Fibromyalgia

Fibromyalgia

Article by Shane Armfield

What is Fibromyalgia?

Fibromyalgia is a disorder that causes widespread pain in the muscles of the body and fatigue. People with fibromyalgia have many “tender points” on the body and increased sensitivity to various things that are not ordinarily painful or unpleasant. They can also experience high levels of fatigue that are disproportionate to their activity levels and sleep.

What Causes Fibromyalgia?

Fibromyalgia is estimated to affect about 5% of the population and occurs in women much more than men. The problematic thing about fibromyalgia is that there is no known cause. It isn’t an inflammatory disease. It isn’t a degenerative disease and isn’t an auto-immune disease. This makes it difficult to diagnose and treat.

The onset of fibromyalgia has been linked to:

  • a traumatic event that caused a physical injury
  • stressful/ traumatic life event such as a car accident or bereavement
  • disease/ illness – sudden onset illness or chronic illness (i.e. IBS, lupus, rheumatoid arthritis)
  • sleep disturbance.

The symptoms of Fibromyalgia vary for each individual, but the most common symptoms are:

  • Widespread muscle pain, stiffness and tenderness in the muscles and joints (see picture above)
  • Fatigue – often disproportionate to the person’s level of activity or amount of sleep
  • Restless sleep or awakening after a long sleep and feeling tired for the rest of the day
  • Anxiety, depression, disturbances in bowel function
  • Poor memory or a feeling of brain “fogginess.”

What are the Symptoms of Fibromyalgia?

  • Pain, stiffness, tiredness and tenderness of the muscles, tendons, and joints.
  • Restless sleep, awakening feeling tired, chronic fatigue, anxiety, depression, and disturbances in bowel function.

These symptoms ‘feed’ off each other, as demonstrated in the following diagram:

How is Fibromyalgia Diagnosed?

The symptoms of fibromyalgia can be associated with many conditions or diseases, making it difficult to diagnose. Your doctor or rheumatologist usually makes the diagnosis after ruling out other diagnoses. As well as palpating several sensitive points around your body, your doctor may perform blood tests, scans and x-rays to rule out other causes of pain.

Conditions that can mimic fibromyalgia features include an underactive thyroid (hypothyroidism), vitamin D deficiency, rheumatoid arthritis, and even sleep apnoea.

Fibromyalgia Treatment

The management of fibromyalgia is complex but can be broken down into several parts. Treatment tries to help you slowly break the fibromyalgia cycle by addressing each of the points shown in the diagram above.

Understanding your pain and symptoms through education

  • Having a good understanding of your symptoms and how your life has been affected by fibromyalgia. Also, having a good assessment of your painful areas can help reduce anxiety or concerns about an injury.
  • Understanding the complex nature and cycles of pain can also help you address fibromyalgia’s impact on your life.
  • Physiotherapy can help with both these aspects of understanding Fibromyalgia.

Exercise in moderation

Exercise is an excellent way to help deal with stress and depression. Regular exercise also helps to improve eating and sleeping habits, which will lead to better general health, better mental health and less sleep deprivation.

  • activities such as hydrotherapy, tai chi, pilates, yoga, walking, swimming or cycling can benefit people with fibromyalgia
  • stretching and mobility exercises can help reduce pain and tightness
  • specific exercises to help build strength and endurance in the ‘posture’ muscles of the body and take the load off achy muscles

Medications

In some cases, your GP may prescribe medications such as an antidepressant to help normalise chemical imbalances and improve pain.

Relief of muscle and joint stiffness, tenderness and pain

  • Massage – can assist pain relief and help muscle relaxation
  • Acupuncture – can be helpful for the comfort of your pain
  • Joint mobilisation – can improve muscle tightness, tenderness and joint stiffness

Managing activity levels and fatigue

  • Fibromyalgia symptoms can fluctuate, meaning that you can have good and bad days. Sometimes overdoing it one day can lead to increased symptoms the next day, so being able to manage your effort is essential.
  • Pacing activities and doing activity/ fatigue diaries can help manage the fluctuations in activity and assist a person in achieving their goals.

Improve ability to cope with daily stress and depression

Daily stresses from work or home can increase your fibromyalgia symptoms. You and your physiotherapist can work with your GP to help you develop strategies to manage these stresses.

Referral to a psychologist can also help in developing strategies to cope with stressful situations.

