#2 Fibromyalgia symptoms – part 1 - PainAug 13, 2021
Tears are one of the most common reactions I get from discussing fibromyalgia with my patients. Tears of relief that there is an answer. Tears of joy that they do not have an autoimmune condition like lupus or RA. Tears of disbelief; they waited 6-8 months to see me to learn they have fibromyalgia. Tears of anger that the diagnosis is not what they expected or wanted. Tears of defeat after learning that this will be a lifelong condition. Or tears of disappointment because no pill can get them feeling better.
Regardless of the cause of these tears, one thing I know, my patients want to feel better. Patients with fibromyalgia do not feel well. The pain in fibromyalgia is widespread or diffuse (all over pain).
The pattern of pain in fibromyalgia is distinct from the pain of degenerative arthritis or RA. Pattern recognition is part of my daily medical practice. Through listening, observation, and careful examination, I can distinguish a variety of painful conditions.
To diagnose fibromyalgia, the pain should be felt in 4 out of 5 body areas – upper and lower parts and left and right, excluding abdomen and face. The 5th area can be the abdomen, chest, neck, upper and lower back. The pain should be present for at least three months at similar intensity. It can come and go or be persistent and may move from one area to another. I often hear that “everything hurts”: joints, muscles, skin, and even hair/scalp. Some feel like they have the flu – body aches and feeling run down. Some describe the feeling of pain as if they “were run over by a truck”. Numbness and tingling can accompany pain, but typically, unlike in neuropathy, it is episodic, random, and can move around the body. Some patients have tender “points” (places that feel tender when pressed), some feel knots or tense muscles, but the tender point count is no longer required for the diagnosis. The joint pain is never inflammatory – no swelling, warmth, or redness. The joints may be painful, tender to touch, stiff, tight, or puffy. When I examine the joints, there is no swelling, even if the patient describes the tightness or perceived swelling.
There are other types of pains in fibro. Tension headaches and migraines are common. These can precede the diagnosis or develop over time. Stress, poor sleep quality and erratic sleep schedule, neck muscle tension, excess caffeine use due to fatigue and frequent use of pain medications are typical headache triggers.
Chest pain is also frequent. It can be described as chest tightness, tension or pain of the rib joints and muscles.
My patients often tell me that they have “good” and “bad” days when it comes to pain.
When it is a good day, they feel nearly “normal”. There is no pain or mild or tolerable pain. They can function. They try to do activities they could not do the day before, when the pain was significant. This feeling of normalcy can last hours to days.
At random, like a flipped light switch, pain increases. It is often triggered by stress, poor sleep, or weather. It is random, but over time some patients may figure out a pattern. The pain incapacitates and quickly changes a “good” day to a “bad” day.
If fibromyalgia is left untreated, patients have fewer and fewer “good” days. Some tell me they have “bad” days and “worse” days.
Next week, I will review additional fibromyalgia symptoms.
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