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.

Understanding your condition is extremely important.  You will find that you will live better with fibromyalgia when you take the time to become comfortable with the main aspects and anatomy of the condition. Do not be afraid of fibromyalgia. At first, the severity of pain is very scary and frustrating. However, it is very important that calmness prevails because anxiety will only make the pain and your sleep patterns worse. People do not usually die of fibromyalgia; they often only wish they did.

Fibromyalgia exercise can really do a lot to help you live better with the disease.  Learn as much as you can about stretching, physiotherapy and other self-help therapies. If you are suffering from a chronic pain syndrome, do not test the limits of the condition by over-exercising or doing tasks that you know are going to cause you more pain later. Pace yourself and attempt to reduce injury and pain. Do, however, try to avoid being a couch potato.  In fact, your condition can worsen if you shy away from activity.

Begin with a good, comprehensive stretching program like my movement therapy videos.

But remember – Going SLOW is the rule of the game. Learn to become aware of your limits.  You will want to push yourself, because while you are moving it will begin to feel good.  But you can damage your progress by pushing too hard.  Be cognizant of how you feel during your stretching and movement; and keep track of how you feel several minutes after your stretching and movement exercise session.

Research physiotherapy professionals in your area and find out who is respected. Someone who has the time and patience to help a fibromyalgic is very important. Fibromyalgia exercise under the guidance of a skilled physiotherapist can help you gain flexibility, reduce stress, and just plain feel better.

Within the area of physiotherapy there are numerous tools such as “cold laser”, traditional ultrasound, and a new powerful focused ultrasound that can break muscle scarring. Manipulation, stretching and traction can be helpful but are often a little too painful for the fibromyalgic in the early stages of therapy. A skilled professional can help to create the program that you will most benefit from participating.

The symptoms of fibromyalgia in therapy are best treated by a combination of the following:

• reassurance and education about the condition
• moderate aerobic and stretching exercises to improve cardiovascular fitness and flexibility
• massage
• pacing of physical activities
• diet modification — especially avoidance of alcohol, caffeine, and nicotine
• medication — low doses of antidepressant medications that increase serotonin can lead to reduced pain and depression along with improved sleep
• stress management
• support by significant others

Three key ingredients of fibromyalgia therapy are a comprehensive approach to wellness, the collaboration among a team of health care specialists who are knowledgeable about fibromyalgia and the individual patient and significant others, and the patient’s taking an active part in the control of symptoms.

Given that this condition is considered chronic and that you have probably consulted with specialists to rule out other contributing factors, the most effective fibromyalgia therapeutic protocols include a holistic approach to managing and reducing symptoms. Ask your doctor to help you with a treatment plan to address three areas: improving sleep, better managing stress or depression; and improving muscle function.

There are other Fibromyalgia Therapies that should be considered.  Injection Therapy is one excellent alternative. There are many ways to perform this with the assistance of needle therapists. One technique is a modified version of Intramuscular Stimulation, or IMS. This involves breaking loose virtually all the scars in the muscle of the neck, mid-back and low back.

You must then proceed to treat the limbs in their entirety. The problem with this technique is that it involves literally two to three hundred needle injections, most of which are quite painful. However, there are techniques to overcome the pain of the treatment. Paraspinal nerve blocks can diminish the pain, as well as pre-medication with analgesics or pain medications.

Magnetic Therapy can also be very effective for pain and prevention. There are several types of magnet therapy. There is large electronic magnetic therapy, which fits like a big doughnut around the body. There are smaller electronic versions, which are almost like magnetic heating blankets. There are even small mineral magnets (which stick to your body) and large mineral magnets (which strap to it). I find them all to be helpful in some way, but magnets are unlikely to be the sole source of recovery for fibromyalgia.

Massage Therapy can be very effective as an adjunct to fibromyalgia treatment. Patients who suffer mild symptoms may benefit even more from massage therapy but I would still add personal stretching to this.

Heat is important as a therapy in itself. Many physicians are advocates for cold, where as I am a strong advocate for heat. Moist and dry heat can both be very helpful. Trial and error will be necessary to find which works best for you and it may vary, time to time and area to area.

Exercise is important to keep up in some way. I know this can be very difficult or near impossible for the severe fibromyalgics. I often suggest walking, swimming or biking in limited amounts. Remember to stretch before, sometimes during and of course, after exercise. You will find stretching after exercise will be easier and more effective.

Drugs! Doctors have an excellent knowledge of the pros and cons of medication and supplemental/herbal therapy. I should add that supplements and herbs are not the same thing. Supplements are substances that supplement what you already have in your body.  Herbs are sometimes supplementing what you already have but are more often new chemicals that are foreign to your body like prescription medication. All can be very helpful but should be considered to be medications with potential side effects.

The mainstay of any conventional doctor for the treatment of fibromyalgia includes non-steroidal anti-inflammatories. These medications can be very helpful in the short-term and will work to allow the spinal muscles to return to their normal length following a protocol of home therapy and exercise.

