Fibro is Fibromyalgia Syndrome, also known as FMS or FM. Fibromyalgia is pronounced Fy – bro – my – al – gee – ah.
Fibro is a chronic illness characterised by chronic widespread pain, hypersensitivity to pain (and other stimuli), chronic fatigue and sleep disturbances. Fibro is a type of chronic pain condition, but Fibro patients experience a wide range of symptoms that can wax and wane over time.
The name “Fibromyalgia” literally means pain in the muscles and fibres (ligaments) of the body, but it is now recognised that this name does not accurately reflect what is happening with the condition. ‘Fibromyalgia Syndrome’ was chosen as a name for the condition in 1990 and it was previously known by many names, including Fibrositis, Unspecified Rheumatism, Muscular Rheumatism and Neurasthenia, all of which names are also now known to not accurately reflect the condition. Some people suggest the condition would better be called Central Sensitisation Syndrome or Pain Amplification Syndrome.
Fibro is a real condition, with an increasing body of evidence to show that it is a Central Nervous System related disorder4.
Fibro is often a devastating condition for patients and the people around them and it has been shown to have more of an impact than many other chronic pain conditions and chronic illnesses.
Who Is Affected?
Fibro can affect anyone. Although it is commonly thought that 80-90% of Fibro sufferers are women, this figure may be an overestimate and men do get it too. And although a large proportion of Fibro sufferers are aged 35-60, anyone from children to the elderly can develop the condition.
Fibro is a surprisingly common condition: it is estimated that between 2% and 4.5% of the UK population has Fibro, which translates to between 1.2 and 2.7 million people in the UK alone. However, this figure has never been accurately measured (it is based on international prevalence statistics) and it may be higher.
Because of its debilitating nature, Fibro has a large impact on everyone connected with a sufferer, from family and friends to employers.
What Are The Symptoms?
The possible symptoms of Fibro are very wide and varied and no two sufferers will have exactly the same problems. However, many have a majority of the common symptoms.
Chronic widespread pain is usually the primary symptom of Fibro. This can be aches, as if you have the flu or have run a long race; it can feel like joint pain, as if you have arthritis; it can be burning pain, feeling like someone is pouring acid through your body; or it can be shooting pain, as if you are being stabbed with large needles.
Fibro patients are also hypersensitive to pain: they feel pain from stimuli that should not be painful. Even the lightest touch can be painful; a hug can be excruciating. And the pain from something as simple as knocking your leg on a desk not only feels far worse than it should do, but can carry on being painful for far longer than normal. The medical terms for this are hyperalgesia (feeling more pain from a slight pain stimulus) and allodynia (feeling pain from a stimulus that should not be painful at all).
Chronic fatigue is common with Fibro and this is often linked with the non-restorative sleep that is typical of Fibro. With this non-restorative sleep, a Fibro sufferer’s brain tends to wake them up slightly every time they get into the deep sleep that is needed for physical rejuvenation. This can lead to more fatigue, more pain and other symptoms. The fatigue of Fibro is not like being a bit tired all the time: it can hit suddenly, leaving a Fibro sufferer almost unable to stand; it can be overwhelming, making it impossible to do anything at all; you can feel so tired that it seems impossible to even lift your head.
Cognitive dysfunction is a common problem with Fibro and is nicknamed “Fibro-fog”. This can include difficulty in understanding something, difficulty in making decisions, memory loss, problems with concentration, difficulties in speaking coherently and remembering words and problems with typing or writing.
People with Fibro often have sensitivities or intolerances to many things, from foods to chemicals. An exposure to something they are intolerant of can cause a flare in all the Fibro symptoms. If someone with Fibro says, for example, that they can’t stay in the same room as a smoker, or someone with strong aftershave on, then they mean it and could be quite ill if they continue to do so. People with Fibro can be hypersensitive to almost anything, including sound and light. Some people with Fibro struggle with sensory overload, where they cannot cope with too many stimuli at one time – for example, they may struggle in supermarkets or shopping malls, where there are a lot of conflicting lights, noises and smells all at once – and this can have an impact on the cognitive difficulties.
