7 stages of fibromyalgia

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Chronic pain, Clinical practice, Co-morbidities, Fibromyalgia and treatment

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Contents

Session Information

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Fibromyalgia (FM) is characterized by chronic widespread pain and tenderness making it difficult to manage. Accounting for FM heterogeneity might elicit an improvement in patient treatment. Chronic diseases are a dynamic process with increasing and decreasing symptomology and clinical manifestations. Several diseases similar to FM have known chronicity trends; rheumatoid arthritis has stages indicated by disease progression, and according to the Centers for Disease Control and Prevention, three different disease courses exist. The objective of this study was to cluster patients into stages, or similar disease profiles, based on severity of FM (i.e., patient co-morbidities, regions of pain, and procedures), as well as time.

Methods: We identified 2,529 FM patients with a total of 79,570 clinical visits between January 1999 and February 2014 from an administrative claims data. Patients were clustered based on similarity of co-morbidities (symptom severity), region of pain (widespread pain), and procedures (treatment intensity) by implementing a sequence of unsupervised and supervised learning techniques. Text analysis and a review of physician notes were conducted to obtain secondary conditions and diseases to assist in the understanding of stage classification.

Results: There were four parent stages of FM identified and labeled: 1) regional FM with classic symptoms; 2) generalized FM with increasing widespread pain and some additional symptoms; 3) FM with advanced and associated conditions, increasing widespread pain, increased sleep disturbances, and chemical sensitivity; and 4) secondary FM reactive to disease. Approximately 45% of patient observations were reclassified when the constraints of time were lifted. Most notably, the rate of stage misclassification dramatically reduced from 11.2% to 4.4% when patients were reclassified based on exponential increases in disease severity as opposed to time. These findings lend support that FM stages are more characterized by disease severity and are less time-dependent.

Conclusion: Generally, patients increase in their symptom severity and region of pain by stage. Parallels are beginning to emerge between the different stages and presentations of underlying conditions. General clustering seems to be occurring but requires more research. Nonetheless, this work makes a case for the presence of FM stages in which important clinical ramifications exist that may lead to a more precise treatment approach for FM patients.

Disclosure: M. Gostine, None; F. Davis, None; B. Roberts, None; R. Risko, None; J. C. Cappelleri, None, 3; A. Clair, Pfizer Inc, 1,Pfizer Inc, 3; A. Sadosky, None, 3.

To cite this abstract in AMA style:

Gostine M, Davis F, Roberts B, Risko R, Cappelleri JC, Clair A, Sadosky A. The Four Stages of Fibromyalgia: Potential for More Precise Treatment Approaches . Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/the-four-stages-of-fibromyalgia-potential-for-more-precise-treatment-approaches/. Accessed February 2, 2020. Favorite Save to PDF

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Fibromyalgia condition is still unknown to modern science. Though there is no proper research evidence to prove the actual reason why people get fibromyalgia, the symptoms and diagnose are made based on some experience from fibromyalgia patients.

A person with fibromyalgia can experience various symptoms as follows:

  • Depression
  • Fatigue
  • Anxiety
  • Pain in body parts
  • Sleeplessness
  • Restless leg syndrome
  • Memory problems and inability to concentrate
  • Irritable bowel syndrome
  • Tender points
  • Menstrual cramps with pain

Some of the symptoms of fibromyalgia can emerge as part of another primary disease an individual has.

But it will be necessary to treat the primary disease first and then go for the treatment of fibromyalgia.

Various stages of Fibromyalgia pain syndrome

Various aspects of fibromyalgia is still a grey area for people and even doctors.

Doctors have identified that genetic factors can also be a reason for fibromyalgia where they are exposed to hypersensitivity pain.

The possible treatment is always directed towards the central nervous system to improve the conditions of the fibro body.

Various stages of fibromyalgia, in other words, is divided into various subsets based on the condition of the patients. Details are as follows:

Predisposed state

Usually, in the predisposed state, the individual will not have any symptom and there is no presence of clinical fibromyalgia in this state.

The fibromyalgia can develop due to hereditary factor. As there is no symptom, the individual can’t even take any steps to control this situation.

This can occur if either both parents are already exposed to fibromyalgia or a sibling already diagnosed with symptoms of fibromyalgia.

Prodromal state

In this state, the individual is slowly led to the condition of fibromyalgia. Still, there will not be a trace of clinical fibromyalgia in the patients.

The pain will be experienced in some parts of the body which will not be widespread focusing on tender points alone.

Some of the core fibromyalgia symptoms may not be present in the individual but however symptoms like restless leg syndrome, irritable bowel syndrome, headaches, etc. can be seen.

We can even say that fibromyalgia is not present yet because there will not be persistent pain or widespread pain in the individual.

It is necessary that fibromyalgia pain should be experienced by the individual before they are exposed to clinical diagnosis of fibromyalgia.

There can be multiple associated conditions present but it is not enough.

Undiagnosed Fibromyalgia

This is the next state of fibromyalgia where the individual will experience chronic pain in either some of the parts of the body or in general.

The pain will be experienced in tender points that provides mild symptoms to actual fibromyalgia.

