Fibromyalgia: symptoms, therapy, causes
Fibromyalgia belongs to the pain syndromes. Deep muscle pain in various parts of the body is typical. Added to this are exhaustion, concentration and sleep problems. The causes of the disease are not yet known, but a disturbed pain processing is possible. Treatment is difficult because common painkillers fail. Inform yourself here about symptoms, therapy and possible triggers of fibromyalgia!
Short overview fibromyalgia
- Symptoms: deep muscle pain, sensations, painful pressure points, exhaustion, irritable bowel syndrome, depression, anxiety
- Painkillers: opioids, cortisone or non-steroidal anti-inflammatory drugs such as paracetamol, ibuprofen, acetylsalicylic acid have little or no effect
- Treatment: Movement, heat therapy, psychotherapy, antidepressants, relaxation techniques
- Nutrition: mainly vegetable based, especially a lot of vegetables, little meat, little alcohol
- Causes: Trigger still largely unknown, possibly disturbed pain processing, genetic causes, altered nerve fibres, psychological trauma
- Diagnosis: Exclusion of other causes, examination of specific pain pressure points, pain questionnaires
- Prognosis: not curable, but manageable, does not leave any permanent physical damage
Fibromyalgia – symptoms
The term “fibromyalgia” stands for fiber-muscle pain. This already describes the central symptom of the disease. Mostly it is a matter of persistent, deep muscle pain, which is accompanied by paraesthesia. So far they cannot be explained by pathological processes. Other main symptoms are sleep disorders and exhaustion. Fibromyalgia is often accompanied by psychological complaints such as depression or anxiety.
Main symptom pain
The main symptom of fibromyalgia is a diffuse and chronic pain. It is often described by those affected as a deep muscle pain that can be accompanied by stiffness, burning, knocking, numbness and tingling. Sometimes joints or muscles also feel swollen.
The pain can be concentrated in certain areas. The neck, back, arms, legs and chest are often affected. However, it can also occur in other parts of the body.
Variable pain intensity: Pain load and intensity are influenced by weather, temperature, time of day, stress and physical activity. In some patients the pain is particularly intense in the morning. He then improves in the course of the day. Heat and moderate activity usually improve fibromyalgia symptoms.
Painful pressure points (tender points): It is typical for patients with fibromyalgia that they react particularly sensitively to pressure at certain points on the body. There are a total of 18 of these so-called Tender Points.
Headaches: In addition to muscular pain, people with fibromyalgia often suffer from headaches or migraines. Irritable bowel symptoms with frequent abdominal pain, diarrhea or constipation are also common. Others again suffer from pain that resembles a urinary tract infection.
Painful face: A special variant of fibromyalgia manifests itself as a so-called temporomandibular joint syndrome, in which the face and jaw are painful. The latter can only move the persons to a limited extent, which causes them problems when chewing.
Main symptoms fatigue and sleep disorders
More than 90 percent of fibromyalgia patients suffer from fatigue and exhaustion. Often they suffer from insomnia – their sleep is light and they wake up frequently. They also suffer more frequently from sleep apnea. Breathing interruptions occur at night while snoring. Sleep is then less restful and the risk of cardiovascular disease increases.
Fatigue in fibromyalgia: The sleep disturbances can lead to a chronic fatigue syndrome (chronic fatigue syndrome, CFS). Fatigue is the technical term for chronic fatigue. In fact, most fatigue sufferers meet the criteria for fibromyalgia. Conversely, more than two thirds of fibromyalgia patients suffer from CFS.
Restless Legs Syndrome: A disease that also frequently occurs in fibromyalgia patients is the so-called Restless Legs Syndrome. Affected persons suffer from agonizing pulling or tingling in the legs when resting. The symptoms can only be relieved by exercise. This can also cause considerable sleep disturbances and subsequent tiredness. Patients with fibromyalgia symptoms should therefore be examined to see whether they also have Restless Legs Syndrome.
Fibromyalgia: psychological symptoms
Fibromyalgia is often accompanied by psychological complaints. Depressive symptoms such as nervousness, anxiety, depression and loss of drive are particularly common. Around 30 percent of those affected by fibromyalgia suffer from real depression. Others also develop an anxiety disorder in addition to fibromyalgia.
Hypersensitivity and regulatory disorders: People with fibromyalgia are often particularly sensitive to stimuli such as odours, noise or light. Further fibromyalgia symptoms occur as a result of the disturbed body regulation. Such vegetative symptoms include increased tremor, excessive sweating (hyperhidrosis), reduced salivation and cold fingers. Irritable bowel syndrome with cramps and diarrhoea is also common in people with fibromyalgia symptoms.