Remember good sleep can help break the triangle of chronic pain, sleep disorder and depression. “Brain fog” may also improve.

Supplements can be very helpful.  There are so many of them and the science behind them is huge, so I will only list a few. There are the old standbys of Glucosamine Sulfate, Chondroitin, Devil and Cat’s Claw and Sharks Cartilage. Most of these products are aimed at cartilage supplementation and reducing inflammation. I have found them all to be helpful in some way and greatly successful for a reserved few.

MSM has been recently introduced but has not been shown to be the cure-all that was promised. I also recommend a highly concentrated professional grade Omega 3 liquid that has made a huge difference in some of my patients with fibromyalgia. It is also a helpful supplement for inflammation, mobility, brain and heart function.

Other supplements include Melatonin, a central brain hormone that can dramatically help sleep and pain in some. It also stimulates growth hormone secretion but is not completely proven to be safe. L-Arginine is one of many amino acids that stimulates growth hormone naturally and may become a major player for pain and rehabilitation.

Creatine and Pyruvate are muscle supplements that enhance aerobic or oxygen metabolism. This has the effect of allowing muscles to tolerate more injury with less shortening, i.e. less Myofascial Pain.

Finally anti-oxidants may be of some benefit, as they help to reduce the damaging free-radicals that are moving through our bodies at all times. Everyday examples include Vitamins A, C and E but some stronger ones include grape seed extract and French Maritime Pine Bark. Of course, it is not a great idea to combine all these supplements at the same time, but rather to introduce them systematically so you can tell what’s working, what’s not and prevent any possible interactions.

The best answer to the question of what is the fibromyalgia cause might be that the cause is not known. The common symptom for those affected with fibromyalgia experience pain in response to stimuli that are normally not perceived as painful by the rest of the population.

Researchers have found elevated levels of a nerve chemical signal, called substance P, and a nerve growth factor in the spinal fluid of fibromyalgia patients. Levels of the brain chemical serotonin are also relatively low in patients with fibromyalgia. Studies of pain in fibromyalgia have suggested that the central nervous system (brain) may be somehow supersensitive. Scientists note that there seems to be a diffuse disturbance of pain perception in patients with 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 onset of fibromyalgia has been associated with psychological distress, trauma, and infection.

While these findings provide some generalities for those who suffer from fibromyalgia, they seem to be more reflective of the effects of the condition rather than the cause itself.

When looking at the symptoms of fibromyalgia, it can be noted that symptoms can be triggered as the result of:  a minor illness like the flu; a trauma incident like an automobile accident or fall; or emotional stress. In addition, it is possible that susceptibility to fibromyalgia results from micro-trauma related to physical de-conditioning, poor posture, and/or muscle overuse.

It can be helpful to understand suggested causes in more detail.  We’ve covered many of the more commonly accepted causes here:

Immune System Problems – Certain immunologic abnormalities are common among people with fibromyalgia. Some research suggests that fibromyalgia is the result of toxins accumulating in the muscles from lactic acid build-up.

Physically Unfit Muscles – There is evidence that many cases of fibromyalgia are found in people who live a chronically unfit lifestyle.  People who do not exercise regularly and live a sedentary lifestyle can be more prone to fibromyalgia than those who are active and exercise regularly.

Disturbance in Brain Chemistry – Many people who develop fibromyalgia have a history of clinical depression.  It is well known that depression is the result of an imbalance in the chemistry of the nervous system.  Research still has not established whether this relationship to depression is a cause of fibromyalgia, or a bi-product of the condition itself.

Sleep Disturbances or Insomnia - Many researchers have noticed that fibromyalgia sufferers have  low levels of serotonin. Moreover, there is a suggestion that the central cause of the pain of fibromyalgia could be due to this low level of serotonin. We know that chronic low levels of serotonin cause one’s sensation of pain to be greatly exaggerated. And, to complicate the matter further, the low levels of serotonin also may be what triggers the insomnia and sleep disturbances that are experienced in many fibromyalgia patients.

Infection with the Epstein-Barr virus (EBV) – There is some evidence that there is a correlation between fibromyalgia and the Epstein-Barr virus, the virus that causes infectious mononucleosis.

Fungal Infection with Candida albicans – There is some evidence that there is an association between the onset of fibromyalgia symptoms and a fungal infection with Candida albicans. Like fibromyalgia, the causes of infections from Candida are varied, although there does seem to be a correlation of infection with the use of antibiotics.  Candida infections show themselves as thrush (inflammation in the mouth and tongue), as vaginitis (inflammation of the walls of the vagina resulting in itching), and other forms of rashes.

Food Allergy – There is some correlation between fibromyalgia and people who suffer from allergies to various foods such as:  dairy products; wheat; fermented foods; potatoes, or eggplant,

Other possible triggers that release fibromyalgia symptoms may include:  emotional stress; intestinal Candida overgrowth; nutritional deficiencies; adrenal exhaustion; chronic mercury poisoning from amalgam dental fillings; anemia, hypoglycemia and hypothyroidism.