Sleep health

Understanding sleep and its influence on health are vital in helping people who have Fibromyalgia. Poor sleep health can affect:

  • Mood – Sleep benefits our mood, memory and concentration
  • Brain function – Sleep helps to organise memories and improve concentration.
  • Emotion – Lack of sleep can make you irritable, affecting your emotions, social interaction, and decision making.
  • Immune system – Without adequate sleep, the immune system becomes weak, and the body becomes more vulnerable to infection and disease.
  • Nervous system – Sleep is a time of rest and repair to neurons. During Sleep, neurons rest, replenish and grow.
  • Hormones – substances produced to trigger or regulate particular body functions are timed to release during sleep or right before sleep.

Surgery

Surgery is not used to treat fibromyalgia. However, if a doctor or specialist felt a problem needed surgery, which influenced your fibromyalgia, then surgery for that specific problem may be an option.

What Results Can You Expect?

Over time, with good advice and commitment to a patient-centred management programme, fibromyalgia symptoms can ease and reduce the levels of pain experienced.

Please seek the opinion of your physiotherapist or doctor for your specific needs.

What is Physiotherapy Treatment?

Physiotherapists help people affected by illness, injury or disability through exercise, manual joint therapy, soft tissue techniques, education and advice.  Physiotherapists maintain physical health, allow patients to manage pain and prevent disease for people of all ages. Physiotherapists help encourage pain relief, injury recovery, enabling people to stay playing a sport, working or performing daily living activities while assisting them to remain functionally independent.

There is a multitude of different physiotherapy treatment approaches.

Acute & Sub-Acute Injury Management

physiotherapy treatment

Hands-On Physiotherapy Techniques

Your physiotherapist's training includes hands-on physiotherapy techniques such as:

Your physiotherapist has skilled training. Physiotherapy techniques have expanded over the past few decades. They have researched, upskilled and educated themselves in a spectrum of allied health skills. These skills include techniques shared with other healthcare practitioners. Professions include exercise physiologists, remedial massage therapists, osteopaths, acupuncturists, kinesiologists, chiropractors and occupational therapists, to name a few.

Physiotherapy Taping

Your physiotherapist is a highly skilled professional who utilises strapping and taping techniques to prevent and assist injuries or pain relief and function.

Alternatively, your physiotherapist may recommend a supportive brace.

Acupuncture and Dry Needling

Many physiotherapists have acquired additional training in acupuncture and dry needling to assist pain relief and muscle function.

Physiotherapy Exercises

Physiotherapists have been trained in the use of exercise therapy to strengthen your muscles and improve your function. Physiotherapy exercises use evidence-based protocols where possible as an effective way that you can solve or prevent pain and injury. Your physiotherapist is highly skilled in prescribing the "best exercises" for you and the most appropriate "exercise dose" for you, depending on your rehabilitation status. Your physiotherapist will incorporate essential pilates, yoga and exercise physiology components to provide you with the best result. They may even use Real-Time Ultrasound Physiotherapy so that you can watch your muscles contract on a screen as you correctly retrain them.

Biomechanical Analysis

Biomechanical assessment, observation and diagnostic skills are paramount to the best treatment. Your physiotherapist is a highly skilled health professional. They possess superb diagnostic skills to detect and ultimately avoid musculoskeletal and sports injuries. Poor technique or posture is one of the most common sources of a repeat injury.

Hydrotherapy

Aquatic water exercises are an effective method to provide low bodyweight exercises.

Sports Physiotherapy

Sports physio requires an extra level of knowledge and physiotherapy to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports & Exercise Physiotherapist.

Vestibular Physiotherapy

Women's Health

Women's Health Physiotherapy is a particular interest group of therapies.

Workplace Physiotherapy

Not only can your physiotherapist assist you in sport, but they can also help you at work. Ergonomics looks at the best postures and workstations set up for your body at work or home. Whether it be lifting technique improvement, education programs or workstation setups, your physiotherapist can help you.

Electrotherapy

Plus Much More

Your physiotherapist is a highly skilled body mechanic. A physiotherapist has particular interests in certain injuries or specific conditions. For advice regarding your problem, please get in touch with your PhysioWorks team.

Article by John Miller

What is Pain?

Pain is the built-in alarm that informs you something is wrong!

Pain is your body's way of sending a warning to your brain. Your spinal cord and peripheral nerves provide an electrical pathway.  Nerve messages travel between your brain and the other parts of your body. Pain travels along these nerve pathways as electrical signals to your brain for interpretation.

