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An Invisible Illness: The Symptoms, Diagnosis and Treatment of Fibromyalgia

Woman with head pain

When patients come in for a first visit and tell me they think they might have fibromyalgia, they’ve often been living with pain and other symptoms for a very long time without knowing the reason. Fibromyalgia is considered an “invisible” disease. It can seem to be a perfect match once someone reads about it online or hears about it from friends or their doctor.

Here I explain the symptoms of fibromyalgia, how it is diagnosed and treatment options that can help.

What is fibromyalgia?

Fibromyalgia describes pain throughout the body, plus chronic fatigue. It causes sensitivity in the nerves.  Research has shown abnormal signals in the brains of people who have the disease. Women are affected twice as much as men.

What are the symptoms of fibromyalgia?

People with fibromyalgia often experience headaches and brain fog; sensitivity to light, odor, noise and medications; bladder irritation; irritable bowel syndrome; and depression. Some patients have chronic severe dry eye but produce tears normally, which could mean that fibromyalgia affects how the eyes perceive sensation. Others may endure body and joint pain, such temporomandibular joint disorder (pain in the jaw).

How is fibromyalgia diagnosed?

We try to confirm the diagnosis by reviewing the symptoms and ruling out other similar conditions.

About 25 percent of people with rheumatological autoimmune diseases, such as lupus, also have fibromyalgia. Rheumatologic diseases generate pain, sending pain signals to the brain through nerve fibers. Repetitive stimulation of these nerve fibers leads to central sensitization, increasing the perception of pain.

This so-called “bottom-up” mechanism for fibromyalgia applies to a lot of our rheumatology patients. That’s why we recommend every patient with fibromyalgia be checked for other rheumatologic autoimmune diseases to ensure that fibromyalgia is not just a symptom of a broader condition.

Conditions such as rheumatoid arthritis, Sjogren’s syndrome and lupus are more obvious to identify. But it’s important to screen specifically for conditions such as psoriatic arthritis and seronegative spondylarthritis, as they don’t show up on a blood test.

How is fibromyalgia treated?

Treatment for fibromyalgia depends on what the cause is. Treating the underlying inflammatory disease is key.

Medication options include tricyclic antidepressant agents, or TCAs, serotonin or serotonin/norepinephrine re-uptake inhibitors and anticonvulsant drugs such as pregabalin, duloxetine, and milnacipran. Cyclobenzaprine, a muscle relaxant, appears to have a good effect on fibromyalgia. Low-dose naltrexone has some value as well. Opioids are not effective in fibromyalgia, as chronic pain stimulates the production of endogenous opioids, which occupy receptors.

While we use medications to control the symptoms of fibromyalgia, lifestyle and mindset changes can be even more beneficial. Maintaining a clean diet is an important first step, and regular exercise is essential. Restorative yoga and cognitive behavioral therapy can also help. Acupuncture, massage and meditation can be valuable. Keeping a journal to write down symptoms and positive thoughts is also a good strategy.

I find the biggest challenge for patients with fibromyalgia is that people around them may find it difficult to understand what they are experiencing. Patients will often appear to be normal and healthy-looking on the outside when in actuality they are living with chronic pain. My final piece of advice is to be open with friends and family. By sharing and connecting, patients will no longer feel alone and misunderstood.

Dr. Weijia Yuan, rheumatologist

Dr. Weijia Yuan is a rheumatologist who specializes in treating patients in an undifferentiated state, and those who have trouble identifying their illness due to the nature of autoimmune diseases. She has adopted a holistic approach to treatments that look at the mind-body as a whole and has seen much success in patients who modify their lifestyle to address the root cause of their disease. Dr. Yuan practices at the HSS main campus in New York City.



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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.