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What is fibromyalgia and how do you treat the pain?

What you can do now:

Not all doctors believe fibromyalgia is real, but to those who suffer from it, there can be no doubt. It can have several causes, but the effects are similar: all-over muscle pain and tenderness, fatigue, trouble sleeping, and often depression and irritable bowel. It's often not hard to treat.

Fibromyalgia exemplifies many of my beliefs about treating pain. It is common, compelling, and sometimes disabling. Fibromyalgia is customarily believed to be extremely difficult to treat, but I don't believe that, just as I don't accept that chronic pain in general is inherently treatment resistant.

What is fibromyalgia?

Fibromyalgia is a surprisingly common, occuring in about 3% of women and 1.5% of men. The incidence increases with age, so it is more prevalent in older adults than younger ones. It is a syndrome, or collection of symptoms that last for weeks, months, or years:

You're not sick, you're miserable

Fibromyalgia isn't a disease, it's a syndrome. By this I mean there is no associated pathology or visible abnormality in the structure or tissues of the body. A disease is defined by its pathology. No pathology—no visible abnormality—means no disease. People who have fibromyalgia live just as long as those without.

In English, this means if you have fibromyalgia, you're not sick in the conventional sense of having a disease. You're miserable. This is an important distinction and has implications for treatment. The fundamental lesson is you won't hurt yourself by trying out different active treatments, unless you have another serious illness that limits your activity.

"Fibromyalgia" may actually be more than one illness

Fibromyalgia usually begins in one of three different ways. The most common onset is following trauma, typically an automobile accident or injury at work. Though a single injury can do it, usually that's not enough. Many of my patients had one or two injuries from which they recovered fully, but the third one was just too much.

Often the injury that precipitates fibromyalgia is shocking but not serious: you fall flat on your face and it knocks the wind out of you. Or you're rear-ended at high speed by another driver, but the emergency room looks you over and sends you home. You feel okay at first, but gradually a slight pain becomes worse and spreads to different areas of your body. (This is particularly apt to occur if you become very upset following the injury, or if you rest excessively.)

One variation on the "starts after an injury" scenario is that you have mild aching following an accident but are basically doing well. Then you change jobs from one where you're up and moving about all day to a desk or computer job where you never move. The lack of exercise precipitates an extreme worsening of pain.

The second common scenario is you develop a viral illness that lingers for weeks, or become ill with pneumonia or rheumatoid arthritis. You may spend a month or more in bed. Some patients with this onset also develop debilitating fatigue, which may become more of a problem than the pain itself.

The third common way fibromyalgia begins is it comes out of nowhere. You just begin to hurt. The majority of people with this pattern have severe emotional distress that they're simply not dealing with.

On occasion, fibromyalgia is secondary to another illness such as rheumatoid arthritis or inflammatory bowel disease. Also, certain illnesses can mimic fibromyalgia, including obstructive sleep apnea, polymyalgia rheumatica, and thyroid disease. Older patients should be evaluated for certain kinds of cancer. Be sure you've been thoroughly evaluated at least once by a competent physician.

Once it's established, fibromyalgia may be a different process in different patients. In some, emotional distress predominates. Others function relatively normally but are in severe pain. A third group is mostly severely fatigued and complains of "brain fog": poor memory and difficulty concentrating.

The longer I treat patients with fibromyalgia, the more convinced I become that emotional distress plays a predominant role in most patients. Look over the topics on emotional healing to learn more.

How to treat fibromyalgia

Treating fibromyalgia requires doing several things at once: ensuring you have the right diagnosis, avoiding the wrong medications, and taking the right medications. Learn effective coping skills to turn off the pain. Here are these principles in a little more detail:


Last updated Fri, Jun 19, 2015

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©2011, James Gagné, MD