fibromyalgia

Transcription

fibromyalgia - Arthritis Society

fibromyalgia
Causes, Symptoms
and Treatments

The CONDITIONS Series
arthritis.ca
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Contents
What is Fibromyalgia?
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Symptoms of fibromyalgia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
How is fibromyalgia diagnosed?. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Why is treatment for fibromyalgia so important?. . . . . . . . . 4
Risk factors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Managing Fibromyalgia
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Sleeping. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Physical activity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Healthy eating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Complementary therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Treatments for Fibromyalgia
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What medications are used for fibromyalgia?.. . . . . . . . . . 14
Fibromyalgia (FM) is a chronic condition that affects
the central nervous system. The defining symptom of
FM is widespread pain that is experienced throughout
the body. The pain can vary from person to person,
may move around the body from time to time and
may change in intensity on an hourly or daily basis.
People with FM may also
experience symptoms such
as fatigue, sleep difficulties,
lack of concentration and
memory, mood swings,
gastrointestinal problems
(e.g., constipation, diarrhea,
etc.) and have a heightened
sensitivity to touch and
pressure, which can
sometimes cause pain.
It is a relatively common
condition affecting two
per cent of Canadians,
primarily occurring in
women (80 to 90 per cent),
but can also affect men,
teenagers and children.
Fibromyalgia is not a
disease of the joints, nor
is it an inflammatory or
degenerative condition.
FM won’t cause permanent
damage to your muscles,
bones or joints. What FM
does have in common with
arthritis is that it can cause
pain and fatigue and can
have a significant impact
on a person’s daily life.
Fibromyalgia is a
chronic condition that
affects the central
nervous system. It is
a relatively common
condition, affecting
two per cent of
Canadians.
Due to its “invisible” nature, FM was often
misunderstood and perceived as an “imaginary disease”
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or something that is “all in your head.” People with FM
may look well, but may in fact be experiencing a lot of
pain. While more research is needed to fully understand
this condition, doctors are now able to diagnose it and
recognize that multiple physiological factors are at play
in creating the symptoms.
For many, there is no known cause of FM. For about
one third of persons the onset of FM may be attributed
to a triggering event, such as a severe illness, a
traumatic incident or a stressful, emotional experience
(e.g., car accident, death of a loved one).
There is currently no cure for FM. However,
medication, exercise, relaxation and stress-reduction
measures as well as other lifestyle changes may help
reduce symptoms.
Facts about fibromyalgia
• Fibromyalgia (FM) affects two per cent of
Canadians.
• It primarily affects women (80 to 90 per
cent).
• It does not lead to joint damage,
destruction and deformity.
• People with diseases such as
rheumatoid arthritis (RA), systemic lupus
erythematosus (commonly called lupus)
and ankylosing spondylitis (AS) can also
have fibromyalgia in conjunction with the
underlying rheumatic condition.
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Fibromyalgia: Causes, Symptoms and Treatments
Symptoms of fibromyalgia
Pain is the most common complaint of people with
fibromyalgia (FM). The pain of FM is widespread and
felt throughout the body. Those with FM are sensitive
to firm pressure applied particularly to soft tissues,
such as muscles and tendons. This increased sensitivity
to pressure is felt as pain. Pressure that can cause
pain may be as gentle as a friendly hug or the weight
of a child climbing
onto a lap.
Other symptoms that
may occur as a result
of FM include:
• feeling
tired and weak
• having
disturbed sleep
• irritability
• difficulty with
concentration
(sometimes called “fibro fog”)
• memory problems
• headaches
• gastrointestinal problems (e.g., constipation,
diarrhea, irritable bowel syndrome, etc.)
• bladder dysfunction
• excessive sensitivity to loud sounds, bright
light, and smells
• temperature sensitivity
Many people with FM feel discouraged; this may lead to
depression and anxiety. In some cases, symptoms may
come and go or they may be aggravated by additional
stress or even at times by changes in the weather.
