Fibromyalgia is a chronic widespread pain disorder that affects approximately 6 to 10 million Americans. While it is most common in women, it occurs in men as well as children. Fibromyalgia shares common features with many other chronic pain disorders including muscle tenderness and stiffness, difficulty with concentration and memory (sometimes referred to as “brain fog” or “fibrofog”), fatigue, sleep problems, and sensitivity to environmental factors such as bright lights, loud sounds, perfumes and weather. As there are many overlapping features with other conditions such as autoimmune disorders, infectious disease (like Lyme disease) and thyroid conditions, it is important to get an accurate diagnosis to tailor treatment.
Research has made a lot of progress in understanding fibromyalgia and other chronic pain conditions in the last 30 years, but the precise cause of fibromyalgia is still unknown. It is considered a multifactorial condition that involves many systems of the body including the musculoskeletal system, the nervous system, the immune system, the endocrine system and even the gastrointestinal system. Research in neuroscience has revealed that chronic pain conditions involve changes in the nervous system that increase the sensitivity of the system.
Pain Is Your Alarm
Pain is a necessary human experience to protect you. If you cut yourself or break a bone, you need to know about it to take care of the injury. Pain is the sound of the alarm going off when danger has been detected, much like a smoke detector going off when smoke is detected. However, the alarm system is only detecting possible danger, not always an actual threat.
For example, you might be cooking and a little smoke from the stove causes the alarm to go off, but there is no danger. Your smoke alarm might be so sensitive that it goes off when you are taking a hot shower. In this situation, the alarm detected heat which might mean danger, but in this case there is no fire. The human nervous system functions in the same way. It detects a potential threat and then the brain has to decide if there might be danger and whether to set off the “pain alarm” to get your attention.
When concerned about fire, or perhaps someone breaking in, you can add smoke detectors, movement sensors or a guard dog. You can make the system more sensitive in order to detect threats or danger. If the sensitivity of the system is increased, it might set off the alarm when things that are not dangerous are detected. For example, the neighbor’s cat coming by the house might make the dog bark, leaves blowing by on the wind might set off motion detectors. Now the system is too sensitive and you don’t get accurate information about actual threats. Your system is overprotective.
Your Body’s Alarms Impact Fibromyalgia
Neuroscience research has determined that the nervous system has an incredible quality called neuroplasticity, meaning the system is highly adaptable. It has the ability to adjust its own sensitivity much like these alarm systems in your home. The brain, the spinal cord and the peripheral nerves can all adapt and change to either increase or decrease the sensitivity of the system. This increased sensitivity of the nervous system is a major factor in fibromyalgia.
What causes the nervous system to become more sensitive? Your nervous system is designed to protect you. If your nervous system perceives danger, increasing the sensitivity of the system can provide more information to be able to decide if there is a threat and what to do about it. In your body, that sensitivity might increase for a short period of time such as if you sprain your ankle. The brain gets extra information from the ankle and the rest of the body for a while so you can attend to the injury, determine how bad it is and what to do next. Once the brain and the body feel safe again, the sensitivity of the system can return to normal. However, this sensitivity does not always return to normal and it may persist even after the injury has healed.
There are risk factors for persistent sensitivity of the nervous system that are also risk factors for fibromyalgia.
- Adverse childhood events.
- Medical illness.
- Psychosocial stressors.
With fibromyalgia, there is strong evidence you experience changes in the sensitivity of the nervous system including neurological connections in the brain, changes in chemical activity (neurotransmitters) in the brain, and changes in the density of nerve fibers in the extremities. The actual changes in the nervous system are the result of complex activity in multiple body systems at a cellular level.
Fibromyalgia Treatment Options
Treating fibromyalgia is a multi-prong approach that addresses the root cause of pain and neurological sensitivity, beyond symptom management:
- Desensitization – The heightened sensitivity to stimuli, such as touch, can be addressed with a gradual program of exposure to the different challenging sensations to help reduce sensitivity.
