i). Experts aren’t really sure how many people have fibromyalgia, but the charity Versus Arthritis says estimates suggest somewhere between 1.8 million and 2.9 million people in the UK are affected (ii). According to the NHS, it most commonly develops in people aged between 30 and 50, but anyone of any age can develop fibromyalgia, even children (iii).
Affecting the muscles, tendons and ligaments, fibromyalgia causes pain that can vary significantly from one person to another as well as from day to day. Some people who have fibromyalgia have severe pain that has a significant effect on their daily life, whereas others have milder symptoms. It can also cause extreme sensitivity to pain, with the slightest touch causing pain and tenderness.
What causes it?
The cause or fibromyalgia is far from clear. It’s not a degenerative disease caused by problems with the joints, bones or muscles like arthritis. However, experts believe it may have something to do with the way pain is processed by the brain and the nervous system (or rather that the nervous system is unable to control or process pain signals). This can make the pain much more difficult to treat, and you may need to try several treatments and combinations of treatments before you find something that works for you.
In some people, fibromyalgia symptoms may be triggered by something as common as stress or a viral infection. Physical or mental trauma may also play a part in its development, including giving birth, having surgery, being involved in an accident, losing a loved one or experiencing a relationship breakdown.
It may also have a genetic link, as you have a greater risk of developing fibromyalgia if one of your parents also has it (iv). There again, some cases of fibromyalgia aren’t connected to anything in particular.
How is it diagnosed?
The problem with fibromyalgia is it can be difficult to diagnose. That’s because the symptoms can be similar to those of several other conditions – including chronic fatigue syndrome, rheumatoid arthritis and multiple sclerosis – and there’s currently no specific test to confirm fibromyalgia.
However, once other conditions have been ruled out, fibromyalgia can be diagnosed if you have severe pain in three to six different areas of your body (or milder pain in seven or more areas). You also have to have had the same level of symptoms for three months or longer.
The most common symptom of fibromyalgia is widespread pain, such as aching, burning or stabbing pain. You may feel it all over, or it could be worse in some areas than others. It may also feel more severe at different times or on different days.
However, pain is just one of many symptoms associated with fibromyalgia, though the number and severity of symptoms tend to vary greatly from one person to the next. These symptoms – and related conditions – include the following:
Fibromyalgia can cause tiredness ranging from a mild tired feeling to the type of exhaustion that you usually feel when you have the flu. One of the possible reasons for this tiredness is that if you have fibromyalgia your condition may stop you from getting much good sleep quality (deep sleep or restorative sleep), so you could wake up feeling tired even when you’ve been asleep for a good eight hours or more.
Muscle stiffness – typically first thing in the morning or if you’ve been in the same position for a long time – as well as muscle spasms are both symptoms of fibromyalgia.
If you have fibromyalgia, you may have difficulty thinking clearly, remembering things or learning new things, as well as not being able to concentrate properly. Sufferers often call this symptom fibro-fog.
Fibromyalgia can also cause numbness, tingling, pins and needles or a burning sensation in your hands and feet (also called paraesthesia). It can also cause the sensation of swollen hands or feet.
This may also be a symptom, especially if you have pain and stiffness in your neck and shoulders.
Some people with fibromyalgia also suffer from depression and/or anxiety, though it’s often thought these may develop as a result of having fibromyalgia, rather than being symptoms.
Restless legs syndrome
A common condition that affects the nervous system, restless leg syndrome (RLS) makes you want to move your legs, and can cause a crawling or creeping sensation that often becomes worse at night. One study suggests people with fibromyalgia are 11 times more likely to have restless legs syndrome than those who don’t have fibromyalgia (v).
Fibromyalgia suffers may experience joint pain in various parts of their body. There’s also thought to be a link between fibromyalgia and temporomandibular joint disorder (TMJD), which causes pain in the jaw area (vi). Other joint-affecting conditions thought to be associated with fibromyalgia include osteoarthritis, rheumatoid arthritis, lupus and ankylosing spondylitis.
Irritable bowel syndrome
Many people with fibromyalgia also have IBS symptoms, such as abdominal pain, diarrhoea, constipation and bloating.
This also commonly affects people with fibromyalgia, making them want to urinate frequently, especially at night.
How fibromyalgia is treated
Treatment for fibromyalgia involves helping you to manage the symptoms, since there’s currently no cure. There are several different types of medicines available, which may be prescribed by your GP or a hospital specialist such as a rheumatologist, neurologist or psychologist, as well as some therapies. Not all treatments work for everyone, and it’s very much a case of trying different ones until you find what works best for you.
