Pain, Exhaustion, and Insomnia: the Trifecta of Fibromyalgia

Thursday 8th February 2024

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With an estimated incidence similar to rheumatoid arthritis, fibromyalgia is a common chronic condition involving widespread pain and fatigue often accompanied by sleep problems.

Fibromyalgia is a common chronic condition involving widespread, all-over-body pain with overwhelming fatigue often accompanied by sleep problems. With an estimated incidence in the European adult population similar to rheumatoid arthritis, prevalence of fibromyalgia increases with female sex and age.

Pain tends to occur as a diffuse aching or burning, with sufferers often experiencing more severe flare incidents following exertion. Ongoing fatigue ranges from feeling tired to the exhaustion of a flu-like illness, often combined with insomnia and sleep difficulties; people with fibromyalgia usually experience deprivation of deep restorative sleep. They often describe feeling suddenly drained of all energy; the ‘pull the plug’ effect.

In addition to the core features of chronic widespread pain and fatigue, patients are typically afflicted by a variety of other symptoms including facial pain, depression and anxiety, problems with memory and concentration (fibro-fog), digestive problems, and headaches and migraines.

Fibromyalgia is considered a disorder of pain regulation in the central nervous system with patients perceiving a higher intensity of pain at lower levels of stimulation compared with non-sufferers. Neuroimaging techniques have detected a deficiency in serotonin resulting in an imbalance of pain signal transmission, but with no evidence of tissue inflammation despite symptoms of soft tissue pain. Thus, without access to sophisticated scanning, fibromyalgia syndrome is a diagnosis of elimination, complicated due to a constellation of issues with similarities to other conditions, especially chronic fatigue syndrome.

The cause of fibromyalgia onset is unknown, but often develops following a trigger trauma, such as a car accident, viral infection, childbirth, surgery, or an emotional event. Often there is no obvious trigger, suggesting a potential genetic component to onset.

Currently, fibromyalgia management aims at reducing pain and improving sleep through a combination of self-management strategies and medication, which often includes antidepressants (tricyclics, SSRIs, and SNRIs) and anticonvulsants (gabapentin, pregabalin). Over-the-counter medications can help relieve the pain of fibromyalgia, but severe pain may require attendance at a specialist pain clinic.

Learning to manage the condition appears to be the most successful method of dealing with fibromyalgia. A combination of heat, rest, and paradoxically physical exercise can help enable some people maintain a productive life whilst living with underlying pain and fatigue.