Usually, in this state, the individual will have the symptoms of fibromyalgia that they don’t usually expose to their doctors.

Some physicians will understand the symptoms and make a diagnosis.

Regional Fibromyalgia

The individuals experience pain in their body in a particular region and not a generalized pain. This is when they are diagnosed with fibromyalgia.

During this state, the individual will experience chronic pain in the upper part of the body or in the lower back region of the body.

In this condition the basic symptoms are seen and also a severe pain is experienced in muscles and soft tissues of the body especially in the trigger points.

Generalized Fibromyalgia

In this stage, widespread pain is experienced by individuals. There will be tender points identified in the diagnosis and they can still have generalized fibromyalgia symptoms with just a few tender points.

There are some common conditions that can be seen in individuals who have generalized fibromyalgia.

They are depression, stress, fatigue, irritable bowel syndrome, sleeplessness, etc. People reach generalized fibromyalgia gradually from regional fibromyalgia.

The other factors like genetics, trauma, etc. can also be considerable factors for this condition.

Fibromyalgia with Particular Associated Conditions

Some separate problems arise in the individuals who have developed associated conditions with fibromyalgia.

These associated conditions are usually separate and need to be addressed separately.

Associated conditions include tension or migraine headaches, fatigue, chronic fatigue syndrome, depression, and irritable bowel syndrome.

These conditions will require additional treatment apart from the regular fibromyalgia treatment that is given.

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Fibromyalgia with Coexisting Disease

For some individuals, there can be complaints on other problems that they have and along with that, they will be having fibromyalgia symptoms.

It cannot be said that the other disease can possibly be a cause of fibromyalgia but it can aggravate the condition if it is already present in the individual. Some of the possible coexisting diseases can be

  1. Hormonal Problems – This includes hypothyroidism, low growth hormone, low estrogen and low cortisol.
  2. Low-grade connective tissue disease – This includes dry eyes syndrome, lupus, and autoimmune disorders.
  3. Infectious problems – This includes viral infections, yeast or parasite infections.
  4. Neurological conditions – This includes head injury residuals, neuropathy, polio sequelae and multiple sclerosis.
  5. Arthritic conditions – This includes osteoarthritis, scoliosis, osteoporosis, cervical spinal stenosis.
  6. Lung conditions – People who have the habit of cigarette smoking can be exposed to such conditions as chronic bronchitis, emphysema, asthma, etc. and can also be due to heavy use of tobacco.

Secondary Fibromyalgia Reactive to Disease

In these individuals, the fibromyalgia condition would have got developed due to an already available disease.

Individuals will have fibromyalgia as a secondary disease. Most people will not have fibromyalgia if they had a primary disease.

But as part of treatment for primary disease fibromyalgia often develops. Fibromyalgia will, however, need its own treatment even after the primary disease is treated.

If diagnosed properly in the earlier stage of fibromyalgia, it can be very helpful to treat the patients easily with the help of the treatment programs available.

The patients can also try home-based remedies for keeping the condition under control with the help of natural ways.

If the pain is in a particular area, it can be handled with many home remedies.

The experiences from various individual help in diagnosing fibromyalgia problems.

The 7 Stages of Fibromyalgia

Angela Wise has expressed her views on the Facebook page “Everything Fibromyalgia” about the different stages of fibromyalgia. A lot of us have come together on this site and others.. because we all have one thing in common. FIBROMYALGIA, FIBRO-MY-ALGIA, sometime in our past, recent or further.

We have been told we have fibromyalgia. It is a syndrome in which a person has long-term, body-wide pain and tenderness in the joints, muscles, tendons, and other soft tissues and BLAH BLAH BLAH you know the rest. For GODS sake we live it everyday. We are more than a diagnosis, and we should not all be lumped together as a whole, there should be stages, and this is why

Stage 1

Fibromyalgia should be for those that have recently been finding out that they are experiencing more pain and fatigue than before, you’re not sure what is going on but you hurt and your tired.. you can still go to work, you can still make it through your day, but you know something isn’t right. So it’s something you’re going to bring up at your next routine doctors visit.

Stage 2

You are in pain a lot , sometimes taking an Advil or ibuprofen or what have you .. you get a little relief, you have already been diagnosed with fibromyalgia, and you have accepted the fact this is something you are going to have to live with, you feel a lot of pain and you are exhausted almost every day…but for the most part you keep going and hold down a job, can still go to events, spend time with your friends and loved ones..and have somewhat of a good time.

Stage 3

You are in constant pain, you are constantly tired, more often than not. You question yourself whether you will be able to function normally anymore. You are thinking about maybe not working because you no longer have the energy you once had..you get home from work and all you can do is rest.. friends call and you have to turn down the invites..you have no energy left and you have to rest up just to go back tomorrow. In this stage you start to feel more alone..and more and more people are beginning to think you whine an awful lot. And this stage can last a long time, years even.

