Fibromyalgia often causes widespread pain – people describe it as ‘hurting all over’. The pain can vary from person to person, come and go, and change in intensity during the day. Other symptoms can include:

Someone with Fibromyalgia is likely to experience some, but not necessarily all, of these symptoms: 

• • Widespread pain without an injury 
  • Tension headaches 
  • Tender points on your body 
  • Fatigue – no energy or struggle to recharge 
  • Difficulty with getting to sleep or staying asleep 
  • Trouble concentrating or remembering things. Often called “fibro fog.” 
  • Depression or anxiety 
  • Digestive problems 
  • Irritable or overactive bladder 
  • Pelvic pain 
  • Jaw pain

Fibromyalgia often runs in families. People with Rheumatoid Arthritis, Lupus, Sjögren’s Syndrome or Ankylosing Spondylitis are also more likely to develop Fibromyalgia although it is not a disease of the joints or an inflammatory condition. Fibromyalgia does not cause permanent damage to bones, joints or muscles.

For these reasons, Fibromyalgia is more often called a syndrome rather than a disease and is very difficult to diagnose because it can mimic other conditions. No one really knows what causes it although it has been linked to psychological trauma and the body’s interpretation of and response to pain signals.

Around 1 in 50 people will develop Fibromyalgia at some time in their life, usually between the ages of 25 and 55. The condition mostly affects women, but men, children and teenagers can have it too.

There is currently no cure for Fibromyalgia but researchers are working on understanding it better. Medication, exercise, relaxation and reducing stress all help reduce symptoms. Most people, with support from their healthcare team, eventually find a way to manage their symptoms.

Fibromyalgia is diagnosed based on symptoms and examination. There are usually no signs of Fibromyalgia on physical examination other than muscle tenderness. Your healthcare provider will consider all the possible causes of your symptoms and decide whether you need tests to rule out other causes. 

There are no X-rays, scans or blood tests that can check for Fibromyalgia. If your symptoms fit what is known about Fibromyalgia and not the symptoms of another illness, then a diagnosis can be made. You can have Fibromyalgia AND another condition with similar or crossover symptoms.  

There are many different sets of diagnostic criteria. The ones healthcare providers in New Zealand use currently are the 2010 American College of Rheumatology criteria.

Three main criteria need to be met for a diagnosis: 

• Your score on the Widespread Pain Index (WPI) is 7 or higher, and Symptom Severity Score (SSS) is 5 or higher. Or your WPI is between 3 to 6 and your SSS is 9 or higher.  The WPI and SSS are questionnaires which your healthcare provider will work through with you. They consider how many areas of the body you experience pain and how much trouble your other symptoms cause. 
• Symptoms have been present at a similar level for at least three months. 
• There is no other disorder that would otherwise explain the pain. 

The International Classification of Diseases, 11th revision identifies Fibromyalgia as chronic widespread pain (CWP), which is diffuse pain in at least 4 of 5 body regions and is associated with significant emotional distress (anxiety, anger/frustration or depressed mood) or functional disability (interference in daily life activities and reduced participation in social roles). 

CWP is multifactorial: biological, psychological and social factors contribute to the pain syndrome. The diagnosis is appropriate when the pain is not directly attributable to a nociceptive process in these regions, and there are features consistent with neoplastic pain and identified psychological and social contributors. 

Who can diagnose Fibromyalgia?

A GP or an experienced nurse practitioner can make a diagnosis. Sometimes, your GP will feel uncomfortable providing more certainty and will refer you to a rheumatologist (joint specialist) or, in areas where there is no rheumatologist, to a general physician.

Each person’s symptoms and experience of Fibromyalgia are different, so management options will vary as well and are usually a mixture of medical approaches and self-care.

Medications

Medications alone are seldom successful in treating Fibromyalgia but they can reduce pain and improve sleep. They include:

• • painkillers such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDS) are usually ineffective in Fibromyalgia, although they may still be useful for relieving underlying arthritic pain.
  • tricyclic anti-depressants such as amitriptyline and nortriptyline are used in low doses to improve sleep and boost the body’s natural mechanisms to reduce pain.
  • anticonvulsants such as gabapentin and pregabalin are used to treat nerve pain (neuralgia) and have been shown to help people with Fibromyalgia.

Exercise

Moving your body will help improve your mood, combat fatigue, increase muscle tone, improve blood flow, ease digestive problems and aid sleep. An exercise programme should include stretching, strengthening and aerobic exercise. The key is to start gradually, especially if you are in pain. Walking, swimming and Tai Chi are all great forms of exercise and warming up first is very important. 

Relaxation

It’s important to balance activity with rest and be guided by what your body needs. Try to reduce stress by planning ahead and breaking activities into small manageable tasks with regular breaks. This will help prevent overwhelming fatigue and decrease your pain. Learn some relaxation techniques to ease muscle tension and anxiety. These might include:

• acupuncture
• massage
• hypnotherapy
• hot and cold packs
• infrared heat
• hydrotherapy
• yoga
• meditation.

Sleep 

Fatigue is a key symptom of Fibromyalgia so getting enough sleep becomes vital. It’s also important not to spend hours in bed as too much inactivity can also be harmful both physically and emotionally. Instead of long naps, try regular micro-rests of 5 to 10 minutes during the day.

Tips for a good night’s rest

• Avoid caffeine in the evening (including soft drinks, alcohol, coffee and tea)
• Avoid smoking
• Turn off screens (TV, mobile devices, laptops) at least half an hour before bedtime
• Develop a regular routine to help you wind down before bedtime
• Go to bed and wake up at the same time each day
• Make sure your bedroom is dark, quiet and a comfortable temperature
• Try a warm bath before bedtime to ease pain and stiffness.

Psychological approaches 

Pain can affect your mood, making you feel sad, anxious, fearful, frustrated or angry. Psychological approaches address the emotional aspects of pain and can help prevent it from becoming overwhelming. Cognitive behavioural therapy (CBT) is one approach that has been shown to help control anxiety for people with fibromyalgia. This should be undertaken with a trained therapist or clinical psychologist. Counselling or psychotherapy may also be helpful.