Fibromyalgia Syndrome

What is Fibromyalgia Syndrome (FMS)?

Fibromyalgia Syndrome (FMS) is a collection of symptoms characterised by widespread pain in the body. The pathology of FMS is not well known, but we do know it is not related to ongoing tissue damage (Clauw, 2014). Instead it’s thought to be connected to an overactive central nervous system that amplifies sensory input from the body and causes pain to present in unusual ways (Clauw, 2014; Gracely & Schweinhardt, 2015).

For example, painful stimuli may produce a stronger pain sensation than it normally would. The term for this is hyperalgesia. In contrast something that shouldn’t be painful, such as light touch, might cause a pain sensation. This is called allodynia. Pain might also be persistent, occur at rest, or be present even in the absence of obvious stimuli. Sensitivity to sensory information like noise, lights and smells can also occur (Clauw, 2014).

This amplification of signals is due to a process called central sensitisation. It’s caused by adaptations to the neurochemistry and function of nerves within the central nervous system. This video on the Pain Management Network website explains it more: https://www.aci.health.nsw.gov.au/chronic-pain/for-everyone/introduction-to-pain

What causes FMS?

FMS is an idiopathic condition. This means that the cause of FMS is unknown. To date we are unable to link any common event or disease process to its onset. Instead it’s thought the cause is different in everyone who develops FMS.

It is suggested that an interaction of genetics and other factors could be linked to the onset of FMS. These other factors include infection, injury, trauma, chronic stress and exhaustion. It’s thought this interaction might disrupt the regular functioning of the body (Clauw, 2014; Dror & Cheung, 2011; Gracely & Schweinhardt, 2015). Research also shows infections and injuries cause central sensitisation in their early phase (Burgess et al, 2002; Vera-Portocarrero, 2006; Watkins et al, 1994; Wei, Guo, Zou, Ren, & Dubner, 2008). This is why the skin over a newly sprained ankle is tender to touch, and why the flu causes the body to ache all over.

Central sensitisation is a normal response to new injuries and infections. When we first injure ourselves the pain we feel helps promote the healing process. It increases our awareness of the injury and encourages us to adopt healing behaviours. Once the injury or infection has resolved the nervous system then returns to its normal state.

The big question is why this process doesn’t happen for everyone? It could be due to the interaction of genetic factors. It could also be linked to the degree of adaptation within the nervous system before healing. Or it may be due to unknown factors. Whatever its cause, once pain becomes persistent it no longer accurately represents the state of the tissues in the body. It also means that pain can be present even when no tissue damage is occurring.

It’s at this stage pain management strategies used in the acute phase become ineffective and the pain becomes chronic in nature.

How is FMS Diagnosed?

FMS is a syndrome. It is diagnosed based on the presence of particular symptoms occurring in combination. Widespread pain that can’t be explained is the most defining feature (Clauw, 2014). There are no specific scans, blood tests or investigations that determine the diagnosis. A doctor or rheumatologist familiar with the condition can make a diagnosis by taking into account the presence of specific symptoms. At the same time they rule out other conditions that could be causing the pain.

What are the signs and symptoms of FMS?

The main symptom of FMS is the presence of widespread pain. Other symptoms include stiffness, sleep disturbance, fatigue, poor concentration and mood disturbances (Clauw, 2014; Petersel, Dror & Cheung, 2011). We know these symptoms can occur with other conditions, which is why it’s important to see a doctor or rheumatologist experienced in FMS.

How is FMS managed?

The variability in causes and pathology of FMS means there’s no quick fix, and not all treatment techniques will work for everyone. Despite this, the pain associated with FMS is able to be well managed in order to maintain or improve daily function. Treatment also helps with a patient’s ability to cope with the pain they are experiencing.

Treatment requires a holistic approach specific to a patient’s presentation. It’s important to identify specific factors that could be contributing to pain and flare-ups. These factors include overdoing activities, poor posture, disturbed sleep and stress. It’s also important to identify factors that promote pain relief, as well as prevent flare-ups. Treatment should also include strategies that encourage good health and well-being. This is what we refer to as ‘seeing the big picture’.

Self-management strategies are vital in achieving the best possible pain management outcome (Clauw, 2014). These strategies include:

Exercise: Exercise improves general health and fitness. It also helps improve physical conditioning. In turn this will help you tolerate more activities, manage stress and sleep better. It is important you find the right type of exercise. Some people benefit from a gentle form of exercise. This includes yoga, Pilates, Tai Chi, hydrotherapy and stretches. Others benefit from cardiovascular exercise like walking, cycling and swimming.

