What is fibromyalgia?

Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, constant fatigue, and tender trigger points throughout the body.

The pain is intermittent – it comes and goes and shifts or travels throughout the body.

The root cause of fibromyalgia is unknown, but it is thought to be related to a combination of genetic, environmental, and psychological factors.

Fibromyalgia is often difficult to diagnose and treat. The pain associated with the condition can be severe, and debilitating and cause severe psychological stress.

In addition to the pain and tenderness, many patients have reported memory impairment, depression and irritability, insomnia, and fatigue or malaise.

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Fibromyalgia Symptoms and causes

The exact cause of fibromyalgia is unknown, but it is thought to be related to a combination of genetic, environmental, and psychological risk factors, culminating in inaccurate pain signals.

It usually starts in middle-aged adults but can be seen in teenagers and older adults.

Fibromyalgia is more disproportionately seen in women than in men.

You are at a higher risk for developing fibromyalgia if you have rheumatic diseases such as lupus, rheumatoid arthritis, osteoarthritis, or ankylosing spondylitis.

Apart from pain, other symptoms of fibromyalgia include:

• Migraine or tension headaches
• Problems with the digestive tract (irritable bowel syndrome, GERD, etc.)
• Pain in the pelvis
• Overactive bladder
• TMJ (jaw pain, jaw clicking, ringing in the ears)

Does chiropractic help fibromyalgia?

Many fibromyalgia sufferers turn to chiropractic care to find relief from their widespread pain and improve their overall quality of life.

Chiropractic care involves using spinal manipulations and other manual therapies to improve the function of the musculoskeletal and nervous systems and range of motion.

Some people with fibromyalgia may find relief from chiropractic care. Still, the evidence for its effectiveness in treating the condition is mixed.

One of the main theories behind chiropractic care for fibromyalgia is that spinal misalignment, also known as subluxations, can cause pain and other symptoms.

By manipulating the spine, chiropractors aim to correct these misalignments and improve the function of the musculoskeletal and nervous systems.

Fibromyalgia and chiropractic research

Some studies have found that chiropractic adjustments can effectively reduce pain and improve function in people with fibromyalgia.

For example, a study published in the Journal of Chiropractic Medicine found that chiropractic care effectively reduced pain, improved sleep, and increased physical function in a group of fibromyalgia patients.

Another study published in the Journal of Manipulative and Physiological Therapeutics found that chiropractic care effectively reduced pain and improved the quality of life in study participants suffering from fibromyalgia.

However, not all studies have found that chiropractic care is effective for fibromyalgia.

A review published in the Journal of the American Medical Association (JAMA) concluded that there is limited evidence to support the use of chiropractic care for fibromyalgia.

The review also found that the quality of the evidence supporting the use of chiropractic care for fibromyalgia was generally low.

There is no known cure for fibromyalgia. Hence, treatment focuses on managing the symptoms, minimizing other health problems, and maintaining overall functioning.

It is important to note that while some people with fibromyalgia may find relief from chiropractic care, the condition is complex and multi-faceted, and chiropractic care may not be suitable for everyone. 

Discuss your treatment options with your healthcare provider to determine the best course of action for your specific needs.

In addition to chiropractic care, other treatment options are available for a fibromyalgia diagnosis.

These may include lifestyle adjustments, medications, physical therapy, occupational therapy, massage therapy, and psychological counseling (Cognitive Behavioral Therapy – CBT).

Many people with fibromyalgia find relief from a combination of these treatments. It is important to work with your healthcare provider to identify the best treatment plan for you. 

What is the best painkiller for fibromyalgia?

As a pharmacist, I would be remiss if I did not discuss the medication therapies available to manage fibromyalgia.

Your doctor may prescribe one or more of the following medications to help relieve your pain and improve your quality of sleep:

Pain-relieving medications

These are primarily over-the-counter (OTC) drugs such as acetaminophen (Tylenol) and NSAIDs (Advil, Motrin, Aleve, etc.).

However, these medications are NOT benign and can harm you if taken inappropriately or against your doctor’s directions.

Please read my detailed article here for a more in-depth review of NSAIDs.

Opioid drugs are not used to treat fibromyalgia pain. Mainly because they do not work for this type of pain. In fact, they will induce greater pain sensitivity (you sense pain more) and make the pain linger!