Myofascial pain is present in many people with Fibro. Myofascial Pain Syndrome (MPS) or Chronic Myofascial Pain (CMP) is a diagnosis in its own right and many people are affected by this kind of issue at some time during their lives as myofascial issues can develop from stress or trauma. Myofascial tension and myofascial trigger points can cause a range of symptoms that many people with Fibro experience, including stiff, knotty muscles, burning or stabbing pain, headaches or migraine and nausea.
Abnormal responses to exercise are often a problem with Fibro. These can include an over-the-top and sometimes delayed reaction to exercise, as well as muscle weakness and poor stamina unrelated to fitness. People with Fibro can find that their ability to perform exercises varies hugely: for example sometimes they might be able to climb the stairs with little problem, but another time they might not have the strength to manage one step. Myofascial issues can have an impact on this, as can the sleep disturbances that are common with Fibro.
Irritable Bowel Syndrome (IBS) is common amongst people with Fibro and this is often worsened by food intolerances sufferers have. Gastro-Oesophageal Reflux Disease and Irritable Bladder are also possible Fibro symptoms.
Autonomic Dysfunction (sometimes called Dysautonomia) of some kind is common with Fibro: this simply means that the Autonomic Nervous System (ANS) isn’t working properly. The ANS keeps various factors in your body at normal levels, including heart rate, blood pressure, perspiration and respiration. Autonomic Dysfunction with Fibro can include not being able to properly regulate your temperature – people with Fibro are often either too hot or too cold – and fainting.
Headaches and migraines are also common amongst people with Fibro.
Other symptoms include Restless Leg Syndrome or Periodic Limb Movement Disorder, Tremors, loss of Coordination, Tinnitus, Mitral Valve prolapse, slow recovery from illness, Sleep Starts (jumping awake as you fall to sleep), Anxiety and problems with the Menstrual cycle in women.
What Causes Fibro?
The root cause of Fibro is as yet unknown, but research continues to explain the mechanisms behind what happens with Fibro.
Research has shown that there may be genetic factors involved in Fibro that could lead to a genetic susceptibility to the condition. If you have a close family member with the condition, you are more likely to develop Fibro, but you will not definitely do so.
For some people, the onset of Fibro is slow or happens in early childhood, but for many people Fibro is triggered by a known event or series of events, such as an illness or injury. The possible genetic susceptibility could help to explain why these traumatic events lead to Fibro in some people and not others and a high genetic susceptibility may mean that a lesser trigger is needed for someone to develop Fibro, or that they could develop a more severe case of Fibro.
Pre-existing conditions (even if the other diagnosis comes after the Fibro diagnosis), such as Hypermobility Syndrome, Lupus or Rheumatoid Arthritis can also lead to Fibromyalgia, when it is then often referred to as secondary Fibro. Hypermobility Syndrome in particular is now thought to be a risk factor for developing Fibro
Most researchers agree that Fibro is a central processing disorder with changes in the neuroendocrine/neurotransmitter systems (the systems that transmit messages around the body) and there is an increasing body of evidence to show that Fibro is a Central Nervous System related disorder. Fibro is sometimes called a central sensitisation syndrome. Abnormal processing by the central nervous system causes the pain amplification that people with Fibro experience. The changes in the neuroendocrine/neurotransmitter systems also explain many of the other Fibro symptoms.
Scientific studies continue to produce evidence about the differences to be found in people with Fibro compared to healthy people.
Key findings include:
• Increased levels of the pain-transmitting chemicals substance P and nerve growth factor in the spine.
• An extreme response to pain in the brain: with a functional MRI scan, the parts of the brain that deal with pain are seen to light up from a significantly smaller pain stimuli in people with Fibro compared to healthy people.
• Disrupted stage 4 (deep) sleep, meaning that sleep is non-restorative, even if the person with Fibro sleeps through the night. Two studies have shown that artificially disrupting stage 4 sleep in a similar fashion for 3 or more nights in a row will lead to Fibro-like symptoms developing in healthy people.
• Reduced availability of opioid receptors, explaining why opioid medications are less effective in people with Fibro.
• A subset of people with Fibro have been shown to have positional cervical cord compression, meaning that the spinal cord in their neck is compressed when they lean their head backwards. This finding is still being studied, but this positional cervical cord compression could be a reason for the autonomic nervous system to be disrupted. People with Fibro who have this particular abnormality may benefit from a specific physical rehabilitation program to stabilise the neck, but it is still relatively early days in this area of research.
• Accelerated brain grey matter loss.