Over-the-counter painkillers and stronger prescription painkillers are used to help relieve fibromyalgia pain. Not all painkillers are suitable for everyone, plus they all have possible side effects. Make sure you read the information leaflet carefully before taking them. If you have severe pain, you may be prescribed opiate painkillers, but these don’t always work in fibromyalgia plus they can be addictive and have more side-effects than simple painkillers such as paracetamol. Pain-relieving gels can also be used, such as those that contain anti-inflammatory medicines.
Several different types of antidepressants can be used to relieve the pain of fibromyalgia, but again they don’t work for everyone. They are thought to work because they increase levels of certain neurotransmitters – or chemicals – in the brain that may be lacking in some people with fibromyalgia. All types of antidepressants cause side effects, and your GP or specialist will help you weigh up whether or not the pain relief they provide cancel out any side effects you may experience.
Medicines normally used to treat epilepsy called pregabalin and gabapentin are sometimes used to treat fibromyalgia, as experts believe they may improve pain in some sufferers. Side effects include dizziness, weight gain and drowsiness.
Cognitive behavioural therapy (CBT)
This is a talking therapy that may help you think about things – such as pain – differently, so that you start to experience pain less severely. It may also help you reduce the extent that pain and other fibromyalgia symptoms interfere with your life. Some specialists also recommend psychotherapy, which aims to help you deal with your thoughts and feelings more positively.
A physiotherapist may help to relieve the pain of fibromyalgia by improving your posture, designing an exercise programme for your specific needs, or by offering hydrotherapy, where you sit, swim or exercise in a heated pool.
Fibromyalgia: how to help yourself
Adopting as healthy a lifestyle as possible may help to relieve some of the symptoms of fibromyalgia. Your GP can advise and help you when it comes to making healthy changes, but in the meantime here are some of the things you could do:
Try to exercise
Being active may be the last thing on your mind when you’re experiencing pain or fatigue. But exercising whenever you can may help to improve your health in general, and even help you to cope with your symptoms, especially muscle stiffness. However, instead of launching into exercising on your own, it’s advisable to ask your GP or physiotherapist to tailor an activity programme especially for you (though walking, swimming, cycling and yoga are all thought to be beneficial). At the very least, always talk to your GP before starting any new type of exercise, especially if you have a condition such as fibromyalgia. Most importantly, don’t try to do too much, too soon. You may find exercising difficult at first, but starting off with just a few minutes of exercise each day can help you to build up to longer sessions as your strength and stamina improves. Eventually, you should be able to exercise for 20-30 minutes, four to five times a week.
Learn to relax
The symptoms of fibromyalgia can be difficult to live with, so it’s important to make time to relax every day. If you find it difficult to relax, there are lots of techniques you can try. You may want to learn how to meditate, for example, or try something like t’ai chi (often called moving meditation). There are books, tapes, CDs and courses you can use to learn different methods of relaxation, or you may find it easier to do something simple, such as having a relaxing bath before bedtime or listening to soothing music. Try this deep-breathing exercise to get you started:
Breathe in slowly and deeply, counting in, two three.
Breathe out slowly, counting out, two three, and feel your body relaxing.
If you prefer, instead of counting, stay a word silently to yourself such as ‘calm’ or ‘relax’.
Keep going for as long as you can (anything from two to 20 minutes).
This is a really helpful thing to do, especially if you suffer from tiredness. It simply means making sure you don’t overdo things. That’s because pushing yourself too hard can make your symptoms worse. Only do as much as you feel you can, making sure you balance periods of activity with plenty of rest. If you work, make sure your employer or manager is aware that you have fibromyalgia, so that they can support you and give you any help you need to take regular breaks.
Many people who have fibromyalgia don’t sleep well. But you may be able to improve your sleep if you take certain steps, like avoiding stimulants such as caffeine, nicotine and alcohol before bedtime and not eating big meals in the evening. You may also find it helpful to create a regular bedtime routine that includes having a relaxing bath and a warm milky drink to prepare yourself for sleep. Read more about getting a better night’s sleep in our guide to sleep and insomnia
Deal with stress
Having a condition such as fibromyalgia can be stressful, so it’s important to try and deal with any other sources of stress in your life. This may sound easier said than done, but there are things you can do, such as talking to somebody you trust about any problems you may have. If you need more advice on tackling stress, take a look at our guide.
