No one knows what causes fibromyalgia, a chronic pain disorder that also causes widespread muscle pain as well as fatigue and memory problems (“fibro fog”). Sometimes it crops up after a physically or emotionally traumatic event, and it seems to be more commonly diagnosed in people with post-traumatic stress disorder (PTSD).

Now a new study confirms this link by examining fibromyalgia incidence among members of the U.S. military. The study, which was published in Arthritis Care & Research, is the first large-scale study to examine the relationship between fibromyalgia and PTSD in active service members.

How The Study Worked

Researchers used data from three different PTSD treatment trials as well as data from a study involving military members who had not yet been deployed. Altogether, more than 4,000 people completed surveys related to fibromyalgia and PTSD.

To assess fibromyalgia, the surveys asked about widespread pain as well as cognitive symptoms, fatigue, and depression. Participants were assumed to have fibromyalgia if such symptoms were significant and persisted for at least three months.

PTSD was assessed in the pre-deployment group with questions about whether someone was “re-experiencing” the following symptoms:

• Flashbacks: feeling or acting like a traumatic event is happening again
• Avoidance symptoms: avoiding things that would remind them of the traumatic experience
• Arousal symptoms: being easily startled or having angry outbursts

Study participants who were already in another PTSD treatment trial had already been diagnosed by clinicians.

According to the findings, nearly 11 percent of pre-deployment military members who had PTSD also met the criteria for fibromyalgia (versus less than 1 percent of the pre-deployment group who did not have PTSD). Meanwhile, nearly 40 percent of the military members who were already in treatment trials for PTSD were found to have co-existing fibromyalgia.

The authors concluded that “the prevalence of [fibromyalgia] was significantly higher in service members with comorbid PTSD and highest among those seeking treatment for PTSD.”

What These Findings Mean

While the prevalence of fibromyalgia in the pre-deployment group was similar to that of the general population, the authors explained that it was “higher than expected for a predominantly male cohort.”

In the general population, fibromyalgia is far more common among women — according to the Centers for Disease Control and Prevention, it is twice as likely in women. This finding might suggest that fibromyalgia is under-reported or under-diagnosed in civilian men.

Although more research is needed to fully understand the connection between fibromyalgia and PTSD, “non-pharmacologic therapies, such as cognitive-behavioral therapies, that focus on underlying psychological distress are recommended for individuals with [fibromyalgia] and PTSD,” the researchers noted.

Get Involved in Arthritis Research

If you are diagnosed with fibromyalgia or another rheumatic disease, we encourage you to participate in future studies by joining CreakyJoints’ patient research registry, ArthritisPower. ArthritisPower is the first-ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. Learn more and sign up here.

Learn more about our FREE COVID-19 Patient Support Program for chronic illness patients and their loved ones.

People with fibromyalgia are all too familiar with its often-debilitating symptoms, which include widespread muscle and joint pain, fatigue, insomnia, and brain fog. Now a new study confirms that similar symptoms often arise in people with post-COVID syndrome.

Post-COVID syndrome — also known as long COVID, long-haul COVID, and post-acute sequelae of SARS-CoV-2 (PASC) — refers to health problems that persist in a subset of people who have technically recovered from COVID-19 (meaning they no longer have an active infection). This condition isn’t a single, specific health problem but rather a mix of symptoms that can vary widely from person to person. Long COVID might include organ damage, depression, persistent loss of taste and smell, or any other new health issue that crops up in the wake of COVID-19.

Post-COVID syndrome might also include neurological problems like fatigue, headaches, dizziness, and brain fog. This constellation of symptoms, of course, sounds a lot like fibromyalgia. To find out whether post-COVID syndrome was actually causing some people to develop fibromyalgia (including the chronic pain that goes along with it), Italian researchers decided to perform a web-based study.

The study, which was published in the journal RMD Open: Rheumatic & Musculoskeletal Diseases, surveyed more than 600 people who had recovered from COVID at least three months before the study began but had ongoing health problems. Those with a pre-existing fibromyalgia diagnosis or a history of chronic musculoskeletal pain were excluded.

Study participants completed surveys that asked about the severity of their COVID infection as well as symptoms that might pertain to fibromyalgia. The questions about fibromyalgia were based on the American College of Rheumatology’s Survey Criteria for Fibromyalgia, as well as the organization’s Fibromyalgia Impact Questionnaire.

The researchers found that about 30 percent of respondents with post-COVID syndrome seemed to meet the diagnostic criteria for fibromyalgia. They suggested that lingering inflammation and/or virus-induced damage to the endothelium (lining of the blood vessels) or immune system might be to blame.

“Some of the proinflammatory cytokines involved in COVID-19 and PACS manifestations, such as interleukin (IL)-1 and IL-6, may contribute to the pathogenesis of [fibromyalgia],” researchers wrote.

Surprisingly, this study found that men were more likely than women to develop symptoms consistent with fibromyalgia. (According to the U.S. Centers for Disease Control and Prevention, women are twice likely to have fibromyalgia as men.) Obesity was also identified as a strong risk factor for developing fibromyalgia-like symptoms after COVID-19 infection.

The researchers noted that “both male gender and obesity have been consistently associated with a more severe clinical course in patients with COVID-19” and speculated that having a more severe case of COVID might somehow predispose obese men to fibromyalgia. However, they did not find a significant increased risk of fibromyalgia among those who had been hospitalized with COVID.

“In the light of the overwhelming numbers of the SARS-CoV-2 pandemic, it is reasonable to forecast that rheumatologists will face up with a sharp rise of cases of a new entity that we defined ‘FibroCOVID,’” the authors concluded.

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Having an invisible illness that causes chronic pain, like rheumatoid arthritis, lupus, or axial spondyloarthritis, comes with a long list of burdens. There are the physical burdens, like the stiff, swollen joints that prevent you from ever feeling comfortable and the 24/7 fatigue that keeps you in bed. There are the emotional burdens, such as sadness over how your life has changed since being diagnosed and anxiety over how your illness may progress over time. And then there is a burden that takes a physical, emotional, and mental toll: the constant challenge of explaining your illness to others.

Telling — or, more accurately, teaching — people about an invisible illness can be challenging. Because, as the name implies, it can’t be seen by others. Unlike a broken bone, where people can see evidence of the injury and pain, an invisible illness does internal damage, and its symptoms hide beneath the surface. Not to mention many invisible illnesses are, well, complicated. Even medical experts can be stumped by the challenges an invisible illness can present.

Of course, sometimes chronic pain is visible. Your gait may change if you have bad arthritis in your hip, say. You could get psoriasis or lupus rashes on your skin. But in general, rheumatic diseases are invisible relative to how much pain, disability, and long-term damage they cause.

Still, telling others about your lived experience with an invisible illness is important. It allows people to better understand your situation, which (hopefully) allows them to make helpful adjustments and offer empathy. It also helps raise awareness which, in turn, can lead to changes that improve the care and quality of life for those living with invisible illnesses.

As part of Arthritis Awareness Month, we asked members of our community how they explain their invisible illness to others. It seems that people have different approaches when trying to teach others about their conditions. Some, like Julie M., compare it to “having the flu every day.” Others, like manasi_i, tell people that “my body is treating itself as an enemy.” One person, Luzsanti, describes their illness as, “the kind of tired and the kind of pain that can knock you out even when you think you are prepared for it.”

But several members of our community shared a sad truth: they don’t even try to explain their condition to others. For many of them, trying to get others to understand an invisible illness can be practically as draining as the illness itself.

People living with chronic diseases should not feel obligated to have to always educate other people about their health issues, yet they often take on that duty or it is thrusted upon them. Every so often they may help enlighten someone who genuinely wants to understand what they’re going through; someone who asks thoughtful questions and offers empathy. Often, however, their “students” hurl judgement and unsolicited advice their way. And the energy required to respond to or brush off these comments is energy people with chronic illnesses can’t spare.

“It’s exhausting trying to get people to get it, and the process usually comes with judgments, assumptions, and bias,” Josie P. says of explaining her illness. “Unless it’s a very close friend or someone who needs to know what’s going on, I just say ‘I have three autoimmune diseases’ and leave it at that.” Josie adds that this approach has been beneficial for their well-being and that, “if people want to learn and ask questions then I am here to educate as much as I can, but as soon as [they] start getting rude and judgmental, we are no longer having a conversation.”