Stage 4

You are in pain all the time, good days are few and far between…your calling into work sick more than you even make it in…you’re in bed a good portion of your day.. when you do have a good day you take advantage of it, and do as much as you can, all the things you have left in the past weeks you cram into your day… knowing tomorrow you will be paying for it..possibly even up to a month..but you do it anyway..

because you finally feel good enough to do SOMETHING! By this time your friends make plans without you, they already know your excuses and are 99% positive you will say no.. so they don’t even bother to ask anymore. Your family begins to think you are using fibromyalgia as an excuse to not do things..

because stages 1-3 you were able to do some of those things even with fibromyalgia, now you can’t..so OBVIOUSLY you are using your diagnosis to get out of everything. You feel alone, isolated, worried..emotional, sad, and well..did I mention you feel alone? This stage can last years as well.

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Stage 5

You have already been let go or have quit your job, you are asking questions about permanent disability and how long it takes.. hoping a majority of people will say 3-6 months tops, but instead your fearful of the horror stories about everyone being denied and it taking years for most..you are struggling to make ends meet, maybe you moved someone in to help or moved in with someone to save…you spend a lot of your day in bed. Although you still take advantage of that one good day once in awhile.

You are sore, very sore.. you cry a lot. You feel like a prisoner in your own skin. By this time you have already explained to your friends that it still feels good to be invited even if you don’t go..they invite you to a few things the next week and then things go right back to the usual..laying in bed crying.. feeling alone.. feeling abandoned.. misunderstood..and you have found that the only people that you can relate to are other people whom have been diagnosed with fibromyalgia. What a good feeling..not so alone anymore.. and you wish that your friends and family could see what its really about, this stage can also last for years.

Stage 6 (The final Stage)-

You may or may not still be waiting on disability, Fibromyalgia is now a way of living, most of your friends are those living with fibromyalgia themselves, everything you do takes your precious energy..simple daily tasks you took for granted in earlier stages, going to the bathroom, washing your hair, taking a shower, getting dressed, tying your shoes..even your everyday jewelry irritates the shit out of your skin..no energy or desire to put on “your face” before going out..no energy to curl or straighten your hair..with all the medication you are on or have tried, you are dealing with those side effects as well as living with fibromyalgia.

You now have Netflix or Hulu because going to the movies happens very rarely..very very rarely..and you are human and still enjoy some normal things..like watching tv… you try to stay current on any news regarding fibromyalgia, in hopes they are closer to finding a cure… most of your friends are not around anymore.. they have things to do.. and you? Well.. you need to rest, because you just vacuumed! It’s easy to feel overwhelmed in this stage, because things are piling up around you… bills, laundry, dishes etc.

You do a little everyday…you push yourself so you don’t feel like your day was wasted in bed..you feel guilty.. very guilty..you know longer pull your own weight in the house..your kids, spouse or family member get things for you more than ever.. tissues, something cold to drink, meals, blankets etc..they try to do it in a nice manner but you still feel like a burden…you can’t remember anything.. even important dates.. birthdays, anniversaries, school events etc…not only can you no longer remember shit..

When you start to say something mid-sentence you’ve forgotten what planet you even live on..let alone what it was you were going to say…(thank God for the few people that do pay attention and can tell us what we were talking about to begin with)..

Also you know more about fibromyalgia in this stage then your own doctor and basically laugh when trying a new medication…same drill as before.. and same results.. nothing helps 100%…your not even sure it’s working at all…but you keep going…at this point you know who really understands and who can care less.. even your so called close family members that claim to care.. you know the truth..and you show extra love to those that get it..because after all, other than your fibro friends they are all you have left…

You may see a stage here you are currently in..some things may not be exact give or take…but I know one thing for sure.. fibromyalgia isn’t the same for all of us..just because you can work and I can’t doesn’t mean I wouldn’t love too, or I am lazy.. it could simply mean I am in a different stage than you are..which is most likely the case..It’s not fair to assume you are better or can handle more pain because you still have a social life.. our hearts ache with pain that fibromyalgia has stolen that from us.. we want it back so bad..

We live for our good days, and we support each other through the bad..please do not judge others before knowing their journey…it’s not your responsibility to decide what stage someone else is in..we are fighting the same battle.. we all want the same cure..we need to try to stay positive to help others through the bad days, so they will return the favor when we have our bad days..love goes a long way.. don’t be afraid to love someone with fibromyalgia..we have some of the biggest hearts.. because we of all people know exactly what it’s like to be misunderstood… However I think Stage 7 could be –

Stage 7: Acceptance

When we finally receive a definitive diagnosis we are filled with fear, sadness, anger, and many other feelings, including relief. Someone has finally given us an answer for why we feel the way we do! Once we learn to accept this, and learn our new normal, we can learn how to adapt to this new life.

There is no set amount of time it takes to learn this acceptance piece, but once we are there, we can start moving forward and learning how this new life will go, accept our “new normal” and begin again.

Read Also:

The Side Effects of Fibromyalgia Noone Talk about

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Stage 1

At the very start of fibromyalgia, you are going to feel mild pain and fatigue. You are going to feel tired all the time. Because of this tiredness, you might not be able to do your daily job perfectly. You are holding to your job but you are pretty sure that something is not right with your body….so you start researching.

