Often called an ‘invisible disease,’ fibromyalgia patients may not always look ill but they can be experiencing intense pain and mental distress. 

“Fibromyalgia is a frequently seen clinical condition where the patient has widespread pain in multiple areas, sleep disturbance, fatigue, cognitive dysfunction, anxiety and depression,” says Joysree Subramanian, M.D., an associate professor and medical director with the department of anesthesiology and pain medicine at Oklahoma University Health Sciences Center in Oklahoma City.

She says the exact cause of fibromyalgia is still unknown; the disease is more prevalent in females, and 75% of fibromyalgia cases remain undiagnosed.

“Diagnosis is not based on radiologic or laboratory tests,” says Subramanian. “Four core areas have to be assessed initially: pain intensity, emotional function, physical function, and overall well-being. Seventy to 80% of patients also experience fatigue and sleep disturbance.”

While primary fibromyalgia is idiopathic, Subramanian says secondary fibromyalgia can be seen in patients with rheumatoid arthritis, lupus and Sjogren’s syndrome. 

“Infectious and inflammatory conditions like Lyme disease, syphilis, tuberculosis and hepatitis C can also be associated with fibromyalgia symptoms,” she says. 

How to Help

With no single test or exam to definitively diagnose fibromyalgia, it can be very discouraging for those suffering with symptoms. To help individuals along their journey, Subramanian encourages patients to keep a pain journal and track the daily activities that they can or cannot do due to pain or fatigue. 

“Share this with your doctor so they can have a better understanding of your symptoms and limitations,” she says, adding that a team consisting of a therapist, physical therapist and pain physician is ideal in helping patients.

“A multimodal approach to treating the pain, sleep, fatigue and associated mood swings will help decrease the symptoms,” she says. “Recently studies showed Tramadol, Naltrexone and Lidocaine infusion can safely decrease pain.”

At this time, she says the role of cannabinoids is inconclusive. When questioned, many patients on cannabis have reported improvement in pain and quality of life, but more research is needed as some studies have shown no improvement in pain. 

“Mindfulness, acupuncture, physical therapy and Kinesio taping, TENS and electrotherapy, pilates, Zumba dancing and aerobics, functional training programs, and music therapy have all been studied for fibromyalgia,” says Subramanian. “Any type of aerobic exercise, pilates or functional training has shown to improve symptoms – better pain control, quality of life, better sleep and less depression.”

She says dietary changes have shown variable results, with a gluten free diet helping irritable bowel syndrome with fibromyalgia symptoms and a study showing a low calorie and vegan diet improving sleep, pain symptoms and depression.

“In some severe cases of pain where a patient has tried multiple medications, we do offer trigger point injections, acupuncture, dry needling and in some cases, ketamine infusion to decrease pain,” says Subramanian.

With so many varying approaches to offer patients relief, she encourages individuals to not delay in seeking help. 

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