Chronic Pain & Fibromyalgia

The cause of fibromyalgia is unknown, but it’s thought to be due to changes in how the nervous system processes pain. It might be triggered by trauma, surgery, infection, arthritis, or major emotional stress, or it may develop gradually over time. People with conditions such as rheumatoid arthritis, systemic lupus erythematosis, or ankylosing spondylitis are more likely to develop fibromyalgia.

The American Physical Therapy Association launched a national campaign to raise awareness about the risks of opioids and the safe alternative of physical therapy for long-term pain management.  Learn more at our #ChoosePT page.

Fibromyalgia isn’t just 1 condition; it’s a complex syndrome involving many different signs and symptoms. With fibromyalgia, you may experience:

• Widespread pain, often a dull achiness, on both sides of the body above and below the waist  
• Spots on your head, neck, chest, shoulders, elbows, hips, or knees that are tender to a firm touch; these “tender points” may move around or come and go
• Muscle stiffness, especially in the morning
• Headache
• Thinking and memory problems
• Fatigue
• Depression
• Anxiety
• Pain or cramps in the abdomen or pelvis
• Irritable bowel syndrome
• Irritable bladder syndrome
• Difficulty sleeping; waking unrefreshed
• Temporomandibular (jaw joint) pain
• Numbness or tingling

Often, stress can make your symptoms worse.

Because there are no blood tests, x-rays, or muscle biopsies that can be used to diagnose fibromyalgia, you’ll need to work closely with your health care providers to obtain an accurate diagnosis. Many conditions can cause pain and fatigue, so it’s important to have a thorough medical examination to rule out conditions other than fibromyalgia, such as rheumatologic or infectious disease, Lyme disease, hypothyroidism, metabolic disease, or side effects due to medication.

Once other conditions have been ruled out, a diagnosis is made based on key symptoms—extreme fatigue, pain in multiple “tender points” (points that are tender to touch and that move around), trouble sleeping, anxiety, and memory problems. Your physical therapist can identify fibromyalgia while performing a routine examination and taking your health history. Your therapist will pay close attention to the pattern of your symptoms. For instance, there are 18 possible tender points, and the more tender points you have, the more likely you have fibromyalgia. The therapist may refer you to a rheumatologist, a physician who specializes in arthritis, for medical care that includes medications.

Living with fibromyalgia can be challenging. Your pain and other symptoms might take different forms from day-to-day. If you avoid activity because of pain, your overall physical fitness might be decreased.

Extensive research supports the use of education, aerobic exercise, and strengthening exercise to help improve fibromyalgia. But fear of pain often keeps people from beginning an exercise program. Your physical therapist will teach you how to interpret pain signals—and how to manage and decrease your symptoms—through a customized exercise program.

Research shows that people who are knowledgeable about their health condition have more confidence, can cope better with their condition, and are more likely to get “back in the swing.” Your physical therapist can explain how fibromyalgia affects the way your body perceives and responds to pain and how you can start to take control of the pain, rather than the pain controlling you. We also have evidence to support that knowledge is power, as it pertains to managing pain. There are several books, such as Why Do I Hurt, that have helped people in pain.

Your therapist also can provide information on local support groups, exercise programs, and self-help programs. 

Your therapist may use manual therapy techniques to move your joints while you are relaxed to help improve your joint motion. These techniques are combined with exercise, stretching, and movements that you control.

Research indicates that the best results are likely to come from combining a variety of treatments. Appropriate medications, exercise, and “mind-body techniques” can work together to help you manage your symptoms.

Some techniques, such as meditation and cognitive behavioral therapy, can change your responses to pain and promote relaxation. Physical therapists also are educated and experienced in how to recognize behaviors that may interfere with recovery of function, and often refer patients to other health care professionals who can help them overcome these barriers.

Your physical therapist might use biofeedback to help you control muscle tension and decrease pain, using a device that provides you with information about the amount of tension in your muscles. The therapist places electrodes on your skin with a soft gel, and these electrodes record muscle tension while your therapist explains how you can relieve that tension.

Your therapist also can show you how to set a routine time for sleeping and waking to allow for good restorative sleep. The therapist will discourage you from sleeping in the daytime, as that can throw off your sleep cycle.

To reduce your pain, your physical therapist may select from a number of treatments:

• Your therapist may use pressure on specific areas of the muscle, followed by stretching or contracting your muscles, to relieve pain and make the muscles more flexible. Your therapist also might use manual therapy techniques to help relieve pain in your muscles and other connective tissues (the material between the cells of the body that support the organs and other tissues).
• In states where it is allowed by the physical therapist practice act, your therapist might use an approach called “dry needling” to relieve your pain by inserting very fine wire-like needles into the painful areas of the muscle.
• Massage therapy can be used to increase blood flow to the tissues and promote muscle relaxation to decrease muscle pain and stiffness, and break up scar tissue.
• Depending on the severity of your pain, your therapist might decide to use electrical stimulation to help relieve pain. Some people find that portable electrical stimulation devices help them manage severe pain independently. Your physical therapist will work with you to help determine if this type of treatment makes sense for you.

Unfortunately, the actual mechanisms behind fibromyalgia are not completely understood. Because of this, there is no way to predict or to prevent its onset. However, early detection of signs and symptoms related to fibromyalgia will help you and your medical providers begin early management, which may enhance your long-term outcomes. 

Claire J. is a 32-year-old woman who has been struggling to get up each morning to get her 2 young children off to school. She has extreme fatigue, trouble remembering things (“I frequently misplace my eye glasses and purse”), and muscle pain and stiffness that seem to move around her body. The symptoms began suddenly and have persisted for 5 months. Her primary care physician is concerned that she might be depressed. He prescribes an antidepressant and refers her for physical therapy.

Claire’s physical therapist conducts a full physical examination and musculoskeletal testing and notes that she has 11 out of a possible 18 tender points, general fatigue, and muscle stiffness. The therapist recommends that Claire see a rheumatologist for medical management and starts her on a program of gentle stretching exercises, paced walking, and meditation using yoga. In addition, Claire and the therapist discuss a sleep hygiene routine and a sleep log, in which Claire will record her sleep patterns over the coming months.

The rheumatologist prescribes medication for Claire, and she continues her gentle stretching and exercise program. She begins sleeping 6 or 7 hours per night. The physical therapist then develops a gentle aerobic exercise program, which Claire says improves her fatigue once she gets herself motivated to do the exercise.

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.