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VIRTUAL CARE

How to Recognize Fibromyalgia and Manage the Pain

Here's how to know whether your chronic pain is fibromyalgia or something else.


Chronic pain seems to be an increasingly common issue. However, knowing when that chronic pain might be indicative of fibromyalgia syndrome is key in getting the pain under control and improving your quality of life as quickly as possible. Let’s talk about what makes fibromyalgia pain different, so you know when it’s time to talk with your primary care provider about seeing a specialist.Man holding knee in pain

Identifying Fibromyalgia Pain

One of the first indicators of fibromyalgia is extended, chronic pain.  “Most patients come to our clinic when they’ve experienced pain for longer than 3 months,” Dr. Jun Xu, MD, said.

Second, fibromyalgia patients experience chronic pain all over their body whereas other pain conditions often have a more localized or focused area of pain that is recurring like neck, shoulders, or knees, for example.

“Pain with fibromyalgia is generalized - it’s widespread and all over the body,” Dr. Jun Xu said. 

A third indicator that your chronic pain might be fibromyalgia is the depth of the pain. Oftentimes, fibromyalgia patients describe a chronic pain that feels like it’s bone-deep. “The third thing is that it’s musculoskeletal pain -- it’s muscle and soft tissue pain.”

While these three symptoms are the most prevalent physical symptoms, Dr. Xu notes that most people with fibromyalgia also experience other symptoms such as chronic fatigue, sleep disturbances, and mental and emotional conditions such as anxiety and depression. The link between these conditions and the chronic, musculoskeletal pain that are hallmark signs of fibromyalgia is still being researched, but Dr. Xu notes that the pain and anatomic pathways in the brain are the same, which may explain the overlap of symptoms.

If this sounds like your pain, and you also experience the other symptoms, Dr. Xu suggests discussing the possibility of fibromyalgia with your primary care physician. 

Fibromyalgia vs. Other Pain Conditions

Perhaps one of the most frustrating components of reaching a fibromyalgia diagnosis for many patients is the overlap of symptoms it shares with other conditions. Knowing when fibromyalgia is the culprit versus other conditions often comes from a series of misdiagnoses or ruling out other options before deciding on a course of treatment specifically geared toward the needs of a fibromyalgia patient.

“Pain is quite often hard to diagnose. There’s no easy way to define that, especially for fibromyalgia. It’s more challenging to diagnose, so it’s a diagnosis of exclusion,” Dr. Xu said. “About 10% of the population will have generalized chronic musculoskeletal pain and we can typically identify an underlying cause. For example, we can more easily identify rheumatoid conditions or chronic inflammation with blood tests. So these are often the first option, and we narrow down from there.”

For patients who are diagnosed with fibromyalgia, there can be a great deal of frustration involved as patients can feel unheard. Dr. Xu emphasizes that it’s crucial for pain specialists to listen to their patient, to understand what they’ve been going through, and to empathize with the upsetting mystery of dealing with such constant pain without a cause to point to.

“The pathology or the mechanism of onset is still not fully understood,” Dr. Xu said. “But there are a few markers that are becoming more commonly known, things that care providers can look for to point toward fibromyalgia faster.” For example, an fMRI can show certain brain activity that is often different in a fibromyalgia patient versus a healthy patient. “One thing that’s a consensus is that there’s altered pain processing or nerve system or tissue. A patient with fibromyalgia tends to be more sensitive to pain,” Dr. Xu said. These markers are helping pain specialists and primary care providers more quickly narrow down options to provide faster, more accurate relief for fibromyalgia patients.

Managing Fibromyalgia Pain

While fibromyalgia is a pain-focused condition, traditional intervention-based treatments are often not the best solution. Fibromyalgia is generalized in nature, so there isn’t a single muscular exercise or series of exercises that will help manage the condition.

Instead, successful treatment often involves medication. Interestingly, many fibromyalgia patients experience a certain level of success with anti-anxiety and antidepressant medication.

“Because they share common chemical pathways like dopamine or serotonin, we do use medications that are for treatment of both depression and fibromyalgia, such as certain antidepressants,” Dr. Xu said.

There is no silver bullet for fibromyalgia treatment, and because there is so much left to discover about the condition itself, there isn’t a known cure yet, either. These two components can make treating the pain and associated emotional and mental symptoms difficult, so Dr. Xu stresses the importance of communication between the patient and their entire care team.

“The most important thing for us to communicate is that there’s no magic bullet or cure. That’s the reality we’re facing. The second reality is just reassurance. We reassure patients that these symptoms do not affect overall system functionality,” Dr. Xu said.

Your care providers will work closely with you to determine the best treatment options. Dr. Xu notes that because fibromyalgia patients are often very sensitive to pain and often experience chronic fatigue, they are often not very active or social. These two things, while understandable, serve to worsen the condition if they aren’t monitored and managed well.

Typically, a full care routine for fibromyalgia includes many of the following components:

  • Medication
  • A low-impact exercise routine such as aquatic aerobics or yoga
  • Cognitive behavioral therapy to help manage mental and emotional symptoms
  • A low-inflammation diet or specific nutritional choices
  • A daily routine that promotes good sleep hygiene, as sleep loss can be one of the most destructive components of this condition

The chronic nature of fibromyalgia means that managing it well and maintaining a quality of life that feels good to you is a marathon, not a sprint. Finding the best treatment methods and care providers that work for you may be a journey, but it’s one worth taking.

“We try to see our patients regularly. I think the regular consultation reassures and stresses the treatment options and encourages the patients to engage in some cognitive behavioral therapy and try some medications. Usually, we do need follow-up. We sometimes have patients for many, many years. It’s a chronic condition, like chronic hypertension or diabetes. We need to manage it medically, pharmacologically, or non-pharmacologically, or a combination,” Dr. Xu said.

The expert collaboration and full breadth of care available at The Iowa Clinic makes managing fibromyalgia from every angle easier. If you think you may have fibromyalgia, contact us to schedule an appointment for further evaluation today. 

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