Fibromyalgia is a chronic rheumatologic condition associated with pain in the body’s connective tissue (ligaments, tendons, and muscles). It is not a form of arthritis, and no joint deformities are associated with fibromyalgia like those observed in rheumatoid arthritis. Fibromyalgia is not a progressive disease, nor is it fatal. Symptoms may remit for periods of months or years.

While symptoms vary from patient to patient who has been diagnosed with fibromyalgia, one of the most common symptoms seen in the majority of patients is fatigue.  Sadly, it seems that fatigue and fibromyalgia go hand in hand.  And this fatigue can often be one of the most devastating symptoms of the disease.

Several of the other common symptoms each have a relationship to fatigue.  Symptoms such as chronic pain, irritability, and a variety of sleep disorders all contribute to that feeling of fatigue.  Often, when discussing fatigue and fibromyalgia with patients, we wonder which came first…the fatigue or the other symptoms.

There are some quick facts that one needs to keep in mind whenever one comes in contact with the individuals who have this condition.

Fibromyalgia is a chronic condition causing pain, stiffness, and tenderness of the muscles, tendons, and joints. Fibromyalgia is also characterized by restless sleep, awakening feeling tired, fatigue, anxiety, and depression.

As we can imagine, with chronic pain, one has problems with sleep.  And those problems merely exasperate the feeling of fatigue.  The pain adds to that burden on fatigue, making both feed off one another.

The cause of the association of fatigue and fibromyalgia is not completely understood. Several researchers have found elevated levels of a nerve chemical signal, called substance P, and nerve growth factors in the spinal fluid of fibromyalgia patients. Likewise, it has been shown that levels of the brain chemical serotonin are also relatively low in patients with fibromyalgia. There have been studies that this low serotonin level is strongly associated with fatigue and fibromyalgia.

Also, patients with fibromyalgia have an impaired non-Rapid-Eye-Movement, or non-REM, sleep phase (which likely, at least in part, explains the common feature of waking up fatigued and unrefreshed in these patients). The impairment of this important part of the sleep cycle is another contributing factor to the feeling of fatigue.

Finally, there is a great deal of stress for those suffering from fibromyalgia.  Chronic pain and fatigue cause that stress, and in turn the stress results in ever increasing feelings of fatigue.

The key to breaking this cycle is to remove one of its components.  I’ve had success with my patients by introducing a multi-faceted approach to the disease that includes stress reduction; movement therapy; better dietary practice; and some supplements.  Together these lifestyle changes begin to minimize several of the individual components that lead to fatigue, and allow the fibromyalgia sufferer to live better with her illness.

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