Lisa T. echoes Josie’s thoughts, saying that sharing their story, “brings nothing but judgment and unwanted advice on how easily I can cure myself.”

“I don’t even try,” Velma M. says. “I’m sick of being told to ‘suck it up’ and ‘get over it.’”

Just as bad as the judgment, are the implications that your chronic illness is a burden to others; that the physical and emotional pain you experience has a negative impact on them.

“I try to get people to understand more [but] it’s apparently too depressing and bothersome,” Michelle S. shares. “[People are] not too concerned about how it’s a life-altering thing and it will eventually take my life.”

Gayle R. has had similar experiences. “I’ve given up trying. I live amidst a world where everyone has something more important going on,” they wrote.

Similar to being told you don’t look sick, having your experience disregarded is harmful to people living with chronic conditions. It dismisses what they physically, mentally, and emotionally go through each day. It silences them. And silencing someone with an invisible illness keeps them from raising awareness and bringing visibility not only to their individual struggles, but to the struggles of the millions of people living with chronic diseases.

Want to Get More Involved with Patient Advocacy?

The 50-State Network is the grassroots advocacy arm of CreakyJoints and the Global Healthy Living Foundation, comprised of patients with chronic illness who are trained as health care activists to proactively connect with local, state, and federal health policy stakeholders to share their perspective and influence change. If you want to effect change and make health care more affordable and accessible to patients with chronic illness, learn more here.

People with fibromyalgia are often hypersensitive to muscle, joint, and widespread pain. Now, new research suggests people who have this disorder may be more sensitive to heat and sound, too.

In a small study, published in the Journal of Pain, researchers tested 51 people for their response to noise and temperature stimuli. Of the group, 23 people had fibromyalgia and 28 did not. All fibromyalgia patients were tapered off their psychotropic medications (such as antidepressants) and pain medications prior to the study but continued to take medications for any comorbid conditions.

Each study participant listened to sounds played through earphones and was asked to rate them based on how mild or intense they sounded. In another part of the study, participants had varying levels of heat or pressure applied to their hands and legs and asked to rate their discomfort.

“Using three different stimulus intensities, our psychophysical investigation of auditory sensitivity provided evidence that [fibromyalgia] patients require less sound pressure to report similar loudness ratings than [healthy controls],” the authors found.

In other words, people with fibromyalgia demonstrated more sensitivity to sounds, and found lower-volume sounds to be more intense, than people without fibromyalgia.

Meanwhile, fibromyalgia patients reported pain at lower levels of pressure and heat compared to what caused healthy participants the same amount of discomfort.

“Many previous reports have suggested that central nervous system augmentation in [fibromyalgia] is not limited to pain but may also affect sound, light, taste and smell,” the researchers wrote. “However, until now, no definitive laboratory evidence of abnormal loudness augmentation was available.”

The authors noted that such sensitivities are often dismissed as being psychological in nature — or, as patients commonly hear, “it’s all in your head.” This study, albeit small, adds to the evidence that nervous system problems likely make people with fibromyalgia patients perceive sound, temperature, and touch as more severe compared to how people without fibromyalgia experience them.

Additional, larger studies will be needed to confirm these findings. The researchers noted that they are also interested in investigating whether fibromyalgia patients might respond differently to light and smell.

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When Zane K. suspected he had fibromyalgia, he mentioned it to his doctor. The response: “He laughed,” Zane recalled in a Facebook post, “and said it was a women’s syndrome.” He had to find a new doctor, endure months of tests, and get a recommendation to see a rheumatologist before he was finally diagnosed with the condition. CreakyJoints member Carl H. had a similar experience: At 38, he felt exhausted and in constant pain. “Getting the doctors to admit I had fibromyalgia was very hard work,” he shared in a post. “I thought I was going mad and it was all in my head.” Fibromyalgia is a disorder characterized by widespread pain accompanied by fatigue, sleep, memory, and mood issues. It’s one of the most common chronic pain conditions, affecting about 4 million adults in the U.S., according to the U.S. Centers for Disease Control and Prevention. (The National Fibromyalgia Associationestimates that number to be higher, around 10 million.) It’s also one the most misunderstood, particularly for men. Some estimates say up to 90 percent of fibro patients are women, and therefore as few as 10 percent are men. That’s why fibromyalgia is often thought of as a disorder that almost exclusively affects women. While it’s true that fibromyalgia is more common in women, recent studies suggest the disparity may not be so great as previously thought. Research indicates that the prevalence of fibromyalgia is actually similar among males and females — it’s just that males are much less likely than females to identify symptoms and be diagnosed with the condition. And survey results published in the journal Arthritis Care & Research found 20 times more men reported fibromyalgia symptoms than had been diagnosed, compared to three times more women.

Why Fewer Men Are Diagnosed with Fibromyalgia

The cause of fibromyalgia is unknown: family history may play a role for some, as certain genes may make you more susceptible. Fibromyalgia may be triggered by physical trauma (like a car accident), emotional stress, or certain infections, according to the Mayo Clinic. And often, fibromyalgia symptoms gradually develop with no one triggering event. As to why fibromyalgia is sometimes overlooked in men, experts suspect a couple of reasons may factor in:

There’s no single test to detect fibromyalgia

To diagnose fibromyalgia, you have to experience widespread pain for more than three months — with no other underlying medical condition that could be causing the pain, according to the American College of Rheumatology. There are no lab tests to confirm a diagnosis, but your doctor may do blood tests and imaging to rule out other health problem that can be confused with fibromyalgia. Read more here about how fibromyalgia is diagnosed. Doctors will also screen for the severity and duration of other symptoms that point to fibromyalgia, such as fatigue, mood disorders, sleep issues, and cognitive problems. “These are all pretty constant,” explains Nilanjana Bose, MD, MBA, a rheumatologist at the Rheumatology Center of Houston in Texas. “It is unlikely or rare that someone has fibromyalgia and doesn’t have a mood or sleep disorder and just has fatigue.” When some doctors see male patients with aches and pains, however, they may not think to ask about other fibromyalgia symptoms as readily, simply because, historically, they were taught to see fibromyalgia more in women. “There could be an unconscious bias on the part of the health care provider,” explains Dr. Bose. In the past, diagnostic criteria for fibromyalgia included a “tender point” exam, where doctors would check 18 specific spots on a person’s body to see how many of them were painful when pressed firmly. To officially diagnose you with fibromyalgia, at least 11 of these 18 points had to test positive for tenderness. Though the criteria changed and tender points alone are no longer used to diagnose fibromyalgia, women in general tend to have more tender points than men, explains Rajat Bhatt, MD, rheumatologist at Prime Rheumatology PLLC in Richmond, Texas — so men have been less likely to pass this traditional test as well.

Gender stereotypes may play a role

While this isn’t true for everyone, in general, “men tend to be more stoic about their pain,” says Dr. Bhatt, “and less likely to express health concerns.” Dr. Bose agrees: Men may feel they’re “not supposed to complain about pain,” which may delay or prevent a diagnosis of fibromyalgia. A survey published in the American Journal of Men’s Health found that men were more likely to wait up to six months before going to their primary care doctor to discuss fibromyalgia. One flagged reason: a general societal belief that a man needs to seem strong and “tough it out.”

Fibromyalgia Symptoms in Men

The science is unclear on whether fibromyalgia symptoms appear differently in men versus in women. One study in the journal Pain Medicine, for example, found that women reported more pain sensitivity while men reported more disability and a longer duration of symptoms. Some research suggests that men have fewer and more mild symptoms than women, other studies suggest the opposite, and still others indicate little difference between genders. What we do know is that chronic, widespread pain is the chief fibro symptom — it’s often described as a constant dull ache that occurs on both sides of your body and above and below your waist. Chronic fatigue, sleep issues, and problems with memory or thinking clearly — often called “fibro fog” — are also common, as well as depression and headaches. The culmination of these symptoms can often be frustrating, and at times debilitating. Some days Harold P. can lift nearly 100 pounds; other days he has trouble lifting a gallon of milk, he shared in a CreakyJoints Facebook post. His memory issues can be crippling: “Did I really just take that med or not? Did I use shampoo or just wet my hair? I lose my train of thought as I am trying to figure things out,” he explains. He’s often in pain, which makes him short-tempered: “Even being touched can hurt.”