Receptor nerve cells in and beneath your skin sense heat, cold, light, touch, pressure, and pain. You have thousands of these receptor cells. Most cells sense pain. Tiny cells send messages along nerves and the spinal cord to your brain when there is an injury to your body,

In general, pain receptors are classified according to their location.

Receptors that respond to injury or noxious stimuli are termed nociceptors and are sensitive to thermal (heat), electrical, mechanical, chemical and painful stimuli. Each nociceptor is connected to a nerve that transmits an electrical impulse along its length towards the spinal cord and then, ultimately, your brain.

It is your brain that informs you whether or not you are experiencing pain. Plus, your pain can plays tricks - especially when you suffer chronic pain.

Pain messages travel slower than other nerve stimulation.

Nerves can also be categorised according to their diameter (width) and whether a myelin sheath is present.

Three types of nerves are concerned with the transmission of pain:

A-beta fibres, which have a large diameter and are myelinated
A-delta fibres, which has a small diameter and also have myelinated sheaths.
C fibres have small diameters, are non-myelinated (slowing their conduction rate), and are generally involved in transmitting dull, aching sensations.

Nerves with large diameters conduct impulses faster than those with a small diameter. The presence of a myelin sheath also speeds up the nerve conduction rate.

One method of easing your pain is to provide your nervous system with high speed "good feelings", such as rubbing your injured area. This is the same principle that a tens machine (pain-relieving machine) utilises to provide pain relief.

More info:

What is Pain?

What is Nerve Pain?

What is Chronic Pain?

What is a Pinched Nerve?

Pain Relieving Machines

Article by John Miller

Nerve Pain

Nerve pain is pain caused by damage or disease that affects the nervous system of the body. It is also known as neuropathic pain or neuralgia. Nerve pain is a pain that comes from problems with signals from the nerves. It is different to the typical type of pain that is due to an injury. It is known as nociceptive pain.

What Causes Nerve Pain?

nerve pain

A problem with your nerves themselves, which sends pain messages to the brain, causes neuropathic pain.

What Are Nerve Pain Symptoms?

Nerve pain is often described as burning, stabbing, shooting, aching, or like an electric shock.

What Causes Nerve Pain?

Various conditions can affect your nerves and cause nerve pain. Familiar sources of nerve pain include:

  • Shingles (post-herpetic neuralgia).
  • Trigeminal neuralgia.
  • Diabetic neuropathy.
  • Phantom limb pain (post-amputation).
  • Cancer.
  • Multiple sclerosis.
  • Chemotherapy.
  • HIV infection.
  • Alcoholism.
  • Other nerve disorders.

Nerve Pain & Nociceptive Pain

You can suffer both nerve pain and nociceptive pain simultaneously. The same condition can cause both pain types.

Nerve Pain Treatment

Nerve pain is less likely than nociceptive pain to be helped by traditional painkillers. Paracetamol and anti-inflammatories seem less effective.  However, other types of medicines often work well to ease the pain. Nerve pain is often relieved by anti-depressant or anti-epileptic medication. Please ask your doctor for more advice.

What is Pain?

Pain is the built-in alarm that informs you something is wrong!

Pain is your body's way of sending a warning to your brain. Your spinal cord and nerves provide the pathway for messages to travel to and from your brain and the other parts of your body. Pain travels along these nerve pathways as electrical signals to your brain for interpretation.

Receptor nerve cells in and beneath your skin sense heat, cold, light, touch, pressure, and pain. You have thousands of these receptor cells. Most cells sense pain. When there is an injury to your body, these tiny cells send messages along nerves into your spinal cord and then up to your brain.

In general, pain receptors are classified according to their location.

Receptors that respond to injury or noxious stimuli are termed nociceptors and are sensitive to thermal (heat), electrical, mechanical, chemical and painful stimuli. Each nociceptor is connected to a nerve that transmits an electrical impulse along its length towards the spinal cord and then, ultimately, your brain.

It is your brain that informs you whether or not you are experiencing pain. Plus, your pain can plays tricks - especially when you suffer chronic pain.

Pain messages travel slower than other nerve stimulation.

Nerves can also be categorised according to their diameter (width) and whether a myelin sheath is present.

Three types of nerves are concerned with the transmission of pain:

A-beta fibres, which have a large diameter and are myelinated
A-delta fibres, which has a small diameter and also have myelinated sheaths.
C fibres have small diameters, are non-myelinated (slowing their conduction rate), and are generally involved in the transmission of dull, aching sensations.

Nerves with large diameters conduct impulses faster than those with a small diameter. The presence of a myelin sheath also speeds up the nerve conduction rate.

