Fibromyalgia Pain Management

Growing up, Larissa had pneumonia 12 times. No doctor could explain to her mother why she kept getting sick. Then, in her mid-twenties, she had a bout of pneumonia from which she never fully recovered. She started experiencing such intense pain and fatigue that she couldn't get out of bed. 

Larissa was ultimately diagnosed with fibromyalgia, Ehlers-Danlos syndrome, and irritable bowel syndrome (IBS). Over the span of two decades, she tried every traditional and alternative treatment she could find to relieve her symptoms. Sometimes treatments would work for a month or two, but she never found lasting relief. 

In her own words: “Fibromyalgia affects every part of your body and every inch of your life. Sometimes you literally feel like you’re going crazy with the symptoms you have.”

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What is Fibromyalgia?

Fibromyalgia is a condition characterized by widespread muscle pain lasting longer than six months. People with fibromyalgia generally experience pain that migrates across the body, impacting various parts of the body over time. In addition to persistent pain, people with fibromyalgia often experience fatigue, sleep disruption, gastrointestinal issues, anxiety, depression, and “fibro fog” (memory loss and/or lack of concentration).

For many people like Larissa, fibromyalgia frequently presents alongside other illnesses, including chronic fatigue syndrome, rheumatoid arthritis, autoimmune conditions like lupus, irritable bowel syndrome, post-traumatic stress disorder (PTSD), Raynaud’s Syndrome, and others.

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Diagnosing Fibromyalgia

Fibromyalgia is difficult to diagnose because diagnostic assessments like blood tests and x-rays can’t be used to diagnose the condition. Therefore, a fibromyalgia diagnosis must be done by carefully ruling out other possible diagnoses, as well as “ruling in” a fibromyalgia diagnosis through common indicators of the condition.

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Ruling out other diagnoses:

‍To assess if you have fibromyalgia, a medical professional must rule out other conditions that may cause widespread pain and fatigue. Conditions that should be ruled out include rheumatic conditions such as rheumatoid arthritis, neurological conditions such as multiple sclerosis, and other conditions such as anemia and hypothyroidism. If all other conditions have been ruled out, this is a strong indicator that you may indeed have fibromyalgia.

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“Ruling in” fibromyalgia:

In addition to ruling out other conditions, a fibromyalgia diagnosis can be “ruled in” by assessing the following indicators:

• Common symptoms of fibromyalgia: widespread pain, cognitive impairment, and fatigue[a]
• Life history: stressful and/or traumatic events in a person’s past
• Personality traits: traits such as perfectionism, high self-expectations, and selflessness

Any of these indicators are helpful for confirming that a fibromyalgia diagnosis is accurate.

Causes of Fibromyalgia Pain

For many years, the cause of fibromyalgia pain remained uncertain. Recent advances in pain science, however, have led to a better understanding of the causes of fibromyalgia and other chronic pain conditions. Fibromyalgia is now classified as a Chronic Primary Pain condition, a classification with important implications.[1]

Chronic Primary Pain refers to pain that is not caused by structural damage to the body, but rather by sensitization of the nervous system, sometimes referred to as “central sensitization.”[2] To put it simply, fibromyalgia pain is caused by a person’s nervous system being on “high alert,” leading to heightened sensations of pain in the body.

The good news is that Chronic Primary Pain is highly treatable. The new classification of fibromyalgia as a Primary Pain condition suggests that fibromyalgia pain can be greatly reduced through Primary Pain treatment. [b]

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Ways to Treat Fibromyalgia Pain

If you have been diagnosed with fibromyalgia, you will find the best relief by seeking treatment for Primary Pain. An important first step in Primary Pain treatment is pain education: learning how pain works and the role that the brain plays in regulating pain in the body. Primary Pain interventions such as Pain Reprocessing Therapy (PRT), Emotional Awareness and Expression Therapy (EAET), Pain Neuroscience education, and other related therapies can be utilized to reduce fibromyalgia pain. It is worth noting that EAET has been found to be particularly effective in reducing fibromyalgia symptoms[3].

These therapies reduce sensitization of the nervous system through reprocessing pain as non-dangerous, leading to lower pain levels. Essentially, people with fibromyalgia have the pain signalling “volume knob” turned way up, making seemingly neutral sensations feel painful, and making painful sensations extra intense. Primary Pain treatment uses a variety of tools to turn down the pain signalling volume knob.

In addition to Primary Pain interventions, lifestyle choices can have a large impact on fibromyalgia pain. Regular exercise helps drive down pain levels. In addition, identifying sources of stress and taking steps to limit them is beneficial, as stress amplifies pain symptoms. (Think of a headache you may have experienced during a stressful workday, or a stomach ache you may have gotten before an exam or public speaking.)

Pharmacological treatments such as antidepressants and gabapentin may be helpful for reducing fibromyalgia pain. However, pharmacological treatments are considered supplementary to the central treatments of fibromyalgia, which are Primary Pain therapy (such as PRT or EAET) and regular exercise. On their own, medications generally don’t resolve fibromyalgia symptoms.

Finally, any other interventions that you find helpful for your fibromyalgia symptoms can be pursued in tandem with Primary Pain treatment. These may include:

• Biofeedback (learning to self-regulate certain bodily functions like your heart rate and muscle tension to reduce pain)
• Cognitive behavioral therapy (CBT)
• Stress management
• Acupuncture
• Chiropractic sessions and massage
• Yoga, meditation, and tai chi
• Aquatic therapy
• Reiki (energy healing performed by a practitioner)
• Diet changes (incorporating more fruits and vegetables)
• Supplements such as omega-3, magnesium, and vitamin D
• Smoking cessation
• Ozone therapy
• Animal-assisted activity sessions
• Group support classes
• Sleeping well

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Fibromyalgia Pain Can be Successfully Treated

After experiencing pain for more than half of her life, Larissa has finally found relief. Through the Lin Health app, she is utilizing pain neuroscience education (PNE), techniques drawn from Pain Reprocessing Therapy (PRT) and Emotional Awareness and Expression Therapy (EAET), and support from her Lin Health Coach to manage her Fibromyalgia, IBS, and other conditions. She feels “normal”, a word she hasn’t been able to use to describe herself for many years.

Her message to others with fibromyalgia and other chronic conditions? “Unfortunately, fibromyalgia affects every part of your body and every inch of your life. But it doesn’t have to. Lin taught me that.

Just try it. You have nothing to lose, other than pain. If it works, you have the potential for your whole life to change.”