Fibromyalgia Stigma for Men

The impact of fibromyalgia on physical health is tough to handle, no matter your sex/gender. But research suggests that men with fibro also feel a heavy burden on their mental well-being, relationships, and careers — in part from social or cultural expectations. In a nationwide survey that included 800 men with fibromyalgia, nearly all said that depression was their top symptom. More than half of respondents (54 percent) reported negative impacts on relationships with both family and friends — saying that while those close to them usually tried to be supportive, oftentimes they would not understand the condition and its effects. Many CreakyJoints members report feeling the same way, sharing how employers did not support them or even their own family members thinking they were exaggerating symptoms. When Will L. was diagnosed with fibromyalgia at age 54, he felt let down: “I’m a big guy, 6’2” and 230 pounds, bearded. I look a lot stronger and healthier than I am,” he shared on Facebook. Because of his symptoms and the physical nature of his profession, Will can’t work the same way he used to and struggles not only with the potential of losing a successful career, but also with how others perceive him. “I fear being seen as lazy when on the outside I look fine,” he says. If someone asks him how he’s doing, he lies: “I’ve learned telling the truth makes them uncomfortable,” he explains. “I often feel shamed, judged, and dismissed.”

How Fibromyalgia is Treated

Treating fibromyalgia includes a mix of medication and self-care to help minimize symptoms and improve general health. No one treatment will work for all fibromyalgia symptoms, or for every person. “Treatment is based on the individual, rather than sex/gender,” says Dr. Bose. Talk to your health care provider to determine the best treatment plan for you. You can read more details here about fibromyalgia treatment, but it may include a combination of: Medication to help reduce pain and improve sleep, including:

• Over-the-counter or prescription pain relievers
• Antidepressants: medications such as duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia.
• Anti-seizure drugs: Epilepsy medications may help reduce certain types of pain, such as gabapentin (Neurontin) to help ease fibromyalgia symptoms and pregabalin (Lyrica), which is FDA-approved to treat fibromyalgia

Physical therapy to help improve strength, flexibility, and stamina. Cognitive behavioral therapy (CBT) to treat underlying depression and address the impact that fibromyalgia is having on your quality of life. CBT is a type of talk therapy meant to change the way people act or think. Read more here about CBT and its use in chronic pain conditions. Lifestyle changes to help improve symptoms and everyday function. Some self-care tips include:

• Make time to relax every day. Deep-breathing exercises and meditation will help reduce the stress that can bring on symptoms, recommends the American College of Rheumatology.
• Get enough sleep. Go to bed and wake up at the same time each day and limit daytime napping. That will help set a regular sleep pattern so your body get the rest it needs to repair itself, physically and mentally.
• Stay active. Exercise may be tough at first, but start low and go slow, gradually adding daily fitness to your routine, like walking, swimming, or stretching. Regular exercise often reduces pain and fatigue. As fibromyalgia symptoms decrease, increase your exercise a little at a time.
• Know your limits. “Regardless of work or family you must be kind to yourself,” advises CreakyJoints member Paul G. “Men need to realize they can be open about the illness — and their limitations.” If you do too much on your good days, you may have more bad days. Keep your activity on an even level. Read more here about energy pacing with fibromyalgia.

For more advice to manage fibromyalgia, here are 18 survival tips from fellow fibro patients.

Track Your Fibromyalgia Symptoms with ArthritisPower

Join CreakyJoints’ patient-centered research registry and track symptoms like fatigue and pain. Learn more and sign up here.

When Jessica B.’s back pain started, she was almost positive it was from a workout injury or muscle strains from toting around her toddler son. She would feel sharp pains in her lower back mostly when standing or lying down for long periods; bending to empty the dishwasher or give her child a bath became really difficult. At first, she saw a chiropractor and did a few sessions of physical therapy, but after a few months, the pain wasn’t letting up.

It wasn’t until she saw an orthopedist — and got X-rays and MRIs — that she learned her ultimate diagnosis: osteoarthritis. She was surprised — “I was only 40, and I didn’t really hear much about people having arthritis in their back” — but also relieved. And once she started taking a prescription nonsteroidal anti-inflammatory medication (NSAID), her pain was notably better.

“I could actually play tennis with my friends for an hour without wincing in pain,” she says.

Indeed, back pain is one of the most common medical complaints. It’s widely reported that about 80 percent of adults experience low back pain at some point in their lives. Most back pain goes away on its own within a few days to a few weeks and is not due to a chronic disease like arthritis. In fact, most acute (short-term) back pain is due to a musculoskeletal injury like a muscle strain or sprain.

When back pain persists for weeks or months, though, it’s time to start investigating whether a medical condition could be responsible for the symptoms. Unfortunately, many people do not suspect arthritis as a cause of their back pain, even though arthritis in the back is very common. Arthritis in the back can also co-occur with other back pain causes, such as slipped or herniated discs or sciatica, which can make it harder to get the right diagnosis and treatment.

When you think of arthritis, you might think of creaky knees, stiff hips, or painful, swollen fingers. Yes, arthritis commonly attacks joints in the hands, knees, and hips. But it can happen anywhere you have joints — including the spine in the back.

Back arthritis is not one disease; rather, many different types of arthritis may cause back pain and stiffness. Symptoms may be related to issues like wear and tear of the joints in the spine, autoimmune disease and widespread inflammation, or infection. Regardless of the exact location or physiological reason, arthritis in the back can be painful and often becomes chronic.

“As you get older, you’re more likely to develop osteoarthritis of the spine,” Michael Tiso, MD, a physician who specializes in internal medicine and sports medicine at The Ohio State University Wexner Medical Center in Columbus. “Oftentimes, people have arthritis in the back without even having any symptoms. While about 10 percent of people in their thirties have lumbar arthritis that is visible on imaging [like X-rays], more than 80 percent of people over age 80 will have arthritic changes you can see on imaging. The percentage of people who are symptomatic is much less, which is why routine imaging is often not helpful.”

Learn more here about what causes back arthritis, different types of back arthritis, and how arthritis in the back is treated.

Symptoms of Arthritis in the Back

Common symptoms of back arthritis may include:

• Back pain, especially in the lower back
• Limited range of motion
• Stiffness and loss of flexibility in the spine, such as being unable to straighten your back or turn your neck
• Limitation of function, such as being unable to get out of bed easily, tie shoes, carry laundry, or do physical activity or exercise
• Tenderness of the affected vertebrae
• Feeling grinding when moving the spine
• Tingling, numbness, weakness, or sharp shooting pains in your arms or legs if nerves of the spine are affected
• Headaches (when the upper, or cervical, spine is affected)
• Pain/swelling/stiffness in other joints, such as knees, hands, and feet (common in inflammatory arthritis)
• Fatigue
• Pain that is felt in the pelvis, buttocks, or thighs

“I’m in agony most days,” CreakyJoints member Jackie R., who has osteoarthritis in her back, shared on Facebook. “Clicking, crunching, popping are normal sounds now.”

Linda H., who has ankylosing spondylitis, told us that she is “always very stiff in the morning and can take a while to loosen up. Generally bending to pick something up is difficult, but vacuuming is the worst.”

Although back pain is a common symptom, not all people with arthritis in the back have symptoms like pain, even those with advanced back arthritis. On the other hand, some people may experience back pain even before evidence of arthritis can be seen on an X-ray.

Mechanical vs. Inflammatory Back Pain

Though many different types of arthritis can affect the back, they generally fall into two basic categories:

• Mechanical causes (which include osteoarthritis)
• Inflammatory causes (which include rheumatoid arthritis as well as arthritis in the spondyloarthritis family, such as axial spondyloarthritis and psoriatic arthritis)

Mechanical back pain is far more common than inflammatory back pain. However, inflammatory back pain may be treated very differently from mechanical back pain. (Medication options for debilitating symptoms include biologics that target the immune system.) So it’s important to get the right diagnosis if you think inflammatory back pain could be the reason for your symptoms.

The differences between mechanical and inflammatory back pain can sometimes be subtle, but there are often clear differences in the nature of the pain, if you know to look for it.

