When you are suffering from the fatigue, deep muscle soreness, and overall pain associated with fibromyalgia, the last thing on your mind is probably exercise. In fact, when doctors first began to diagnose fibromyalgia, they recommended lots of rest and relaxation. It turns out, however, that fibromyalgia exercise can be an important part of treating your symptoms. Here’s what we know.
What does fibromyalgia feel like?
Fibromyalgia is a common chronic widespread pain condition. It affects 2-4 % of the U.S. population, however, only half of patients with the condition have a diagnosis. It is about seven times more common in women and the typical age of onset is between 20 and 55 years. Fibromyalgia appears to be caused, at least partially, by genetic factors. First degree relatives of fibromyalgia patients were more than eight times more likely to develop fibromyalgia themselves than non-relatives.
Patients often describe their pain as aching, exhausting, nagging or hurting. In addition to widespread pain, most patients suffer from:
- Sleep issues
- Cognitive difficulties (fibrofog)
- Impaired memory
- Morning stiffness
Multiple conditions may occur alongside fibromyalgia including:
- Tension/migraine headaches
- Irritable bowel syndrome
- Temporomandibular disorder (TMJ/TMD)
- Interstitial cystitis
- Chronic pelvic pain
- Vision issues
- Depression and anxiety
What causes fibromyalgia?
This complex disorder has no definitive diagnostic test and researchers still aren’t sure what causes it. In 2014, the journal Arthritis and Rheumatology published a study revealing that people experiencing poor sleep, anxiety, and other health problems were more likely to develop fibromyalgia. Environmental factors may also play a role in fibromyalgia development. Fibromyalgia patients tend to report more stressful negative lifetime events than healthy controls.
Although the underlying cause of fibromyalgia has not been established, recent data suggests that alteration of pain processing by the central nervous system may contribute to the chronic wide spread pain. Fibromyalgia is the prototype of a unique type of pain, central sensitization syndrome.
According to the American College of Rheumatology, fibromyalgia can be diagnosed when a patient with at least three months of widespread pain shows eleven or more of the classic eighteen “tender points” during a physical exam. Because many fibromyalgia patients have fewer than eleven tender points, a new questionnaire now replaces these criteria. Now, diagnoses occur when patients meet multiple, varied criteria.
Why is fibromyalgia exercise important?
About 10 million people in the U.S. have the disorder, according to the National Fibromyalgia Association, and most of these people are women. Because fibromyalgia affects so many facets of a person’s life, treatment requires a comprehensive lifestyle approach.
Methods of managing the disorder include gentle exercises such as yoga or water aerobics, relaxing nighttime routines to improve sleep quality, and pain management techniques including acupuncture, relaxation exercises, and nutritional supplements. A healthy, anti-inflammatory diet may also help reduce pain.
Experts generally recommend low-impact aerobic exercise to avoid aggravating pain and other symptoms. A program of walking, stretching, and strength training may be particularly beneficial. Here’s why.
1. Increases serotonin levels in the brain
Exercise increases serotonin levels. Serotonin is the “feel-good” neurotransmitter in our brain, the same neurotransmitter that regulates mood. People who suffer from fibromyalgia generally have lower levels of serotonin.
The good news is that regular exercise helps to increase levels of serotonin, resulting in more feelings of well-being and a general, all-around boost to mood. Intense exercise (like high-intensity interval training) can also increase endorphins, the chemicals in the brain that are famous for producing the “runner’s high.” When our brains release endorphins, our bodies are flooded with a feeling of well-being. Exercise actually makes you feel better, starting in your brain.
2. Regulates cortisol levels
Exercise also helps to regulate cortisol levels. High cortisol levels are associated with high levels of stress, and people who suffer from chronic pain usually have a steady undercurrent of stress running through their day.
Exercise regulates cortisol and adrenaline by kicking production of both into high gear at the beginning of exercise and then dropping at the end. Enhance this effect by exercising earlier in the day, when cortisol levels are naturally highest, and feel the calming effects of exercise for the rest of the day.
3. Improves joint mobility
Another benefit of exercise is a basic physical one. Our muscles and joints work better when we use them.
Think of a rusted door hinge, rarely opened, long neglected. When we first start to swing the door back and forth after a long period of inactivity, it creaks and doesn’t want to move. As we continue to move the door, maybe adding a little lubrication (good nutrition and lots of water for squeaky joints!), the door begins to swing more freely and without protest.
Same goes for our joints and muscles. The first step will be the hardest, but with each subsequent step, our bodies get stronger and feel better.
4. Provides mental health benefits
In addition to the health and pain relief benefits of working out, if you exercise with friends, building community is a bonus. Sharing yourself when you are feeling good, having support in your journey to feeling better, and just getting time with friends to talk and laugh while doing something healthy is a mental health bonus.
Suffering from a hidden illness like fibromyalgia can be a lonely experience. Working out with friends or taking a class with a group of soon-to-be friends can help connect you with others.
What other treatments help with fibromyalgia?
Moderately intense aerobic exercise can decrease your pain, but you should undertake it gradually to avoid exacerbating your symptoms. You should also work closely with your doctor whenever adding exercise to your routine.
Beyond fibromyalgia exercises, there are other lifestyle changes that can help decrease symptoms. Intensive patient education can improve pain, sleep, fatigue, and quality of life. There has been some evidence of improvement in pain, fatigue, mood, and physical function with cognitive behavioral therapy. Other therapies include acupuncture, biofeedback, water therapy, and strength training.
The earliest clinical trial for medications to treat fibromyalgia in 1986 looked into amitriptyline (Elavil), which is a widely used tricyclic antidepressant. Amitriptyline was the recommended first line treatment at that time. The results of multiple trials on that medication and similar medications were mixed in terms of achieving significant improvement of fibromyalgia symptoms. Trials on opioid analgesics failed to show significant improvements for fibromyalgia patients.
Pregablin (Lyrica) is an anti-convulsant that emerged as the first FDA-approved medication for fibromyalgia after it showed statistically significant improvement in pain when used for fibromyalgia in a placebo-controlled trial. Dizziness and somnolence happened in 38% and 20% of the study patients taking the medication respectively.
Duloxetine (Cymbalta) was FDA-approved for fibromyalgia several years later to provide another option through a different mechanism of action. Being an anti-depressant, it addressed a common problem seen in fibromyalgia patients. Nausea may occur in up to 29% of patients taking this medication.
Milnacipran (Savella) belongs to the same category of medications as Duloxetine. It was the last FDA-approved medication for fibromyalgia after showing significant improvement in a three-month trial. In addition to nausea, new onset hypertension was a common adverse event. You may need to monitor your blood pressure while taking this medication.
Get help with your fibromyalgia
Even though only three medications are FDA approved for fibromyalgia at this time, we have a much better understanding of this disease than we did ten years ago. New medications are constantly in development as treatments for fibromyalgia. Patients and physicians continue to be hopeful that the future might bring a cure for such a disabling and widespread disease.
No matter how medications may play a role in treatment, though, it’s best to take them in concert with other therapies to manage symptoms, like fibromyalgia exercise.
Need help managing your fibromyalgia? You can find a pain doctor in your area by clicking the button below or looking for one in your area by using the tips here: https://paindoctor.com/pain-management-doctors/.