Antidepressants

There is strong evidence that drugs that treat depression are also very good at managing fibromyalgia pain (even if you are not depressed).

The United States Food and Drug Administration (FDA) has approved duloxetine (Cymbalta) and milnacipran (Savella) for the treatment of fibromyalgia.

Discussing these drugs’ medicinal properties, dosing, and warning is outside the scope of this article. I have written another article that takes a deep dive into all of the medications in this drug class. Please read it here.

Anti-seizure medications (Antiepileptics, specifically, the gabapentinoids)

These drugs work best to dull the pain signals transmitted by your nerves (which makes sense since anti-seizure drugs work by tamping down nerve signals in the brain to prevent seizures) and improve sleep. Examples are pregabalin (Lyrica) and gabapentin (Neurontin).

The gabapentinoids come with potent side effects such as sedation/sleepiness, dizziness, weight gain, and swelling.

Older antidepressants such as amitriptyline (Elavil) and muscle relaxers such as cyclobenzaprine (Flexeril) can also be used. However, these medications are very high in an adverse drug effect called anticholinergic burden, which is very harmful in older adults.

Older adults need to be very mindful of these negative drug effects! They can increase the risk of falls, memory loss, and hospitalization.

Who typically diagnoses and treats fibromyalgia?

Fibromyalgia is not an autoimmune or inflammatory disease that causes damage to the joints and muscles.

However, because it causes pain and fatigue similar to arthritis, you may be referred to a Rheumatologist for a proper clinical work-up, diagnosis, and follow-up care.

Conclusion

Chiropractic care may effectively reduce pain and improve function in some people with fibromyalgia. Still, the evidence for its effectiveness is mixed. It is essential to discuss your treatment options with your healthcare provider and consider a range of treatment options when seeking relief from fibromyalgia pain.

Frequently asked questions

How common is fibromyalgia?

• One in every fifty people in the United States suffers from this medical condition.

Is fibromyalgia an autoimmune, inflammatory, joint, or muscle disease?

• No. There is research evidence that suggests the involvement of the nervous system.

What causes fibromyalgia?

• No one explicitly knows. There is speculation among the medical community that genetics may play a role in the development of fibromyalgia. Mostly, it seems that some type of triggering factor is responsible for setting off fibromyalgia.

How is fibromyalgia diagnosed?

• Physicians will base their diagnosis on all of an affected individual’s symptoms. No test exists that will provide a diagnostic certainty of fibromyalgia. Your doctor might order lab tests and X-rays to rule out other medical problems mimicking fibromyalgia (polymyalgia rheumatica, spondyloarthritis, inflammatory myopathy, systemic inflammatory arthropathies, and hypothyroidism).

Can fibromyalgia be reversed or cured?

• Unfortunately, there is no cure. Treatment is supportive, aimed at alleviating pain, improving quality of life and mobility through medication and non-medication strategies.

Can you use chiropractic for fibromyalgia?

• The evidence is mixed. Some studies suggest that chiropractic manipulation helps to relieve pain and promote better sleep. In contrast, other studies fail to show these results strongly. The best option is to discuss your plan with your doctor and try alternative therapies such as chiropractic care slowly, carefully, and methodically.

What medications can you use to treat fibromyalgia?

• You can use OTC pain medications such as acetaminophen and NSAIDs. Anti-seizure drugs like pregabalin and gabapentin can be used effectively. Antidepressant drugs such as duloxetine can be used as well. Your doctor may put you on more than one pain medication to manage your pain more effectively.

References

1. Berman BM, Swyers JP. Complementary medicine treatments for fibromyalgia syndrome. Baillieres Best Pract Res Clin Rheumatol. 1999 Sep;13(3):487-92. doi: 10.1053/berh.1999.0039. PMID: 10562380.
2. Ernst E. Chiropractic treatment for fibromyalgia: a systematic review. Clin Rheumatol. 2009 Oct;28(10):1175-8. doi: 10.1007/s10067-009-1217-9. Epub 2009 Jun 21. PMID: 19544042.
3. https://www.niams.nih.gov/health-topics/fibromyalgia/diagnosis-treatment-and-steps-to-take
4. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Fibromyalgia
5. https://www.mayoclinic.org/diseases-conditions/fibromyalgia/diagnosis-treatment/drc-20354785