Patients suffering from fibromyalgia are particularly sensitive at certain points on the body. These painful pressure points (tender points) are usually found at the transition from muscles to tendons.
Severities of fibromyalgia
How strong and varied the fibromyalgia symptoms are in a patient varies greatly. This is why doctors also divide the disease into different degrees of severity.
Affected persons with milder forms have little or no other physical and psychological complaints apart from pain in various parts of the body. They often experience longer symptom-free intervals and their quality of life at work and in their leisure time is hardly affected.
Others have other physical and psychological fibromyalgia symptoms in addition to chronic pain. They are moderately or even significantly impaired in their everyday life.
Fibromyalgia – Therapy
The triggers and disease mechanisms of fibromyalgia are only rudimentarily known. Fibromyalgia therapy therefore does not aim to cure the disease, but to improve the symptoms.
But this is difficult in many cases. Therefore, the main concern is to deal with the disease in the best possible way and to achieve the highest possible quality of life, even if the pain does not disappear.
The causes of this condition are not known, it is not possible to treat it causally with medication. In addition: Although a disturbed pain processing is suspected, the known pharmaceuticals are not satisfactory in their effectiveness. For example, many only help against the pain in the short term.
Pain reduction is definitely in the foreground of the therapy. However, patients must also learn how to deal adequately with pain. Painlessness is unfortunately not a goal! Best is an interdisciplinary holistic therapy, including cognitive behavioral therapy and psychodynamic therapy methods. This can significantly improve pain intensity, work ability and viability.
The most important component of fibromyalgia treatment is movement. Physicians recommend that patients do low to medium intensity endurance training two to three times a week.
The aim is to remain in the so-called aerobic zone, where the body does not consume more oxygen than it is currently absorbing. A good indication is that during the training you still have enough air to talk effortlessly.
Suitable sports for fibromyalgia include
In addition to cardiovascular fitness, those affected should specifically train the function of their joints and muscles, flexibility, strength and coordination. Experts recommend
- Water gymnastics (two to three times a week)
- Dry gymnastics (two to three times a week)
- Functional training (twice a week)
A heat treatment can improve the symptoms. In most patients, cold aggravates the symptoms. However, some patients are also helped by a whole body cold therapy. During this process they stay for a few minutes in a cold chamber with extremely low temperatures.
Balneotherapy with medicinal baths also has a soothing effect on many patients. Massages on the other hand are expressly not recommended for fibromyalgia treatment.
How much pain is perceived depends on the inner attitude towards the complaints. Within the framework of cognitive behavioural therapy, patients learn to reassess pain. It is then still there, but is no longer the focus of consciousness.
To this end, the therapist, in cooperation with the patient, also uncovers patterns of thought and perception that have a negative influence on the course of the disease. If they are broken through, this can change the perception of pain considerably.
Stress intensifies the symptoms of people with fibromyalgia. Therefore relaxation techniques are important elements of fibromyalgia therapy. These include autogenic training and progressive muscle relaxation according to Jacobsen. Far Eastern relaxation techniques such as Tai-Chi, Qi-Gong and Yoga can also help.
In more severe cases, drugs can be an important complementary component of fibromyalgia therapy.
Many patients with fibromyalgia develop accompanying psychological disorders such as anxiety or depression. In addition to cognitive behavioural therapy, medication can also help them.
Antidepressants act on the messenger metabolism in the brain. Through this mechanism of action, they not only reduce the depressive symptoms, but also relieve pain and fatigue and promote general well-being. Therefore they can also help patients with severe fibromyalgia who do not have depressive symptoms.
The drugs prescribed are selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants, especially those with the active ingredient amitriptyline.
Tricyclic antidepressants not only relieve muscle pain, they also improve sleep. However, such drugs should only be taken permanently if they are effective.
Another important group of drugs for fibromyalgia therapy are the so-called anticonvulsants. They were developed to treat nerve pain and epilepsy, but can also relieve pain and improve sleep as part of fibromyalgia therapy.
Pregabalin, for example, blocks certain messenger substances that are responsible for the transmission of pain. Such drugs can particularly help patients for whom severe pain is at the forefront of the disease. Possible side effects include dizziness, weight gain and edema in arms and legs.
Although pain is the main symptom of fibromyalgia, most common painkillers are not recommended for fibromyalgia therapy – they have little or no effect.
Fibromyalgia is not associated with inflammatory changes. For this reason, no anti-inflammatory painkillers such as ibuprofen, acetylsalicylic acid and paracetamol are used, nor is cortisone.
