Fibromyalgia is a is disorder that manifests as widespread pain in association with an increased sensitivity to touch, severe fatigue, sleep disturbance and mood problems. Headaches, irritable bowel and irritable bladder are common features.
The pain of fibromyalgia is generally described as a constant dull ache and usually involves both sides of the body, but one side can be affected more than the other. The sleep disturbance can manifest in many ways including non-refreshing sleep, sleep disrupted by pain, difficulty falling asleep or restless legs. Difficulty concentrating on tasks and remembering things are recognised symptom and often labelled as ‘brain fog’ and this can be made worse with the sleep disturbance. Anxiety and depression are a common part of the disorder.
It is thought that the brain is amplifying the pathways by which you process pain. It often occurs secondary to other rheumatological problems that can cause pain (such rheumatoid arthritis, or SLE), and the pain persists when the inflammatory component of those disorders is treated. In others, it can be secondary to surgery, trauma, infection or stress. It is much more common in women, so female hormones are thought to play an important role. Sudden changes in hormones around menopause can be a trigger. It also runs in families, so genetics may play a part.
There is no test to diagnose fibromyalgia, but the diagnosis is made based on symptoms, typical examination findings, and by excluding all the conditions that can cause these symptoms.
Treatments for fibromyalgia include pain modulating medications that work on the brain (e.g. amitriptyline, nortriptyline, gabapentin, pregabalin, duloxetine, venlafaxine, etc.). Another novel pharmaceutical options which is sometimes considered is low dose naltrexone (LDN).
Stress and sleep management techniques, and regular cardiovascular exercise are equally important in managing symptoms.