All About Fibromyalgia Pain
By Samuel B. Pegram, M.D.
Sometimes, pain isn’t because of an injury. It’s because of your brain.
Fibromyalgia pain is an interesting concept, because it’s actually a neurological issue.
Years ago when doctors started learning about fibromyalgia, we weren’t aware that it was a neurological problem. Because people had pain in areas that weren’t their joints, doctors thought it was a muscular problem. And in fact, many years ago, we would actually go about biopsying some areas of tenderness, looking for inflammatory cells that weren’t actually there.
Fibromyalgia was called fibritis for a while, because doctors thought it was inflammatory. But eventually, we came to learn that instead of ‘itis,’ it was ‘algia,’ because we learned that it’s an issue with the central nervous system’s ability to process sensory input.
So… what is fibromyalgia?
It’s when patients feel an overall sensation of innocuous things– like a hug. Instead of feeling good, it hurts, but unlike with blunt trauma where we can see where nerve damage is, the causes aren’t quite clear since the pain is coming from the brain.
The big thing about fibromyalgia is how difficult it is for patients to identify their pain. With other pain like arthritis, patients are usually able to quickly identify where the pain is: their knees, their neck, or their hands. But with fibromyalgia, it’s different. Uncovering what exactly is hurting and what’s not hurting is extremely difficult, because the pain is a general pain, making day-to-day tasks like putting on clothes extremely painful.
What causes fibromyalgia?
The causes for fibromyalgia pain aren’t quite known, though we suspect a couple of causes.
Some people get fibromyalgia after experiencing a traumatic injury. Others are naturally predisposed to it. We know that women are more likely to get it than men, because we’ve predicted that hormones have at least a partial influence on it.
We also know that patients who have documented autoimmune conditions like lupus or rheumatoid arthritis are more predisposed to it, as well. We know it’s genetic; so if a family member of a patient has it, we know that it’s more likely that they could have it, too.
When fibromyalgia is present, a patient’s body is having a problem processing innocuous types of stimuli to the peripheral nerves. So when you’re going in for a hug, your sensory input is off kilter, and it’s getting a hypersensitivity reaction, even though there’s no physical injury that we can see on the outside (or even on the inside).
There are also certain illnesses that we can identify that might show that a patient has fibromyalgia (since there isn’t a blood test for it). Many patients who end up having fibromyalgia pain are suffering from headaches, bladder discomfort, cystitis, irritable bowel, nausea, diarrhea, constipation, all of which with no physiological reason (meaning there’s no problem seen in the organs it’s affecting).
How do you diagnose fibromyalgia?
Diagnosis is strictly clinical, which is different in most of our diseases in rheumatology because we’re in a very test-latent type of speciality.
A clinical diagnosis means that we’re diagnosing based upon what we see, what the patient tells us, and what we identify upon examination.
What we see with it is multiple areas of soft tissue tenderness, called tender points. Some common places include the base of the neck, the lower portion of the back and the outer aspect of the hips, anterior portion of the chest wall, and sometimes the outer aspect of the elbows.
One of the things that helps me determine the diagnosis is when I ask patients where they’re hurting.
If a patient has something like arthritis, they can tell me it’s in their knee, ankle or hands. But if a patient has fibromyalgia, they have a really hard time telling me what’s hurting, because the pain is very diffused.
How do you treat fibromyalgia?
Treating fibromyalgia pain is a tough one, because it’s a nerve-induced process. We do use medicines, which are using other conditions to settle down hypersensitivity of the nerve. We call these “neuroleptics,” or drugs that are tranquilizers.
Then, there are a number of medicines that are approved by the FDA for treatment, Savella, Cymbalta and Lyrica. These three are proven to be effective on clinical trials. They all settle down nerve ending pain, not only in fibromyalgia, but in other disease processes where pinched nerves are causing pain.
Some patients’ fibromyalgia will burn out over time, but that’s the exception more than the rule. I generally tell patients that the medicines I mentioned above are like chronic therapy. Some of these medicines come with more severe side effects like drowsiness, headaches, etc., though, it’s important to consult a doctor before deciding on which pain care plan to choose.
If these three medicines don’t work for a patient, or if a patient chooses not to use these, some older medicines actually serve as pretty effective alternatives. A lot of them are antidepressants, which seem to have a strong benefit as well, because remember– fibromyalgia is in fact a neurological issue.
The APC difference in fibromyalgia
One of the great parts of being in a multidisciplinary environment like APC is the accessibility to many different specialities with the drop of a hat.
For example, I had a young lady come to me with a diagnosis with fibromyalgia from another facility. Remember that because fibromyalgia makes all of the nerves in the body hypersensitive, it’s difficult for patients to identify specific areas of pain.
For this patient, she was able to identify exactly where her pain was. Her joint examination was also remarkable, which led me to believe that she didn’t have fibromyalgia. And it ended up that she in fact didn’t have fibromyalgia!
So for her being here at APC, I’m a rheumatologist, not a pain specialist. We have an entire housefull of experienced and educated men and women who do nothing but attend to pain control. Orthopedic surgeons, neurologists, neurosurgeons, that are just a phone call away in case we need to bring other specialities into the mix.
The best thing you can do when you have chronic pain
It’s not common that we see patients who are frustrated after having gone to multiple physicians who tell patients that their pain is all in their head. Or, they’re being pulled to many different doctors, sometimes having weeks or months in between visits, unable to truly identify what’s going on.
One of the best choices you can make for your chronic pain is finding a multidisciplinary pain clinic for your personal pain care plan.
So find the APC clinic closest to you, and call us up today!
The author of this article, Dr. Pegram is a 2021 Medical Honoree of the Arthritis Foundation for the “Walk & Watch to Cure Arthritis.” He’s a member of the American College of Rheumatology and has practiced Rheumatology here in Texas for over twenty years. He’s available at our APC clinic in Round Rock and in Waco.
If you think you’re suffering from fibromyalgia, call us up today so you can work with Dr. Pegram or another one of our fantastic medicine professionals. We can’t wait to see you!