Those with fibromyalgia (FMS) have a shared experience of living with pain. But what that feels like can be quite different from person to person due to the fact that there are so many different types of fibromyalgia pain. Some break it down into seven varieties: hyperalgesia, allodynia, paresthesia, muscle pain, joint pain, headaches, and abdominal pain. How many of these one has, and to what extent, varies widely—and this can change over time.
By reviewing the ways fibromyalgia pain can manifest, at the very least, you can feel more at ease knowing that you are not alone in your experience. If your loved one has fibromyalgia, understanding how complex and multi-faceted fibromyalgia pain is can help you better understand what he or she is going through.
"Hyper" means excess and "algesia" means pain. Hyperalgesia is the medical term for pain amplification in FMS. Our brains appear to take normal pain signals and "turn up the volume," making them more severe than they would normally be. And when your brain says pain is severe, it actually becomes severe.
You are not alone if you feel like you always have the flu, or if you "hurt all over." Diffuse and persistent muscle and soft tissue pain (sometimes referred to as myofascial pain) is commonly described as a deep and gnawing soreness, stiffness, aching, or throbbing all over the body, including the arms, legs, neck, and shoulders—is a hallmark feature of fibromyalgia.
Although, keep in mind that early on in the disease, a person may note pain confined to one specific area, like the neck and shoulders.
As part of the diagnosis of fibromyalgia, a doctor may identify areas of the body called "tender points" that hurt when pressed on with only mild to moderate pressure.
Joint aching and a sensation of swelling are common in people with fibromyalgia. More specifically, pain located at temporomandibular joint (TMJ), which connects your jaw to your skull on either side of your face, is common. TMJ pain is often described as a dull, persistent ache that can move to the ear, temple, around the eyes, the lower jaw, or back of the neck.
But unlike inflammatory arthritis, there is no actual joint swelling or inflammation in fibromyalgia. This is a prime distinguisher from diseases like systemic lupus erythematosus and rheumatoid arthritis, in which a person's joints can be visibly swollen.
Is your skin painful to the touch? Allodynia, when mild pressure from clothing or gentle massage causes pain, is a symptom that perplexes many. It is believed to be a hypersensitive reaction that may result from the central sensitization associated with FMS. The pain signals originate with specialized nerves, called nociceptors, that sense information about things like temperature and painful stimuli right from the skin.
A lot of people describe allodynia as skin sensitivity that is similar to a bad sunburn.
Allodynia is a fairly rare type of pain—other than FMS, it's only associated with a handful of conditions, including neuropathy, postherpetic neuralgia (shingles), and migraine.
Many people with fibromyalgia describe neuropathic pain, which causes odd nerve sensations that feel like crawling, tingling, burning, itching, or numbness in the arms and legs. Sometimes, these sensations can be painful. Despite these nerve-related symptoms in FMS, there are no objective findings of nerve damage on a physical exam. In other words, strength, reflexes, and sensations are all normal, despite this neuropathic pain.
Many common fibromyalgia treatments can help alleviate neuropathic pain in fibromyalgia, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Some people also find vitamin B12, capsaicin cream, massage, and acupuncture helpful.
Headaches, though common in general, can also be a result of or associated with fibromyalgia. Tension headaches are the most common type experienced by those with FMS. According to a study in the Journal of Headache Pain, of those with tension headaches, nearly 35 percent also have fibromyalgia. Migraine headaches follow, with approximately 24 percent of migraineurs also having a diagnosis fibromyalgia.
Tension headaches cause a dull tightening pressure sensation all around the head and while uncomfortable and nagging, they are not disabling. On the other hand, migraines are more painful, often occur on one side of the head, and may be associated with both light and sound sensitivity. Some people with migraines also experience a migraine aura, a neurological disturbance that typically involves vision changes, like seeing flashing or shimmering lights, kaleidoscopic shapes, or zigzag lines.
Interestingly, anxiety and poor sleep are two factors that link having a headache disorder to fibromyalgia. This makes sense, considering that both anxiety and poor sleep are known to contribute to central sensitization—the heightened perception of pain. This remains the foundation upon which fibromyalgia and chronic headache disorders are believed to develop.
People with fibromyalgia are 50 percent more likely than people without it to develop irritable bowel syndrome (IBS), which is a digestive disorder characterized by cramping abdominal pain and bloating. Other symptoms of IBS include constipation, diarrhea, nausea, a feeling of incomplete evacuation, and mucus in the stools. Acid reflux, too, is commonly seen in people with fibromyalgia and causes heartburn, and sometimes regurgitation, among other symptoms.
Besides abdominal pain, people with fibromyalgia may experience pelvic pain, especially discomfort that comes from the bladder. Pelvic pain in fibromyalgia may be associated with symptoms of interstitial cystitis, such as an increased urge to urinate and increased urinary frequency.
It's difficult to live with fibromyalgia pain, especially when it's unpredictable. The more you learn about your pain and its triggers, the better you may be able to manage it. For instance, we know that moderate exercise and adequate sleep can improve symptoms and that physical or mental stress, cold and damp weather, and poor sleep can worsen them.
Finding the right set of treatments takes time and experimentation, but many do find significant relief with time, dedication, and patience.
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Kodner C. Common Questions About the Diagnosis and Management of Fibromyalgia. Am Fam Physician. 2015 Apr 1;91(7):472-78.
Wolfe et al. 2016 revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria. Semin Arthritis Rheum. 2016 Dec;46(3):319-29.
Yang TY, Chen CS, Lin CL, Lin WN, Kuo CN, Kao CH. Risk for Irritable Bowel Syndrome in Fibromyalgia Patients: A National Database Study. Medicine (Baltimore). 2017 Apr;96(14):e6657.
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