• Abnormalities in the dopamine systems of the brain, including a reduced dopamine response to pain. As dopamine is thought to act as the brain’s “filter”, these findings could help explain the autonomic dysfunction and central sensitisation of Fibro. A few medications that boost dopamine in the brain are used as treatments for Fibro (pramipexole/Mirapexin and nefopam/Acupan) and some people do very well with these.
• Changes to the Hippocampus, a part of the brain involved in many processes, including pain perception and memory formation.
• Dysregulation of the HPA (hypothalamic-pituitary-adrenal) axis, which is a complex set of interactions between the hypothalamus, the pituitary gland, and the adrenal gland. The HPA axis controls reactions to stress and regulates various body processes including digestion, the immune system, mood, and energy usage.
• Dysfunction of the Autonomic Nervous System.
• Altered blood flow in the brain.
How Is Fibro Diagnosed?
There is currently no definitive test for Fibro and there is no way for doctors to “see” the condition in patients as part of regular clinical practice, although complicated brain scans have shown positive readings in research studies into Fibro.
In making the diagnosis, the physician will first rule out other conditions that might be causing some of the symptoms. Such conditions include:
- ME/CFS, a condition with many symptoms that overlap with Fibro symptoms that can be very hard to rule out.
- Systemic Lupus (SLE), an autoimmune condition. It is relatively common for people with SLE to also develop Fibro.
- Rheumatoid Arthritis (RA).
- Polymyalgia Rheumatica (PMR), a painful inflammatory condition that typically affects older women.
- Multiple Sclerosis.
- Thyroid conditions.
- Crohns Disease, Ulcerative Colitis and Coeliac Disease.
- Lyme Disease, an infectious condition carried by ticks. Other, similar, conditions should also be ruled out if they seem likely.
- Chronic myofascial pain, a condition that can also be a symptom of Fibro.
- Hypermobility Syndrome, which is also thought to be a risk factor for developing Fibro.
- Sleep apnoea, a condition where you stop breathing momentarily during sleep.
- Neuropathic pain, which is pain caused by damage to the nerves.
- Vitamin and mineral deficiencies – low levels of vitamin D and magnesium in particular can cause symptoms similar to Fibro and may be worsening the condition in people who have Fibro as well.
This is done primarily through blood tests and physical exams, although further testing may be done, such as x-rays and even MRIs if checking for conditions such as Rheumatoid Arthritis or MS. It is worth noting that the presence of another condition does not rule out the possibility of Fibro as a diagnosis. Fibro is not a diagnosis of exclusion and should be diagnosed by its own characteristic features, but it is important for the diagnosing physician to know whether your symptoms could be explained by another condition – for example, joint pain could be explained by Rheumatoid Arthritis – and so whether some of those characteristic features are already accounted for.
When all possible other causes of the symptoms have been ruled out (or taken into account), then the physician will first look at the patient’s symptoms and symptom history to see if they tie in with a Fibro diagnosis.
The American College of Rheumatology (ACR) published a set of criteria for the diagnosis of Fibro in 1990. For this, patients need to have had pain in all four quadrants of the body (i.e. on both the left and right sides and above and below the waist) for at least 3 months. For the ACR criteria, patients also need to have 11 out of 18 specifically chosen tender points. The tender points are spots on the body where everyone is more sensitive and so where it is easiest to test for the hypersensitivity to pain that characterises Fibro.
There can be many more points on the body in which patients are sensitive, but these were chosen as the standard 18 to test. In order for the test to have most meaning, the physician needs to follow some basic guidelines for doing the test.
How Is Fibro Treated?
Fibro is a complex condition with a number of other conditions that can occur as symptoms, making it very complicated to treat. Exactly what works for one person may not be the best treatment for another.
The most effective treatment for Fibro is often through a multidisciplinary approach, using medications, complementary and supportive therapies, and lifestyle adaptations.
It is rare that one approach alone can manage Fibro in the best way possible.
It is very important for Fibro patients that they have a doctor that will work with them. Fibro doesn’t fall perfectly into any one medical discipline, so the best doctor for a Fibro patient may be a GP, a rheumatologist, a neurologist, a pain management specialist – basically any doctor who is interested in treating Fibro.
