Understanding Fibromyalgia: Causes, Symptoms, Treatment, and the Role of Physiotherapy
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on October 22, 2024
Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. It affects millions of people worldwide, primarily women, and often has a significant impact on daily activities and quality of life. While there is no cure for fibromyalgia, understanding its causes, symptoms, and treatment options—including the role of physiotherapy—can help manage the condition effectively. The underlying mechanism of fibromyalgia is thought to involve abnormal pain processing by the brain and nervous system, resulting in heightened pain perception.
What is fibromyalgia?
Fibromyalgia is a chronic disorder that affects the way the brain and spinal cord process pain signals, resulting in amplified pain sensations. The condition is often classified as a central sensitivity syndrome, where heightened pain sensitivity occurs due to changes in the central nervous system's response to normal sensory stimuli (Clauw, 2014). The American College of Rheumatology (ACR) defines fibromyalgia as widespread pain present for at least three months, along with tenderness at specific sites across the body (Arnold et al., 2019).
Recent studies suggest that fibromyalgia may not solely be a disorder of the musculoskeletal system but also involves neurological, immune, and genetic factors. These abnormalities lead to alterations in pain perception, fatigue, and cognitive issues, often referred to as "fibro fog" (Häuser & Fitzcharles, 2018). This comprehensive view of fibromyalgia highlights the complexity of the condition and the need for a multidisciplinary treatment approach.
Fibromyalgia impacts people differently, but the widespread nature of the pain and the sensitivity to touch are two defining characteristics. Other common symptoms include difficulty sleeping, morning stiffness, headaches, and irritable bowel syndrome (Clauw, 2014).
Understanding fibromyalgia as a condition of altered pain processing rather than solely a musculoskeletal disorder helps guide more effective management strategies, incorporating neurological and behavioural interventions along with physical care.
Causes of fibromyalgia
The precise cause of fibromyalgia remains unknown, but research points to several contributing factors. Recent advances in the understanding of fibromyalgia suggest that it may result from a combination of genetic, environmental, and physiological factors that trigger an abnormal pain response in the central nervous system (Clauw, 2014).
Genetics: There is growing evidence that fibromyalgia runs in families, suggesting a genetic predisposition. Certain genes related to serotonin and dopamine metabolism may be associated with an increased risk of developing fibromyalgia. These genes are involved in mood regulation and pain processing, which explains why people with fibromyalgia often experience co-occurring conditions like anxiety and depression (Arnold et al., 2019).
Infections: Some infections have been shown to trigger or exacerbate fibromyalgia symptoms. Infections such as Epstein-Barr virus, Lyme disease, and hepatitis C are linked to the onset of fibromyalgia. These infections may lead to long-term changes in immune function, contributing to the development of chronic pain and fatigue (Häuser & Fitzcharles, 2018).
Physical or emotional trauma: Many patients report that their fibromyalgia symptoms began after experiencing significant physical trauma, such as a car accident, or emotional stress, such as the loss of a loved one. Traumatic events may trigger an abnormal pain response, possibly due to changes in how the brain processes stress and pain signals (Clauw, 2014).
Recent research also suggests that central nervous system abnormalities play a major role in fibromyalgia. Specifically, patients with fibromyalgia exhibit increased connectivity between brain regions responsible for processing pain, contributing to heightened pain perception (Clauw, 2014).
Understanding these factors helps explain why fibromyalgia can develop in seemingly healthy individuals and why the condition manifests with such a wide array of symptoms.
Signs and symptoms of fibromyalgia
Fibromyalgia is characterized by widespread pain that affects both sides of the body and is present for at least three months. However, pain is not the only symptom; fibromyalgia is a multisystem disorder that affects different aspects of physical and mental health. Common symptoms include:
Widespread pain: The hallmark of fibromyalgia, this pain is often described as a dull ache that affects muscles, ligaments, and tendons. It is typically felt on both sides of the body, above and below the waist.
Fatigue: People with fibromyalgia often wake up feeling tired, even after long periods of sleep. This fatigue can interfere with daily activities and reduce overall energy levels.
Cognitive difficulties: Often referred to as "fibro fog," this symptom affects memory, attention, and concentration. People with fibromyalgia may find it difficult to focus or complete tasks that require mental clarity (Arnold et al., 2019).
Sleep disturbances: Many people with fibromyalgia experience sleep disorders, such as restless legs syndrome and sleep apnea. These conditions exacerbate fatigue and pain (Häuser & Fitzcharles, 2018).
Headaches and migraines: Chronic headaches, including tension headaches and migraines, are common in fibromyalgia and may further diminish quality of life (Clauw, 2014).
Fibromyalgia's symptoms often fluctuate, meaning that patients may experience periods of flare-ups and remissions. This variability can make it challenging for individuals to manage their daily routines and maintain a stable quality of life.
Identifying these symptoms early and working with healthcare providers to establish an appropriate treatment plan is crucial for managing the condition.