Stage 2

Pain and Fatigue increase day by day and now you are very miserable. Sometimes you take anti-inflammatory medicine to get rid of the pain but the pain does not go away. You are convinced now that it’s not an ordinary pain and there is something is going on with your body. You are exhausted almost all the time from fatigue but you are still holding on to your normal routine, can still meet with friends, can go to events and have some good time now and then.

Stage 3

Pain is totally unbearable now and you are wondering whether it is some kind of infection or allergy, Whether I would b able to function like a normal person again. You are now thinking about leaving your job because you don’t have the energy to keep up with the job. All you are doing now after coming back from work is rest, rest and Rest and you are expecting that if I take a good long nap then I might have the energy to go back to work tomorrow. This stage is so dangerous because now you are going to cut people out of your life because you can’t properly give them time. This stage can last for years

Stage 4

You are in awfull lot of pain all the time. Good days are hard to come by. You are calling in sick to work almost every other day because you don’t have the energy to go to work. You are in bed for almost 16 hours a day. Even though if you have a good day and you wanted to take advantage of it. Fibro flare comes in your way and you might not be able to get from bed for the next couple of days because of flare. This time your friends won’t invite you to your events or gathering because they already know your excuses and they think you are whining about it. My Family thinks that I am making things up and don’t wanna be with them. You are going to feel lonely, worried and isolated from others, more than ever because no one can really understand your pain. This stage can last for years and its the worsts.

Stage 5

Up till this stage you might already have let go of your job or at least thinking about it. Now you are thinking about how to get permanent disability because you can’t put up with this unrelenting pain. You are thinking about how long does it take to get disability, also you are worried about getting denied from disability. Maybe Now you have hired a maid because you can barely move. Sometimes you cry in a corner like what is Happening to me. You are entrapped in your own body and there is nothing you can do about it. If you have a good life partner who can understand what is going with you, can really cheer you up.

Stage 6

You are now alone in this. You have started looking about fibromyalgia on social media. You find many other people who are going the same as you. Now taking shower is feel like a BIG job and once you take a shower, you are done for the rest of the day. Strong lights hurt you, Even the slightest touch to your body can cause really agonizing pain. You are on hard medication. Doctors can’t find a proper cure to your problem, they just suggest you some pain relief medicine. You don’t really care about your clothing now. In fact, you prefer to be in your PJ’s because you feel comfortable in them. Those good days when you were athletic and have a good memory are like a dream to you.

You still like some things in life like watching TV. You are trying to be in sync with current news to find out whether there is a new cure for fibromyalgia. Your friends don’t bother talking to you about yourself as they have other things to do. You need to rest a lot which causes many things to pile up like bills, house cleaning, and dishes. You might have even gained a lot of weight with all those medicines and now you are also thinking about losing some weight but you can’t because you just don’t have the energy to do a workout. You might try a new doctor in search of finding relief from all this pain and fatigue but all they gave you some sleep medicines. Life is like a living Hell NOW.

Stage 7

A Question which I ask myself, Why me?. I was having a good life like a normal person and then BAM !, FIbromyalgia hits me like a Bus and now I am disabled for the rest of my life. We are still looking for a possible cure but it doesn’t seem like we are ever gonna have one.

Early Signs of Fibromyalgia: A Complete guide

Early Signs of Fibromyalgia: What is Fibromyalgia?

The term “myalgia” refers to pain in a muscle or group of muscles. Thus, Fibromyalgia is a chronic widespread pain condition of the muscles, tendons, and ligaments. It is the most common source of chronic pain for women ages 20 to 55. There is no cure, but medications are helpful in controlling the symptoms.Innovative online test to detect cognitive alterations in patients with fibromyalgia. Perform a complete cognitive screening and evaluate the risk index of the presence of neuropsychological alterations related to fibromyalgia (Fibrofog). Professionals have determined that Fibromyalgia impacts the nervous system. According to the American College of Rheumatology, Fibromyalgia is not an autoimmune condition or an inflammatory disease process like arthritis because it does not result in damage to the muscles or the joints. However, it is often secondary to a primary inflammation-driven illness such as lupus, or rheumatoid arthritis, and patients can have inflammation-like symptoms.

Types of Pain Associated With Early Signs of Fibromyalgia

Because fibromyalgia affects the nervous system, symptoms are thought to be related to heightened pain sensations. The body’s nerve endings send incorrect electrical signals to the brain. With nerves in overdrive, what is typically a non-painful stimulus (i.e. a slight touch) causes significant pain. An amplified pain response exceeds the basic ache. Fibromyalgia leads to numerous types of pain:

  • Aching
  • Stiffness
  • Stabbing
  • Shooting
  • Burning
  • Throbbing
  • Sensations of Hot or Cold
  • Pinching

Early Signs of Fibromyalgia: Common Fibromyalgia Pain Locations

Fibromyalgia pain is displayed in numerous locations in the body. While the condition results in painful muscles, discomfort can span from head to toe. Areas with the most pronounced pain differ from patient to patient. The main diagnostic tool for Fibromyalgia is the tender point exam, which entails a medical professional pressing down on 18 symmetrical “pain points.” Those early in the diagnostic process frequently complain of deep muscle pain in the legs and hips, but some experience pain throughout the entire body at once. Common locations of Fibromyalgia pain include:

  • Hips
  • Legs
  • Arms
  • Back
  • Front and Back of Neck
  • Shoulders
  • Head
  • Chest

Early Fibromyalgia Symptoms: Physical

Contrary to what the general public assumes, Fibromyalgia is a multi-system illness. The effects are not confined to the chronic, widespread muscular pain. Patients with Fibromyalgia actually have a host of symptoms in multiple organ systems.

