Can Fibromyalgia Cause Back Pain?
Most people will experience back pain at some point in their life. And while there are many causes of back pain, one that can be difficult to diagnose is fibromyalgia.
“Over 80 percent of people, regardless of other physical health issues, will experience back pain at some point in their lives. So knowing the difference between fibromyalgia back pain and regular back pain can be tough,” says Amy Orr, a chronic pain advocate and researcher, and author of “Taming Chronic Pain: A Management Guide for a More Enjoyable Life.”
Fibromyalgia causes symptoms such as chronic widespread pain, along with fatigue, sleep problems, and mood or memory issues.
Fibromyalgia pain affects the muscles and soft tissues of the body. The back, in particular, may be affected because it has many muscles that are needed for posture.
“Because fibromyalgia affects muscles directly, [the back] is an easy place to become sore,” says Orr, who has had symptoms of fibromyalgia for most of her life, including chronic back pain.
The other thing that separates fibromyalgia pain from pain due to other conditions is that it generally occurs throughout the body, rather than in just one place.
“Back pain can be one of the areas where a person with fibromyalgia can have pain, but to really have fibromyalgia, they need to have pain in several different locations,” says Lyn Hulst, MD, a chronic pain management specialist at Mary Free Bed Rehabilitation Hospital in Grand Rapids, Michigan.
Causes of Fibromyalgia
Michael Hildebrand, PT, DPT, COMT, owner of M3 Physio in northeast Louisiana, says the cause of fibromyalgia is poorly understood.
“But it is likely due to an oversensitive nervous system,” he says. This is similar to “your house alarm going off every time the wind rattles the window.”
In laboratory studies, people with fibromyalgia perceive greater levels of pain with the same stimuli than people without fibromyalgia. This includes physical pressure, heat, cold and electrical stimulation.
Genetics likely plays a role as well. If someone in your family has fibromyalgia, you may have risk factors for the disorder due to certain genetic mutations.
Fibromyalgia is also up to four times more common in women than in men. Women may even be more likely to have certain symptoms such as an increased sensitivity to pain.
From Back Pain to Fibromyalgia
Fibromyalgia symptoms can begin suddenly, such as after surgery, physical injury, infection or stress. But in some people, the symptoms gradually become worse, with no obvious triggering event.
Back pain can sometimes be the first symptom that people notice. This can occur years before someone is diagnosed with fibromyalgia. In one study, one-quarter of women with chronic low back pain were later diagnosed with fibromyalgia.
“Similar work has been done looking for the incidence of fibromyalgia in people with chronic migraines,” says Hulst.
It’s not clear why some people start out with just back pain — or chronic migraines — and later develop fibromyalgia. One study identified several factors that may increase the risk of back or neck pain leading to widespread chronic pain.
- moderate or severe pain level
- female gender
- history of abuse
- family history of widespread chronic pain
- pain severe enough to interfere with daily activities
- having irritable bowel syndrome, irritable bladder syndrome, migraines and/or restless legs
- using more strategies to manage their pain
Another study found that being older and having depression were also risk factors.
Is It Fibromyalgia or Just Back Pain?
Back pain can be difficult to diagnose because it can have many causes, such as age-related changes to the spine, trauma or a strained muscle or pinched nerve.
However, fibromyalgia is also difficult to diagnose because the symptoms are not always clear-cut and there is no quick blood test for it. But there are ways for doctors — and patients themselves — to pick up on it.
Rebecca Park, a registered nurse and founder of RemediesForMe.com, says it is difficult to diagnose fibromyalgia because the symptoms are often similar to other conditions. She adds, “To make things more confusing, these symptoms can come and go and can also occur concurrently with other disorders.”
This includes irritable bowel syndrome, restless leg syndrome, depression, anxiety and other neurological symptoms.
Back pain associated with fibromyalgia is typically unrelated to spine injuries like a herniated disc. The pain experienced with fibromyalgia also stands out from other conditions that cause back pain.
Physicians should suspect fibromyalgia if “someone has complaints of pain in a number of different areas of their body,” says Hulst. This pain should be present at a similar level for at least three months.
“People with fibromyalgia will also have associated symptoms,” says Hulst, “including fatigue, impaired sleep and cognitive symptoms.”
This last one is sometimes known as “fibro fog,” which can include forgetfulness, problems with concentration and attention, and thinking more slowly.
In order to diagnose fibromyalgia, doctors also have to rule out other conditions that could be causing the same symptoms. This includes autoimmune diseases such as lupus or rheumatoid arthritis. With back pain, it can include conditions like ankylosing spondylitis, a type of arthritis that mainly affects the spine.
If you have already been diagnosed with fibromyalgia, changes in your back pain can sometimes mean something else is going on.
“If it's a different type of back pain than you're used to with fibromyalgia, or if your usual methods of alleviation do not work, then it's possible the pain is not fibro-related and is instead something else,” says Orr. “This is important for women especially, as back pain can be a warning sign of much more serious conditions, such as ovarian cancer.”
If your symptoms have changed or are concerning, see your doctor.
Treatment for fibromyalgia back pain
There is no cure for fibromyalgia. So people with this condition must use therapies to lessen their symptoms. Relieving back pain due to fibromyalgia involves treating fibromyalgia using a mix of self-care and medications.
Your doctor may recommend medications such as:
- Antidepressants to relieve depression symptoms such as sadness and irritability. This can include serotonin and norepinephrine re-uptake inhibitors (SNRIs) or tricyclic antidepressants.
- Anti-seizure drugs, which may reduce certain types of pain. These include gabapentin (Neurontin) and pregabalin (Lyrica).
Other treatments for fibromyalgia include acupuncture, massage therapy and hydrotherapy. Beyond treatment options, Park says the top three lifestyle changes improve quality of life in fibromyalgia patients are diet, exercise and weight loss.
“Getting active, as tolerated, is best,” says Hildebrand, “slowly pushing your limits, but not causing a [fibromyalgia] flare-up — using whatever activity you like to do, such as walking, biking, swimming, weightlifting, etc.”
Getting enough sleep is also important. This may include setting up a regular sleep cycle, avoiding electronic screens before bed, limiting caffeine intake late in the day and sleeping in a dark room.
Because the brain plays a big role in how people with fibromyalgia perceive pain, relaxation techniques can help shift the brain’s focus away from the pain. This includes cognitive-behavioral therapy, meditation or mindfulness training, and breathing exercises.
“For people with back pain, fibromyalgia and chronic migraine, our work is to get the brain focused on other things that are more enjoyable and productive,” says Hulst. “And to help the person learn to live with the pain, rather than try to find a cure or complete elimination of the pain.”
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