One method of easing your pain is to provide your nervous system with high speed "good feelings", such as rubbing your injured area. This is the same principle that a tens machine (pain-relieving machine) utilises to provide pain relief.

More info:

What is Pain?

What is Nerve Pain?

What is Chronic Pain?

What is a Pinched Nerve?

Pain Relieving Machines

Article by John Miller

Chronic Pain

Recent research has helped to shed more light on the changes that occur in your body with chronic pain.

What is Normal ‘Protective’ Pain?

Normally pain is good. It informs you about potential or actual damage to your body’s tissues. Nociceptor nerve cells in the tissues of your body, react to strong stimuli such as pressure, heat, cold or chemicals.

These nociceptors send a message to the spinal cord, which then forward another message up to the brain. Your brain then processes these messages and produces a coordinated response to escape whatever is causing the tissue damage.

What is ‘Pathological’ Pain?

Research has shown that changes occur in your body at all levels of pain processing. These changes include:

Changes at the Injury Site

At the site of the injury, your peripheral nerve becomes much more easily excitable.  This means that it takes far less of a stimulus to cause it to fire off. In some cases, even a gentle brush against the skin is enough to fire off the pain pathway.

Unfortunately, it is not just the damaged nerves that become more excitable, but also the neighbouring nerves, which means even further amplification of the nerve messages. Some nerves can also start firing off spontaneously, which means that they do not need a stimulus to fire off.

Changes in your Spinal Cord

In the dorsal horn of the spinal cord, changes occur in some of the cells that receive the nociceptor messages. These changes lead to greater sensitivity to the spontaneous nociceptor messages mentioned previously. Changes can also occur in some cells that leads to a ‘memory’ developing between two cells, which leads to an amplified response in the neighbouring cell.

Changes in your Brain

Usually, your brain can decrease the level of pain you experience by releasing natural opioid hormones. When you suffer chronic pain, changes occur in the midbrain which actually increases the nociceptive messages. This means you’ll perceive even more pain.

Chronic pain messages stimulate parts of the brain involved in emotion, fear and feelings. This may help explain why conditions such as depression, sleep disorders and pain catastrophising are linked with chronic pain.

We also know that chronic pain leads to atrophy or ‘shrinking’ of parts of the cortex and midbrain. Brain-stimulating activities may help to limit this ageing.

Do You Need More Information about Chronic Pain?

If you need more information about your pain or how to best manage your chronic pain, please consult the advice of your physiotherapist. Your physiotherapist is highly trained at helping you to understand and reverse the changes that occur with chronic pain.

What is Pain?

Pain is the built-in alarm that informs you something is wrong!

Pain is your body's way of sending a warning to your brain. Your spinal cord and nerves provide the pathway for messages to travel to and from your brain and the other parts of your body. Pain travels along these nerve pathways as electrical signals to your brain for interpretation.

Receptor nerve cells in and beneath your skin sense heat, cold, light, touch, pressure, and pain. You have thousands of these receptor cells. Most cells sense pain. When there is an injury to your body, these tiny cells send messages along nerves into your spinal cord and then up to your brain.

In general, pain receptors are classified according to their location.

Receptors that respond to injury or noxious stimuli are termed nociceptors and are sensitive to thermal (heat), electrical, mechanical, chemical and painful stimuli. Each nociceptor is connected to a nerve that transmits an electrical impulse along its length towards the spinal cord and then, ultimately, your brain.

It is your brain that informs you whether or not you are experiencing pain. Plus, your pain can plays tricks - especially when you suffer chronic pain.

Pain messages travel slower than other nerve stimulation.

Nerves can also be categorised according to their diameter (width) and whether a myelin sheath is present.

Three types of nerves are concerned with the transmission of pain:

A-beta fibres, which have a large diameter and are myelinated
A-delta fibres, which has a small diameter and also have myelinated sheaths.
C fibres have small diameters, are non-myelinated (slowing their conduction rate), and are generally involved in the transmission of dull, aching sensations.

Nerves with large diameters conduct impulses faster than those with a small diameter. The presence of a myelin sheath also speeds up the nerve conduction rate.

One method of easing your pain is to provide your nervous system with high speed "good feelings", such as rubbing your injured area. This is the same principle that a tens machine (pain-relieving machine) utilises to provide pain relief.

More info:

What is Pain?

What is Nerve Pain?

What is Chronic Pain?

What is a Pinched Nerve?

Pain Relieving Machines