Functional Medicine for Fibromyalgia

What is fibromyalgia?

Fibromyalgia is a chronic (long-lasting) disorder that causes pain and tenderness throughout the body, as well as fatigue and trouble sleeping. People with fibromyalgia have an increased sensitivity to pain, so they feel pain when others do not.¹

Fibromyalgia is not a form of arthritis. It is not an inflammatory or autoimmune disease either. The pain may feel like it comes from the joints, but the joints are not damaged.^{3, 4, 6}

Fibromyalgia affects 2% to 4% of people, usually women. Anyone can get it, even children. It usually starts in middle age, and the chance of having it goes up as you get older. It occurs in people of all racial and ethnic backgrounds.^{1, 3}

You may be more likely to have fibromyalgia if you have other conditions, especially rheumatic diseases, mood disorders, or conditions that cause pain. These include rheumatoid arthritis, lupus, depression, anxiety, chronic back pain and irritable bowel syndrome.¹

The cause of fibromyalgia is not known. It tends to run in families, so genes likely play a part. Researchers believe things outside your genes also play a role. These may include having a disease that causes pain, or mental health problems such as anxiety or depression. Other possible triggers include physical or emotional trauma, sleep problems and infections, such as a virus. But no specific infection has been identified.^{1, 4}

Researchers think fibromyalgia comes from a problem with how the central nervous system (the brain and spinal cord) processes pain signals. Brain imaging and other studies have found changes in the nerve pathways that send and receive pain signals.^{1, 4, 7}

One idea that helps explain this is central sensitization. It means the brain and spinal cord amplify, or turn up the volume on, pain signals. Pain can then feel stronger, last longer and spread wider than the cause would normally explain. Studies suggest central sensitization plays an important part in fibromyalgia pain. These nervous system changes may also add to the fatigue, sleep troubles and "fibro fog" that many people with fibromyalgia have.^{1, 5}

Common symptoms of fibromyalgia

Fibromyalgia symptoms are different for each person. The main symptom is chronic, widespread pain throughout the body or in many areas. It is often felt in the arms, legs, head, chest, belly, back and buttocks. People often describe it as aching, burning or throbbing.^{1, 3}

Pain may get worse with physical activity, cold or damp weather, and anxiety and stress. Other symptoms may include:^{1, 4}

• Fatigue, or an overwhelming feeling of being tired¹
• Trouble sleeping, or not feeling refreshed after sleeping all night^{1, 3}
• Muscle and joint stiffness¹
• Tenderness to touch¹
• Numbness or tingling in the arms and legs¹
• Problems with concentrating, thinking clearly and memory, sometimes called "fibro fog"¹
• More sensitivity to light, noise, odors and temperature¹
• Digestive issues, such as bloating or constipation¹
• Migraines or tension headaches³
• Depression or anxiety³
• Bladder problems or pelvic pain³

How fibromyalgia is diagnosed and treated

There are no specific lab or imaging tests for fibromyalgia. It is diagnosed mainly by having pain all over the body, along with other symptoms. To be diagnosed, you must have had widespread pain for at least 3 months, along with one or more of these: ongoing sleep problems, fatigue, or thinking or memory problems.^{2, 4}

Pain and fatigue are common in many conditions, so doctors usually try to rule out other causes. Your doctor will likely ask where your pain is, how bad it is and how long it has lasted. They will also examine your joints to check for other conditions, such as rheumatoid arthritis or lupus. Fibromyalgia does not cause any changes on blood tests or x-rays. But these tests can help check for other causes, such as thyroid problems or diseases driven by inflammation.^{2, 3}

There is no cure, so treatment focuses on relieving symptoms. Exercise is a key part of treatment, and even modest amounts help. It is best to start at a low level and build up slowly. Low-impact activities, such as walking, biking, swimming and water exercise, are especially helpful. Yoga and tai chi are also helpful.²

Cognitive behavioral therapy can help, especially along with other treatments. It is a type of counseling that teaches skills to better control pain. Your doctor may also prescribe medicines to ease pain and improve sleep, such as certain antidepressants or anti-seizure medicines. The U.S. Food and Drug Administration (FDA) has approved three medicines for fibromyalgia. You may need to try different medicines before finding relief, and improvement is often gradual.^{2, 3}

Opioids are not recommended for fibromyalgia. Anti-inflammatory pain medicines usually do not help, because fibromyalgia does not cause tissue inflammation.^{2, 3}

Most people with fibromyalgia are cared for by their primary care provider. Rheumatologists (doctors who specialize in arthritis and other diseases of the bones, joints and muscles) also treat it. Care often takes a team, which may include physical therapists, mental health professionals, pain specialists and sleep specialists.²

How our care fits alongside your rheumatologist

Avicenna Functional Medicine does not replace your rheumatologist, your primary care doctor, or the treatment they prescribe. Our role is to add to your care, not to take its place.

In a functional medicine visit, we look at factors that may contribute, such as nutrient status, gut health, sleep, stress and nervous system regulation, alongside the care you already receive. It has been suggested that low vitamin D might worsen fibromyalgia symptoms. Researchers are also studying whether low magnesium plays a part. Digestive problems, such as irritable bowel syndrome, are among the other signs of fibromyalgia. Anxiety and stress can make fibromyalgia pain worse.^{3, 4, 6}

Please do not stop or change any prescribed medication without talking to the doctor who prescribed it. Some supplements studied for fibromyalgia may have side effects or interact with medicines. Even vitamins and minerals can be harmful in large amounts. Check with your doctor before starting anything new.^{2, 6}

What to expect at Avicenna

All visits are by telehealth, for patients located in Florida and Texas. We are a cash-pay practice, and we accept HSA and FSA. Care usually follows these steps:

• A free, 30-minute discovery call to talk about your health and whether our approach is a good fit for you
• A full intake visit with our health coach, under clinician supervision, covering your history, symptoms, current treatment and goals
• Testing chosen for you, where it is likely to be useful
• A personalized plan, with follow-up visits to review how you are doing and adjust the plan as needed

When to get urgent care

Contact your doctor if you have symptoms of fibromyalgia. Fibromyalgia often occurs with rheumatic diseases, and it can make them harder to diagnose and treat. Some people with fibromyalgia have other diseases at the same time, so tell your rheumatologist about any new or changing symptoms.^{2, 4}

Depression and anxiety are often present in people with fibromyalgia. If emotional problems come up, see a mental health professional.^{2, 4}

Telehealth visits with our team are not for emergencies. Call 911 right away if you have warning signs of a medical emergency, such as:⁸

• Chest pain or pressure that lasts two minutes or more⁸
• Trouble breathing or shortness of breath⁸
• Sudden confusion, unusual behavior or trouble waking up⁸
• Fainting or passing out⁸
• Sudden dizziness, weakness or changes in vision⁸
• Being unable to speak⁸
• Severe belly pain, or sudden severe pain anywhere in the body⁸
• Coughing up or vomiting blood⁸
• Thoughts of suicide or of harming someone else (you can also call or text 988)⁸