For many people, FM develops gradually and has no
known cause. For others, FM may develop after an acute
illness, a traumatic incident or a stressful, emotional
experience. Researchers are still looking for what
triggers FM. Recent studies suggest that in people with
FM, pain messages are not being communicated by the
body properly so that instead of gradually dissipating,
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the pain signal gets amplified. Picture it as though the
body’s volume control had been turned up to “high,”
putting the nervous system into overdrive, which in
turn triggers more pain messages in a self-perpetuating
cycle. Pain is normally an important safety mechanism
for the body, but in a person with FM this feedback loop
results in excessive and chronic pain. A person may also
experience FM if their body’s natural pain-dampening
mechanisms are not functioning properly.
How is fibromyalgia diagnosed?
Your doctor will make a diagnosis of FM by assessing
your pain and taking note of symptoms that are
present. He or she may also ask additional questions
about symptoms that may not be present, perform an
examination and may conduct testing, such as blood
tests or X-rays depending on the clinical findings.
Why is treatment for fibromyalgia so
important?
Although there is no single treatment that works for
everyone, over time most people with FM will discover,
with the help of their health-care team, what offers
them the best relief. Often, medications will only
provide modest relief from symptoms. However, good
health-related practices
such as regular physical
activity, keeping a routine
and pacing and controlling
stress can all help improve
FM symptoms. Eliminating
all symptoms is rarely
achieved; therefore the
aim of a treatment plan
should be to improve
your symptoms as best
as possible so that you
continue leading an active
and enjoyable life.
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Body parts affected by fibromyalgia
Fibromyalgia is a disease that causes pain
and tender points throughout the body. Areas
commonly affected include:
•
•
•
•
•
•
•
Neck
Back
Chest
Elbows
Hips
Buttocks
Knees
Risk factors
Research has not yet identified the exact cause of
fibromyalgia (FM). It can occur on its own, but links
have also been made to
the following factors:
Age:People between
the ages of 20 and 50
years old are most at
risk of developing FM.
Gender:Of those living
with FM, 80 to 90 per
cent are women.
Family History:
People who have a
family member with FM may be more likely to have the
condition themselves.
Rheumatic disease:Those who have an existing
rheumatic disease, such as rheumatoid arthritis (RA),
ankylosing spondylitis or lupus, may be more likely
to develop FM.
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There is no single treatment that works for everyone.
Over time, most people with FM will find the balance
of treatments that gives them the best relief. Your first
important step is to become an active participant in
your treatment and develop coping strategies to manage
your FM. It is also important to learn more about your
condition and share that information with family and
friends, so they can better understand what you’re
experiencing and how it affects you.
Non-medication therapies, such as physical activity
(walking, low-impact aerobic programs, yoga, tai chi,
aquatic programs, using an exercise bike or treadmill),
stress management and relaxation techniques, are a
very important part of treating FM. It is important
to note that comfortable physical activity is good for
your overall health and will not cause you harm. You
can also try keeping
a diary over several
weeks to encourage you
to keep up a regular
routine. This can help
to keep track of the
connection between
your FM symptoms and
your daily activities,
which can help you
manage your FM.
Sleeping
Fatigue is a key symptom of FM, so getting enough and
proper sleep is important when it comes to managing
your condition. Sleep can not only ease fatigue, but
also the pain of FM. It is also important that you do not
spend extended hours in bed as too much rest and sleep
can also be harmful. Finding the right balance is key.
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Tips to help you get a good night’s rest:
• Avoid caffeine in the evening (e.g., soft drinks,
alcohol, coffee, caffeinated tea)
• Avoid watching TV or using electronic devices,
such as mobile devices and laptops, late at night
• Set a regular routine to help you wind down before
bedtime
• Go to bed and wake up at the same time each day
• Ensure your bedroom is dark, quiet and a
comfortable temperature
• Avoid smoking
Physical activity
Although pain and
fatigue can make
exercise difficult, it
is important to be as
physically active as
possible. Research
shows that regular
physical activity is one
of the most effective
treatments for FM.