It can be very hard to find a good doctor for Fibro, with many patients settling for a doctor that believes in the condition, even if they aren’t treating it as well as they could. Some doctors who are specialised in other conditions don’t want to specialise in Fibro as well. Finding the best treatment for a Fibro patient can take a long time and be a frustrating process. It can also require significant research into medication options and possible referrals, which some doctors simply do not have the time for. These are only two reasons why a doctor may not want to treat Fibro patients.
It is worth remembering that there are some doctors who are genuinely interested in Fibro and in helping Fibro patients, so if a Fibro patient has a doctor who is unable or does not want to treat Fibro, then it is worth carrying on looking for a good doctor. A good doctor should recognise the complexity of Fibro as well as its impact on the lives of the patient and everyone around them. They should be willing to try many options and recognise that, just because one treatment doesn’t work for a Fibro patient, it doesn’t mean that there isn’t something else that will.
If you have a sympathetic GP who is not confident that they know enough to help you treat your Fibro, then they can refer you to a consultant for specialist advice. If there isn’t a consultant or clinic local to you that can help you , then your GP can refer you out of area—to the FM Clinic at Guy’s Hospital, London for example—via the NHS Choose and Book system. Your GP will still have an important role to play.
If you cannot get an NHS referral, or if you do not want to wait for the time it can take to get a specialist appointment on the NHS, then you have the option of going private. This is also an option with complementary services, such as physiotherapy, hydrotherapy, massage etc—many people in the UK end up doing this because the NHS cannot afford unlimited appointments of this kind.
Lifestyle adaptations can be very hard to implement, particularly when they involve giving up enjoyable things. However, most people with Fibro find that the condition is very hard to control without lifestyle adaptations.
Pacing, or activities management, is something that many Fibro patients find helpful. This aims to avoid a cycle of overexertion followed by crashing, which can make life very difficult to manage for a Fibro patient and may also lead to a worsening of symptoms. The key is finding a level of activity that can be maintained in the long-term and this will be different for everyone and can vary as symptoms wax and wane. This can mean not doing some activities that the patient might otherwise have done, which is often what people find hard.
Avoiding stress and learning to manage it better are strategies that can help many people, not just Fibro patients. However, it is common with chronic illnesses that stress can impact on symptoms, by making the patient run down and more susceptible to flares and infections. Avoiding stressful situations is one way to lower your stress levels, but this is not always possible and so it is good for Fibro patients to learn how to manage stress better so that it doesn’t impact on their health. Although depression and anxiety do not cause Fibro, catastrophising (always thinking the worst) and distress are known to increase perception of pain, so it is good to try and avoid these through coping strategies. Relaxation techniques, counselling, CBT (Cognitive Behavioural Therapy) and better support in the patient’s life generally are all things that can help them to learn to manage stress better.
For some patients with Fibro, an individually tailored exercise program can be helpful. It is important to make sure that the exercise program is included in the patient’s pacing and that changes can be made to accommodate flares of symptoms. Ideally, anyone who is helping someone with Fibro with their exercise program should have some understanding of Fibro and the importance of not pushing you too hard. It can be helpful to see a physiotherapist or rehabilitation specialist at first, particularly if a patient has severe Fibro or is very unfit. The treatment of comorbid conditions, such as myofascial pain or tendonitis, can also be important for the success of an exercise program.
Better sleep habits can help with poor sleep or insomnia. This includes going to bed at the same time each night, not watching TV in bed and taking time to relax properly before going to bed.
A healthy diet is good for anyone and it is important for someone with Fibro to maintain a reasonably healthy diet because the negative effects of an unhealthy diet may have more of an impact. There isn’t a specific diet recommended for Fibro, but it is worth checking for food intolerances and adjusting diet to avoid these. Diet and different ways of eating can also be extremely useful in controlling Irritable Bowel Syndrome, which many people with Fibro have.
Warm water therapy, with or without exercise, is the complementary therapy with the most scientific evidence behind it for the treatment of Fibro. It can include swimming, aqua aerobics, pool walking or just floating in warm water. If a local swimming pool is not warm enough, then a hydrotherapy centre may be more suitable. If a suitable pool is unavailable, then warm baths can be beneficial.