- Cognitive behavioral therapy/mindfulness –If you have significant stress in your life or have a mental health diagnosis such as anxiety or depression, talk to your primary care provider about a referral to a counselor or psychologist. Both formal therapy, and a home practice of mindfulness and stress relief activities can help.
- Sleep – During sleep, the body replenishes all the important chemicals it needs during the day, heals injured tissues and restores balance to your systems. If sleep is disrupted, these important processes are not completed. Rest is vital to these functions. If you need help with sleep concerns, a sleep medicine physician can assess and treat sleep conditions. A behavioral health therapist can address sleep problems without medication.
- Nutrition – Those with chronic pain or fibromyalgia often have digestive problems. Research also indicates there may be associations with diet and inflammation. The chemicals and hormones used to regulate body systems are all made in the gut. If you have nutrition questions, ask your primary care provider for a referral to a dietitian or functional medicine provider. If you have more severe digestive issues, a gastroenterologist can help.
- Acupuncture and myofascial release – There is evidence that acupuncture and some forms of myofascial release are beneficial in reducing pain and nervous system sensitivity. Acupuncture also shows some benefits in treating fatigue. These treatments can reduce pain, enabling you to participate in activity to improve your function and quality of life.
- Pharmacological – There are multiple medications for treating fibromyalgia that you can discuss with a physician. There are options for medications beyond opioids to improve your quality of life.
- Exercise – The research on treatment for pain demonstrates strong evidence that exercise is one of the best treatment options. Exercise helps with pain by increasing your body’s own production of the natural chemicals and hormones that reduce pain. Exercise improves fatigue, sleep and quality of life. Start slow and gradually increase a little every session. Tailoring the exercise program to your needs is important and a well-rounded program should include aerobic exercise, strength training, flexibility and balance training. Aquatic exercise can be very beneficial if you struggle with land-based exercise initially or if you are at high risk for falling. There is also strong evidence for the benefits of meditative movement such as Tai Chi and yoga. If you have no experience with exercise and don’t know where to start, you can seek help from a physical therapist.
Start Slow With Exercise
Moving is something that can be incorporated into your routine right away. However, to best manage your pain, keep these tips in mind:
Choose something you enjoy. If you enjoy swimming then get to the pool, if you love being outdoors then get out for a hike. There is evidence that having positive experiences with exercise provides you with dopamine, the “feel good” hormone, and that can reduce pain and keep you coming back for more.
Consistency is more important than intensity. It is more beneficial to get in a 15-minute walk three times per week than to go for an hour once per month. The nervous system needs exposure and practice with the activities you want to do in order to adapt your tolerance to them. Make a plan and stick to it.
Start slow with low intensity, and gradually increase. You don’t have to work up a sweat or work out for several hours every day to benefit from exercise. It is common for those with chronic pain or fibromyalgia to experience a lot of post-exercise soreness, so you must start slow. If you know you can tolerate a 10-minute walk, start there and then gradually add a little more time each week. The recommendation, even for elite athletes, is to only increase your intensity by 10% per week, so stick to a schedule of measured increases.
Cool down after exercise. To help reduce post-exercise soreness, take time to bring your heart rate back down to a resting level. An increased heart rate signals “fight or flight” which can increase overall sensitivity. Bringing your heart rate down at the end of an exercise session helps put you back into “rest and digest” mode. Slow nasal breathing, a four-second inhale followed by a four-second exhale, for five minutes at the end of an exercise session can be very effective in reducing delayed onset muscle soreness and the sensitivity of the nervous system.
Set a SMART goal. Whether it be walking 30 minutes per day by the end of the year or being able to climb the stairs at your best friend’s house, setting goals can keep you motivated and help you figure out the steps to get to where you want to be. Goals should be Specific, Measurable, Attainable, Relevant and have a Timeline.
Be optimistic. There are many ways to adapt exercises to meet your needs, and a lot of resources to help you on your way. If you do not have experience with exercise or have barriers to being able to exercise and need guidance, seek a referral for physical therapy.
Check with your physician before beginning an exercise program. Based on your medical concerns, exercise can be modified to suit your needs
Learn more about physical therapy services at Samaritan.