You can take this quiz to see if your back pain is more likely inflammatory or mechanical, but generally inflammatory back pain:

• Strikes at a younger age (generally before age 40-45, and often first in the teens and twenties)
• Feels better with exercise and movement and worse with rest and inactivity
• Lasts for three months or more, but can come and go
• Feels stiff first thing in the morning for 30 minutes or more
• Can wake you in the middle of the night in severe pain

Types of Arthritis that Affect the Back

If you have arthritis in your back, it’s important to understand the type of arthritis that might be causing it. Different types of arthritis have specific medications and treatments. Here are some of the more common types of arthritis that affect the back.

It is common for people with back pain to have more than one cause, which could include arthritis as well as other causes (more on those below).

Osteoarthritis

Osteoarthritis (OA) is by far the most common form of back arthritis; risk increases with age. Osteoarthritis is a degenerative joint disease where the cartilage cushioning the ends of a joint wears away gradually. In the back, OA commonly affects the facet joints, which are found at the back part of the vertebrae in the spine. As the cartilage wears away between the facet joints, it can cause pain and stiffness in the back. Patients with OA tend to have mechanical pain such as minimal pain in the morning, worse pain with activity, and improvement with rest, says Brett Smith, DO, a rheumatologist with Blount Memorial Physicians Group in Alcoa, Tennessee.

OA in the back usually coincides with disc changes in the back that become more common with age.

The vertebrae in the spine are cushioned with discs that have a jelly-like center. These discs are what give the spine its flexibility. Over time, the discs lose their cushioning and height. This causes the spaces between the vertebrae to compress, which can make them rub against each other. In response to this stress, the body starts to make bony growths called osteophytes (bone spurs), which can pinch the nearby nerves and cause weakness or numbness. This is part of a process known as spondylosis, and includes degenerative disc and facet arthritis. Sometimes this can lead to other issues like spinal stenosis (narrowing of the spinal canal) as well, says Dr. Kirschner.

Osteoarthritis often affects the lower back (lumbar spine) and neck (cervical spine) and develops through wear and tear, though it has a strong genetic component, too, says Jonathan S. Kirschner, MD, RMSK, physiatrist at Hospital for Special Surgery in New York City.

OA pain is typically more noticeable when you bend backward or twist your back or when you’re standing for a while, says. Dr. Kirschner.

Spondyloarthritis

Spondyloarthritis (SpA) is an umbrella term for several different types of arthritis that have certain traits and symptoms in common; namely, that they cause inflammation in the spine. Arthritis types in this category includes axial spondyloarthritis, psoriatic arthritis, reactive arthritis, enteropathic arthritis, and undifferentiated spondyloarthritis.

There are two main kinds of SpA: axial (in which symptoms predominantly affect the back, though other joints can be involved) and peripheral (where other joints in the body, like the hands, feet, or knees, are predominantly affected, though the back may be as well).

Axial Spondyloarthritis

Axial spondyloarthritis (axSpA) is the most well-known type of inflammatory arthritis for causing back pain. It is generally broken down into two types: non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS). Non-radiographic axial spondyloarthritis means inflammation is occurring in the spine and sacroiliac joints (which connect the spine to the pelvis) but damage to the joints is not visible on X-rays. With AS, damage to the joints can be seen on X-rays. AS, too, causes bony growths on the spine, but these are different from those that occur in osteoarthritis.

In AS, the hallmark bony growth is called a syndesmophyte, which originate in the low lumbar spine and work their way up the spine and do not project out, says Dr. Smith. They are calcifications of the ligaments, says Dr. Kirschner.

AxSpA occurs because the body’s immune system is overactive, releasing chemicals into the blood and joints that cause pain, stiffness, and eventually joint damage. Over time, the bony growths around the vertebrae can cause parts of the spine to fuse together, leading to limitations in flexibility and mobility.

Psoriatic Arthritis

Psoriatic arthritis (PsA) is another type of spondyloarthritis. It can cause back pain, but it more commonly affects the peripheral joints, such as those in the fingers, toes, and knees. However, research shows up to half of patients with PsA also have inflammation in the spine that causes inflammatory back pain-like symptoms.

Psoriatic arthritis is linked to psoriasis, an autoimmune skin disease that causes red, silver, scaly rashes on the skin. The majority of PsA patients have both psoriasis plaques as well as pain, stiffness, and swelling in various joints. However, in some patients, joint symptoms precede skin symptoms or skin symptoms can be very subtle, so people may not necessarily think to connect psoriasis and PsA.

Adding to the confusion: People with axial spondyloarthritis are at greater risk of also having psoriasis. For some patients who have both psoriasis and inflammatory back pain, it may not be entirely clear whether they have psoriasis and axial spondyloarthritis or psoriatic arthritis with back pain. Learn more here about how doctors distinguish axSpA from PsA.

Reactive Arthritis

Reactive arthritis is considered a type of peripheral spondyloarthritis that happens in reaction to an infection in your body. Common causes include gastrointestinal illnesses like Shigella, E. coli, or campylobacter. Additional causes include sexually transmitted infections, such as gonorrhea or chlamydia, or urinary tract infections. Conjunctivitis (inflammation of the eyelids) commonly accompanies the arthritis, says Adam Kilian, MD, a rheumatologist and assistant professor of medicine at The George Washington University School of Medicine and Health Sciences in Washington, D.C. This arthritis is more common in smaller joints, but it affects the spine in about half of cases, he says.

Enteropathic Arthritis

Enteropathic arthritis, also known as inflammatory bowel disease-associated (IBD-associated) arthritis, is a peripheral spondyloarthritis that occurs in about 10 percent of people with inflammatory bowel disease (ulcerative colitis or Crohn’s disease), says Dr. Kilian. It commonly affects the sacroiliac joints, causing inflammatory lower back pain.

Undifferentiated Spondyloarthritis

This is a type of peripheral spondyloarthritis when it’s not entirely clear which type of peripheral spondyloarthritis is the most fitting diagnosis, says Dr. Kilian. Since the different types of spondyloarthritis have many common features, it may be difficult to differentiate them early in the course of disease when symptoms may be mild.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disease in which the body’s immune system attacks itself, causing inflammation and pain in various joints. RA most commonly affects the joints of the limbs — and notably often first strikes in the hands and feet — but it can also affect the spine. When RA affects the back, the cervical spine (the neck) is affected, which may cause neck pain or sharp-shooting pains down the arms if the nerves are compressed, says Dr. Kilian.

Other Possible Causes of Back Pain

Lumbar Muscle Strain

Sometimes the muscles of the lower back become strained or spasm. This accounts for most cases of short-term (acute) back pain. These kind of back problems can occur from an injury, like lifting something improperly or overdoing it during physical activity. This can cause low back pain and stiffness, but it generally goes away within a few days to a few weeks.

Sciatica

The sciatic nerve is the largest nerve in the body, running from the lower part of the spinal cord, through the buttock, and down the back of the leg to the foot. Sciatica refers to pain that radiates from your lower back to your buttock and down the back of your leg. It is often accompanied by low back pain. It most commonly occurs when a herniated disc or narrowing of the space between the vertebrae compresses part of the nerves that go to the leg, says Dr. Kilian.

Scoliosis

You may never have realized it, but your spine may be curved to the side instead of straight, either in an “S”- or “C”-like shape. This condition is known as scoliosis. The physical changes of scoliosis often start in childhood or adolescence, but the condition might not start causing back pain until middle or older age. Scoliosis usually causes back pain from muscle imbalance or because it leads to other conditions (like spine arthritis or disc disease), but it in and of itself doesn’t cause pain, says Dr. Kirschner.

Fibromyalgia

Fibromyalgia is a chronic pain disorder that is thought to be due to how the brain processes pain, rather than due to a mechanical or inflammatory trigger of pain. In patients with fibromyalgia, pain processing centers may be on “high alert” so things that ordinarily wouldn’t be painful to someone without the condition — say, gently brushing against someone — can be very painful to them. The condition is known for causing widespread muscle pain and extreme tenderness in many areas of the body, says Dr. Kilian. Many people also experience sleep problems, debilitating fatigue, headaches, and mood disturbances like depression and anxiety. The lower back is a common site of fibromyalgia pain.