Natural relief for fibromyalgia
There are several nutritional and herbal supplements that may provide natural relief for fibromyalgia symptoms, including the following:
Found in a range of foods, including whole grains, nuts and green leafy vegetables, magnesium may be useful for general muscle health as well as muscle and nerve function (one of the symptoms of magnesium deficiency is muscle cramps and twitches). Magnesium may also be helpful for restless leg syndrome (RLS), a condition associated with fibromyalgia (vii).
5-hydroxytryptophan – or 5-HTP for short – is a non-essential amino acid that’s often used as a natural remedy for depression and low mood, with studies suggesting it may be as effective as antidepressants (viii). It may also help with sleep difficulties, which are also associated with fibromyalgia (ix). Plus there’s some evidence that 5-HTP can reduce some of the pain and stiffness of fibromyalgia (x).
St John’s Wort
The traditional herbal remedy St John’s Wort is often used for the relief of slightly low mood and mild anxiety, based on traditional use only. There’s some evidence it may be at least as effective as conventional antidepressants in treating mild to moderate depression (xi). This remedy may interact with some other medicines, so consult your GP before taking it if you’re on any kind of medication.
Some experts believe the omega-3 fatty acids found in fish oils may help to reduce pain. One study suggests 59 per cent of volunteers with neck and back pain stopped taking painkillers after taking omega-3 supplements (xii). Other studies also suggest omega-3 fatty acids may also be useful as a natural treatment for depression (xiii).
Conditions that cause joint pain such as osteoarthritis and rheumatoid arthritis are thought to be associated with fibromyalgia. Turmeric – a spice widely used in Indian cooking – is also used in Ayurvedic medicine (Indian herbal medicine) to treat the symptoms of arthritis, and there is some evidence that its active ingredient, curcumin, may provide natural pain relief (xiv).
If you experience difficulties getting to sleep because of your fibromyalgia, the traditional herbal remedy Valerian may help. One study suggests it is more effective than placebo in helping people to fall asleep faster (xv).
Several of the B vitamins are necessary for nerve function, and may arguably be useful for fibromyalgia since the condition is thought to be caused by the way the brain and nervous system process pain.
Living with fibromyalgia can be a challenge but there are things you can do that may help keep your symptoms under control and give you a better quality of life.
Also known as palmitoylethanolamide, PEA is a type of fatty acid made naturally by the body and found in all cells, tissues and fluids including the brain (it’s also found in foods such as soya beans, peanuts, eggs, flaxseed and milk). Described as an endocannbinoid-like chemical that belongs to a family of fatty acid compounds called amides (xvi), PEA is an alternative to CBD, since both substances are thought to have similar properties including the ability to reduce pain and inflammation. However researchers suggest PEA is safer than CBD, since it has been studied more extensively and has a more robust safety profile (xvii) with no known side effects (xvi).
Your body naturally increases its production of PEA when your cells are damaged or threatened. But in certain situations – such as when your body is experiencing chronic inflammation – the level of PEA in your cells drops (xvi). When this happens, PEA supplements may be helpful. In fact one study suggests taking PEA supplements may indeed be beneficial in the treatment of pain for people affected by fibromyalgia (xviii).
An acetylated form of the amino acid l-carnitine, acetyl l-carnitine (or ALC for short) has a variety of roles in the body. For instance it’s involved in energy metabolism and has antioxidant properties, plus it modulates brain chemicals including serotonin, dopamine and acetylcholine. Researchers have also investigated the use of ALC – which is available in supplements – in treating chronic pain, including conditions such as fibromyalgia. One study has looked at whether taking ALC and PEA would help people with fibromyalgia who were being treated with the medicines pregabalin (an anticonvulsant) and duloxetine (an antidepressant) (xxi). For 24 weeks, one group of volunteers took pregabalin and duloxetine, while the second group took the same medicines along with ALC and PEA. At the end of the study period, the second group experienced a higher level of improvement in pain levels compared with the first group. The researchers concluded that their study supports the supplementary value of ALC and PEA in people with fibromyalgia.
ALC is not suitable for children or during pregnancy and breastfeeding. It may also interfere with how well thyroid hormone works in the body, so speak to your GP before taking it if you have an underactive thyroid and are taking thyroid medication. Other medicines that may be affected by ALC include warfarin, an anticoagulant drug used to slow blood clotting (xxii).
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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.