Why Joint Pain is Different in Fibromyalgia

Unlike most joint pain, the pain associated with Fibromyalgia (FM) is not associated with tissue inflammation and destruction. Fibromyalgia is a mysterious disease affecting musculoskeletal tissue that afflicts individuals with pain, stiffness, and tenderness of the muscles, tendons, and joints.[i] Joint deformities such as that seen with osteoarthritis and rheumatoid arthritis are not seen in fibromyalgia.

Pain in fibromyalgia is widespread, affecting both sides of the body and associated with tender points in localized areas. Pain typically affects the neck, buttocks, shoulders, arms, upper back, and the chest. Pain is referred to as central pain, neuropathic pain, nociceptive pain, or central sensitivity syndromes, and its origin is currently considered to be distorted pain or sensory processing, rather than a local or regional abnormality. The persistent pain of FM is characterized by central sensitization  (CS) which is an incorrect and abnormal response of the central nervous system (CNS)  to a  peripheral stimulus, which is due to hyperexcitability and hypersensitivity of the neurons.[ii]

FM has been associated with neurogenic inflammation in the neurons and the release of cytokines. Excitatory neurotransmitters such as glutamate and substance P are higher in individuals with FM and other neurotransmitter dysfunctions also occur, which leads to the central and local pain symptoms.

The quality of pain from FM is variable. It can be regional or general, and described as sharp, burning, searing, tingling, shooting or stabbing, deep aching, or feeling bruised all over. Often, it is perceived in all limbs as well as the upper and lower back. Cold or humid weather, poor sleep, anxiety, stress, or inactivity can amplify or aggravate pain. 

There are no specific biomarkers to diagnose FM. The American College of Rheumatology (ACR), uses 2 variables for a clinical diagnosis of FM which include bilateral pain above and below the waist is centralized pain in nature, and secondly that the chronic, centralized pain that lasts more than 3 months.

There are many co-morbidities often associated with fibromyalgia including osteoarthritis, Rheumatoid Arthritis (RA), Chronic Fatigue Syndrome (CFS), interstitial cystitis, Irritable Bowel Syndrome (IBS), anxiety disorders, depression, thyroid dysfunction, among others. A systematic review of the research shows a high number of individuals with FM have temporomandibular disorders[iii]. In addition to pain, fibromyalgia sufferers often experience symptoms such as fatigue, sleep disturbances, and cognitive problems.

Treatment of FM includes a combination of pharmacologic and nonpharmacologic treatment methods including antidepressants, analgesics, sleep aids, cognitive therapy, exercise, stress management techniques, and patient education. In general, steroids, opioids, and NSAIDs have not been effective in controlling FM pain. To manage pain, supplements to reduce glutamate and address neurotransmitter imbalances may be helpful. It is also important to assure mineral balance to support neurotransmitter balance and function.

While the pain and symptom management of FM can be challenging, it is important to look for underlying imbalances such as thyroid dysfunction, leaky gut, toxins, and food sensitivities such as gluten sensitivity and not just treat pain. Any of these can contribute to joint pain or other musculoskeletal pain. A functional practitioner can help identify those root issues contributing to the symptoms of FM. An expert and reliable FM resource is Dr. Rodger Murphree.

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[i] Jahan F, Nanji K, Qidwai W, Qasim R. Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management. Oman Med J 2012 May; 27(3):192-195.

[ii] Cassisi G, Sarzi-Puttini P, Casale R, Cazzola M, Boccassini L, Atzeni F, Stisi S. Pain in fibromyalgia and related conditions. Reumatismo. 2014 Jun 6;66(1):72-86. doi: 10.4081/reumatismo.2014.767. PMID: 24938199.

[iii] Ayouni I, Chebbi R, Hela Z, Dhidah M. Comorbidity between fibromyalgia and temporomandibular disorders: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019 Jul;128(1):33-42. doi: 10.1016/j.oooo.2019.02.023. Epub 2019 Feb 28. PMID: 30981530.