Early signs of Fibromyalgia: Interstitial Cystitis (IC)

Also named painful bladder syndrome, patients with Fibromyalgia are prone to developing interstitial cystitis (IC). IC affects the urinary system—the bladder and kidneys. The kidneys produce urine. That waste is stored in the bladder until the brain sends a message to the nerves signaling that the bladder is full. In a normal functioning urinary system, nerve signals prompt the release of urine via the urethra (the tube that carries urine from the body) without pain. Communication between the nerves and the brain is interrupted by interstitial cystitis. It is no wonder that Fibromyalgia and interstitial cystitis are related, as the chronic pain of Fibromyalgia is thought to be from incorrect nerve signals too. The bladder symptoms are extensive.

Early signs of Fibromyalgia: Urgent and Frequent Urination

Patients with Fibromyalgia and IC feel the need to urinate from only small amounts of urine in the bladder. Although the bladder is hardly considered full, the discomfort felt is comparable to holding urine all day long—simply from the nerve miscommunication. Frequent and urgent urination is a symptom of both conditions, especially as patients seek to reduce the sensations of urgency. The Urology Care Foundation states, “the average person urinates no more than 7 times a day he or she does not have to get up at night more than once to use the bathroom.” But, frequency and urgency caused by IC ensues both day and night.

Early signs of Fibromyalgia: Pain and Pressure of Bladder

Like the other forms of Fibromyalgia pain, the pain caused by interstitial cystitis can be migratory and intermittent. The pelvis, urethra, lower back, behind the vagina in women, and the scrotum in men are the typical locations of IC pain. From my personal experience with the condition, the pain is similar to a urinary tract infection with the burning accompanied by an intense pressure.

Early signs of Fibromyalgia: Glomerulations (Bleeding)

Interstitial cystitis is chronic inflammation of the bladder. Irritation of the bladder can cause damage. Inflammation over a period of time can result in ulcers and glomerulations, which are pinpoint hemorrhages of the bladder wall that may cause bleeding. 95% of patients with IC experience glomerulations. The tiny hemorrhages are not-life threatening, but the minute amounts of bleeding are occasionally startling to those unaware of the possibility.

Early signs of Fibromyalgia: Triggers

Diet and lifestyle factors are not the underlying reason for IC, but diet and lifestyle choices have a huge influence on interstitial cystitis. Acid foods, foods with artificial sweeteners, spices, and caffeinated beverages are the main triggers. Sex is also painful and exacerbates symptoms. Learning your triggers is key to pain management.

Early signs of Fibromyalgia: Gastrointestinal

Digestive problems are prevalent amongst those with Fibromyalgia. Patients undergo comprehensive testing to get to the root of their digestive ailments, yet rarely is an abnormality identified. Regardless of its acceptance in medical literature, the connection is not completely understood. Doctors believe that since overactive pain receptors are the culprit of Fibromyalgia pain, receptors throughout the gastrointestinal tract are similarly hypersensitive. Gastrointestinal Symptoms:

  • Gas
  • Bloating
  • Fullness
  • Heartburn/Indigestion/Reflux
  • Nausea
  • Vomiting
  • Constipation
  • Diarrhea
  • Abdominal Pain

Early signs of Fibromyalgia: Irritable Bowel Syndrome (IBS)

Stomach woes that come and go are commonplace for patients with fibromyalgia. If GI symptoms increase in frequency, it could suggest a secondary disorder known as Irritable Bowel Syndrome (IBS). Irritable Bowel Syndrome and Fibromyalgia are functional disorders. Functional disorders are clinically diagnosed by symptom presentation because there is no testing to confirm the diagnosis. Whereas fibromyalgia is characterized by hypersensitivity of the muscles, the hypersensitivity in IBS stems from the intestine. Symptoms are persistent and identical to the ones listed above—alternating diarrhea and constipation, abdominal pain, gas, bloating, etc.

Early signs of Fibromyalgia: Sleep Disorders

We all yearn for a peaceful repose when under the weather. A problem for Fibromyalgia patients is that they feel unwell the majority of the time, but their symptoms prevent them from quality sleep. Studies show that three quarters of those with Fibromyalgia suffer from a sleep disorder. Fibromyalgia interferes with the brain’s sleep signal, causing one to have reduced slow wave sleep. Slow wave sleep is the deepest form of rest.

Early signs of Fibromyalgia: Insomnia

Jokingly called “painsomnia,” Fibromyalgia patients struggle with insomnia. Insomnia is a sleep disorder defined as the inability to fall and stay asleep. Pain is a contributing factor to insomnia. Despite already having difficulties falling asleep, patients awake intermittently throughout the night due to pain. Many are diagnosed with restless leg syndrome along with insomnia, as Fibromyalgia patients toss and turn because of the need to move their legs to find the least painful sleeping position.CogniFit Insomnia neuropsychological assessment that allows for a complete cognitive screening and assessment of the risk index of having this sleep disorder with excellent reliability.

