As a family physician, I treat patients with a wide variety of medical conditions ranging from hypertension and diabetes, to lower back pain and arthritis. Fibromyalgia is a complex pain condition that affects an estimated five million Americans. Of all the conditions that I treat, fibromyalgia is one that is often difficult for patients. It negatively impacts quality of life and often makes the simplest tasks seem difficult.
Fibromyalgia is often misunderstood. Patients with fibromyalgia have widespread pain with additional symptoms that commonly include fatigue, sleep problems (waking up not feeling refreshed) and memory problems. Some patients also have depression, anxiety, headaches, digestive problems and pelvic pain.
Fibromyalgia is diagnosed based on a physician’s physical exam findings and the symptoms that the patient reports. To meet the criteria for fibromyalgia, one must have widespread pain (as measured by the Widespread Pain Index) as well as symptoms such as fatigue, sleep problems and other somatic symptoms (above), which are measured by the Symptom Severity Score. Pain must be present for at least three months and symptoms cannot be attributable to another health condition.
Fibromyalgia can be a difficult condition to diagnose because the symptoms often mimic those of other medical conditions. In addition, each patient with fibromyalgia is different and has a unique constellation of symptoms that can vary. While we might use lab tests to diagnose other medical conditions, no lab tests or imaging studies can be used to diagnose fibromyalgia. All of these factors can make diagnosing this condition tricky for patients and physicians.
A recent article by neurologist and sleep specialist Gerard Meskill cited research that fibromyalgia might be linked to sleep disorders. The hypothesis stems from the fact that impaired sleep is often a symptom of fibromyalgia. Current research also suggests that fibromyalgia is caused by abnormal pain processing in the central nervous system (brain, spinal cord). This causes patients with fibromyalgia to experience more intense pain than those without the condition when exposed to painful stimulus and may even experience pain in response to something not normally painful. This is similar to having a heightened alarm system in the body. Patients with fibromyalgia have an alarm system that rings “louder” when experiencing painful and often sends out false alarms.
Research is critical to better understanding fibromyalgia. A recent study published in the European Journal of Pain, researchers evaluated whether lidocaine injections would help patients with fibromyalgia. There were 62 women divided into three groups and each was given a total of four injections, two muscle injections into the shoulders and two injections in the lower back. One group received four lidocaine injections, another group received two lidocaine and two saline injections and the third group received four saline injections.
The researchers found that the women who received lidocaine injections reported decreased mechanical and heat pain in some areas of their body compared to the women who received saline injections. Interestingly, the authors note that while the lidocaine was best for reducing pain, the saline placebo also significantly helped. They conclude that the process of injection may itself be therapeutic in these patients. This study and others contribute to our growing body of knowledge about potential fibromyalgia treatments, but more research is needed before recommending lidocaine injections.
Even though there is no known cure for fibromyalgia there are many treatment options for this condition. Currently, there are several medications available to treat both fibromyalgia and the symptoms it causes. In addition, aerobic exercise, cognitive behavioral therapy, yoga, tai chi, manipulation and other non-pharmacologic methods are often recommended to help symptoms. For many patients, combining different therapies works best. Speak with your doctor to see what treatment option might be right for you.
For those with fibromyalgia, it is important to eat a healthy diet, exercise, get enough sleep and minimize stress. In addition, make sure to find a physician that you trust and that you can speak to openly and honestly. With fibromyalgia as with other medical conditions, teamwork is crucial and a healthy doctor-patient relationship is essential. Make sure you have a good support system, maintain a positive outlook and remember that it is possible to live a very full and productive life with fibromyalgia.