Herniated Disc

A herniated disc is a problem with one of the rubbery cushions (discs) that sit between the individual bones (vertebrae) that stack to make your spine. A spinal disc has a soft, jellylike center (nucleus) encased in a tougher, rubbery exterior (annulus). A herniated disc occurs when some of the nucleus pushes out through a tear in the annulus. It can happen in any part of the spine and can irritate a nearby nerve. Depending on the herniated disc’s location, it can result in pain, numbness, or weakness in an arm or leg.

Degenerative Disc Disease

Degenerative disc disease is a condition where pain is caused from an unhealthy disc. Normally, discs don’t have much feeling, says Dr. Kirschner. But after a disc injury, new nerves grow into the area that can transmit pain signals, he says. Several factors can cause discs to degenerate, including age; smoking, disc herniations (injuries that cause tears in the outer lining of the disc leading to the inner core of the disc), and drying out of the disc. Degenerative disc disease is a separate but related process from osteoarthritis of the spine, as it can lead to bone spurs and joint degeneration.

Lumbar Spinal Stenosis

Lumbar spinal stenosis is a narrowing of the spinal canal through where the spinal cord and nerve roots run through within the spine, says Dr. Kirschner. This compresses the nerves that branch out from the spinal cord, causing symptoms such as tingling, numbness, or weakness. You may have sharp shooting pains that radiate down a leg. Or, pain can be dull, burning, tearing, or feel like a muscle pull, says Dr. Kirschner. These symptoms are often exacerbated by extending the back backward (such as when walking down the stairs) and relieved with flexing the back forward.

Osteoporosis-Related Fractures

As many as 54 million American adults age 50 and older have osteoporosis and low bone mass, according to the National Osteoporosis Foundation. Osteoporosis happens when your body creates new bone more slowly than it breaks down old bone tissue, resulting in weak and brittle bones that are abnormally porous and compressible, like a sponge. As bones weaken and become more brittle, a fall or even a mild stress event like coughing can cause bones to break. Fractures caused by osteoporosis often occur in the spine.

“Osteoporosis does not cause back pain unless a fracture is present,” says Dr. Kirschner. “But not all fractures are painful.” He says that because people don’t “feel” osteoporosis, people at an increased risk of osteoporosis should have regular bone density screenings and get appropriate treatment to reduce the risk of fractures, such as getting enough calcium and vitamin D, doing weight-bearing exercises, and taking bone-building medications if necessary.

Check out this osteoporosis risk calculator from the non-profit American Bone Health.

Other serious, though rare, conditions can also cause back pain, including infections, tumors, kidney stones, female reproductive problems like endometriosis or fibroids, or abdominal aortic aneurysm.

This is not a complete list of back pain causes and it’s important to see a health care provider to understand what might be causing your back pain.

How Arthritis in the Back Is Diagnosed

Diagnosing arthritis in the back begins with taking your medical history and doing a physical exam of your back and legs to assess your mobility/flexibility and make sure your nerves are working properly. The doctor will ask questions about:

• Where the pain is occurring
• How long the pain has lasted
• What the pain feels like/how severe it is
• What situations/activities make the pain feel better or worse
• How the pain is affecting/limiting your daily function

Imaging tests are usually needed to help confirm a diagnosis of arthritis. X-rays are typically the first imaging test ordered. They can joint damage/bone spurs, but cannot show damage to soft tissues such as muscles, ligaments, or bulging discs. Other tests may be ordered to look for changes or damage that is not visible on X-rays. These may include MRI, CT, ultrasound, bone scans, or other tests as needed. The gold standard to diagnose arthritis in the back is actually an injection called a medial branch block, but it’s not often necessary, says Dr. Kirschner.

If your doctor suspects you could have a type of inflammatory arthritis, they may order blood tests to look for signs of inflammation, such as C-reactive protein or erythrocyte sedimentation rate.

Other blood tests may look for genetic markers associated with axial spondyloarthritis, such as HLA-B27, or antibodies associated with rheumatoid arthritis (such as rheumatoid factor or anti-CCP).

How Arthritis in the Back Is Treated

Treatment for back arthritis depends on many factors, including your age, level of pain, type and severity of arthritis, other medical conditions and medications, and personal health goals. Because joint damage caused by arthritis is irreversible, treatment usually focuses on managing pain and preventing further damage.

Medications

Analgesics and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Analgesics (such as acetaminophen) can help with mild to moderate pain and are considered a first-line medication for osteoarthritis, says Dr. Tiso. Over-the-counter NSAIDs like ibuprofen (Advil) and naproxen (Aleve), as well as prescription NSAIDs, can help relieve pain and swelling in the joints. However, though many NSAIDs are available over the counter, they can cause side effects (such as stomach ulcers, increased heart attack risk, and kidney problems), especially when taken for the long term and/or in high doses. NSAIDs are a first-line of treatment in OA as well as axial spondyloarthritis to reduce pain and stiffness. In inflammatory arthritis, they can be used along with other kinds of medication to treat inflammation, pain, and swelling.

Corticosteroids

Steroids are anti-inflammatory medications that may be used when there is an inflammatory cause of back pain. Your doctor may initially prescribe a steroid if you have a systemic inflammatory type of arthritis, says Dr. Kilian. However, if you don’t have inflammatory arthritis, steroids are typically not recommended.

Radiofrequency Ablation

Although not technically medication, another option for treating osteoarthritis in the back is radiofrequency ablation, an outpatient procedure in which the nerves to the facet joint are burned with a needle. The treatment can provide longer-term pain relief for some patients; pain can be eased for one to two years, says Dr. Kirschner. However, it may not work in all patients and recent osteoarthritis treatment guidelines say there is only limited evidence for its effectiveness. It has limited effectiveness in knee OA, but guidelines don’t comment on spine OA, says Dr. Kirschner. Other studies show that radiofrequency ablation of the spine is highly effective, he says. Read more here about radiofrequency ablation for arthritis pain.

Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

Disease-modifying anti-rheumatic drugs include conventional immune-modifying drugs, such as methotrexate, as well as biologic medications, which are more targeted to certain immune system pathways. DMARDs reduce immune system activity to stop inflammation and they are only used to treat certain kinds of inflammatory arthritis, such as rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis.

Many different types of DMARDs are available and some are more appropriate for certain types of arthritis than others. The type of DMARD that is recommended for you will depend on the type of inflammatory arthritis that you have, says Dr. Kilian, as well as other factors, like your insurance coverage.

Lifestyle Modifications

Weight Loss

The spine wasn’t meant to carry large amounts of excess weight. Maintaining a healthy weight helps reduce stress and pressure on the joints and losing excess pounds can lead to less pain and better function. One study published in the journal Arthritis & Rheumatology found that people who were overweight or obese had significantly more disc degeneration in the lumbar spine, for example.

Aim to eat an array of anti-inflammatory foods, which may help reduce inflammation. Choose colorful fruits and vegetables, legumes and nuts, olive oil, fish, and whole grains, says Dr. Kilian. Avoid heavily processed foods and simple carbs like breads, pastas, and foods high in added sugar.

“Maintaining a healthy weight minimizes excess force on the joints and is one of the most important aspects of joint health,” says Dr. Kilian.

Exercise

When your back is causing agony, exercise may be the last thing you can fathom. But exercise is a critical part of managing arthritis in the back, regardless of the type of arthritis. Check with your doctor before starting any new exercise plan; you may also want to work with a physical therapist or trainer who can show you how to modify exercises so they won’t exacerbate your pain.

For inflammatory types of arthritis like axial spondyloarthritis, gentle exercise, including stretching moves in yoga and Pilates, may actually make acute back pain feel better because it helps fight the stiffness that comes from revved-up inflammation.

For osteoarthritis, regular strength training and flexibility exercises are important to help strengthen core and back muscles, which support a healthy spine and may help prevent further joint degeneration.

Cardiovascular exercise, such as walking, swimming, or cycling, is also important to promote good circulation in the spine and help with maintaining a healthy weight.

Physical Therapy

Physical therapy has been shown to help with most types of back pain. Your doctor may send you for physical therapy to help improve your range of motion and strengthen the muscles in your back and core, which play a role in a large amount of back pain, says Dr. Smith.

