Jenny L. F. Andrus, MD
Fibromyalgia syndrome (FMS) can be a confusing and frightening diagnosis. Patients often get this diagnosis after having been seen by many different specialists. They’re often confused and frustrated by the lack of clarity surrounding the cause or the treatment.
This diagnosis is more of a description of your problem rather than an explanation of the cause. Although some symptoms can be the same, there are many unique symptoms of different origins which may be present in patients with the same diagnosis of FMS. The diagnosis of FMS is made after excluding other identifiable causes. It may be a diagnosis given to you in addition to other painful conditions, like osteoarthritis or spinal stenosis.
There are many different theories about what causes FMS. Some research suggests that it\’s the result of central sensitization in the brain and spinal cord. This results in dysregulation of the nervous system causing inappropriate pain signals to be sent to the brain. There’s research which points to a potential genetic component and some studies show that early life trauma and mood disturbances may predispose some patients to develop chronic pain.
FMS appears to be more of a dysfunctional problem. That means that there’s likely not a specific abnormality but that the nervous system is not processing information correctly. What causes this to happen is up for debate and even how it happens is a topic of controversy.
Like many disorders such as osteoarthritis, diabetes and hypertension, the foundation of treatment is self-care. For instance, if you have diabetes, it doesn’t matter what medications you are on, if you eat sugar all day, your blood sugar won’t be well controlled. This pertains to chronic pain as well. Although there are many things I can do for you medically, the very best treatment for FMS is self-care. Exercise and stress management are the absolute fundamentals of treatment. Often patients say they can\’t exercise due to pain or have no control over their stress. My goal is to help you find alternatives and guide you through this process take charge of your pain.
Stress and anxiety are commonly seen in those patients with chronic pain. Depression and mood disorders are often seen in those with FMS. Failure to treat these issues usually results in very poor outcomes for our patients. Sometimes, patients say that if we could just make their pain go away they would not have depression. Unfortunately, in FMS, it’s not that simple. Cognitive behavioral therapy and mindfulness have the potential to be very helpful. Dr. Emily Ludwig, Pain Psychologist at OSC, is an expert in cognitive behavior therapy and mindfulness, specifically related to chronic pain. Referral to a psychologist for assistance in managing symptoms does not mean you\’re crazy or making up your symptoms. Psychological support is significantly helpful in managing pain and improving quality of life.
There is much information online about FMS. You must be careful with what you read online and in blogs or group chats about treatment options. Much of this information has very limited to no research to back it and no information on safety. The American College of Rheumatology is a good source for further information.