Early signs of Fibromyalgia: Sleep Apnea

Fibromyalgia impedes normal breathing patterns during sleep. Those with fibromylagia experience pauses in breathing attributable to sleep apnea. Loud snoring, daytime fatigue, irritability, morning headaches, dry mouth, and gasping for air while asleep are sleep apnea symptoms that fibromyalgia patients may notice if they also have apnea. Clinical and Experimental Rheumatology found that upper airway resistance syndrome, a variant of sleep apnea where the upper airway narrows, is common in women with Fibromyalgia. This has profound repercussions on quality of rest.

Early signs of Fibromyalgia: Fatigue

Dwindling energy levels are par for the course with Fibromyalgia. Insomnia and sleep apnea do not help, as the body is working diligently to function and it cannot acquire proper rest. The current theory about the relationship between fibromyalgia and fatigue is that because the nerves are constantly sending inappropriate signals, the body grows tired. Fatigue is so considerable in fibromyalgia that chronic fatigue syndrome is an overlapping diagnosis.

Early signs of Fibromyalgia: Neurological

As previously explained, fibromyalgia originates from the nervous system. The nerves of a fibromyalgia patient are in a constant state of misfiring. The brain conveys improper signals to the organ systems and vice versa. Basically, the body does not get the memo for ideal functioning. It is no surprise that the hyperactivity of the nervous system seen in fibromyalgia causes a plethora of neurological symptoms.

Early signs of Fibromyalgia: Noise, Light, and Smell Sensitivity

Look around you. What do you see, touch, hear, smell? Familiar environments should not be overwhelming. However, basic stimuli overstimulate the senses in those with fibromyalgia. Loud noises, bright lights, and strong smells trigger symptoms ranging from migraines to increased chronic pain. Muscles grow tense following an exposure. Simply shopping at a store with fluorescent lighting is enough to trigger a flare.

Early signs of Fibromyalgia: Allodynia (Touch Sensitivity)

The hug from a friend, a pair of jeans in contact with your skin, the slightest contact with the bedsheets—imagine if the slightest touch caused you pain. That is the reality of fibromyalgia. Heightened pain receptors in patients with fibromyalgia lead to allodynia, which is the medical verbiage for touch sensitivity.

Early signs of Fibromyalgia: Temperature Sensitivity

Sunburns throughout childhood are evidence that heat produces pain, as is the burning sensation from grabbing a pile of snow with bare hands. In normal circumstances, extreme temperatures precipitate injury. Those with fibromyalgia have a lower temperature threshold. It takes a less extreme temperature to instigate discomfort. Malfunction of the autonomic nervous system, a condition known as Dysautonomia, is another factor contributing to temperature sensitivity in fibromyalgia. The autonomic nervous system controls all bodily processes that occur automatically. Patients can encounter rapid and drastic temperature changes because the body cannot maintain homeostasis when under stress.

Early signs of Fibromyalgia: Neuropathy

Fibromyalgia does not result in direct damage to muscles or nerves. Still, the diagnosis of Fibromyalgia leaves one prone to neuropathic conditions like small fiber neuropathy because of secondary health problems. Comparing various subjects, patients with fibromyalgia proved to have a decrease in nerve fibers in their skin and the subjective pain responses consistent with small fiber and peripheral neuropathy. Small fiber nerves in the skin are crucial to autonomic function. If patients with fibromyalgia are suffering from autonomic dysfunction, then neuropathy is a probable outcome. Autonomic symptoms such as orthostatic hypotension, tingling in hands and feet, incontinence, numbness and tingling in the limbs, and muscle weakness are indicative of neuropathy secondary to fibromyalgia.

Early signs of Fibromyalgia: Vision Changes

Another phenomenon of fibromyalgia’s vast effect on the nervous system is its act on vision. In fibromyalgia, especially early on, patients notice a sporadic decline in vision. These changes manifest subtly. For example, blurred vision while focusing on a subject and difficulties with night driving. Dry eyes and eye pain are vision symptoms correlated with the nervous system signals gone rogue.

Early signs of Fibromyalgia: Lack of Balance/Coordination

Approximately 75 percent of fibromyalgia patients have poor balance and coordination due to dizziness. Symptoms are the worst upon standing, which could be from of autonomic dysfunction prevalent in those with fibromyalgia—Postural Orthostatic Tachycardia Syndrome (POTS). As the body attempts to regulate functions when standing, signals from the nervous system are not reaching the heart. With postural changes, blood pressure drops and heart rate increases to compensate. Dizziness can escalate to episodes of syncope (fainting) and pre-syncope (blackouts). The aftermath is lack of coordination and injury from falls. It prevents daily tasks like cooking, cleaning, shopping, and exercise.

