Some Health Resolutions you CAN stick to in 2024

Fibromyalgia (FM) is a complex condition estimated to affect 2–8% of the population with a range of symptoms including widespread pain, fatigue, brain fog, poor sleep, headaches, lower abdominal pain or cramps, and depression.

Because it has such a wide range of symptoms GPs struggle to diagnose it as their focus is to identify a problem and ‘fix’ it with appropriate treatment. If your finger suddenly hurts and you look down and see it caught in a mousetrap, you know what happened, why you are in pain and what you can do about it. The problem with FM is that your foot can start hurting for no apparent reason, and then your back hurts, then your shoulders, and all with pain that is excruciating one moment and disappears the next day. If you have FM this probably sounds familiar and if you don’t you hopefully understand how difficult it can be to diagnose and treat.

To add to the confusion the symptoms often begin after an event, such as physical trauma, surgery, infection, or significant psychological stress or gradually accumulate over time with no single triggering event and women are more likely to develop FM than men. 

The lack of clear, distinct symptoms, usually combined with many negative medical test results, meant GPs regularly dismissed FM as a psychological problem that was just in your head. Things have moved on since those days and there is scientific evidence indicating that FM is caused by repeated nerve stimulation. This leads to the pain receptors in the brain and spinal cord becoming more sensitive to pain and overreacting to painful and nonpainful signals. 

Many factors can lead to these changes in pain sensitivity, including: 

Genetics. 

Because FM tends to run in families, there may be certain genetic mutations that make you more susceptible to developing the disorder.

Infections.

Some illnesses appear to trigger or aggravate FM.

Physical or emotional events.

FM can be triggered by a physical trauma, such as a car accident or prolonged psychological stress.

Your sex.

FM is diagnosed twice as often in women than men.

Despite knowing significantly more about the development of FM there is still no easy way to diagnose the problem. When it was first recognised in 1990 it was diagnosed by poking 18 specific points on the body and if > 11 were tender it confirmed FM. As you can see this is not a very scientific diagnosis and the symptoms could be confused with other problems like rheumatoid arthritis, polymyalgia rheumatica, multiple sclerosis, Parkinson’s disease, hypothyroidism, or a vitamin D deficiency to name a few. Unfortunately, this approach is still used by many GPs in the NHS 😲

The latest diagnostic criteria came out in 2016 and the key requirements for an FM diagnosis are cognitive problems (brain fog), widespread pain, fatigue and sleep disturbance where you wake up feeling unrefreshed most days over 3 months. You can find more details on FM classification in this excellent paper.

In the meantime the NHS will keep poking your tender spots until it catches up with the latest scientific thinking.

You have confirmed Fibromyalgia, now what?

While it is a challenge confirming that you have fibromyalgia (FM) this also means there is no ‘one size fits all’ treatment approach. There are many treatment options, and they don’t all work for everyone so it usually involves some trial and error to find what works best for you. 

This link will take you to 104 treatments used for FM and rate them from most to least effective for the individual. The key thing is that treatments are rated according to what works for a particular person and while it works for them it may not have the same effect on you so always use caution and investigate the potential benefits and risks before trying something out.

Medication 

Prescription meds are a common part of the FM treatment approach and can include pregabalin or gabapentin which are antiepileptic drugs that can also treat nerve-related (neuropathic) pain. 

Antidepressants like duloxetine, citalopram, fluoxetine (Prozac), sertraline, and amitriptyline can help reduce nerve pain and improve sleep by increasing the levels of the neurotransmitter serotonin. Don’t worry if you are prescribed these meds as the dose will be much lower than what would be used to treat depression. 

Opioids like Tramadol and codeine are commonly prescribed for treating FM but their effectiveness is variable. They do work for some people and not others so it can be worth giving them a try to see if they work for you. 

Naltrexone is typically used to treat alcohol and opioid dependence but at low doses, it has been found to provide pain relief for FM. You can find out more about low-dose naltrexone (LDN) here. 

