Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain and spinal cord process painful and nonpainful signals. (1)
What are the main symptoms of fibromyalgia?
The primary symptoms of fibromyalgia include: (2)
- Widespread pain. The pain associated with fibromyalgia often is described as a constant dull ache that has lasted for at least three months. To be considered widespread, the pain must occur on both sides of your body and above and below your waist.
- Fatigue. Fibromyalgia often causes extreme fatigue that doesn’t get better with sleep. You may awaken tired even after sleeping for long periods.
- Sleep problems. People with fibromyalgia often experience sleep disturbances, including waking up frequently during the night and having trouble falling into deep sleep.
- Cognitive difficulties (“fibro fog”). A symptom commonly called “brain fog” impairs the ability to focus and pay attention on mental tasks.
- Other problems. Many people who have fibromyalgia also experience tension headaches, depression and anxiety. Issues with pain or other symptoms also can interfere with daily activities.
What does the pain from fibromyalgia feel like?
People with fibromyalgia typically describe their body pain as:
- Aching all over
- Burning
- Stabbing
- Shooting
- Throbbing
- Radiating
- Tender
The intensity of the pain varies from person to person. Some people experience minor discomfort, while others have debilitating pain. The pain comes and goes in episodes often related to stress or overexertion.
Where does the pain occur?
Fibromyalgia pain can occur in specific “tender points” throughout the body. These include:
- Back of the head
- Between shoulder blades
- Top of shoulders
- Front sides of neck
- Upper chest
- Outer elbows
- Upper hips
- Sides of hips
- Inner knees
In addition to tender points, fibromyalgia pain often affects the muscles and joints, such as:
- Lower back
- Hips
- Shoulders
- Neck
- Arms
- Legs
- Feet
- Hands
How does the pain from fibromyalgia feel compared to arthritis?
There are some similarities and differences between fibromyalgia pain and arthritis pain:
| Fibromyalgia Pain | Arthritis Pain |
|---|---|
| Widespread | Localized to joints |
| Constant dull ache | Sharp, stabbing, throbbing |
| Whole muscles ache | Pain directly over joints |
| Migrating pain | Consistent location |
| Sensitive skin | Unaffected skin |
| Alleviated by massage | Worsened by touch |
| Non-deforming | Can cause joint deformities |
What causes the pain and tenderness?
Researchers don’t know exactly what causes the increased pain sensitivity associated with fibromyalgia. Possible explanations include:
- Abnormal pain signal processing. People with fibromyalgia appear to have differences in the way their central nervous system processes pain signals. Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This leads to an increase in pain sensitivity that persists even after the original injury or illness resolves.
- Chemical imbalances. People with fibromyalgia seem to have altered levels of certain brain chemicals that help transmit and modulate pain signals. This includes neurotransmitters like serotonin, norepinephrine and dopamine.
- Sleep disturbances. The relationship between fibromyalgia and sleep problems goes both ways. Not getting restful sleep can intensify fibromyalgia pain. And the chronic pain of fibromyalgia makes it difficult to sleep well.
- Stress. Most people with fibromyalgia report that stress, anxiety, depression, viral illnesses and trauma tend to aggravate symptoms.
- Genetics. Because fibromyalgia often runs in families, researchers believe certain genetic mutations may play a role in causing fibromyalgia.
Other contributing factors
Researchers have identified various other factors that may contribute to causing fibromyalgia, including:
- Injuries
- Rheumatic diseases, such as rheumatoid arthritis or lupus
- Viral or bacterial infections
- Obesity
- Metabolic syndrome
- Endocrine disorders
- Certain neurological conditions
How does the fatigue of fibromyalgia feel?
The fatigue and tiredness caused by fibromyalgia is different from normal fatigue in several ways:
- You feel exhausted even after a full night’s sleep.
- The fatigue is widespread, not isolated to one body part.
- You have no energy and feel drained.
- Mental fogginess and impaired concentration accompany the tiredness.
- The exhaustion worsens with exertion but is not relieved by rest.
The intensity of the fatigue waxes and wanes from day to day. Some days you may feel so worn out that even simple chores like making the bed or washing dishes seem impossible. Other days you may just feel somewhat more tired than usual.
What causes the fatigue?
Researchers think several factors contribute to the extreme fatigue and lack of energy associated with fibromyalgia:
- Nonrestorative sleep. Fibromyalgia interferes with going into the deep, restorative stages of sleep.