Early signs of Fibromyalgia: Cognitive Problems

The infamous “fibro fog” is the source of much grief. Fibromyalgia impairs cognitive function. Patients periodically feel confused—like a thick haze is clouding their thoughts. This encompasses the symptoms of forgetfulness, unclear speech, and insufficient focusing skills. Putting the silverware in the freezer or fumbling for words seems laughable initially, but it is distressing when similar events transpire daily. Medical professionals claim cognitive impairment in fibromyalgia is derived from an overactive nervous system. The body has trouble balancing regular environmental stimuli while also processing increased pain signals. Trouble sleeping and distraction from pain adds to the mental burden.General Cognitive Assessment Battery from CogniFit: Study brain function and complete a comprehensive online screening. Precisely evaluate a wide range of abilities and detect cognitive well-being (high-moderate-low). Identify strengths and weaknesses in the areas of memory, concentration/attention, executive functions, planning, and coordination.

Early signs of Fibromyalgia: Headaches

Whether from sleepless nights, noise or light sensitivity, or vision changes, headaches are a common symptom. Chronic headaches and migraines are a comorbidity for over 75% of fibromyalgia patients. The attacks of unbearable head pain can trigger full-body flares. It is plausible that patients with migraines have altered brain chemicals, like substance P and serotonin, which are strongly connected to pain sensations and cause migraine symptoms.

Early Fibromyalgia Symptoms: Psychological

The number of fibromyalgia patients who are told their illness in their head is unfortunate. With diagnosis based on clinical presentation, patients with fibromyalgia are usually debilitated for years before they receive a name for the symptoms plaguing their body. Fibromyalgia is in your head, but not in the way some think. Psychological symptoms emerge from the physical condition.

Early signs of Fibromyalgia: Depression and Anxiety

Depression is distinguished from normal feelings of unhappiness when a sense of worthlessness, guilt, and unexplained sadness persists longer than 2 weeks. Anxiety—the worry and fear surrounding life—is a consequence of depression. Both mental disorders are linked to fibromyalgia. A neurotransmitter imbalance is the primary cause of depression and anxiety in those with Dysautonomia and fibromyalgia, as the body’s fight or flight response is on the fritz. Nevertheless, other aspects of life with fibromyalgia are responsible for mental disorders. Chronic pain is a distressing event. Isolation, fear of the future, and anxiety about symptoms fuels depression.

Early signs of Fibromyalgia: Emotional/Mood Sensitivity

Rapid mood swings arise from fibromyalgia for the same reasons as depression and anxiety. Chemicals in the brain become imbalanced. So, the heightened sensitivity to pain is akin to increased emotional sensitivity. Chronic pain is emotionally taxing. Every person deals with pain in their own manner and that can mean spells of moodiness or sadness over enduring physical symptoms 24/7.

Early Signs of Fibromyalgia: Unusual symptoms

As you have gathered, there is more to fibromyalgia than what meets the eye. Although the symptoms of the invisible illness affect a specific set of main body systems, a combination of unusual manifestations can accompany the condition.

Early signs of Fibromyalgia: Sweating

Excessive sweating is a peculiar symptom of fibromyalgia. Profuse sweating is attributable to 4 separate elements of the condition: dysfunction of the autonomic nervous system responsible for sweating, a byproduct of secondary anxiety, medication side effects, and temperature sensitivity.

Early signs of Fibromyalgia: Bruising

A constellation of unsightly bruises is classic to fibromyalgia skin. Easy bruising happens from frequent injury after dizzy spells, nutritional deficiencies with rampant GI symptoms, and accidents from sleep deprivation. Practicing good sleep hygiene can eliminate the chance of the latter.

Early signs of Fibromyalgia: Swelling

Fibromyalgia is deemed a non-inflammatory illness because it does not cause damage to the joints and basic inflammation markers in blood-work are within normal limits, but swelling elsewhere in the body indicates the potential for an inflammatory process. Clinical evidence proves a subset of fibromyalgia patients have an increase in cytokines, which are inflammatory mediators in the immune system. In the absence of inflammation is swelling from fluid retention edema. The puffiness from edema tends to go to the hands, feet, eyes, and forehead area.

Early signs of Fibromyalgia: Muscle Twitches

The average Joe is familiar with the annoying eyelid twitch deemed a sign of stress or fatigue. That mechanism is intensified in fibromyalgia. Random muscles throughout the body twitch because the nerves are activated without ever receiving signals.

Early signs of Fibromyalgia: Menstrual Pain or Changes

Women are more likely to develop fibromyalgia than men. Female patients report worsening of their symptoms around their menstrual cycles. Since pain signals are always increased, cramps and other unpleasantness during that time of the month escalate pain levels.