Diagnosis of fibromyalgia
Diagnosing fibromyalgia can be difficult because its symptoms overlap with other conditions, such as rheumatoid arthritis, lupus, and chronic fatigue syndrome. Unlike other diseases, there are no specific lab tests or imaging techniques that can confirm a fibromyalgia diagnosis. Instead, diagnosis is based on clinical evaluation and ruling out other potential causes.
The American College of Rheumatology's diagnostic criteria for fibromyalgia include:
Widespread pain index (WPI): This assesses the areas of the body affected by pain.
Symptom severity scale (SSS): This evaluates the severity of fatigue, sleep disturbances, and cognitive issues.
Duration: Symptoms must be present for at least three months (Arnold et al., 2019).
Physicians will often conduct blood tests to rule out conditions like hypothyroidism, rheumatoid arthritis, and lupus. Additionally, a physical exam may help assess the degree of tenderness at specific points on the body, a key feature of fibromyalgia.
Early and accurate diagnosis is important for managing symptoms and improving outcomes. By working closely with healthcare providers, patients can develop a comprehensive treatment plan tailored to their needs.
Treatment of fibromyalgia
While there is no cure for fibromyalgia, a variety of treatments can help manage symptoms and improve quality of life. Treatment typically focuses on reducing pain, improving sleep, and addressing mental health challenges.
Medications: Common medications for fibromyalgia include pain relievers such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and prescription medications like pregabalin and duloxetine, which help regulate pain signals in the brain (Clauw, 2014).
Antidepressants and anticonvulsants: Antidepressants like amitriptyline and anticonvulsants like gabapentin can help manage pain and improve sleep by altering neurotransmitter levels. These medications have been shown to reduce pain intensity and improve sleep quality in patients with fibromyalgia (Arnold et al., 2019).
Cognitive behavioral therapy (CBT): CBT is an effective tool for helping patients cope with the emotional and psychological impact of fibromyalgia. It focuses on changing negative thought patterns and teaching stress management techniques (Häuser & Fitzcharles, 2018).
Exercise: Regular, low-impact aerobic exercise such as walking, swimming, or cycling can improve physical function and reduce pain. Exercise helps promote healthy sleep, reduces fatigue, and enhances mood. It is important for patients to start gradually and build up their tolerance over time (Clauw, 2014).
By using a combination of medication, therapy, and lifestyle changes, patients can manage fibromyalgia symptoms and lead a more fulfilling life. However, the treatment must be tailored to each individual based on their symptoms and needs.
The role of physiotherapy in managing fibromyalgia
Physiotherapy plays a crucial role in managing fibromyalgia by helping patients address pain, improve physical function, and enhance their quality of life. The goal of physiotherapy is to provide individualized treatment that targets the specific needs of the patient.
Manual therapy: Techniques such as massage and myofascial release can help reduce muscle tension, improve circulation, and alleviate pain in tender areas. Manual therapy has been shown to improve range of motion and decrease pain intensity (Clauw, 2014).
Graded exercise therapy (GET): GET involves gradually increasing physical activity in a structured way. This helps patients build endurance, improve strength, and enhance flexibility without triggering pain flare-ups. Studies show that graded exercise can significantly reduce fibromyalgia-related fatigue and stiffness (Häuser & Fitzcharles, 2018).
Pain managementeducation: Physiotherapists can teach patients techniques for managing pain at home, such as pacing activities, using heat therapy, and adjusting posture to reduce strain on muscles and joints. Learning how to self-manage pain helps patients take control of their symptoms and minimize disruptions to daily life (Clauw, 2014).
Physiotherapy is a key part of a multidisciplinary approach to managing fibromyalgia, offering targeted interventions that reduce pain and improve physical function.
Conclusion
Fibromyalgia is a multifaceted disorder that affects various aspects of physical and mental health. While the exact cause is still not fully understood, ongoing research continues to reveal important insights into the central nervous system’s role in the disorder. Managing fibromyalgia requires a holistic approach that includes medications, cognitive therapy, exercise, and physiotherapy. By working with healthcare professionals to develop a personalized treatment plan, individuals with fibromyalgia can manage their symptoms and improve their quality of life.
Consult with a certified physiotherapist today to create a personalized plan for managing fibromyalgia symptoms and improving your overall well-being.
References:
Arnold LM, Bennett RM, Crofford LJ, Dean LE, Clauw DJ, Goldenberg DL, Fitzcharles MA, Paiva ES, Staud R, Sarzi-Puttini P, Buskila D, Macfarlane GJ. AAPT Diagnostic Criteria for Fibromyalgia. J Pain. 2019 Jun;20(6):611-628. doi: 10.1016/j.jpain.2018.10.008. Epub 2018 Nov 16. PMID: 30453109.
Clauw, D. J. (2014). Fibromyalgia: A clinical review. JAMA, 311(15), 1547-1555. https://doi.org/10.1001/jama.2014.3266
Häuser, W., & Fitzcharles, M. A. (2018). Facts and myths pertaining to fibromyalgia. Dialogues in Clinical Neuroscience, 20(1), 53-62.
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.