Quit Smoking

Smoking typically makes arthritis more resistant to treatment and more difficult to control. It affects all tissues of the body and reduces the body’s ability to heal itself. “Smoking is awful for your bone health and impairs bone healing,” says Dr. Kilian. Talk to your doctor about strategies to help you quit, he says.

Adjust Posture

A physical therapist can provide postural training to make sure the way you naturally sit and stand doesn’t further contribute to your back pain. Your posture should be straight and upright with little to no slouching, says Dr. Tiso.

Avoid Being Sedentary

Also important: getting up at regular intervals if you have a job that keeps you sedentary. Sitting for prolonged periods isn’t good for the low back, he says. Take frequent breaks or try using a standing desk for periods of time throughout the day. It’s also a good idea to look at your work station and make adjustments if necessary. You may want to use an ergonomic chair that gives proper lumbar support or tools such as an ergonomic computer mouse or computer stand.

Surgery for Back Arthritis

Surgery is a last resort when it comes to arthritis in the back. “Know that 95 percent of people with back pain will not need surgery, and 75 percent will fully recover within three months,” says Dr. Tiso.

Doctors recommend that you try medications, physical therapy, and weight loss (if necessary) before considering surgery, says Dr. Kilian. “The best surgical outcomes often occur in patients who are actively involved in physical therapy and have a healthy body weight,” he says.

The type of surgery depends on the type of arthritis and region of the back that is affected. Depending on the procedure performed, surgery aims to decompress any pinched nerves and free up the nerve roots from bone spurs and other tissues that may be pressing on them.

Spinal fusion

Spine surgery may be performed if there is a danger to the nerves or as a last resort for severe disabling back pain, says Dr. Kilian. It’s most beneficial when nerve roots are severely compressed, he says. A spinal fusion, for example, fuses two or more vertebrae together in your spine permanently. Here, they won’t move. They’re typically done for severe spinal arthritis causing deformity or for scoliosis, says Dr. Kirschner.

Lumbar disc replacements

In a lumbar disc replacement, you replace a worn or degenerated disc in the lower part of your spine with an artificial disc. This disc is made of metal or metal and plastic. Not everyone is a good candidate for this type of surgery. You may be a good candidate if you’re not overweight or haven’t had spinal surgery, and your back pain mainly comes from one or two discs in your lower spine.

Just remember that arthritis in the back pain doesn’t have to get in your way of living a healthy and active life. “It shouldn’t be a crippling, life-ending problem,” says Jonathan Hersch, MD, FAAOS, an orthopedic surgeon and sport medicine physician at West Boca Medical Center in Boca Raton, Florida. “Most people can live a healthy and functional life with minimal pain if they seek the right medical attention.”

Not Sure What’s Causing Your Back Pain?

Check out PainSpot, our pain locator tool. Answer a few simple questions about what hurts and discover possible conditions that could be causing it. Start your PainSpot quiz.

This has been reviewed and updated as of November 4, 2020.

Fibromyalgia — a condition that causes widespread pain, fatigue, and sleep and cognition issues — is not uncommon. According to the U.S. Centers for Disease Control and Prevention, it affects about 4 million U.S. adults. But fibromyalgia is often challenging to diagnose and treat because it frequently occurs alongside other chronic diseases, including autoimmune or inflammatory types of arthritis.

People who get diagnosed with fibromyalgia may, in fact, have fibromyalgia plus other health issues that go undiagnosed. Or they might not have fibromyalgia at all, but rather another health condition altogether.

One common area of confusion has to do with fibromyalgia and a type of inflammatory arthritis called axial spondyloarthritis (axSpA). For a variety of reasons, doctors suspect that axSpA goes undiagnosed in many people who have symptoms of it. Fibro may be one of those conditions that either co-occurs with axSpA or is mistaken for it.

Because fibro and axSpA are treated with very different medication regimens, if patients who think they have fibro could actually have axSpA, this misdiagnosis could have a deleterious impact on their health, as persistent untreated symptoms could lead to long-term joint damage, disability, and a significant decrease in quality of life.

Researchers, including those from our non-profit organization, the Global Healthy Living Foundation (GHLF), set out to learn more about this potential overlap and what it may signify for helping people get better care.

In research presented during ACR Convergence 2020, the annual meeting of the American College of Rheumatology, researchers surveyed 301 patients who reported a diagnosis of fibromyalgia in our ArthritisPower research registry to understand more about their symptoms and patient journey. (Preliminary findings from this research were presented earlier this year at the European E-Congress of Rheumatology 2020, held virtually by the European League Against Rheumatism [EULAR]).

The patients in the study reported having a diagnosis of fibromyalgia without also having a diagnosis of rheumatoid arthritis or psoriatic arthritis. They were asked whether they had a diagnosis of axial spondyloarthritis or ankylosing spondylitis (AS), then answered a number of different survey questions, including those that measure pain interference, sleep disturbance, and fatigue; the Bath Ankylosing Spondylitis Disease Activity Index; and a customized survey developed by the research team.

Here is what we learned.

Symptom Overlap Between Fibromyalgia and Axial Spondyloarthritis

Of the 301 fibromyalgia patients who completed the surveys, only 40 people reported also having a diagnosis of axial spondyloarthritis.

But many patients with fibro and without an axSpA diagnosis reported having symptoms consistent with those of axSpA. For example:

• 94 percent of fibro patients without an axSpA diagnosis reported back pain lasting longer than three months
• 61 percent of fibro patients without an axSpA diagnosis reported that their back pain onset was gradual
• 62 percent of fibro patients without an axSpA diagnosis reported that their back pain did not improve with rest
• 21 percent of fibro patients without an axSpA diagnosis reported that they had back pain at night
• 78 percent of fibro patients without an axSpA diagnosis said their back pain started before age 45

You can see in Figure 1 below that in many cases, the symptoms of fibro patients without an axSpA diagnosis were similar in prevalence to those of fibro patients with an axSpA diagnosis.

Formal Axial Spondyloarthritis Diagnosis Is Not Common

A full 11 percent of fibro patients in the study reported having all of the symptoms consistent with patient-reported versions of a set of common criteria for axial spondyloarthritis.

This includes back/buttock pain >3 months, age of symptom onset <45; sacroiliitis diagnosis, and at least one spondyloarthritis feature.

However, of this group, only 32 percent reported having an axSpA diagnosis. That means that 68 percent of people surveyed who had symptoms consistent with axial spondyloarthritis did not have that formal diagnosis.

Axial Spondyloarthritis Is Not Well-Known by Fibro Patients

Of the 257 fibro patients without an axSpA diagnosis, only 7 percent had recalled their health care provider ever discussing with them the possibility of having axial spondyloarthritis, including non-radiographic axSpA diagnosis.

Axial spondyloarthritis is an umbrella term for inflammatory arthritis that primarily affects the spine and sacroiliac joints. Ankylosing spondylitis is a form of AS where joint damage is visible on X-rays; non-radiographic axial spondyloarthritis has similar symptoms but without that visible joint damage.

There are many reasons axSpA may not be discussed between doctors and patients with fibromyalgia. You can read more about these issues here, but they include the fact that axSpA can be — incorrectly — thought of as a “man’s disease” and fibro more commonly occurs in women.

Another is that axial spondyloarthritis is not well-known in general; when patients present with the red-flag symptoms of back pain, buttock pain, or pelvic/hip pain, it is commonly chalked up to mechanical causes, such as muscle strain or overuse injuries.

Delays in Diagnosis and Symptom Burden

Some 80 percent of all patients surveyed felt they have had an undiagnosed condition in addition to their fibro and other current diagnoses.

Of those with fibro and axSpA, 52 percent believe that their axSpA should have been diagnosed earlier, with 39 percent reporting that one reason for the delay was their doctors’ belief that fibro was the cause of any axSpA symptoms they experienced.

The study also found that half of all the patients surveyed felt that their fibro was rarely or never well-managed.

Fibro is primarily managed with lifestyle changes and medications that include anti-epileptic drugs and antidepressants, while axSpA is typically managed with non-steroidal anti-inflammatory medications or biologic drugs that target the immune system to tamp down inflammation.

If fibro patients are not improving on their current treatment regimen and have symptoms consistent with axSpA, it may be good to discuss the possibility of this diagnosis with a health care provider.

