Medically reviewed by Dr. Milorad Radusin, MD
Tired. No energy, every day. Sleep that does nothing and pain throughout the body. These are the classic symptoms of fibromyalgia disorder.
Problems with memory and concentration, muscle spasms, numbness in the extremities, and even problems with the digestive tract often accompany the common symptoms.
The worst of all of these is the pain since it often prevents sleep and will cause a feedback loop of symptoms as actual exhaustion stacks on top of the fatigue from the disorder.
You would expect pain medication to be central to treatment, right? Treatment for this disorder is more complex than simply relieving pain.
If you are not fully familiar with the disorder, this video by Dr. Gordon Irving of the Swedish Pain and Headache Center of Seattle is a very simple and thorough introduction to it.
Current research shows that the disorder is one of the central nervous systems, with measurable and observable abnormalities in the brain and spinal cord.
Symptoms are not constant, can come and go with varying intensity, and can even enter into an extreme level referred to by patients often as a ‘flare-up’.
One of the types of pain experienced can be treated using specific opioids, such as tramadol (sold under the brand name Ultram), but this is a simple answer to a complex question that is not intuitive.
It will not directly treat any symptom of fibromyalgia, but there is a place in the treatment of fibromyalgia that it fits.
A Complex and Tangled Web of Symptoms
The common symptoms of fibromyalgia are typically not constant in intensity and can vary from day to day. The less common symptoms come and go with a little warning and no discernible pattern.
Poor quality sleep increases symptom variety and intensity, as does moderate physical activity. This seemingly random frequency can make understanding the condition difficult because one day sufferers can be nearly fully functional and the next day they can barely get out of bed.
The full list of symptoms is extensive and seemingly unrelated. The most common are poor sleep quality, generalized pain, pain in the joints, neuropathic pain, constant fatigue, intolerance to exercise, stiff joints in the morning, muscle spasms, numbness of the extremities, problems concentrating (referred to by patients as ‘fibro fog’) and feeling pain from light touches in certain areas of the body known as ‘tender points’.
Less common symptoms include intolerance of hot or cold environments, problems with the digestive system, problems with urination, anxiety, depression, and problems with language.
With this shifting and a random group of symptoms, fibromyalgia is often misdiagnosed as either another condition or as a psychosomatic, or imaginary, condition.
Since there are no clinical tests for fibromyalgia and it is diagnosed by eliminating all other known causes for the symptoms and signs in a patient, it often takes years for sufferers to receive a proper diagnosis.
The idea that the disorder is entirely caused by mental illness is false and should not be assumed. The symptoms are real. The pain is real.
The most debilitating symptom of the disorder is the ‘flare-ups’. Symptoms increase to extreme levels that leave untreated sufferers bedridden during a flare-up.
Even with treatment, they can rob a patient of full function when they occur, even to the point that they are unable to work while the flare-up is happening.
The sufferer may be nearly fully functional on all other days and only have symptoms during flare-ups.
Although they can be triggered by too much physical activity or having poor sleep the night before, flare-ups can also happen with no known trigger.
Their frequency varies from patient to patient, with two or more in a month being a common rate.
The numbness in the hands, flare-ups, difficulty with concentration, and intolerance of physical activity limit what a person with fibromyalgia can do.
Without effective treatment, they often can not work and have difficulty with even household chores or personal hygiene.
The sensitivity to hot and cold environments can stop them from enjoying activities in their personal life since going outdoors can be very uncomfortable and even trigger symptoms.
The constant fatigue and concentration problems can make social interaction difficult or even impossible, depending on the current severity of the symptoms.
Successful treatment for most with fibromyalgia is possible and returns almost all functions. They are able to work and suffer only mild symptoms.
They are typically limited to working in sedentary jobs that are indoors because of the risk of exacerbating symptoms.
There are also those patients that can not take all of the medications or the drugs are not effective enough at treating their symptoms. Treatment can improve function and quality of life for these patients, however.
What We Know About the Disorder
As has been the case since when the disorder was first identified in the early 1990s, there is no known cause for fibromyalgia.
Without a known mechanism that causes the observed signs and symptoms of the disorder, doctors are limited to trying to counter the symptoms directly through medication, diet, and exercise.
This method of treatment has yielded results for the most patient and even full remission in some. Not everyone can tolerate all of the medications that are effective at treating the disorder, however. For them, even minor improvements in pain level and reduced symptoms is the goal of treatment.
Current research has narrowed down the area of the body responsible for fibromyalgia to the central nervous system, as reported in Science Daily.
Scientists can now focus their search in this area of the body. It is a difficult area to analyze and experiment with and research specifically into fibromyalgia is not funded as largely as other medical research, such as for Alzheimer’s disease or cancer.
Recent research has shown that inflammation of the nerve tissue and activation of white blood cells, the cells that make up your body’s immune system and fight infections, are present in the brain of fibromyalgia patients.
