Is Your Chronic Fatigue Actually Fibromyalgia?

A rheumatologist details how to tell if you have fibromyalgia.

If you’re tired all the time and have widespread body pain, you may be looking for an explanation or wondering if it’s all in your head. One explanation may be fibromyalgia — a condition in which chronic fatigue and body pain are classic symptoms. While fibromyalgia affects about 4 million U.S. adults, the disease remains largely a mystery. Here Leanna Wise, MD, a rheumatologist at Keck Medicine of USC, talks through common fibromyalgia symptoms and treatment options — as well as why it can take a long time to get a fibromyalgia diagnosis.

What is fibromyalgia?

“Fibromyalgia is a condition that causes individuals to be more sensitive to pain, causing widespread body pain,” says Dr. Wise, an assistant professor of clinical medicine at the Keck School of Medicine of USC.

Sometimes, this type of widespread, chronic pain is associated with autoimmune diseases, where the body attacks itself and causes inflammation. However, this is not the case for fibromyalgia. Instead, fibromyalgia is thought to be a condition of the nervous system. Current research shows that people who have fibromyalgia have alterations in the brain pathways that transmit and receive pain, making these people more sensitive to pain. These altered signals in the brain are believed to cause difficulties processing sensations and other common symptoms of fibromyalgia, such as sleep disturbances and fatigue.

What causes fibromyalgia?

“The root cause of fibromyalgia is not clear,” Dr. Wise says. “A definitive cause of the condition is unknown. Research suggests there are many factors involved in its development.”

Studies show it can be triggered or aggravated by multiple physical and/or emotional stressors, which include infections, as well as emotional and physical trauma. While some studies have shown that people can be genetically predisposed to the condition, no gene has been identified as a direct cause of fibromyalgia.

What are the symptoms of fibromyalgia?

“Fibromyalgia is often associated with many debilitating nonpain symptoms, such as chronic fatigue, poor and unrefreshing sleep, anxiety, depression, irritable bowel syndrome, migraines and trouble with concentration — also called ‘fibro fog,’” Dr. Wise says.

Other common symptoms of fibromyalgia include tingling in your hands or feet and pain in your jaw, called temporomandibular joint syndrome (TMJ). In addition, abnormalities with the way the brain processes other sensory input may lead to sensitivity to pressure, hot or cold temperatures, bright lights and noises.

Are there risk factors for developing this condition?

“Some risk factors for fibromyalgia include history of trauma, untreated mental health concerns, obesity, a sedentary lifestyle and underlying autoimmune diseases,” Dr. Wise says.

Women are twice as likely to have fibromyalgia than men. And it most often starts in those middle-aged or older. Additionally, a fibromyalgia flare may be triggered by hormonal changes, the weather or stress.

Is there a test for fibromyalgia?

Diagnosing fibromyalgia can be difficult. There isn’t a definitive blood or imaging test to diagnose fibromyalgia.

“The symptoms of fibromyalgia are nonspecific, meaning that fibromyalgia is not the only condition in which people can experience pain, fatigue and other bothersome symptoms,” Dr. Wise says. “Undiagnosed thyroid problems, anemia and vitamin deficiencies, autoimmune diseases and even medication side effects can overlap with fibromyalgia symptoms.”

Because its symptoms are so similar to those in other health conditions, a fibromyalgia diagnosis is often a process of elimination.

“A primary care doctor and/or a rheumatologist can help to test for and rule out other diseases that can be similar to fibromyalgia,” Dr. Wise says.

In addition to ruling out other diseases, your doctor will assess your medical history, X-rays, blood tests and how long you’ve had widespread pain and other symptoms to help make a diagnosis.

The majority of patients find that their fibromyalgia is best controlled when managing it with a variety of lifestyle changes, as well as with prescription medications.

Leanna Wise, MD, a rheumatologist at Keck Medicine of USC

How is fibromyalgia treated?

Although fibromyalgia is not curable, it can get better with a combination of treatments. “The majority of patients find that their fibromyalgia is best controlled when managing it with a variety of lifestyle changes, as well as with prescription medications,” Dr. Wise says.

The best fibromyalgia treatment involves lifestyle interventions to help reduce symptoms. “In particular, regular exercise — both aerobic and weight training — and ensuring quality sleep are cornerstones of therapy,” Dr. Wise says.

“Other helpful treatments include cognitive-based therapy for management of any underlying anxiety and depression; techniques to manage stress, like meditation or prayer; and maintaining a healthy weight,” she says.

Drug treatments may complement your at-home plan. “Some prescription medicines, including medications that help with nerve pain, can also be used for treatment,” Dr. Wise says.

Fibromyalgia is associated with higher rates of depression and anxiety, so it is important to take charge of your condition with self-management strategies under your doctor’s supervision.

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