General achiness that changes from day to day. Fatigue. Trouble remembering or concentrating. Headaches. These symptoms may point to fibromyalgia, a chronic disease that affects some 4 million people in the U.S. But they may also point to a number of other conditions, which makes diagnosing and treating fibromyalgia particularly tricky.
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While it’s one of most common reasons for chronic pain, no one knows exactly what causes myalgia, or muscle pain. It’s thought to be related to increased sensitivity to pain signals in the body, and doctors also know that there are both physical and mental components to the disease. That makes a coordinated care team an important part of a diagnosis and treatment plan.
The pathway to diagnosis
Fibromyalgia involves a number of physical and emotional factors and, because it’s thought to be linked to changes in how the body processes pain signals, it can’t be detected by one single test. But a primary care physician can get that process moving in the right direction.
“Generally speaking, if they’ve had three months or greater of generalized pain, a primary care doctor might think about fibromyalgia,” says Benjamin Abraham, MD, a pain management specialist.
Patients may present with a number of symptoms including jaw pain, tooth grinding, headaches, abdominal pain and generalized fatigue, Dr. Abraham says, so the first step is to rule out other pain-inducing conditions with related symptoms, such as:
- Rheumatoid arthritis, which causes inflammation in the joints
- Lupus, which affects major organ systems
- Multiple sclerosis, which involves damage to nerve cells in the brain and spinal cord
A primary care physician may order blood or imaging tests, or visits with a dentist, rheumatologist or neurologist, to rule out these and other conditions.
What a pain management specialist can do
Doctors who specialize in pain management have special training in the complexities of pain and how it can be addressed with drugs, relaxation practices and technologies.
In his clinic, Dr. Abraham says treatment takes a multidisciplinary approach that addresses both the physical and mental aspects of fibromyalgia. “We’re using a six-session shared medical appointment in conjunction with a pain psychologist,” he explains. Treatment might also involve care from neurologists and rheumatologists.
A number of different medicines can be used for fibromyalgia; one treatment that Dr. Abraham has used with excellent results in well-selected patients is low-dose naltrexone. There is great debate about the exact way in which this medicine reduces pain, but it’s thought to reduce inflammation of the pain nerves.
But much of what a pain management specialist can offer is focused on non-medicine treatment. An important part of treating the pain and fatigue is stress management and physical exercise. Medical research seems to support that relaxation practices like yoga, massage therapy and acupuncture may improve sleep, fatigue and quality of life.
Dr. Abraham says he’s seen some patients greatly improve their pain with physical therapy or tai chi, which is a mind-body practice that involves meditation, gentle movements and calming techniques. In a study of 226 people with fibromyalgia published earlier this year, those who did tai chi once or twice weekly reported a similar or greater improvement in pain than another group that did aerobic exercise sessions instead.
Another therapy that’s sometimes used to address muscle pain is trigger point injection, but Dr. Abraham says this doesn’t often produce long-term relief for fibromyalgia patients and isn’t typically part of their treatment plan. Research suggests that post-procedure soreness is also more common and more pronounced in people with fibromyalgia.
As public awareness and medical understanding of fibromyalgia continues to grow, new medications and treatments are being studied.