Inflammation is also seen in other tissues throughout the body in this disorder. This inflammation can be self-sustaining and is not seen in normal brains unless there is an infection of the brain tissue or the cerebrospinal fluid, the fluid that surrounds the brain and spinal cord and is used for cushioning impacts and for various vital functions.
These functions include the regulation of blood flow in the brain and protection against infection. Some neurotransmitters are found in trace amounts in the fluid.
The metabolites of neurotransmitters serotonin and norepinephrine have been observed in abnormally low levels in the cerebrospinal fluid of those with fibromyalgia disorder.
One current theory that is being explored by researchers is that the abnormal brain chemistry and inflammation cause cascading bursts of nerve activity in the pain centers of the brain when stimuli, like touch, is experienced instead of the normal reaction.
Another, that is more promising at coming to a mechanism that causes the disorder, involves a combination of a metabolic disorder in the brain cells interacting with an infection or injury to cause chronic inflammation of the nerve tissue in the brain.
Both of these theories are years away from yielding any treatment that may help with the disorder, but this does show that impressive progress towards finding a cause has been made in recent years.
Current Therapies in Use
With the menagerie of symptoms, our limited understanding of the disorder, and the inconstant and variable nature of the symptoms, a multi-pronged approach to treatment that focuses on addressing and countering symptoms is used by doctors for treating this confounding disorder.
There are medications that can help or eliminate each of them, but some of them cause drowsiness in the majority of patients, which can take the fatigue that comes with fibromyalgia from problematic to debilitating.
There are also the side effects and tolerability issues related to whether or not patients have severe enough side effects from a medication that they can not take medication. Medication selection is tailored to the individual patient.
This can take months or even years of trial and error to find a combination of drugs that are effective.
In some cases, drug intolerance can prevent the effects of treatment from being achieved, but stability and even slight improvements in symptoms are welcomed in such cases.
The common route of treatment used by doctors to treat fibromyalgia is well summarized in this article by the National Health Service of the United Kingdom.
It addresses each of the common symptoms and what medication options are commonly used to address them. This is not exhaustive in its depth, but it will give you some idea of the wide spectrum of treatment options available for fibromyalgia.
One of the cornerstones of the treatment of the disorder in the management of pain. Since there are multiple sources of pain and the level of pain can itself become fully debilitating, this symptom requires special attention?
Light exercise, even just walking a little, has been shown to be highly effective in improving all symptoms of fibromyalgia, but pain levels need to be reduced to a point that will allow exercise to begin in the first place.
As with any chronic condition, the goal of treatment is to restore as much normal function to the patient as possible.
In most cases, the nearly full function can be achieved with therapy for patients with this disorder. This takes time, however.
Medications need to be introduced, exercise started, and even psychological therapy added while the function is restored.
It is very frustrating for patients to no longer be able to take part in activities or work they had done before.
This can lead to depression which is common in those with chronic conditions. Treatment of this depression, if it occurs, will help speed recovery of function and quality of life.
Why Does it Hurt So Much and Can Medication Help?
The pain felt by sufferers of fibromyalgia comes in four types, each with a different cause and treatment.
Untreated, the pain is intense enough to leave a sufferer bedridden and in tears, unable to function well enough to even bathe or cook meals. The pain can even become intense enough to cause nausea.
The first is called neuropathic pain. It is the same kind of pain that severe diabetic patients feel in their extremities.
Low levels feel like itching or insect crawling on your skin, with moderate intensity feeling like the sensation of local anesthesia, complete with numbness, pins, and needles, and severe is similar to the sensation of being stabbed with multiple small knives.
In fibromyalgia, this can occur anywhere in the body, however. This includes places that shouldn’t ever itch, like the teeth. It is treated using Lyrica (AKA pregabalin) or gabapentin.
Second is pain caused by the imbalance of the neurotransmitters serotonin and norepinephrine in the brain.
The metabolites, the leftover molecules from the processes of breaking down a substance by the body, of these neurotransmitters can be found in the cerebrospinal fluid.
This is similar to the pain that is felt by severely depressed patients and is treated with the same medications that treat mental illness.
The frequently used drug is Cymbalta (AKA duloxetine), but as is common for this family of medications, effectiveness, and tolerance varies greatly from person to person, so other medications are also used.
The third is where more classic pain-relieving medications, like tramadol, can be used. Muscle spasms, experienced by almost all fibromyalgia patients, will cause pain as they happen, just after they are finished, and even during the following days.
The rapid contractions in the muscle quickly cause it to switch to an anaerobic energy source, producing lactic acid, just like when you exercise or use a muscle for an extended period of time.
That same soreness will occur in muscles that have been in spasms. Although muscle relaxants, such as cyclobenzaprine, can help prevent the spasms, their side effects include drowsiness while the regular dosage could be simply insufficient to stop the muscle spasms at all times.
