Fibromyalgia or Widespread Pain
By Lori Montgomery, MD, CCFP
Many chronic pain patients have more than one pain problem and may develop new pain as time goes on. In fact, some will develop widespread pain, which goes along with other symptoms related to hyperactivity in the nervous system. This constellation of symptoms is often called fibromyalgia (say: fie-bro-my-ALH-uh).
Signs and symptoms
Fibromyalgia affects three to six percent (3 to 6 out of 100) of the population. It varies in severity. Some patients are very mildly affected, while others are very disabled. Some possible symptoms are:
- widespread pain
- non-restorative sleep (sleep after which they do not feel rested)
- irritable bowel syndrome (chronic constipation and/or diarrhea)
- temporomandibular joint dysfunction (jaw pain)
- painful bladder syndrome (painful or frequent urination)
The cause of these symptoms is not known for certain. Some cases will develop after a prolonged period of more localized pain. Whiplash associated disorder is one example. Others develop slowly. Still others begin after an event such as a surgery or serious infection. It is clear that the nervous system is more active than normal in this disease.
We do not yet understand what triggers this process. Scientists know that people with fibromyalgia have increased levels of certain pain sensitizing neurochemicals around their spinal cord. Their brains also process pain in different places than people without the disease. We still do not know what sets this process in motion.
So far, there is no diagnostic test for fibromyalgia. A doctor will attempt to rule out other causes of widespread pain first. The doctor will then make a diagnosis of fibromyalgia based on your symptoms and physical exam findings.
There are many medicines that have been found to be effective in large studies of fibromyalgia patients. Not all medicines may be suitable for you based on your other medical conditions or other medicines you take. Some patients may benefit from:
- tricyclic antidepressants (such as amitriptyline or nortriptyline)
- gabapentin or pregabalin
- serotonin-norepinephrine reuptake inhibitors (such as venlafaxine or duloxetine)
Some patients may also find cannabinoid medicines helpful to help them sleep.
Aerobic activity has been shown to be very effective. Aerobic means “with oxygen.” Aerobic activity is often performed at a moderate level for a long period of time. For example, running long distances is an aerobic activity. This is hard to do for many fibromyalgia patients, due to flares of pain or fatigue that becomes worse. A number of different health care providers have expertise in creating an activity program that allows you to make slow increases without flaring pain.
Studies have shown that non-drug therapies can help to reduce pain levels and enhance pain coping. These include:
- activity pacing
- cognitive behavioural therapy
These self-management strategies can help you to improve your function so you can do more and enjoy life more.
Rashiq S, Schopflocher D, Taenzer P, Jonsson E (eds). Chronic Pain: A Health Policy Perspective, Wiley Blackwell, 2008.