- Chronic pain. Dealing with constant widespread aching drains your energy reserves.
- Anemia. Fibromyalgia sometimes causes iron deficiency anemia, leaving you tired and weak.
- Poor circulation. Reduced blood flow to the muscles can result in oxygen deprivation and excessive fatigue.
- Medications. Certain drugs prescribed to treat fibromyalgia symptoms, like muscle relaxants and antidepressants, can cause drowsiness.
- Depression. Approximately 30% of people with fibromyalgia suffer from major depression, which is marked by chronic fatigue.
How does “brain fog” feel with fibromyalgia?
One of the most common cognitive complaints among people with fibromyalgia is reduced mental clarity, often described as “brain fog.” It involves problems with:
- Concentration
- Memory
- Distractibility
- Multitasking
- Word-finding
- Processing speed
This fibromyalgia-related “brain fog” can make you feel like your thinking is clouded or muddled. You may experience mental confusion, forgetfulness, difficulty absorbing new information, and frequent pauses when speaking as you search for the right word.
What causes “fibro fog”?
Researchers aren’t certain what causes fibromyalgia brain fog, but possible explanations include:
- Sleep deprivation. Nonrestorative sleep can hamper memory and cognitive functioning.
- Neurotransmitter imbalances. Altered levels of certain brain chemicals may impair mental processes.
- Poor blood flow. Decreased circulation to the brain can cause cognitive problems.
- Hormonal fluctuations. Changes in hormones like cortisol, estrogen and thyroid hormones affect cognition.
- Medications. Fibromyalgia drugs like muscle relaxants and anti-seizure drugs can cause mental fuzziness.
- Nutrient deficiencies. Low levels of vitamins B12, vitamin D and magnesium are linked to brain fog.
- Depression and anxiety.Fibromyalgia is associated with mood disorders that cloud thinking.
How does fibromyalgia affect your emotional health?
In addition to physical symptoms, fibromyalgia takes an emotional toll in several ways:
- Frustration. Fibromyalgia is unpredictable, and you may feel frustrated by frequent flares, constant pain and being unable to do activities you previously enjoyed.
- Anger. You may feel angry that you have to deal with this mysterious condition without a clear cause or cure.
- Fear. Worrying about how much pain the next flare-up will bring or what disability lies ahead is common with fibromyalgia.
- Depression. About 30% of people with fibromyalgia experience major depression, while the rate of anxiety exceeds 60%.
- Stress. Trying to cope with unrelenting pain is highly stressful. Stress exacerbates fibromyalgia symptoms.
- Isolation. Debilitating pain and fatigue may curtail social activities, leading to feelings of loneliness.
Emotional distress doesn’t cause fibromyalgia, but it can worsen the physical pain. And conversely, constant pain can lead to depression, anxiety and stress.
What helps relieve fibromyalgia pain?
While there is no cure for fibromyalgia, certain self-care strategies and medical treatments can help ease symptoms. Things that may help reduce fibromyalgia pain include:
- Low-impact aerobic exercise such as walking, cycling or water aerobics
- Muscle relaxants like cyclobenzaprine (Flexeril)
- Over-the-counter analgesics such as acetaminophen (Tylenol) or ibuprofen (Advil)
- Antidepressants, particularly duloxetine (Cymbalta) and milnacipran (Savella)
- Anti-seizure drugs such as pregabalin (Lyrica) and gabapentin (Neurontin)
- Massage therapy and myofascial release techniques
- Heat or cold therapy for sore muscles and joints
- Relaxation practices like meditation, deep breathing and guided imagery
- Cognitive behavioral therapy (CBT) to develop coping skills
A balanced treatment approach that combines medications, exercise, stress reduction, pain management, and professional counseling generally works best for fibromyalgia.
Conclusion
Fibromyalgia is characterized by chronic widespread pain, profound fatigue, sleep disturbances, and cognitive difficulties. The pain typically feels like an intense dull ache affecting both sides of the body and can alternate between periods of flares and remission.
In addition to constant body aches, people with fibromyalgia struggle with exhaustion, nonrestorative sleep, mood disorders, and “fibro fog” mental cloudiness. Living with constant pain and disability puts great emotional strain on people with fibromyalgia and their loved ones.
While fibromyalgia is not fully understood, researchers believe it involves atypical sensory processing and pain signaling in the central nervous system. A variety of medications, lifestyle adjustments, and stress-reduction techniques can help relieve symptoms and improve quality of life.