The fourth and last kind is a consequence of the numbness caused by neuropathic pain. This can cause issues with coordination, walking, and even result in falls.
This results in injuries to oneself without even realizing it until the sensation in the affected area returns. Over the counter pain relievers, such as NSAIDs (aspirin, ibuprofen, etc.), and low-level opioids like tramadol and codeine can easily treat this type of pain.
The Dangers of Opioid Use
Any time powerful and addictive drugs are going to be used, caution and care need to be taken to ensure safety and minimize the risks associated with such medications.
Your doctor will want to closely monitor your use of an opioid and refills for the medication will typically require a visit to the doctor’s office for an examination. There are also side effects to the long-term use of opioids that need to be accounted for and mitigated.
As one takes medication like tramadol, an opioid, the body will become adapted to its presence. Over time, it will take a larger dosage to achieve the same results.
This will also increase the side effects, such as the upset stomach, drowsiness, and constipation.
There is also a form of whole-body pain that can occur during withdrawal from opioids. This can start to happen between doses as your body becomes accustomed to having the drug present.
Increasing a fibromyalgia sufferer is extremely counterproductive since it will increase their other symptoms and could even cause a flare-up to occur.
Then there is an addiction to consider. Opioids are addictive. They affect the reward center in the brain heavily and addiction to them is difficult to treat.
Even low doses can lead to addiction, especially when taken as part of long-term pain management.
Lower level and newer opioids are safer, but there is no way to avoid all of the risks that come with using any drug in this family.
Pharmaceutical companies intended to create a safer opioid when they developed tramadol. For the most part, they succeeded, but no opioid is 100% without risk of addiction, withdrawal symptoms, and side effects.
The Right Tool for the Job
The common side effects of opioids are drowsiness, constipation, and nausea/vomiting. Long-term use causes dependence, addiction, and depression.
Alcohol and sleeping pills are taken with opioids that can lead to death since their suppression of the autonomic nervous system, the part of the nervous system that regulates breathing, heart rate, blood sugar, and body temperature which could be impacted so greatly that breathing can be stopped.
With fibromyalgia disorder causing fatigue and sleep problems, along with other less common symptoms that affect the autonomic processes of the body, most opioids would compound with symptoms instead of bringing relief.
Fatigue, having drowsiness added to it, will result in excessive sleeping and all of the negative effects that would have on a patient’s body and life.
A lower incidence of addiction reduces the intensity of side effects, and minimized withdrawal pain is found in tramadol when compared to other opioids.
It also does not cause the euphoria that most other opioids cause when taken at high doses, so the potential for abuse of the medication is greatly reduced.
This makes it a good match to use for pain in fibromyalgia when over the counter options, mainly NSAIDs, are insufficient to bring relief.
It is not perfect, however, and if you are considering bringing it up as an option with your doctor, I would recommend reading this article on the medication from the Mayo Clinic.
How does Will Treatment help With the Pain?
Even with the effectiveness of the medications that are available, there are those that suffer from fibromyalgia that are not able to achieve full relief of their symptoms.
Many are unable to work because of the intensity of the symptoms or because of the flare-ups and random nature of their symptoms making consistent work impossible.
For these people, any improvement is beneficial and could even lead to a path of greater function and quality of life.
There have been scientific studies that show the benefit of lowered pain levels in fibromyalgia when tramadol is added to a treatment regime.
This one from the National Institutes of Health in the US used a small group of fibromyalgia patients to test tramadol’s effectiveness in the treatment of fibromyalgia disorder.
Although it is not definitive, further research has come to the same conclusions and has led to tramadol being added to the treatment options for the disorder.
Sleep quality has been shown to directly affect the intensity, frequency, and number of symptoms. With the constant fatigue found in the disorder, sleeping pills are generally avoided since they commonly cause drowsiness during the day, even if they improve sleep quality.
Reductions of pain level, such as those shown to come from treatment with tramadol, can easily allow for much more effective sleep.
A Light at the End of the Tunnel Does Exist
Reduction of pain levels by using multiple drugs is one of the keys to the treatment of fibromyalgia disorder.
This includes using classic pain-relieving medications like NSAIDs and the opioid tramadol. Stopping any part of the cycle of self-perpetuating symptoms will help.
All of the symptoms of the disorder become worse with higher pain levels, causing more pain. When pain is reduced, improved concentration lowered neuropathic symptoms, and fewer muscle spasms will be experienced.
With lowered pain, improved sleep can be achieved, lowering symptoms further. Then exercise can be added and pain reduced even further.
Now that you have all this information, you have a much better understanding of this disorder. If you, a friend, or family member has fibromyalgia disorder, I hope that this work has helped you understand it more and how it can be treated.
With the help of a doctor and current treatment, it is possible to reclaim your life from fibromyalgia, even if it is just a little of what you had before.