“There is clearly a lot of symptom overlap between fibromyalgia and axial spondyloarthritis,” says study co-author Kelly Gavigan, MPH, Manager of Research and Data Science at GHLF. “This study adds to the growing body of evidence about how these conditions either co-exist or are mistaken for each other. Based on these findings, it is likely that a number of people with fibromyalgia and who also have axSpA symptoms either have a misdiagnosis or an additional diagnosis yet to be confirmed.”

“We encourage patients to track their health with the different surveys and tools within ArthritisPower,” says Louis Tharp, Executive Director of GHLF. “This can allow you to look for patterns in symptoms over time and have a more informed discussion with your health care provider if your current treatment is no longer helping.”

Found This Study Interesting? Get Involved

If you are diagnosed with arthritis or another musculoskeletal condition, we encourage you to participate in future studies by joining CreakyJoints’ patient research registry, ArthritisPower. ArthritisPower is the first-ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. Learn more and sign up here.

This study was supported by UCB, which is a corporate sponsor of the Global Healthy Living Foundation.

Learn more about our FREE COVID-19 Patient Support Program for chronic illness patients and their loved ones.

This has been reviewed and updated as of May 30, 2020.

Living with fibromyalgia means coping with a number of symptoms: widespread muscle pain (myalgia), extreme tenderness in many areas of the body, sleep disturbances, fatigue, headaches, and mood issues like depression and anxiety. But how does having fibromyalgia impact your risk of COVID-19 and ability to manage these symptoms while staying at home?

Here’s what experts want fibromyalgia patients to know as they continue to navigate the coronavirus pandemic.

Does Fibromyalgia Make You at a Higher Risk for Coronavirus?

The answer depends on whether you have primary or secondary fibromyalgia, says Petros Efithimiou, MD, FACR, a rheumatologist who practices in New York City.

Primary fibromyalgia, which is the most common form, is a chronic pain syndrome in which the body and brain process pain and stimuli differently, explains Dr. Efithimiou. Importantly: “There is no immunosuppression.”

Since fibromyalgia doesn’t compromise your immune system, there is “no increased risk for acquiring COVID-19 nor increased risk for mortality from that disease,” says Frederick Wolfe, MD, a rheumatologist and fibromyalgia expert in Wichita, Kansas.

“People with a diagnosis of fibromyalgia should follow the suggestions of medical authorities for ordinary citizens,” he says, including proper handwashing, practicing social distancing, wearing cloth face masks in public, and avoiding close contact with other people if you need to go to work or run an essential errand.

Secondary fibromyalgia, on the other hand, often occurs in patients with conditions that can affect the immune system, such as lupus, rheumatoid arthritis, or axial spondyloarthritis. In this case, your immune system may be suppressed and you could be considered at a higher risk for COVID-19, especially if you have additional co-occurring health conditions, such as heart disease, lung disease, or diabetes.

Knowing the difference is important.

“People might think that fibromyalgia is an autoimmune disease since they are often referred to and treated by rheumatologists, and some of their symptoms may mimic those of lupus or other rheumatology patients,” says Nilanjana Bose, MD, MBA, a rheumatologist at the Rheumatology Center of Houston in Pearland, Texas.

But fibromyalgia is not an autoimmune disease, which occurs when the body’s immune system mistakenly attacks your own cells and tissues.

• Read more about rheumatoid arthritis and the coronavirus pandemic
• Read more about axial spondyloarthritis and the coronavirus pandemic
• Read more about psoriasis and psoriatic arthritis and the coronavirus pandemic
• Read more about lupus, hydroxychloroquine, and the coronavirus pandemic

Do Fibromyalgia Medications Affect the Immune System?

There is not necessarily a straightforward or universal way to treat fibromyalgia. Your medication options will depend on your most concerning symptoms as well as if you have any co-occurring conditions. Drugs used to treat primary fibromyalgia may include antidepressants, anti-seizure drugs, and non-steroidal anti-inflammatory drugs (NSAIDs):

• Tricyclic antidepressants: amitriptyline (Elavil), nortriptyline (Pamelor), cyclobenzaprine (Flexeril)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): duloxetine (Cymbalta) or milnacipran (Savella)
• Selective serotine-reuptake inhibitors (SSRIs): fluoxetine (Prozac) or paroxetine (Paxil, Pexeva)
• Anti-seizure drugs: gabapentin (Neurontin), pregabalin (Lyrica)
• Non-steroidal anti-inflammatory drugs (NSAIDs): Advil or naproxen

If you develop COVID-19 symptoms, it’s probably best to avoid NSAIDs like ibuprofen (Advil) or naproxen (Aleve); you’re better off taking acetaminophen (Tylenol). According to a well-publicized article in British Medical Journal, “prolonged illness or the complications of respiratory illness or the complications of respiratory infections may be more common when NSAIDs are used — both respiratory or septic [blood infection] complications and cardiovascular complications,” said Paul Little, MD, professor of primary care research at the University of Southhampton in the UK.

“The medication patients take for pain and fibromyalgia, such as gabapentin (Neurontin) and pregabalin (Lyrica) do not decrease the ability of the immune system,” says Dr. Efithimiou.

Additionally, antidepressants do not affect the immune system, says Dr. Bose, and “you should continue these medications to avoid flares.”

You should not stop taking any medications or adjust your dose of any medications without first talking to your doctor.

Read tips on making your next telehealth visit as successful and helpful as possible.

Distinguishing Fibromyalgia Symptoms from Coronavirus Symptoms

Many of the symptoms you may experience with fibromyalgia — including chest pain, body aches, fatigue, and malaise — can also be symptoms of COVID-19. But experts say you should be able to tell the difference.

“We tell our patients, if you feel any drastic changes — such as feeling out of breath or sharp pains in your chest — or feel different than your baseline, you need to tell us,” says Dr. Efithimiou. “We ask them to evaluate the intensity and character of symptoms. People are quite anxious, but they should stay away from the hospital.”

Anxiety and depression can cause physical symptoms, including body aches, fatigue, and chest pain. “The best way to tell the difference between potential COVID-19 symptoms and those of your chronic condition is to seek professional medical advice through an office visit or telehealth, which is available at many locations,” says Brett Smith, DO, a rheumatologist with Blount Memorial Physicians Group in Alcoa, Tennessee.

Read more here about the 9 coronavirus symptoms that should be on your radar.

Managing Symptoms of Fibromyalgia Under Quarantine

Fibromyalgia symptoms such as pain and stiffness, fatigue, disrupted sleep, anxiety, and depression may feel intensified right now. “It’s a two-way street,” says Dr. Efithimiou. “The more you can control anxiety, the better your fibromyalgia symptoms are going to be.”

We asked rheumatologists and psychologist John S. Fry, PhD, a former member of the National Fibromyalgia Association, what you can do to manage these symptoms during the COVID-19 pandemic.

Exercise

Many people find that exercise helps ease their fibromyalgia symptoms and quality of life. The coronavirus shouldn’t stop you from moving. Go for a walk, walk your dog, try online yoga, tai chi, or strength-training classes. Pace yourself and give yourself plenty of rest between sessions.

Practice relaxation techniques

It’s important for people with chronic pain and fatigue to learn how to relax their bodies by meditating, doing yoga, or practicing deep breathing or progressive muscle relaxation. While there are apps available to walk you through these strategies, telemental health can help you hone these and other pain management skills, says Dr. Fry, who is licensed to practice in California.

Check out these mental health resources from clinical psychologist Laurie Ferguson, PhD.

Lean on loved ones

Dr. Fry believes it should be called “spatial distancing” not “social distancing,” especially since it’s so important for people living with chronic illness to have social support from friends and loved ones right now. Make sure to carve out time to connect with others, whether that’s calling a friend, FaceTiming or Skyping, or arranging a Zoom meeting with family and friends, says Dr. Fry. And take advantage of those loved ones who are around you 24/7; don’t hesitate to ask for a gentle massage or help with household chores, he adds.

“Many fibro patients may have underlying depression and/or anxiety or a history of past trauma. It is important to broaden your safety net during the pandemic,” says Lenore Brancato, MD, clinical assistant professor in the division of rheumatology at NYU Langone Health in New York City. “With constant solemn news in the media and necessary isolation from family and friends, it can stoke anxiety for everyone, especially patients with fibro.”

