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What is Fibromyalgia?

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Everyone experiences tender points around the body from time to time, usually as the result of a minor injury, but in fibromyalgia persistent pain is felt at specific places around the body.

What are the symptoms?

Widespread muscle pain and fatigue plague those with fibromyalgia. People affected describe the pain as throbbing, aching, stabbing or shooting in nature. They will often say they ‘ache all over’. It’s often associated with stiffness, which, like the pain, may be worse first thing in the morning.

Those with the condition may become hypersensitive to pain, finding that even the slightest touch is painful, and that pain lasts longer than would be expected.

Triggers can aggravate the pain and there are many. Common ones include stress, fatigue, changes in the weather and even physical activity.

The tender points that are characteristic of fibromyalgia affect specific parts of the body – the elbows, around the neck, the front of the knees and the hip joints, for example. These are painful in response to the slightest pressure.

In addition to these characteristic symptoms, some people also experience other symptoms including such as difficulty sleeping, headaches, numbness, tingling and depression.

Another problem that those with fibromyalgia may experience is ‘fibro-fog’ which can cause difficulty making decisions, understanding things, and problems with memory and concentration.

Fibromyalgia

Fibromyalgia

Fibromyalgia differs from arthritis because it doesn’t cause inflammation or result in damage to the joints or muscles. Most people with fibromyalgia find their symptoms tend to come and go over time, although for some the symptoms are constant.

What causes it?

There’s no known precise reason for why fibromyalgia occurs, but a number of theories exist. The most popular is that it may result from a problem with the transmission of pain messages to and from the brain such that the brain becomes more sensitive to pain. Most researchers believe those who develop fibromyalgia react to pain differently from those without the condition. This may be because of genetic predisposition to fibromyalgia, or it may be a result of environment.

There is evidence that those with fibromyalgia have lower levels of the chemicals serotonin, noradrenaline, and dopamine so this may be responsible. Some scientists believe that disturbed sleep may result in the development of fibromyalgia.


Many people relate the onset of their problem to a significant life event, such as a bereavement or illness. Some experts have suggested that a virus, as yet unidentified, may be the trigger in susceptible individuals.

Who’s affected?

Around one in 50 people develops fibromyalgia at some point in their lives, most often during middle age. The majority of those affected are women, although men and children can be affected.

Those with other chronic medical conditions, such as rheumatoid arthritis or lupus, are more likely to develop fibromyalgia.

How is it diagnosed?

Making a diagnosis of fibromyalgia isn’t easy, because tiredness, fatigue, poor sleep and muscle pain are symptoms common to many conditions. These need to be ruled out before a positive diagnosis can be made.

But there are criteria that need to be fulfilled if a diagnosis of fibromyalgia is to be confirmed. Widespread pain, meaning that it must be felt above and below the waist and on the right and left side of the body, should have been present for more than three months, and tenderness or pain should be felt in at least 11 of the 18 specified tender points when pressure is applied.

What’s the treatment?

Although there’s no cure and no specific treatment for fibromyalgia, there are plenty of things that can help. It’s important to remember that it doesn’t damage the muscles or other parts of the body and in time many people improve.

A number of different drugs may be recommended including painkillers and anti-inflammatory medication, and antidepressants to treat pain and any associated emotional and cognitive problems

Physiotherapy can help and physiotherapists can provide a programme of gentle exercise and stretching to help maintain muscle tone, reduce pain and stiffness, lift mood, and boost energy levels. Low-impact aerobic exercises are felt to be best.

Emotional support is important, as the long-term nature of this condition tends to drag people down. Depression is common in sufferers and counselling and anti-depressant therapies can be used to overcome this.

It’s important to think positively and make necessary lifestyle changes. These may include changes in the way things are done at home or at work. Occupational therapists can provide advice about what changes may be needed and how they can be made.

Some people find they benefit from complementary therapies such as relaxation therapy, massage, acupuncture and osteopathic manipulation. Stress management is essential to lessen the chances of symptoms being exacerbated. It’s also important to get enough sleep and to eat a healthy diet.

Hot flushes – How to cope with them

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Slow deep breathing may be one of the most effective ‘natural’ treatments for menopausal hot flushes.

Abdominal breathing exercises can halve the number of attacks, according to researchers investigating treatments for a condition that affects seven out of 10 women during and after the menopause.

Now, a much larger clinical trial of breathing exercises is underway as researchers look for new treatments for the condition.

Although hormone replacement therapy has been considered the most effective treatment for hot flushes, it is not suitable for all women, and reports linking it to increased risks for breast cancer, heart disease, and stroke, have led to increasing numbers women looking for alternatives, fuelling a search for new remedies.

Hot flushes, a sensation of intense heat, sweating, and flushing, which last for five to 10 minutes, are the main reason women seek medical help for the menopause, ahead of night sweats and mood and sleep disturbances.

But despite the huge number of sufferers, and the distress it can bring about, the exact cause of hot flushes is not known, although there are a large number of theories.

One suggestion is that the drop in oestrogen levels, that occurs around the menopause, affects the part of the brain involved in body temperature control. Another theory is that changes in other brain chemicals, including serotonin, are implicated.

Whatever the cause, the effects can include a rise in skin temperature in the cheeks, forehead, upper arms, chest, abdomen, back, calves, thighs and fingers, with increased blood flow in the hands, calves, and forearms. The increase in heat causes blood vessels just under the skin surface to dilate – get bigger – resulting in the classic florid cheek look associated with hot flushes.