Although pain and
fatigue can make exercise
difficult, it is important
to be as physically active
as possible. Research
shows that regular
physical activity is one
of the most effective
treatments for FM.
An exercise program
designed for you
with advice from a
health-care provider,
such as a physician
or a physiotherapist/
occupational therapist,
is ideal. However,
participation in
community-based
programs that
are comfortable is
sufficient. Regular
physical activity can
reduce pain and fatigue, improve mobility and sleep
issues as well as alleviate depression. Overall, it can
help someone with FM to lead a more productive and
enjoyable life.
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People living with fibromyalgia may experience muscle
stiffness. A common misconception is that this tension
will be reduced by rest. On the contrary, inactivity
can cause muscle weakness and worsening stiffness.
(However, it is important to always listen to your body
and if you are in a lot of pain, reduce or only perform
light range of motion exercise).
There are different types of exercises you can do to
lessen your pain and stiffness:
Range of motion (also called stretching or flexibility
exercises):To achieve the most benefit, these exercises
should be done daily. Also, visit arthritis.ca/videos to
view our “Simple Stretches” video.
Strengthening:Exercises that maintain or increase
muscle tone. These exercises include weight training
movements done with a set of “free” weights, your own
body weight or weight machines.
Endurance:Exercises that strengthen your heart, give
you energy, control your weight and help improve
your overall health. These exercises include walking,
swimming and cycling. It is best to avoid high-impact
exercises like step aerobics, jogging or kickboxing
unless you are very well-conditioned.
There are many low-impact exercise options that can
benefit people living with fibromyalgia. Consult your
health-care provider to find exercises that are suitable to
you and your particular condition.
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Examples include:
Tai chi:Tai chi, an ancient Chinese martial art, is
a combination of movements performed in a slow,
focused manner. Though it has many variations and
styles, tai chi is a low-impact exercise and is reminiscent
of both yoga and meditation. Tai chi could improve
pain and physical function in some people as well as
alleviate depression and contribute to health-related
quality of life.
Yoga:Numerous studies have been done on the benefits
of yoga for people living with fibromyalgia. The practice
of breath control, simple meditation and stretching can
improve a person’s state of mind and help them better
manage their pain. Regular yoga under the guidance of
a certified instructor can also boost one’s general health
and increase energy levels.
NOTE: People living with fibromyalgia should avoid strenuous
yoga routines, such as Bikram and power yoga, unless they are
very well-conditioned.
Water and aerobic exercise:Water exercises, such as
swimming and water aerobics, are excellent for people
living with FM and
suitable for all ages and
fitness levels. Water can
help you move in ways
that would otherwise
be painful. Other lowimpact aerobic exercises
that can get your heart
pumping include biking
and walking. All these
exercises can help
improve your sleep,
keep weight under control and help to alleviate stress
and depression that is sometimes linked to FM.
NOTE: For more exercise tips, check out our Physical Activity
and
Arthritis guide, available at arthritis.ca/publications.
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Healthy eating
Although no specific diet has been proven to help FM,
healthy eating will give you the energy to complete your
daily activities, as well as contribute to a strong immune
system, bone and tissue health.
Three ways to improve your nutrition include:
1.Reduce sugar intake:Sugar added to foods
contributes calories, but few other nutritional
benefits. This refers to white, brown, cane and raw
sugar as well as syrup and honey. Use dried fruits
like raisins or dates to sweeten food since they
provide vitamins, minerals and fibre.
2.Eat more vegetables and fruit:Vegetables and fruit
should make up the largest part of your diet. Try
to have at least one vegetable or fruit at every meal
and as a snack. Besides being an excellent source of
energy, vegetables and fruit boost your fibre intake,
which in addition to whole grains are filling and
help control how much you eat.
3.Choose “healthy fats”:The type and amount of
fat you eat is important. You need some fat in your
diet, but too much can be bad for your health. Fat is
high in calories and some types of fat (saturated and
trans fats) may increase risk of developing factors
that may lead to heart disease. Polyunsaturated
and monounsaturated fats are recommended as the
main source of fat in your diet. Monounsaturated
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fat is found
naturally in olive
and canola oil,
avocados and nuts
like almonds,
pistachios
and cashews.