Myofascial release therapy can be an effective treatment for Myofascial Pain Syndrome and Myofascial Trigger Points. Myofascial Pain is often experienced by Fibro patients and it can require a different kind of treatment than the Fibro itself. Myofascial Pain Syndrome can cause many symptoms similar to Fibro, including pain, stiffness, headaches, nausea and tingling sensations, so the treatment of this condition if it is present can relieve a Fibro patients’ symptoms significantly. There are various forms of Myofascial Release therapy and although many physiotherapists, massage therapists and even osteopaths will perform some kind of Myofascial Release, a specialist practitioner will know how to do it with the most effectiveness and least amount of discomfort.
Nutritional or herbal supplements are often promoted to people with Fibro. There is limited research evidence for their use, but some people find them helpful. It is worth using a few common-sense rules when considering supplements. Always check with your doctor(s) and pharmacist before starting something new – supplements can have side effects just like medications do and some supplements can interact with medications, food or other conditions. Make sure that supplements are helping and that you are not wasting your money – start supplements one at a time so that you can tell which one helps and which one gives you side effects and if you think a supplement may be helping, try coming off it to check – you may just be having a good month anyway. Beware of anything that says it can cure Fibro – it is likely a scam.
Other complementary therapies that some Fibro patients find helpful include the application of heat and/or cold, various forms of massage, acupuncture, acupressure, yoga, relaxation techniques, breathing techniques, biofeedback, aromatherapy, cognitive therapy and osteopathic or chiropractic manipulation.
Most people with moderate or severe Fibro require medications at some point to help get the condition under control or keep it under control.
It is good to remember that there is no one medication that can treat everyone with Fibro. Everyone responds differently to different medications and people with Fibro often experience issues with the side effects of medications.
However, just because one medication doesn’t work for a certain person with Fibro, it doesn’t mean that they either don’t have Fibro or that no medication will work for them.
It can take time and trial and error to find the right medication or combination of medications to help manage any one person’s Fibro and it can be easy to get discouraged. However, issues such as side effects can often be overcome – it is common for medications to have initial side effects that ease after a few weeks for example and sometimes a change in dose, how/when you take the medications and possibly other medications to control side effects can be helpful – and effective medications can then be used without problematic long-term side effects. “Start low, go slow” is the advice often given by experts and although this can lengthen the time it takes to reach a properly therapeutic dose, it can be helpful in managing side effects with a sensitive Fibro system.
It should be remembered however, that there is no “magic pill” for Fibro and that effective medications often need to be used as part of a multidisciplinary (and often multi-medication) treatment program that will require work by the patient as well as their healthcare team.
This covers a vast range of medications that may be of use in managing Fibro symptoms.
Many of these medications are also used for the treatment of depression, as low levels of some neurotransmitters (chemicals involved in transmitting signals from nerve cells to other cells), such as serotonin, are found in patients with depression as well as Fibro patients. If a doctor prescribes an anti-depressant for Fibro, they are not saying that they think you are depressed, just that the medication might help regulate some of the abnormalities found in Fibro. The EULAR (European League Against Rheumatism) Guidelines on the Management of Fibro (the first such guidelines to be released) say that “antidepressants are recommended for the treatment of FMS because they decrease pain and often improve function.”
Tricyclic antidepressants (TCAs) are often the first medication tried in the treatment of Fibro. They include amitriptyline, nortriptyline and dosulepin. TCAs are an old class of anti-depressant, but for Fibro they have the advantage that they work on both serotonin and norepinephrine levels as well as having pain relief and muscle relaxant effects. TCAs can also help with sleep. However, the risk of problematic side effects increases as the dose increases and some people have a problem with the effectiveness of these drugs wearing off over time. TCAs are usually used for Fibro at lower doses than would be used for depression. Research suggests that amitriptyline should only be used as a treatment for Fibro at low doses and for relatively short periods of time.
Trazodone is an old anti-depressant that is chemically unrelated to TCAs or other classes of anti-depressants. It tends to have less side effects than the TCAs and is sometimes prescribed to help control the sleep issues of Fibro.
Selective Serotonin Reuptake Inhibitors (SSRIs) are a more modern type of antidepressant. They include citalopram, fluoxetine and paroxetine. They are used less often in treating Fibro because they work almost entirely on the levels of serotonin, but they can be better tolerated than TCAs in some people.