Early signs of Fibromyalgia: Allergies

Food allergies, hay fever, plain ol’ sensitive skin—the allergies of fibromyalgia patients are ever increasing. The Asthma and Allergy Foundation states that an “allergy is an abnormal reaction of the body to an encountered allergen introduced by inhalation, ingestion, injection, or skin contact, often manifested by itchy eyes, runny nose, wheezing, skin rash, or diarrhea.” The role of allergies in fibromyalgia is connected to the immune response. With the body fighting itself, it mistakenly recognizes certain triggers as harmful. Many with fibromyalgia are diagnosed with Mast Cell Activation Syndrome (MCAS). MCAS is a condition where the mast cells (allergy cells) are easily triggered to release chemical mediators (i.e. histamine, cytokines, prostaglandins, etc.). Allergic and non-allergic symptoms result such as chronic bone pain, flushing, fainting, nausea and vomiting, and more. Fibromyalgia is a complicated illness. Science has barely scratched the surface of its effects. With time, my hope is that medical professionals will learn more about how its symptoms impact the human body. Those with fibromyalgia deserve great respect. After all, navigating life with chronic pain is not easy. References Frieri M. Mast Cell Activation Syndrome. Clin Rev Allergy Immunol 2015. . 10.1007/s12016-015-8487-6. Gracely, R. H., Ceko, M., & Bushnell, M. C. (2011). Fibromyalgia and depression. Pain research and treatment, 2012, 486590. Rodriguez-Pinto I, Agmon-Levin N, Howard A, Shoenfeld Y. Fibromyalgia and cytokines. Immunol Lett 2014;161:200–3.

Cheyanne is currently studying psychology at North Greenville University. As an avid patient advocate living with Ehlers Danlos Syndrome, she is interested in the biological processes that connect physical illness and mental health. In her spare time, she enjoys immersing herself in a good book, creating for her Etsy shop, or writing for her own blog.

How to recognise fibromyalgia flares

Although some triggers for fibromyalgia are beyond a person’s control, others can be managed and flare-ups prevented. It is often easier to prevent a flare than treat one.

Below are several lifestyle changes and tips that may help relieve symptoms and make fibromyalgia easier to live with day to day.

Keeping a log of triggers

Share on Pinterest Keeping a log of daily activities and routines may help to identify triggers of fibromyalgia flare-ups

Triggers for fibromyalgia vary from person to person. Maintaining a log of activities, meals, sleep times and duration, and symptoms of fibromyalgia may help to identify particular triggers.

Recording these activities might highlight patterns of what triggers a flare. This might help a person with fibromyalgia find out how to better manage or avoid those triggers.

Reducing stress and relaxing

Stress makes symptoms of fibromyalgia worse. Many people with fibromyalgia experience stress and feelings of depression, anxiety, and frustration. People may benefit from trying to avoid or limit exposure to stressful situations and making time to relax.

While techniques such as meditation or deep breathing may help manage stress, it is important that people with fibromyalgia do not avoid physical activity altogether. People with fibromyalgia who quit work or stop exercising do not do as well as those that stay active.

Options to assist with stress management are available and include cognitive behavioral therapy (CBT), group therapy, and feedback from qualified health professionals.

Getting enough sleep

Fatigue is one of the main symptoms of fibromyalgia. It is essential that a person with fibromyalgia get enough sleep.

Sleep hygiene practices that may help include going to bed and getting up at the same time every day and limiting napping during the day.

Sometimes, people with fibromyalgia experience restless legs syndrome and pain that can interfere with sleep. A doctor can recommend treatments for these problems, which may aid restful sleep.

Exercising regularly

Regular physical activity can often decrease or improve symptoms of fibromyalgia. Although exercise may increase symptoms of pain at first, it may help prevent pain over time.

Activities that are recommended for people with fibromyalgia include walking, biking, swimming, and water aerobics. Maintaining good posture habits, stretching, and relaxation exercises may also help.

For maximum effect, it is recommended that people with fibromyalgia begin with gentle exercise, such as walking, and build up endurance and intensity slowly.

Resistance and strengthening exercises may improve muscle strength, physical disability, depression, and quality of life. They can also improve tiredness, function, and boost mood in people with fibromyalgia.

Not doing too much

While regular physical activity is recommended to help manage fibromyalgia symptoms, it is crucial to limit overexertion not to do too much.

Moderation is the key. If a person with fibromyalgia does too much on days where their symptoms are good, they may end up having more bad days. However, on bad days, individuals should still try to be as active as they can. Keeping activity levels as even as possible provides the best outcome.

Diet

Although there is no specific diet recommended for people with fibromyalgia, there are certain foods that appear to make fibromyalgia symptoms worse.

Try an elimination diet, in which you exclude certain food groups each week to see if symptoms improve. If symptoms get better after ruling out a certain type of food, they may well be connected to fibromyalgia symptoms.

Maintaining proper nutrition will help boost energy levels and help avoid other health problems.

Fibromyalgia and Social Security

Many people with fibromyalgia find themselves unable to work or resume a normal standard of living.

For such people, Social Security rulings in the United States dictate that so long as a medical or osteopathic doctor can determine that the disease causes medically determinable impairment (MDI), the condition will qualify as a disability for Social Security payments.

This means that a doctor should be able to confirm:

  • a history of widespread pain
  • a minimum of 11 tender points following examination
  • repeated instances of at least six fibromyalgia symptoms
  • evidence that other explanations or conditions have been ruled out.

The Social Security Administration (SSA) requires medical documentation dating back 12 months related to the disease, and may conducts interviews with relatives, friends, neighbors, and past employers to confirm the diagnosis.

In some cases, the SSA may fund a consultation to confirm the debilitating nature of the disease.

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