Similarly, painkillers containing opioids are usually unsuitable for fibromyalgia therapy. Most of them do not work, the exception is tramadol, which also has an antidepressant effect. This drug is also mainly prescribed to patients with pronounced pain symptoms.
Since the therapy with conventional medicine is often not sufficient, many patients turn to alternative healing methods. These include methods of traditional Chinese medicine such as acupuncture, but also osteopathy.
Other fibromyalgia patients rely on homeopathy. Depending on the nature of the symptoms, different homeopathic remedies are possible. For example, Rhus toxicodendron is said to relieve pain.
At the beginning of a fibromyalgia therapy, training can be very helpful. In this framework, patients learn to live with the disease in the best possible way. For example, people who suffer from fibromyalgia need more relaxation, sleep, but also exercise than healthy people.
Some people with fibromyalgia suffer so much from symptoms such as pain, severe fatigue or depression and anxiety that they often miss work. In extreme cases, they even have to take early retirement.
With such severe impairments and loss of performance, a rehabilitation therapy in which many approaches to fibromyalgia therapy are bundled together can be useful.
Fibromyalgia treatment should be tailored to the individual patient as far as possible. Experts have identified three patient groups for this purpose:
- Patients for whom anxiety and depression are the main symptoms
- Patients who suffer from pain in particular
- Patients who are so severely restricted by exhaustion, pain or psychological complaints that they are often absent from work or even threatened with early retirement.
It is crucial for the success of the therapy that the patient actively supports all measures. It is therefore important that patient and doctor plan the procedure together. This also includes the gradual application of the therapy options. It depends on the type of symptoms, the severity and the course of the disease.
A special diet is not yet recommended for fibromyalgia. However, many patients report that their complaints improve if they eat certain foods more often or avoid others.
Lots of fruit and vegetables: fruit and vegetables contain many antioxidants. They intercept aggressive oxygen molecules in the body, so-called free radicals. With fibromyalgia, a particularly large number of these could circulate in the body. Therefore, a plant-rich diet could have a positive effect on the course of the disease.
Little meat: meat contains a lot of arachidonic acid, which promotes inflammatory processes. People with fibromyalgia can also cover their protein needs through dairy products or vegetable protein sources such as soy and other legumes.
Luxury foods only in moderation: Alcohol, chocolate and coffee, but also nicotine increase muscular restlessness. Therefore, they should not be consumed too much. Instead, green tea is recommended, which has a strong antioxidant effect.
More information on how best to eat in fibromyalgia can be found in the article Fibromyalgia – Nutrition.
Fibromyalgia: causes and risk factors
The causes of fibromyalgia are still not fully understood. In most cases there is no clear trigger for the pain disorder. It is not an inflammatory rheumatic disease of the muscles or joints, nor is it pain due to wear and tear.
It is true that those affected feel pain in muscles and connective tissue. However, on X-rays or CT scans no pathological changes are found, even after years. Common laboratory tests, for example for rheumatism factors, remain without result.
Disturbed pain processing
The most important hypothesis regarding the causes of fibromyalgia is currently that the patients’ central nervous perception of pain is altered. The threshold of pain perception is lower than usual, so that the brain already perceives slight stimuli as pain and attaches greater importance to it.
Genetic alterations that result in increased pain sensitivity have not yet been identified, but they could be a cause of fibromyalgia. This is supported by the fact that family members of fibromyalgia patients have an eightfold increased risk of the disease.
Altered nerve fibres
Investigations by the University of Würzburg have for the first time shown a real organic finding in fibromyalgia. The researchers found that the small nerve fibres in the muscle tissue of patients with fibromyalgia were altered. Whether this applies to all patients with fibromyalgia is still open.
Psyche, stress and trauma
Since there is usually no organic explanation for the pain, those affected were long considered to be imaginary sick people. Or it was wrongly assumed that their symptoms were a purely psychosomatic expression of depression.
This hypothesis has now been refuted, even though the psyche may well play a central role in the development of the disease. Stress and physical or emotional injuries (traumas) can promote the development of fibromyalgia. It often occurs in phases of great stress. People who were abused or sexually abused in childhood or as adults are also more likely to suffer from fibromyalgia.
In addition, the high level of stress associated with a severe course of disease can actually promote anxiety and depression.
An unfavourable lifestyle can also promote the disease. These include smoking, overweight and low physical activity.
Middle age, female sex
Fibromyalgia can occur at any age. However, it occurs most frequently between the ages of 20 and 50. 80 percent of those affected are female.