For the 70 to 75 per cent of women who have menopausal hot flushes, some of whom experience several attacks a week for four or more years, there is a bewildering range of over-the-counter and prescription treatments available. Many have been found to be effective, but large numbers have not, and in some cases the placebo or dummy treatment has been shown to be as effective as the therapy on trial.

Dr Elena Umland, of Thomas Jefferson University, Philadelphia, who has carried out a new review of treatments, says that evidence for the effectiveness of some herbal remedies that many women take is inconsistent and inconclusive, and that the way they work is not known.

“The physical and financial burden imposed by menopause associated hot flushes is immense,” she says. “Optimum management includes lifestyle changes in all women and HRT in women with moderate-to severe symptoms. Less effective herbal remedies or non-hormonal therapies may be appropriate in certain women, such as those with mild symptoms or those who cannot or will not take HRT.”

What works, what might, and what doesn’t

Hormone therapy

Trials show it is effective. According to a report from Thomas Jefferson University, an analysis of 24 trials, which included 3,329 women, showed a 75.3 per cent drop in the frequency of hot flushes experienced each week, and an 87 per cent reduction in severity of symptoms.

Deep breathing

In new research at Indiana University, doctors are recruiting around 200 women for the biggest trial yet of slow deep breathing. It follows a number of small studies which have shown that it can be highly effective. Results from a study at Wayne State University in America, show that paced respiration – slow, deep, abdominal breathing – reduced hot flush frequency by around 50 per cent. Other exercises could work too. A study by the American College of Sports Medicine showed that strength training helped to reduce hot flushes by up to 50 per cent.

Lifestyle changes

Can be effective. “Lifestyle changes should be implemented by all women with menopause-associated hot flushes, Interventions that help regulate core body temperature include wearing lightweight cotton clothing, dressing in layers, using fans or air conditioning, consuming cool or cold foods and drinks, and avoiding hot foods and drinks,” say Thomas Jefferson University researchers.

Anti-depressants

Low doses of some antidepressants may reduce hot flushes, according to research at the US Mayo Clinic. Selective serotonin re-uptake inhibitors – SSRIs – are among those that have positive effects. “Many doctors now consider these anti-depressants the treatment of choice if you have troublesome hot flashes and can’t – or choose not to – take hormone therapy. But they aren’t as effective as hormone therapy for severe hot flashes and may cause unwanted side effects, such as nausea, dizziness, weight gain or sexual dysfunction.”

Hot flushes

Hot flushes

Gabapentin

An anti-convulsant, used for treating seizures and pain associated with shingles, has been shown to reduce symptoms, according to a Wayne State University School of Medicine report, but it is not known how. A study involving 59 women found a reduction of hot flush frequency of 45 per cent compared to 29 per cent for placebo treatment.

Clonidine

A pill or patch used to treat high blood pressure, may provide some relief, although there may be side effects including dizziness, drowsiness and dry mouth. According to a Wayne State University School of Medicine study, two small trials found that the pill reduced hot flush frequency by 46 per cent and the patch by 80 per cent.

Acupuncture

Mixed findings from research. In one study, women who were having moderate to severe hot flushes, who were given acupuncture did benefit. “Individually-tailored acupuncture treatment was associated with significantly greater decrease in the severity, but not the frequency, of hot flushes, when compared to placebo acupuncture,” say the researchers from Stanford University in America.

Yoga

A study at the University of California showed that eight weekly 90-minute sessions led to an average drop in hot flushers each week of 30.8 per cent. The researchers say bigger trials are now needed.

Soy

Some trials show it is helpful, while others have found no effect. Its use is based on the idea that soy contains compounds called isoflavones which have some small oestrogen-like effect. A study at the University of Minnesota concluded, “Consumption of 30 mg/day of soy isoflavones reduces hot flashes by up to 50 per cent.”


Vitamin E

An antioxidant, it has been extensively used for menopausal symptoms. But a Mayo Clinic report says, “Studies using vitamin E in doses up to 400 international units a day have found little benefit in relieving hot flashes. Vitamin E is no longer recommended for treating hot flashes.”

Black cohosh

It’s widely used, but some research questions its effectiveness. In a year-long clinical trial funded by the US National Institutes of Health, it was found to be no better than a placebo for relieving hot flushes. The women given black cohosh-containing supplements had the same number of daily hot flushes as women given a placebo. “While its safety record has been good, there’s no longer much reason to believe that it’s effective for menopausal symptom relief,” concludes a Mayo Clinic report.

Red Clover

“Although several small studies of red clover for menopausal symptoms had mixed results, a large study found that red clover had no beneficial effects on menopausal symptoms,” says a report from the US National Institutes of Health.

Other herbal remedies

A wide range of herbs are used for hot flushes, but researchers say evidence of effectiveness is lacking for most. Clinical trials have not supported the use of sage, ginseng, liquorice, sarsaparilla, dong quai, ginkgo biloba and valerian root for hot flushes, according to a report in the medical journal Geriatric Nursing.

DIY breathing exercise for hot flushes

Deep breathing, or relaxation breathing or paced respiration, involve breathing in deeply and exhaling at an even pace. Do this for several minutes while in a comfortable position.

You should slowly breathe in through your nose. With a hand on your stomach right below your ribs, you should first feel your stomach push your hand out, and then your chest should fill. Slowly exhale through your mouth, first letting your lungs empty and then feeling your stomach sink back. You can do this almost anywhere and several times during the day, whenever you feel stressed. You can also try this if you feel a hot flush beginning or if you need to relax before falling asleep.