Pacing techniques: These techniques allow you to continue or increase your activity levels, while simultaneously reducing flare-ups.

Adopting good posture, ergonomics and manual handling: These reduce the effort on your body to perform tasks and activities. They also help decrease pain flare-ups.

Sleep hygiene: This helps improve sleep.  Poor sleep is known to be a contributing factor to increased pain.

Stress management and relaxation: Muscle tension and elevated stress hormones in the body can also increase pain.

TENS (Trans Electrical Nerve Stimulation): This helps provide temporary pain relief.

Heat Packs: These provide temporary relief from pain and stiffness.

Manual therapy can also provide pain relief during flare-ups. Techniques include massage, trigger point therapy, dry needling and acupuncture. Manual therapy is most effective when used in conjunction with the above techniques.

Medication may be a treatment option that is considered. It is important to remember that pain medication only offers temporary relief. It is not a magic cure. Medication shouldn’t be considered the ‘knight-in-shining-armour’ for FMS treatment. It is most likely to be effective when combined with the self-management strategies above.

Medication is either prescribed on a regular, long-term basis or when needed to reduce a pain flare-up. How medication is used is largely dependent on the severity and frequency of the pain. Another factor taken into consideration is how well the person tolerates pain medication. The effectiveness of the medication and the person’s ability to cope with pain are also important factors to consider.

While medication can be beneficial in the management of pain it can also produce side effects. This is why it’s important to speak with your doctor. They will help you understand the risk and benefits of all treatment options.

What is the prognosis of FMS?

FMS is not a progressive condition (Clauw, 2014). Pain associated with FMS is managed using a combination of pain management techniques. The success of each technique varies between people. It is also based on underlying factors and how well techniques are implemented. Techniques need to be practiced and used regularly to have the best effect.

Here at Physiotas our physiotherapists can help identify factors that may be contributing to your pain and flare-ups. They can also recommend the best course of treatment for you. It is important to remember you may need to try many different self-management strategies. It is also important to know what each strategy is trying to achieve. Our physiotherapists will work closely with you to help you move better and feel better.

Please feel free to contact us at any of clinics to discuss how we can help you start managing your symptoms today.

References:

  1. Burgess, S.E., Gardell, L.R., Ossipov, M.H., Malan, T.P., Vanderah, T.W., Lal, J., & Porreca, F. (2002). Time-dependent descending facilitation from the rostral ventromedial medulla maintains, but does not initiate, neuropathic pain. Journal of Neuroscience, 22(12), 5129-5136.
  2. Clauw, D.J. (2014). Fibromyalgia: A clinical review. Journal of the American Medical Association, 311(15), 1547-1555.
  3. Gracely, R., & Schweinhardt, P. (2015). Key mechanisms mediating fibromyalgia. Clinical and Experimental Rheumatology, 3 (Suppl. 88), S3-S6.
  4. Petersel, D.L., Dror, V., & Cheung, R. (2011). Central amplification and fibromyalgia: Disorder of pain processing. Journal of Neuroscience Research, 89, 29-34.
  5. Vera-Portocarrero, L.P., Yie, J.X., Kowal, J., Ossipov, M.H., King, T., Porecca, F. (2006). Descending facilitation from the rostral ventromedial medulla maintains visceral pain in rats with experimental pancreatitis. Gastroenterology, 130, 2155—164.
  6. Watkins, L.R., Wiertelak, E.P., Goehler, L.E., Mooney-Helberger, K., Martinez, J., Furness, L., Smith, K.P., Maier, S.F. (1994). Neurocircuitry of illness-induced hyperalgesia. Brain Research, 639(2), 283–299.
  7. Wei, F., Guo, W., Zou, S., Ren, K., & Dubner, R. (2008). Supraspinal glial–neuronal interactions contribute to descending pain facilitation. The Journal of Neuroscience, 28(42), 10482-10495.

About the Author:

Megan Clark is a Physiotherapist at Physiotas.

Megan completed her Bachelor of Physiotherapy with honours in 2005 and has been working in musculoskeletal physiotherapy ever since. She has a keen interest in the field of Pain Management (acute and chronic) which she developed whilst working as a physiotherapist in the United Kingdom in an occupational pain management rehabilitation setting. Megan is currently completing her Masters in Pain Management at Sydney University and she contributes to various multidisciplinary pain management programs. Her other main professional interests include occupational rehabilitation and Clinical Pilates.