Polyunsaturated
fats, especially
omega-3 and
omega-6 fatty
acids, can be
Healthy eating will
found in coldgive you the energy to
water fish (e.g.,
char, mackerel,
complete your daily
salmon and
trout), walnuts,
activities as well as
sunflower seeds
contribute to a strong
and flaxseeds. Try
not to eat trans
immune system, and
fats, which are
bone and tissue health.
found in fried and
processed foods,
and saturated fats, which mainly come from animal
sources of food, such as red meat, poultry and
full-fat dairy products. (Tip: Choose healthier dairy
products (e.g., skim, 1 or 2% milk, low-fat yogurt
and less than 20 per cent milk fat (M.F.) for cheese).
NOTE: For more healthy eating tips, check out our guide to
Nutrition
and Arthritis, available at arthritis.ca/publications.
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Complementary therapy
People with a chronic disease like fibromyalgia may
decide to try complementary and alternative therapies to
help them manage the symptoms of their condition.
Before you try any of these treatments, always inform
your health-care provider of any complementary and
alternative therapies you are taking, receiving or would
like to try. Your health-care provider can offer valuable
advice about these treatments, especially how they may
affect other medications and treatments.
Acupuncture
Acupuncture, an ancient Chinese therapy, involves
pricking the skin or tissues with needles to alleviate
pain and treat various physical and mental health
conditions. While studies on the effectiveness of
acupuncture for fibromyalgia show somewhat mixed
results, you may wish to try it. It is important to find a
certified practitioner.
Physiotherapy
Physiotherapy is a science-based practice that aims
to enhance or restore function of different systems
of the body. Physiotherapists are trained to diagnose
musculoskeletal complaints and are able to plan a
treatment for joint and muscle problems using physical
remedies, such as massage, specialized exercise
programs, stretching,
hydrotherapy,
breathing techniques,
etc. These treatments
can help relieve pain,
improve posture and
strength and allow
you to become more
independent and
active over time.
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Occupational therapy
Occupational therapy is a form of therapy for those
recuperating from physical or mental illness. It
encourages rehabilitation through the performance of
day-to-day activities. For instance, an occupational
therapist may offer you guidance on how to pace
yourself, change the way you work, modify your
environment and/or use labour-saving gadgets.
Massage
Massaging of muscles and other soft tissues by a
professional massage therapist may lead to a shortterm decrease in stiffness and pain. Other benefits may
include a reduction in stress and anxiety as well as
improved sleep patterns.
Meditation
Meditation is a
mind-body practice
intended to quiet the
mind by focusing on
your breathing. Some
studies have found
that meditation, if
practiced regularly, can
ease pain and anxiety
in individuals with
fibromyalgia. It can also offer people a heightened sense
of calmness and control.
NOTE: For more information on complementary therapy, check
out
Complementary and Alternative Therapies, available at
arthritis.ca/publications.
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What medications are used for fibromyalgia?
Unfortunately, there is no single medication that
works extremely well for all people living with FM.
The medication treatment of FM is best understood
as “symptom-based” care. This means that you and
your doctor should identify the symptoms that cause
you greatest distress, keeping in mind that the key
symptoms of FM are pain, sleep disturbance, mood
disorder and fatigue. There are medications available for
the management of the first three symptoms, but as yet
there is no recommended treatment for fatigue.
Often treatment for FM is given on a trial basis. It is
important for you and your doctor to decide whether a
new medication has indeed had a sufficiently positive
effect to justify continuing the treatment. If the positive
effect is only minimal or if there are side effects of the
medication, then it is best advised that the medication
should be discontinued.
Only two medications have been formally approved
by Health Canada for treating the symptoms of FM:
pregabalin (an anti-convulsant drug) and duloxetine
(a drug with anti-depressant properties). However, a
number of established medications that are designed
for other health conditions are sometimes prescribed by
doctors for use in helping to manage FM symptoms: this
is called “off-label” use. Please discuss the use of any
medication with your health-care provider.
