Fibromyalgia is a condition that we seem to hear a lot about but overall seems to be a bit of a mystery to those of us who don’t suffer from it. Part of the reason for the mystery is that Fibromyalgia is largely a diagnosis by exclusion, meaning that no other diagnosis seems to make sense of the symptoms.
Technically speaking though fibromyalgia is a condition characterized by chronic pain, stiffness, and tenderness through the muscles, joints, and tendons. In addition to these symptoms, many patients also report they have a hard time sleeping and always feeling tired.
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There are a few different reasons why we see fibromyalgia in certain people. One factor seems to be related to an overactive sympathetic nervous system. This is the part of our nervous system that controls our “fight or flight” response, rather than our “rest and digest” response controlled by the parasympathetic nervous system.
This essentially means the body perceives a “threat” and is constantly on edge, which has an effect on our heart rate, digestion, and breathing. In a similar way, fibromyalgia is affected by the immune system. Our immune response to infection, trauma, or inflammation is for the body to produce chemicals that stimulate our healing and pain response.
In fibromyalgia this pain response in constantly working so the chemicals that create our pain our always present, which then leads to a heightened sensitivity to things (i.e. light pressure, movements) that we normally would not find painful.
There are potentially several factors that play a role in causing fibromyalgia in certain people but as we said earlier the exact cause is still relatively unknown. There seems to be a connection to a person’s diet and activity level, as well as psychological and behavioural factors.
Occupational, environment, and seasonal factors also seem to be at play when it comes to mood and stress. Pre-existing health issues such as rheumatoid arthritis, lupus, and other systemic conditions may also be contributing factors. Some research even suggests adverse childhood experiences such as PTSD may also play a role.
Now that we know a little more about fibromyalgia, what can we do about it? When it comes to treatment it is very important to approach fibromyalgia from different angles to include the physical and psychological symptoms. Treatment really begins with helping people understand what is happening and why they feel the way they do.
Once they have a reassurance that the pain does not necessarily mean “damage” is being done to the tissues, then an exercise program can begin. Activity pacing, knowing your own limits, and having body awareness are all important factors for the patient and the therapist to consider when developing an exercise program.
Everyone will be different in what they can tolerate but an exercise program should include both resistance training and aerobic exercise. One great option for people with fibromyalgia is aquatic therapy, as it doesn’t cause excessive strain on the muscles or joints!
Although active rehabilitation is the best treatment, medications such as antidepressants, SNRIs, and pain medications specific to nerves can also provide some relief. Other pain management tools such as manual therapy and TENS can also be helpful when used in combination with an active exercise program.