Serotonin-Norephinephrine Reuptake Inhibitors (SNRIs) are an even more modern class of antidepressants and they work on both Serotonin and Norephinephine levels, like the TCAs do. They include venlafaxine (which can also have a slight effect on dopamine levels), duloxetine and milnacipran.
Norephinephrine Reuptake Inhibitors (NRIs or NARIs) are not often used in the treatment of Fibro, but one medication that can be considered a NARI but also works on dopamine levels is Bupropion (Wellbutrin), which has the advantage over many other antidepressants of not having weight gain as a side effect.
Dopamine agonists mimic the action of dopamine in the brain, fooling the body into thinking that it has more dopamine available than it actually has. Dopamine agonists were originally used for the treatment of Parkinsons Disease, but are also recognised as being a treatment for Restless Leg Syndrome. Their use in the treatment of Fibro is still being studied, but they have proved promising in trials so far. Pramipexole (Mirapexin) is recommended for by the EULAR Guidelines for the Management of Fibro because it reduces pain, but it can be problematic for some people because of side effects.
Acupan (Nefopam Hydrochloride) is a non-opioid analgesic that is used for both the fast treatment of acute pain and the treatment of constant, chronic pain. How Acupan works is not well understood, but inhibition of serotonin, dopamine and noradrenaline reuptake is thought to be involved. It is of particular interest for the treatment of Fibro because of its effects on dopamine and it tends to have less severe side effects than Pramipexole.
Tropisetron is a serotonin 5-HT3 receptor antagonist that has been used experimentally for Fibro. It is recommended by the EULAR Guidelines for the management of Fibro because it reduces pain, but it is not often used because it is difficult to administer.
Simple analgesics, such as paracetamol, and mild opiates, such as codeine and the atypical opiate Tramadol, are recommended for the treatment of pain in Fibro patients.
Research has suggested that opioid medications do not work as efficiently in Fibro patients as in healthy people because of a lack of available opioid receptors in the brain of Fibro patients. According to the EULAR Guidelines for the Management of Fibro, strong opioids – e.g. morphine – are not recommended for Fibro. If a doctor is unwilling to prescribe strong opioids for a Fibro patient, it is not necessarily because they do not believe that the patient is in pain: probably more that they are unsure that the side effects and risk of addiction with strong opioids are worth it when they do not work very efficiently and other forms of medication may work better.
Acupan (Nefopam Hydrochloride) is a non-opioid analgesic that is used for both the fast treatment of acute pain and the treatment of constant, chronic pain. How Acupan works is not well understood, but inhibition of serotonin, dopamine and noradrenaline reuptake is thought to be involved. It is of particular interest for the treatment of Fibro because of its effects on dopamine.
Non-steroidal Anti-Inflammatory Drugs (NSAIDs), such as Ibuprofen, are sometimes used as mild analgesics in the treatment of Fibro. However, Fibro itself does not have inflammation associated with it and so the anti-inflammatory benefit of NSAIDs is wasted. NSAIDs also carry a risk of gastrointestinal complications and Fibro patients are already at higher than normal risk of suffering from gastrointestinal conditions, such as Irritable Bowel Syndrome (IBS) and reflux.
Other medications can have pain relieving effects and may be used in the treatment of Fibro.
Fibro patients often suffer from non-restorative sleep and/or insomnia. Successfully treating the sleep issues can lead to a decrease in symptoms generally.
Herbal supplements, such as Valerian, and over-the-counter medications, such as the sedative anti-histamines, are often prescribed first for sleep issues.
Some of the neurotransmitter medications can help with sleep and the TCAs are often prescribed for this reason.
Medications used primarily as muscle relaxants can also often help with sleep (see Other Medications). Clonazepam in particular is often prescribed partly to help with sleep.
With the stronger medications designed specifically to help with sleep issues, doctors often have to take into account whether long-term use could end up causing more sleep issues. However, short-term use of these medications can sometimes be helpful in reducing the fatigue of Fibro, and may help cut short flares of the condition. Medications found in studies to be helpful in the treatment of sleep issues in Fibro patients include zopiclone and zolpidem.
Sodium oxybate is the only medication that is known to really generate the restorative deep Stage 4 sleep that people with Fibro lack. It is an old medication that is not widely used, but it is being studied as a treatment for Fibro and seems to be effective in treating Fibro generally.
Injections and Infusions
There are a number of injections and infusions that may be helpful in managing Fibro and these are sometimes available from Pain Management clinics or specialist doctors.