Pain-relieving medications
Pain-relieving medications called analgesics are used
either periodically or on a more regular basis by most
people with FM.
Acetaminophen is considered a mild analgesic and often
takes the edge off pain. This medication should however
be used at the lowest dose for as short a period of time
as possible, as long-term use may have a potentially
serious negative effect on liver function.
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Stronger painkillers, in the category of opioid
medications, should only be considered for use in the
most severe situations, and
other than tramadol are
generally not recommended
to be used by persons
with FM. Many questions
remain regarding the safety
of opioids in the long term.
If you’re using an opioid
to treat the pain of FM,
it is important to ensure
that the benefit of pain
relief is not outweighed by
negative side effects, such
as drowsiness, difficulty
concentrating and thinking,
sleep disturbance, nausea,
loss of appetite and
constipation. To justify
The medication
continued treatment with
an opioid, there should
treatment of FM
be both improvement in
is best understood
pain, as well as a clear
improvement in function.
Anti-convulsant
medications
as “symptom-based”
care. You and your
doctor should identify
the symptoms that
cause you greatest
distress.
This category of
medications reduces pain by
cooling down the activity
of nerves that are fired
up. They work similarly
to a dimmer switch for
a light bulb. The most common anti-convulsant
medications used in fibromyalgia are gabapentin and
pregabalin. Both are considered safe medications that
avoid significant side effects on major organs (such
as stomach, liver or kidneys). The most common side
effect of this category of medications is sleepiness.
This can be an advantage when the medication is
used at night and may help sleep disturbance, but
can be troublesome during the day. If combined with
alcohol or tranquilizers, however, the negative effect
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of unsteadiness or sleepiness may be exaggerated and
could lead to harm.
Anti-depressant medications
Anti-depressant medications can be used to control pain
and have shown success in treating FM. This group of
medications act on pain by boosting the body’s natural
mechanisms that reduce pain. Tricyclic anti-depressants
were the first drug treatments recommended for the
treatment of FM, and still remain a useful drug for
some. They may help sleep as well as pain, have been
used for many years and are relatively inexpensive.
Newer anti-depressants belong to the group of serotonin
norepinephrine reuptake inhibitors (SNRIs). Studies
to date report that they may have some modest effect
on pain, fatigue and mood in some people with FM.
Duloxetine falls into this category.
Many people with FM also experience symptoms of
depression or anxiety, and in this case when these
symptoms are sufficiently severe to affect wellbeing, your doctor may decide to prescribe a specific
medication to improve your mood. Depending on the
anti-depressant medication chosen, there may be the
added effect of calming anxiety, promoting sleep or
improving energy.
NOTE: For more information on arthritis medications, check out
Arthritis
Medications: A Reference Guide, available at
arthritis.ca/publications.
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About The Arthritis Society
The Arthritis Society has been setting lives in motion
for over 65 years. Dedicated to a vision of living well
while creating a future without arthritis, The Society is
Canada’s principal health charity providing education,
programs and support to the over 4.6 million Canadians
living with arthritis. Since its founding in 1948,
The Society has been
the largest nongovernment funder
of arthritis research
in Canada, investing
over $190 million
in projects that have
led to breakthroughs
in the diagnosis,
treatment and care of
people with arthritis.
Become a Volunteer
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How We Can Help
The Arthritis Society offers free education, programs
and support to Canadians living with arthritis.
• Programs and services: Join us for adult and child
educational sessions, such as the Chronic Pain
Management Workshop (arthritis.ca/cpmw) and
various public forums.
• Online self-management courses: Try e-learning
programs like You and Your Health-Care Provider:
A Guide for Effective Conversations and Overcome
Fatigue (arthritis.ca/education).
• Publications: We publish several information
booklets to help people living with arthritis
understand more about their condition and
treatment options as well as tips on how to selfmanage. For a list of arthritis conditions and related
resource materials, including a digital copy of this
information, visit arthritis.ca/publications.
Learn more and connect with our
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