Exercise and Physical Therapy 

Exercise is the most recommended treatment for FM and studies, have shown it to be consistently effective. It improves fitness, sleep, and quality of life and may reduce pain and fatigue with the added benefit that it does not cause any serious adverse effects The key thing is that it has to be moderate and stay within your limits as pushing yourself too hard can make your symptoms worse. It may not be obvious what your limits are, but it’s really important to increase the length and intensity of your exercise extremely slowly.

Common types of exercise for FM include: 

  • Warm-water exercise Yoga
  • Tai chi
  • Pilates
  • Walking

Before starting any form of exercise the key things to think about include:

  • Pushing yourself to get moving, but don’t push too hard
  • Expect some setbacks and you’ll need to experiment to find your current level of tolerance to exercise.
  • Take days off when you need them, but don’t give up! The payoff could be less pain, more energy, and a better quality of life so keep going but listen to your body.
Stress Management and Mental Health Therapy

Stress is believed to be a major trigger of FM symptoms, so stress management is important. Consulting a psychotherapist or other mental health practitioner can be useful to help minimise the impact of stress on your symptoms.

Stress management and exercise can be combined by practicing something like yoga or tai chi. and meditation/ mindfulness can also help.

If you have depression, which is common in people with fibromyalgia, you may want to try cognitive behavioral therapy (CBT) which can help you cope better with the realities and limitations of a chronic illness.

Cannabis and CBD

Medical marijuana and cannabidiol (CBD) products have gained popularity as FM treatments due to their effect on the endocannabinoid system. This system plays important roles in many functions that are impaired by FM, including things like pain processing, temperature regulation, stress response, energy metabolism, and sleep.

More research is needed but CBD, and other cannabis-based medications are looking like promising FM treatments.

Supplements

Many people with FM use supplements to help manage their symptoms and these include:

  • Magnesium
  • Coenzyme Q10 (CoQ10)
  • Chlorella green algae
  • Acetyl-l-carnitine
  • Vitamins C and E

Early research suggests a vegetarian or vegan diet may help ease FM symptoms and a low-FODMAP (low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet may, also be effective.

Manual Therapy

Manual therapies like osteopathy (😉), massage therapy, and physiotherapy have been shown to help reduce FM symptoms Acupuncture & electroacupuncture have been shown to improve overall well-being and enhance the benefits of exercise and medication in reducing pain and stiffness. You’ll need to find a therapist who has a good understanding of FM so that they can adapt their techniques to provide maximum benefit without increasing your symptoms. Electrical Neuromodulation Electrical neuromodulation is a treatment approach that you may not have heard of but it has been effective in the treatment of FM. Transcutaneous electrical nerve stimulation (TENS) and transcranial direct current stimulation (tDCS), help reduce pain and depression and improve functioning.

While TENS machines are cheap and easily available for home use I can’t say the same for tDCS. The NHS recommends it for the treatment of depression but I can’t find it recommended for the treatment of FM so you will need to do your own research on this one. You could try asking your GP but don’t be surprised if they give you a puzzled look.

Fibromyalgia is complicated, isn’t it?

As you can tell from all of the above if you have Fibromyalgia (FM) managing your symptoms can become a full-time job. Probably the most important thing to understand is what triggers your FM flare-ups and to do your best to avoid them.

Things you need to consider are:

  • Avoid or manage your stress
  • Get plenty of rest.
  • Stay active without overdoing it.
  • Work out what the best treatments are for you and stick to them.
  • Watch for signs of a flare and take action to minimise it.

Because there are so many options finding the right treatments for you will take time and experimentation. You should expect setbacks as you try things that don’t work or cause negative side effects but don’t give up as you will find other things that will help.. When you find a treatment or management tool that works even if it only improves your symptoms a small amount stick with it. You are more likely to find 10 treatments that each reduce your symptoms by 5% rather than one treatment that reduces them by 50%.

This trial-and-error process can be overwhelming at first. But eventually, spotting and avoiding triggers and staying on track with treatments will become second nature.

If you need support with any of the above, give me a call on 01604 532853 or drop me an email bob@painfreeliving.co.uk

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