In some cases fibromyalgia seems to develop in the course of another disease. In contrast to primary fibromyalgia, where no other diseases are possible causes, this is called secondary fibromyalgia. Among the diseases that promote fibromyalgia are
- rheumatic illnesses
- Infectious diseases, mostly viral infections with the Epstein-Barr virus, hepatitis viruses and HI viruses
- certain tumour diseases
- Disorders of the hormonal balance
Fibromyalgia: examinations and diagnosis
If a fibromyalgia syndrome is suspected, the family doctor is the first point of contact. If necessary, he treats the illness in cooperation with specialist colleagues, specialised pain therapists, neurologists, psychotherapists and physiotherapists.
It often takes a long time before a diagnosis of fibromyalgia is made, as the clinical picture is very varied and difficult to grasp. Those affected often wander from doctor to doctor for years. They suffer from the fact that their complaints cannot be attributed to any diagnosis. This creates uncertainty, also delays treatment and thus worsens the prognosis.
Medical history interview
The basis of the medical examination is the interview. This allows the complaints to be determined and classified more precisely. Typical questions from the doctor are:
- How does your pain feel?
- Where exactly is the pain?
- Are you familiar with any rheumatic diseases?
- Is your everyday life affected by the complaints?
- Do you suffer from insomnia?
- Do you have gastrointestinal problems?
- Is your mood impaired?
Fibromyalgia is a so-called exclusion diagnosis. This means that all other possible diseases must first be excluded before a fibromyalgia diagnosis can be made.
Cornerstones of diagnosis
For the diagnosis, the pain must have been present in different parts of the body for at least three months. For this purpose, the doctors also evaluate various pain scales and questionnaires.
Furthermore, the so-called Tender Points play a central role in the clarification. These are certain pressure points at which pain can typically be triggered in patients with fibromyalgia. If the patient reacts to pressure with pain at eleven of 18 points, this is an indication of fibromyalgia syndrome. Conversely, there are also pressure points that should not be painful during the test.
Pain diary as a diagnostic aid
The doctor will ask the patient to keep a pain diary in which he will record the type, duration and location of pain as well as any accompanying abnormalities. These include gastrointestinal complaints and problems with urination.
Psychological stress such as concentration or sleep disorders and lack of drive should also be recorded and discussed. Such accompanying symptoms are typical of fibromyalgia syndrome.
On the Internet you can find various online questionnaires for the fibromyalgia self-test. However, they are not very meaningful, as the diagnosis is very difficult and requires a lot of experience. In addition, the tests sometimes only include individual symptom areas, such as pain.
Caution: Danger of confusion!
The complaints suffered by fibromyalgia patients also occur with other diseases. These include:
- Rheumatoid Arthritis (RA)
- Systemic lupus erythmatosus (SLE)
- Ankylosing spondylitis (AS)
- Polymyalgia rheumatica (PMR)
- Hyperthyroidism and other hormonal diseases
- Muscle inflammation
- Neurological diseases of the central or peripheral nervous system
In order to exclude or uncover them as the cause of the complaints, the doctor carries out a series of examinations. This includes
- X-ray, CT or MRI
- Blood test, among other things for the so-called rheumatism factors
If no pathological changes are detected during these examinations, this indicates fibromyalgia.
Psychologically induced pain disorders
There is also a risk of confusion with “persistent somatoform pain disorder” and “chronic pain disorder with psychological and somatic factors”. With these, the pain is caused by strong psychological stress – which does not mean that they are mere imagination. This is not the case with fibromyalgia, although psychological stress can worsen the symptoms.
Fibromyalgia: course of the disease and prognosis
Fibromyalgia is not yet curable. However, it does not cause permanent damage to muscles and joints, so that patients are neither threatened with disability nor have their life expectancy shortened.
The aim of the therapy is to reduce the symptoms as much as possible. The treatment is not always easy, but there are numerous methods of modern pain therapy available. Close cooperation between patient and doctor is necessary for success.
If the symptoms cannot be sufficiently alleviated, the level of suffering is high. The consequences are frequent sick leaves. Some patients, in their need, consider applying for recognition as severely disabled or even retirement due to their fibromyalgia.
However, it is difficult to get a pension actually granted, as the severe symptoms can hardly be proven by hard evidence so far. Those affected should contact self-help groups and fibromyalgia organisations on this matter.
It is important to get the complaints under control as quickly as possible. An early start of therapy within two years of the onset of symptoms relieves up to 50 percent of those affected of most of their pain. Beyond the age of 60, the symptoms of fibromyalgia syndrome often improve on their own.