Trigger point injections are to treat the myofascial trigger points that many people with Fibro suffer from. The injections are made directly into the area affected by the trigger points which, in people with Fibro, is often primarily the neck, shoulders and back. The injections work to disrupt the myofascial trigger point, giving that area a chance to relax. However, unless a patients finds that they are lucky enough to get months of relief from these injections, they are not an ideal long-term treatment option and are usually best combined with a program of specialist massage, stretches and medications to reduce muscle tension and hypersensitivity. Trigger point injections can actually be done in some people with dry needles (i.e. injections with no drugs), but lidocaine, corticosteroids and even Botox are also used.
Botox or injections of Botulinum toxin is widely known as a cosmetic procedure to reduce wrinkles. However, Botox injections can also be very effective for pain relief as a form of Myofascial trigger point injections. Botox is expensive and so the injections are not widely available on the NHS.
Corticosteroid injections are sometimes used as a form of Myofascial trigger point injection, but they are also used for inflammatory conditions, such as tendonitis or bursitis, which people with Fibro may also have.
Lidocaine can be used in a number of ways as a treatment for Fibro. It can be used a a form of Myofascial trigger point injection. It can be used as a low-dose general injection, sometimes along with a combination of magnesium and vitamins (when it is known as a modified Myers Cocktail), to reduce overall pain and provide a Fibro patient with a boost that is particularly useful when starting treatment or in combating flares. And it can be used as a high-dose infusion, taking several hours or even days, to reduce Fibro pain. The infusions are expensive because the patient needs to be monitored carefully as there is a risk of cardiac or respiratory complications, but some people find them very helpful.
Strong opioids, such as morphine, are not recommended as a treatment for Fibro because they cannot work as well in people with Fibro and the risk of side effects is very high.
Anti-convulsants used in the treatment of Fibro include Pregabalin and Gabapentin. Pregabalin (Lyrica) was the first drug to be officially approved for the treatment of Fibro by the American Food & Drug Administration. It was originally developed as an anticonvulsant and is the more modern form of the similar medication Gabapentin (Neurontin). This kind of medication was then found to be useful in the treatment of neuropathic pain. As well as helping pain levels, some Fibro patients have found that it can help with sleep and some other symptoms.
Muscle relaxants are sometimes used to help manage Fibro when muscle spasms, stiffness and myofascial tension are a problem. Many muscle relaxants also have a sedative effect that may help with sleep issues. These medications include baclofen, cyclobenzaprine (Flexeril), tizanidine (Zanaflex), and carisoprodol (Soma). Other medications, such as TCAs and benzodiazepines also have a muscle relaxant effect.
Benzodiazepines and related medications have been shown in some studies to have a beneficial effect on Fibro patients. They include clonazepam (Klonopin or Rivotril), Lorazepam and olanzapine (Zyprexa), a thienobenzodiazepine. Clonazepam and Lorazepam in particular are known to help with the sleep issues and muscle pain of Fibro and seems to work at reducing the autonomic arousal that is a part of Fibro. Some doctors are wary of using benzodiazepines, because of the possible side effects and risk of addiction, especially with long-term use, but for low dose, short-term or occasional use as a secondary medication, they can be helpful.
Fibro itself does not usually have inflammation associated with it and the use of corticosteroids (a common treatment for inflammatory conditions) is not recommended with Fibro. However, local corticosteroid injections are sometimes used as a treatment for inflammatory conditions that may be partly due to the Fibro, such as tendonitis or even myofascial trigger points. See Injections and Infusions for more information.
What Is The Prognosis?
The prognosis for people with Fibro today is better than ever.
Huge strides have been made in understanding of the condition in recent years and research continues to be carried out to push this understanding forward further and develop more and more effective treatments for the condition.
With effective treatment, patients with Fibro can improve, sometimes significantly. Even those patients who have multiple health conditions can find that effective treatment of their Fibro makes a huge difference to their lives.
Many patients, in the UK especially, struggle to get a timely diagnosis and effective treatment. However, this does not mean that effective treatments do not exist and FibroAction is working to improve access to these treatments.
Getting Fibro under some kind of control can take a lot of work and some time, but with a good healthcare team, a supportive network of family and/or friends and a positive, proactive attitude, it is possible.