To anyone regularly dealing with overweight and obese patients, the frequent association between excess weight and chronic musculoskeletal pain is no secret.
This association is particularly true for the rather enigmatic syndrome of fibromyalgia, characterised by the presence of generalized pain in muscle and joints, often associated with fatigue, poor sleep, and depression. Patients typically present with exquisite tenderness over discrete anatomical points, commonly referred to as tender points. While there is still much debate around the exact etiology or even the exact diagnostic criteria (e.g. number of tender points) for fibromyalgia, there is no doubt that the presence of this syndrome can prove a major barrier to weight management.
Indeed, it is not at all clear whether there may in fact be an etiological link between fibromyalgia and obesity. As outlined in a paper by Akiko Okifuji and colleagues from Salt Lake City, UT, published last year in Clinical Rheumatology, 70% of fibromyalgia patients in their study were overweight or obese and presented with elevated levels of IL-6, catecholamines, cortisol, and CRP, all of which are common findings in obese patients. Furthermore, the patients with fibromyalgia, as do obese patients, presented with reduced sleep duration and efficiency. Based on these commonalities, Okifuji and colleagues concluded that excess weight and obesity may well play a role in fibromyalgia and related dysfunction.
Interestingly, in 2008, Alan Saber and colleagues published an article in Obesity Surgery describing a significant improvement in pain score and points of tenderness in patients with fibromyalgia who underwent laparoscopic Roux-en-Y gastric bypass surgery. Based on these findings, the authors suggested that weight loss may be an important treatment modality for severely obese patients with this syndrome.
Whether or not less drastic approaches to weight management can provide benefits remains to be seen. Nevertheless, there have been reports of limited response to education, exercise, and psychological interventions. Thus, currently accepted non-pharmacological treatments for fibromyalgia remain rather limited.
Recently, a Cochrane review concluded that duloxetine is efficacious for treating pain in fibromyalgia and another systematic review found evidence that gabapentin and pregabalin can also reduce pain in these patients.
Nevertheless, fibromyalgia continues to be a common but largely undertreated problem in overweight and obese patients and can often pose a significant barrier to increasing physical activity or modifying ingestive behaviour.
As blogged before, assessment for muskuloskeletal pain should be a regular and essential feature of any assessment for overweight and obesity.
I very much look forward to comments from any readers struggling with fibromyalgia or from colleagues on how they manage this debilitating syndrome.
AMS
Edmonton, Alberta
In The News
January 26th, 2010 at 8:58 am
In addition to this post, you may want to watch a recent CTS interview with Fibromyalgia Specialist Dr. Alison Bested and Dr. Alan Logan a Naturopathic Doctor, discuss managing fibromyalgia and the role of inflammation.
I am not sure I fully agree with all of these views and could probably have a long discussion with both these colleagues, but here, for what it is worth, is the link:
http://ctstv.com/ontario/player.php?ctsvidID=17298&show=On%20The%20Line
January 26th, 2010 at 7:26 pm
I have been diagnosed with FM, but it appears to be minimal. It’s been more than 10 yrs now. I am slightly overweight, but have been able to stay very active. I do weight training and get a lot of satisfaction from it. Pushing the cardio side is harder, as is losing 10 lbs.
January 28th, 2010 at 7:15 pm
I became ill at 49 in 1990 with what was diagnosed in 1997 to be fibromyalgia and chronic fatigue syndrome. Prior to becoming ill, I was basically healthy and active, walking almost four miles a day, and enjoying fairly strenuous outdoor activities (wood cutting and splitting, carpentry, hiking, canoeing, gardening). After I became ill, I could hardly walk around the block. In the intervening years, my body size has doubled. Efforts to exercise have left me exhausted and in worse pain. I am so miserable and in so much pain that life has become a tremendous struggle. I have received no treatment from my HMO other than prescriptions for amitriptyline or trazodone.
A couple of weeks ago, I decided to try the program outlined in Dr, Mark Hyman’s UltraSimpleDiet, which appears to be remarkably similar to the ideas outlined by Drs.
Bested and Logan in the linked interview above. I lost 6 pounds in the five days in the preparation phase, in which you are asked to give up sugar and white flour, and nothing else. I am currently finishing the fourth day of the detoxification program itself and believe that some of my symptoms have improved slightly, more specifically the brain fog and pain. I recently heard from someone newly diagnosed that she feels much better after having made similar dietary changes.
The medical establishment seems to have little idea how to deal with some of these debilitating conditions, other than to repress the symptoms with medication. I’m appalled at how little is known about nutrition and its effect upon various illnesses. And I view my illness and the resultant inability to be active as the reason why I have become so large, as I have for the most part eaten reasonable amounts through the years.
February 28th, 2010 at 10:59 am
fibro does cause weight gain.the pills have side effect of weight gain and also for the lack of excersise.i have gained 25 pounds in 2 years.
June 16th, 2010 at 6:01 am
[...] Compounds Pain in Fibromyalgia As blogged before, overweight and obese patients frequently present with fibromyalgia, characterized by chronic pain, fatigue and depressed [...]
June 16th, 2010 at 8:12 am
My wife has full blown rheumatoid arthritis. She was also the past president of the arthritic society and is still deeply involved with disseminating information about the disease.
She maintains that rheumatoid arthritis is a for real physical disease that destroys the body inch by inch and day by day and you die from pain whereas FM is an illness of the mind that is impossible to measure.
Regardless of the opinions and arguments for and against having or not having FM it is a physical fact that being overweight is not caused by either having or not having FM but at the same time it is not healthy to be overweight regardless of what other disease a person may have.
Now if there was an operation to sew the mouth shut I would not be overweight from compulsive over eating.