Fibromyalgia is closely related to chronic fatigue syndrome (CFS), which causes similar symptoms, except that in fibromyalgia, muscle pain predominates over fatigue, whereas in CFS, fatigue predominates over pain.

Each patient with fibromyalgia is unique. So a discussion of the fibromyalgia symptom profile must first introduce the reality that there is a wide array of combinations of symptoms that result in the diagnosis of fibromyalgia. The fibromyalgia symptom profile is a different combination of symptoms present among the sufferers of this condition. Any of the symptoms discussed here can occur intermittently and in different combinations.

The most common fibromyalgia symptom is diffuse pain with achiness, stiffness, and extreme tenderness in muscles and/or points where ligaments attach muscles to bones. Although pain may occur widely in many areas of the body, specific sites of tenderness referred to as “tender points” typically occur. These “tender points” can occur around the neck, shoulders, upper back, lower back, hip and knee areas.

This universal symptom of fibromyalgia of pain is not caused by tissue inflammation. Instead, these patients seem to have an increased sensitivity to many different sensory stimuli and an unusually low pain threshold. Minor sensory stimuli that ordinarily would not cause pain in healthy individuals can cause disabling, sometimes severe pain in patients with fibromyalgia. The body pain of fibromyalgia can be aggravated by noise, weather change, and emotional stress.

The pain as reflected as this fibromyalgia symptom profile is generally widespread, involving both sides of the body. Pain usually affects the neck, buttocks, shoulders, arms, the upper back, and the chest. “Tender points” are localized tender areas of the body that can bring on widespread pain and muscle spasm when touched. Fibromyalgia tender points, or pressure points, are commonly found around the elbows, shoulders, knees, hips, back of the head, and the sides of the breastbone.

Fibromyalgia “tender points” are sometimes incorrectly referred to as “trigger points,” which is terminology that is used to describe a situation whereby pressing on certain trigger points can initiate a sequence of symptoms. This is not the case with fibromyalgia tender points, which are chronically a focus of pain and tenderness in the particular area involved.

Another very common fibromyalgia symptom is fatigue, characterized by a lack of endurance or an overall lack of energy. This fatigue occurs in 90% of patients. Fatigue may be related to abnormal sleep patterns commonly observed in these patients. Normally, there are several levels of depth of sleep. Getting enough of the deeper levels of sleep may be more important in refreshing a person than the total number of hours of sleep. Patients with fibromyalgia seem to lack the deep, restorative level of sleep, called “non-rapid-eye-movement” (non-REM) sleep. Consequently, patients with fibromyalgia often awaken in the morning without feeling fully rested. Some patients awaken with muscle aches or a sensation of muscle fatigue as if they had been “working out” all night!

Brain fog is another description of the symptom of fatigue, and some with this fibromyalgia symptom may range from mild to fully incapacitating. This form of fatigue isn’t the same as the general muscle fatigue, and has been described as “brain fatigue”—patients feel totally drained of energy. Many patients say that they feel as though their arms and legs are tied to concrete blocks, and they have difficulty concentrating (i.e., brain fog).

Mental and/or emotional disturbances occur in over half of people with fibromyalgia. These symptoms include poor concentration, forgetfulness, mood changes, irritability, depression, and anxiety. Since a firm diagnosis of fibromyalgia is difficult, and no confirmatory laboratory tests are available, patients with fibromyalgia are often misdiagnosed as having depression as their primary underlying problem. As you can see, the fibromyalgia symptom profile is complicated by the fact that many of the underlying problems in fibromyalgia, such as lack of the restorative value of sleep, will then trigger other symptoms. It ends up being a condition that propagates a cycle of symptoms that will tend to reinforce one another.

Other symptoms related to fibromyalgia may include: sleep disturbance; coldness in hands or feet along with discoloration of skin (bluish or reddish) associated with poor blood circulation (Raynaud’s phenomenon); migraine and tension headaches (experiences in roughly 70% of fibromyalgia patients); abdominal bloating with alternating diarrhea and constipation (irritable bowel syndrome, which is found in 40 to 70% of patients with fibromyalgia); Gastrointestinal Esophageal Reflux Disease (GERD) that includes heartburn, chest pain, regurgitation, indigestion, and chronic cough; temporomandibular joint dysfunction (TMD) is seen in 25% of the fibromyalgia patients, although close to 75% of patients experience some degree of jaw discomfort; muscle tremors; irritable bladder, causing painful and frequent urination; and blurred vision. Emotional stress, anxiety, fatigue, and cold or humid weather may aggravate symptoms.

As you can see, the fibromyalgia symptom profile is very diverse. Several of the symptoms we’ve listed actually tend to cause other related symptoms. If you find that you have one or more of these symptoms on an ongoing basis, it is critical that you consult your health care professional for an assessment and accurate diagnosis.