Fibromyalgia, a chronic condition characterized by widespread musculoskeletal pain, tenderness, fatigue, sleep disturbances, anxiety, cognitive dysfunction, and heightened pain sensitivity to stimuli, affects the fibrous connective tissues and muscles of the body. It is often accompanied by peripheral tingling in the hands and feet, headaches, mood swings, bowel irritability, and generalized stiffness upon awakening.
Diagnosing fibromyalgia can be challenging due to the lack of diagnostic testing and the frequent movement of painful symptoms throughout the body. The criteria for diagnosis involve scoring 19 different body parts where pain has been experienced, coupled with poor sleep, fatigue, and cognitive problems. If pain has been present in 7 or more of these body parts for at least 3 months with a severity score of 5/10 or higher, fibromyalgia is likely to be diagnosed. (0/10 = no pain, 10/10 = maximum pain)
The 19 body parts included in the scoring system are: Jaw, Neck, Back, Chest, Shoulder, Upper arm, Lower arm, Hip, Upper leg, Lower leg, Upper abdomen, and Lower abdomen (right and left for each area).
Fibromyalgia has been identified in 2-4% of the population, with females being 6 times more prevalent than males. It typically manifests around middle age and can worsen with age. The exact cause of fibromyalgia remains unknown, but several factors are thought to be associated, including viral illnesses, genetic predisposition, trauma, obesity, and autoimmune disorders. A recent study suggested that approximately 80% of its 2500 participants had a precipitating event, such as emotional or physical harm, acute illness, or chronic stress.
Despite ongoing research, the exact etiology of fibromyalgia remains elusive. It is believed that neurochemical imbalances in the central nervous system amplify the perception of pain. Elevated levels of neurotransmitters that facilitate pain transmissions are accompanied by decreased levels of those that inhibit pain transmission.
Inhibit pain is decreased. So, while someone without fibromyalgia may not feel any pain when pressure is applied to soft tissue, a person with fibromyalgia would likely feel a much higher sense of pain with the same action due to the imbalances within the central nervous system.
Non-pharmacological approaches include aerobic and strengthening exercises, meditative therapy, and cognitive behavioral therapy (CBT). Exercising can be beneficial for fibromyalgia patients. Given the tendency towards peripheral ischemia (decreased blood flow into the extremities, such as the arms and legs), any exercise that promotes blood flow would be beneficial.
Aerobic exercise improves tissue oxygenation, circulation, and blood flow, and has shown to improve both physical function and pain symptom reductions. However, aerobic activity should be of low impact to avoid excessive joint trauma. Examples of low-impact aerobic exercises include walking, swimming, cycling, and dancing.
Strength training exercises not only improve physical function but also have an impact on pain levels, fatigue, depression, sleep, and overall quality of life. Since fibromyalgia is so widespread, strength training will need to target global musculature.
All exercise, whether aerobic or strengthening, should be paced steadily and include rests. Pain levels should never be marked at higher than 3-4/10. Intensity should be mild to moderate, and 3X weekly for at least 4 weeks to feel the benefits. The program should be ongoing to maintain those benefits.
Meditative therapy, such as Qigong, Yoga, and Tai Chi, can help promote an improved mood, combat depression, fatigue, and sleep disturbances through relaxation, meditation, and deep breathing. The emphasis on controlled breathing and awareness can help you relax and focus your mind, assisting with emotional turmoil. Tightness in the muscles, which can cause unwanted joint stresses, can be loosened as you expand through poses and movement flows. Balance and strength will also likely improve.
Improvements can be made with advancements. If you’re having trouble sleeping, music therapy has been shown to be effective in reducing stress, depression, and anxiety. Try taking a relaxing bath with soothing music before bed. Also, go to bed when you’re tired, maintain a regular sleep schedule, avoid alcohol and caffeine, and avoid strenuous exercise close to bedtime.
Cognitive Behavioral Therapy (CBT) is based on the idea that our thoughts are the cause of our feelings and behaviors, rather than external situations. It helps us realize that we have more control over our lives than we may think and that we can change things by changing our thoughts. The goal of CBT for fibromyalgia is to alter the perception of pain by learning to modify dysfunctional thoughts and improving coping skills. Common CBT practices include mindfulness-based cognitive therapy, which involves switching off the endless chatter in your mind and letting go of negative thoughts and concerns, and cognitive restructuring, which involves challenging your thoughts and beliefs and turning negative thoughts into positive ones. For example, instead of saying, “I couldn’t finish the housework because of pain,” say, “I was able to complete part of my housework today.”
Wrote by Helen Johnson, PTA, Clinical Director
Written By:
Helen Johnson, PTA
Physical Therapist Assistant, Ocoee Clinical Director
