Fibromyalgia is one of the more mysterious and controversial diagnoses that exist in modern medicine. Doctors and scientists debate about many issues related to this diagnosis: is fibromyalgia real? What is the origin of fibromyalgia pain? How should doctors approach fibromyalgia treatment? Now, emerging scientific research has improved our understanding of fibromyalgia, pain, and how it affects your sleep.
What Is Fibromyalgia?
The first description of fibromyalgia came from Sir William Gowers in 1904 (Inanici & Yunus, 2004). Gowers described a syndrome in which fibrous tissue becomes inflamed, leading to low back pain. He dubbed this phenomenon “fibrositis.” This term persisted until 1976, when research on patients with widespread pain, tender points, and sleep disruption led to the scientific community labeling the syndrome “fibromyalgia.” However, the term has been mired in controversy ever since its inception. This is because the precise underlying causes of fibromyalgia are unknown. It was not until 1990 that the American College of Rheumatology published official criteria for the diagnosis of fibromyalgia. Even now, some scientists and doctors are skeptical about the diagnosis.
Fibromyalgia is characterized by a diffuse set of symptoms that center around pain. These include:
Widespread pain. Many patients with fibromyalgia describe the pain as a continuous dull ache. However, pain may also be deep, radiating, shooting, or causing tenderness. For the pain to be considered part of fibromyalgia, it must have occurred for at least three months and cannot be related to another medical condition (for instance, chronic low back pain because of an injury). Furthermore, fibromyalgia pain is typically widespread. This means that it occurs on both sides of the body, involving multiple body regions above and below the waist.
Chronic fatigue, even if getting the recommended number of hours of sleep
Sleep difficulties, including the presence of sleep disorders such as restless legs syndrome or sleep apnea
Cognitive difficulties, sometimes called “fibro fog.” This may include difficulty paying attention and concentrating on tasks that require mental effort.
Migraines or painful headaches
Depression or anxiety
Is Fibromyalgia Real?
So, is fibromyalgia real? The short answer is yes. People with fibromyalgia are undeniably experiencing pain, sleep disturbance, and cognitive symptoms. The idea that pain is “just in your head” or “not really happening” is misleading and damaging for patients. It is important for the medical community to affirm that these individuals are dealing with a painful, often debilitating condition that may significantly affect their quality of life.
Part of the controversy about whether fibromyalgia is real is due to a lack of information about its underlying causes. Despite decades of research into the area, no precise cause or causes of fibromyalgia have been identified (Erlich, 2003).
Genetic factors, a history of infections, repetitive injuries, or undergoing a physically or emotionally traumatic event can all increase your risk of developing fibromyalgia. One theory is that certain genes make patients with fibromyalgia more sensitive to stimuli that other individuals would not register as painful. Thus, the brain or spinal cord may process pain differently, leading to symptoms of fibromyalgia. How the cognitive and sleep disturbances fit into this theory is as-yet unknown.
One other possibility is that psychological factors, such as depressed mood, anxiety, or emotional trauma may alter the way the body experiences pain. Individuals with fibromyalgia are significantly more likely to report these psychological difficulties.
This is not to say that fibromyalgia pain is “in your head”; rather, it suggests that the effects of pain may be magnified in certain people experiencing psychological distress. Scientific research has already established that conditions such as depression can affect how people process pain signals (Bair et al., 2003). Research is ongoing to determine if fibromyalgia may be triggered or exacerbated by these psychological factors.
Fibromyalgia and Its Effects On Your Sleep
Sleep disturbance is one of the core clinical features of fibromyalgia. Indeed, sleep disturbances observed on electroencephalogram were first characterized in 1975, before the diagnosis became widespread (Inanici & Yunus, 2004). How these sleep difficulties manifest can vary from person to person. However, the most commonly reported problems include:
Difficulty falling asleep
Frequently awakening from sleep, often because of pain
Feeling unrested in the morning, despite getting enough sleep
Sleep apnea. Sleep apnea is a condition in which the brain does not get enough oxygen during sleep. People with fibromyalgia are also more likely to have sleep apnea.
Restless legs syndrome. Patients with fibromyalgia are more likely to experience periodic leg movements that disrupt sleep. These movements are involuntary jerks of the legs, which can make it difficult to fall asleep and stay asleep.
Sleep studies of people with fibromyalgia reveal several differences in how they cycle through various sleep stages. For example, individuals with fibromyalgia sometimes experience alpha-delta sleep pattern, in which alpha waves (which are observed during an awake, alert state) are seen when a person is experiencing deep, delta-wave sleep (Harding, 1998). This results in a larger amount of shallower stage 1 sleep, a reduction in deep sleep, and a larger number of awakenings during the night. These differences in sleep architecture correlate with individuals’ subjective ratings of sleep quality.
The relationship between fibromyalgia pain and sleep appears to be bidirectional. People with fibromyalgia experience chronic pain, making it difficult for them to get to sleep and maintain good quality sleep. Additionally, being sleep deprived magnifies the experience of pain, meaning that pain symptoms become exacerbated the following day. This creates a vicious cycle in which pain fuels sleep problems, and sleep problems fuel pain. Finding effective treatments for fibromyalgia-related sleep difficulties is essential to improving quality of life for people with fibromyalgia.
Treatments for Fibromyalgia and Sleep
Because there is no clinical consensus on the precise underlying causes of fibromyalgia, there is no single recommended treatment protocol. The first step in treating fibromyalgia is employing strategies to help manage pain and sleep problems.
Behavioral interventions can also be very helpful in improving sleep. For instance, cognitive behavioral therapy for insomnia (CBT-I) is an empirically validated treatment that has been shown to be effective in improving sleep quality in a number of patients. A 2014 study found that patients with fibromyalgia who received CBT-I had better outcomes than those who simply received education about sleep hygiene practices. Combining this treatment with pharmaceutical interventions or behavioral strategies for pain management may be effective for people with fibromyalgia.
Furthermore, pain management interventions are also helpful for improving sleep quality. Physical therapy to build strength and flexibility may reduce your pain and help you get to sleep. Additionally, some patients respond to interventions such as acupuncture, massage therapy, yoga, or tai chi. Ask your doctor about these interventions and other lifestyle changes that may be helpful for you.
Medications can be used in conjunction with behavioral strategies to manage pain and sleep symptoms. Doctors often prescribe tricyclic antidepressants and selective serotonin reuptake inhibitors for patients with fibromyalgia. These treatments increase levels of the neurotransmitter serotonin in the brain. As serotonin is involved in regulating sleep and wakefulness, increasing serotonin levels can lead to improvements in sleep quality. Furthermore, antidepressant medications may regulate underlying mood problems that are often seen in fibromyalgia.
Other medications prescribed to treat fibromyalgia include anti-seizure medications. For example, the epilepsy medications gabapentin and pregabalin can be helpful in reducing pain symptoms, which may in turn improve sleep quality.
One of the most important factors in dealing with fibromyalgia is getting an accurate diagnosis. Because of the strong relationship between pain and sleep, it is helpful to work with a Seattle sleep specialist to provide individualized treatment recommendations for you. Ruling out other sleep disorders is an important part of the fibromyalgia diagnostic process.