Exploring Fibromyalgia
Widespread pain, fatigue, and 'fibro fog', how Lady Gaga raised awareness, and how lifestyle and medication can improve quality of life.
In 2017 and 2018, Lady Gaga opened up about rescheduling her tour due to widespread, debilitating chronic pain and her fibromyalgia diagnosis. She has courageously raised awareness ever since. It can be hard to believe that such an energetic performer lives with this condition.
Fibromyalgia is a chronic condition that causes widespread musculoskeletal pain. Contrary to popular belief, it does not cause systemic inflammation and is not an autoimmune disease. Symptoms include tenderness to touch or pressure (for at least three months), severe fatigue, sleep disturbance or unrefreshing sleep, and impaired memory or clarity ('fibro fog'). It often occurs alongside migraines or tension headaches, anxiety or depression, IBS or GERD, overactive bladder, pelvic pain, TMJ pain, and sleep disorders.
Diagnosis is based on a clinical history; a tender-point exam is not required. There is no specific blood test or imaging, these are used to rule out conditions with a similar presentation, like hypothyroidism, rheumatoid arthritis, and lupus (which, unlike fibromyalgia, can cause inflammation). Risk factors include female sex, certain genetic mutations, existing conditions like lupus, RA, or osteoarthritis, and physical or emotional stress and trauma.
There is no cure, but symptoms can improve with lifestyle changes, therapy, and medication. Low-to-moderate impact aerobic exercise (walking, cycling, swimming, water aerobics, yoga, tai chi) can improve quality of life, some pain may occur initially, so work with your physician or physical therapist. Cognitive behavioral therapy can reduce stress and tenderness. Helpful habits: exercise regularly, eat healthy (limit alcohol, caffeine, sugar, and processed foods; add omega-3s, fruits, and vegetables), reduce stress, drink water, and get more sleep. Identifying triggers and improving sleep patterns are key.
Medications approved or used for fibromyalgia affect specific brain chemicals: duloxetine (Cymbalta), milnacipran (Savella), amitriptyline (Elavil), and pregabalin (Lyrica) or gabapentin (Neurontin). Acetaminophen, NSAIDs, or cyclobenzaprine (Flexeril) may help other sources of pain, while opioids and benzodiazepines should be avoided. A rheumatologist often evaluates fibromyalgia because it can mimic autoimmune disease, and a primary care physician, physiatrist, sleep specialist, psychiatrist, or therapist may help create a long-term self-management plan. This information is educational and not a substitute for medical advice.
Dr. Maggie Cadet, MD