Rehab Articles

Fibromyalgia symptoms typically intensify, or flare, periodically. These flares can be unpredictable; what was an invigorating walk one day could be excruciatingly painful the next.

Symptoms may also ease considerably or even disappear for days, months, or longer, only to re-appear again at a later date.

Fibromyalgia Range of Symptoms
The number and type of fibromyalgia symptoms vary with the individual, but chronic pain and stiffness, fatigue, sleep problems, and cognitive impairment are common.

Musculoskeletal pain
The body pain can range from a dull ache to a burning or shooting pain, and parts of the body may feel sore. Some individuals compare the body pain to that of the flu. The pain may be worsened by a variety of factors, such as physical activity, cold or damp weather, stress, or the time of day.

Tender points
A characteristic sign of fibromyalgia is the small, sensitive spots around the body known as tender points. Tender points are discreet areas of tenderness in the muscular and tendinous tissue in the body. Pain radiates out from these points, and some individuals have pain in all 19 tender points.

These points are painful when minor pressure is applied, as when a doctor presses his or her finger on the area during a physical examination. The pain is felt in the body’s soft tissues, such as muscles and ligaments.

Stiffness
Many patients report stiffness, which is generally widespread and diffuse. As is typical of other rheumatic diseases, the stiffness is usually worse in the morning and may improve as the day progresses. It is usually exacerbated the day after physical exertion or exercise.

Fatigue
Patients sometimes report feeling exhausted or weighed down by fibromyalgia. It is common to experience short periods of energy (such as for 24 to 48 hours), only to rebound into feeling fatigued and tired again.

For some, fibromyalgia fatigue is more of a disability than the pain, as it can substantially impact quality of life. Fatigue can make it difficult to sustain or progress in a career, make social plans, and participate in life's milestones, such as family events. Lack of social interaction can in turn contribute to a feeling of isolation or depression.

Non-restorative sleep
Most individuals with fibromyalgia have sleep problems and feel tired upon waking no matter how long they sleep. Pain is often one cause, but individuals with fibromyalgia are also more likely than average to have sleep-related problems such as restless legs syndrome and sleep apnea, which causes breathing to stop briefly while sleeping.

These sleep disruptions may prevent an individual from getting the deep sleep that allows muscles to relax and tissues to rebuild. Some doctors think the lack of quality sleep may contribute to fibromyalgia’s mental sharpness and fatigue issues. Sleep deprivation has been shown to make pain worse even for those without chronic conditions.

Difficulty focusing
Difficulties with focusing, paying attention, and retaining new information are sometimes referred to as “brain fog” or “fibro fog.” Patients may also have trouble using the right words when they talk or have short-term memory loss. These cognitive issues tend to occur most when the individual is feeling tired, stressed, or anxious.

The lack of sharpness varies from person to person, and can last hours, weeks, or longer. For some people, the problem can be serious enough to affect job performance. Driving is unsafe if the impairment is severe.

Additional Symptoms and Coexisting Conditions
Individuals with fibromyalgia are more likely than others to have coexisting medical issues including, but not limited to:
•    Ankylosing spondylitis
•    Anxiety
•    Bladder problems, including painful or frequent urination
•    Coping with Fatigue syndrome
•    Depression
•    Dizziness/balance problems
•    Dry mouth
•    Extra sensitivity to bright light, foods, and noise
•    Gynecological problems, including endometriosis, painful periods, and vulvodynia
•    Hypothyroidism (underactive thyroid gland)
•    Irritable bowel syndrome
•    Low back pain
•    Multiple chemical sensitivities
•    Muscle twitches and cramps (also called muscle spasms)
•    Myofascial pain syndrome
•    Numbness/tingling in hands and feet
•    Post-traumatic stress disorder
•    Restless legs syndrome
•    Rheumatoid arthritis
•    Sleep apnea
•    Systemic lupus erythematosus (lupus)
•    Painful or frequent urination
•    Temporomandibular joint (TMJ) disorders, including tinnitus (ringing in the ears)
•    Tension and migraine headaches
•    Temperature sensitivity

Some of these symptoms are particularly prevalent. In one study of 529 patients, 71% reported anxiety, and 56% reported symptoms of depression.

Reponses to an online survey by the National Fibromyalgia Association with more than 10,000 responses also pointed to a large number of overlapping conditions. More than 60% reported low back pain, and more than 40% listed one or more these symptoms:
•    Arthritic joint pain
•    Balance problems
•    Irritable bowel syndrome
•    Muscle spasms
•    Numbness
•    Recurrent headaches
•    Tingling

Keeping a diary of activities, stressors, and environmental factors may help patients track what makes symptoms better or worse. Once these “triggers” are known, strategies to avoid or minimize them can be developed.

Modulating Factors
While the timing of some symptom flares is unpredictable, the following situations typically lead to an exacerbation of symptoms:
•    Cold, damp weather
•    Stress
•    Overexertion

Fibromyalgia symptoms typically intensify, or flare, periodically. These flares can be unpredictable; what was an invigorating walk one day could be excruciatingly painful the next.

Symptoms may also ease considerably or even disappear for days, months, or longer, only to re-appear again at a later date.

References
1.Schrimpf M, Liegl G, Boeckle M, Leitner A, Geisler P, Pieh C. The effect of sleep deprivation on pain perception in healthy subjects: a meta-analysis. Sleep Med. 2015;16(11):1313-20.
2.Arnold LM, Crofford LJ, Martin SA, Young JP, Sharma U. The effect of anxiety and depression on improvements in pain in a randomized, controlled trial of pregabalin for treatment of fibromyalgia. Pain Med. 2007;8(8):633-8.
3.Fibromyalgia in Primary Care: Incorporating Patient Insights into Patient Care.
4.Kravitz HM, Katz RS, Helmke N, Jeffries H, Bukovsky J, Fawcett J. Alprazolam and ibuprofen in the treatment of fibromyalgia: report of a double-blind placebo-
controlled study. Musculoskelet Pain 1994;2:3–27.
5.Goldenberg DL, Felson DT, Dinerman H. A randomized, controlled trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia. Arthritis Rheum. 1986;29(11):1371-7.

ARTICLE BY: Steven Yeomans, DC, FACO