Read more here about why you need to start ‘intermittent media fasting’ to cope with coronavirus.

Create a schedule

Whether you plan out a detailed schedule of your day or jot down a To-Do list every morning, creating a routine for yourself will help alleviate feelings of isolation and create some normalcy as you follow shelter-in-place orders. As you complete your tasks, “take a few seconds to savor the fact that you got it done,” Dr. Fry says.

Shift your self-talk

Self-talk can make a huge difference in how you manage your anxiety, which is likely causing you to catastrophize and think in black and white, explains Dr. Fry. Instead of saying to yourself something like: “Coronavirus is everywhere. I’m trying to protect myself. I’m scared. I’m going to get it — and if I do no one will be there for me,” say to yourself something like:  “I might get the coronavirus, but I might not if I’m careful.”

Remind yourself that you’re not alone. You likely have friends and family members and reaching out to them does not make you a burden. Think about the last time a friend called you for emotional support. After you hung up the phone, did you think it was a burden? Helping others is a behavior that’s been proven through research to make people happy, says Dr. Fry.

Read these 20 journal prompts to help chronic illness patients.

Find a healthy distraction

As you stay at home as much as possible, home in on hobbies and activities to help exacerbate feelings of anxiety and social isolation. Whether you paint, garden, color, scrapbook, or catchup on a Netflix series, it’s important to get into things that give you pleasure.

Prioritize sleep

When you live with fibromyalgia, getting quality sleep is a struggle. Unrelenting pain can disrupt sleep, which can lead to increased achiness and fatigue, creating a vicious cycle. Anxiety over the coronavirus can make it even harder to fall asleep or stay asleep all night. Now’s the time to make an extra effort to shut off those worries before shut-eye and change your perspective. “Before bed, write down three good things that happened, even if it’s been a horrible day,” says Dr. Fry. “Even if they’re little things: my dog licked my hand, I saw a pretty hummingbird, a friend called me today. This too shall pass.”

“Facilitating restorative sleep, which can be difficult during the best of times for fibro patients, requires attention,” says Dr. Brancato. “Sleep hygiene and  sleep rituals, such as legs up the wall or simple inversions and meditation practice may be helpful. Daily exercises (even seated biceps curls or leg lifts)can help reduce pain and relieve stress. Exercise can also foster improved sleep.”

Read more here about managing painsomnia during the age of COVID-19.

Get Free Coronavirus Support for Chronic Illness Patients

Join the Global Healthy Living Foundation’s free COVID-19 Support Program for chronic illness patients and their families. We will be providing updated information, community support, and other resources tailored specifically to your health and safety. Join now.

It’s like wearing one ear plug, floppy shoes, and a parka while swimming through a muddy ditch. And then falling asleep and waking up with no idea where you are, who you are, and what somebody just said — you see mouths moving, but it’s gibberish. Then it all trickles back to reality slowly. You feel hungover, and typically hurt everywhere.

That’s what fibro fog feels like to CreakyJoints member Kathy M. Another describes it as being under water — where your senses are dulled and movement is slow and clumsy.

Fibro fog, or brain fog, is symptom of fibromyalgia that you may not expect. But it is one that can be just as problematic as the pain that’s characteristic of the condition. “Fibro fog is something we hear about quite a bit,” says Christopher Morris, MD, a rheumatologist with Arthritis Associates of Kingsport, in Tennessee. Patients will say they seem more forgetful or feel like they’re walking around in a daze all the time.

What Exactly Is Fibro Fog?

Fibromyalgia causes aches and pains all over the body, as well as fatigue, sleep, and mood issues. It can also lead to problems with memory or thinking clearly. These cognitive difficulties — called fibro fog — are common: Research suggests more than half of people with fibromyalgia show a decline in memory and clear thinking.

When you have fibro fog, it can cause you to be in a state of confusion that you don’t even know you’re in, CreakyJoints member Joan W. shared on Facebook. You can’t find the words you want to say or you misspeak without realizing it. You may also experience:

• Memory issues or forgetfulness
• Impaired ability to concentrate or stay focused
• Decreased alertness
• Problems thinking clearly or mental slowness
• Difficulty holding a conversation

Some research has also shown deficits in what’s known as executive functioning skills, such as planning abilities, decision making, and abstract thinking.

The impact of fibro fog on everyday life is significant. In fact, patients with fibromyalgia often report that these cognitive symptoms are more disabling than their pain. It makes you feel like you’re losing your mind, CreakyJoints member Sharon C. shared on Facebook.

What Causes Fibro Fog?

Scientists don’t know for sure. Some experts theorize that fibro fog may be related to the impact of fibromyalgia pain. Managing chronic pain demands attention and may some take mental effort, which can reduce available cognitive processing resources and affect performance on a cognitive task.

Also, fibromyalgia in and of itself is a neurologic health problem, adds Dr. Morris. There is a dysregulation of how certain neurologic pathways and neurotransmitters function within the brain, which may also play a role in cognitive issues. “All of the things that are interacting in some of the same pathways that are causing the pain might be having the same effect on thought processes,” he explains.

Fibro fog may also be associated with other aspects of fibromyalgia, such as poor sleep. Sleep is often disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea. Sleep deprivation can cause processing problems, adds Dr. Morris.

Depression, which is common among people with fibro, may be another factor. One study published in the journal PLOS One suggests many of the cognitive issues experienced by patients with fibromyalgia can be attributed to depression.

More research is needed as to how and why fibromyalgia is associated with cognitive problems.

How to Treat and Manage Fibro Fog

The cognitive effects of fibromyalgia can be challenging, and — as some CreakyJoints members admit — embarrassing. It’s important to stick to your fibromyalgia treatment plan, which may include medication, therapy, and self-care. There’s no one-size-fits-all approach to managing fibromyalgia, says Dr. Morris. But the goal is the same: help minimize symptoms and improve general health. You and your doctor will determine the best plan for you.

To help cut through the brain fog and thinking more clearly, here are some strategies:

Exercise your body

This is the best treatment for fibromyalgia, says Dr. Morris. Research from Sweden showed that physical exercise over a long term improves cognitive processing, as well as overall symptoms of fibromyalgia. Start slowly and with light stretching, then gradually increase activity. Some good exercises include walking, swimming, and water aerobics. Your doctor or physical therapist can recommend workout that are safe and appropriate for you.

Work out your brain

Brainteasers, puzzles, playing games like trivia and checkers, and other mentally stimulating activities may also help keep your mind sharp. “You have to exercise the brain the same way as you exercise the body,” says Dr. Morris.

Stick to a sleep schedule

That means hit the sack at the same time every night and wake up at the same time every morning — even on weekends. This helps to regulate your body’s clock so you fall asleep faster, and rest more soundly. Getting enough sleep lets your body repair itself, physically and mentally. “With fibromyalgia, quality is just as important and quantity,” adds Dr. Morris.

Other tips to help improve sleep: Skip naps, especially in the afternoon; limit caffeine, which can disrupt sleep; and avoid electronics before bed.

Find ways to help you focus

Break up tasks into small steps, so you’re not trying to do too much at once. And when you do start a task, avoid distractions (like a loud TV) so you can give it your full attention. This is also part of energy pacing, another important technique for managing fatigue in fibro.

Make time to relax each day

Deep-breathing exercises and meditation can help reduce the stress that can bring on symptoms, according to the American College of Rheumatology.

Use Our ArthritisPower App to Manage Your Fibromyalgia

Join CreakyJoints’ patient-centered research registry and track symptoms like fatigue and pain. Learn more and sign up here.

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Most experts don’t consider fibromyalgia — a chronic pain disorder that also causes fatigue, memory issues, and other symptoms — to be a type of arthritis, though it’s not uncommon for inflammatory arthritis patients to also have fibromyalgia. Now new research suggest that also having fibromyalgia might make arthritis harder to control.

Fibromyalgia is often treated with NSAIDs (non-steroidal anti-inflammatory drugs), anti-seizure drugs, or antidepressants that have been shown to help relieve pain. People with inflammatory arthritis may use pain medication as well, but they also rely on drugs that slow or stop the progression of arthritis. These include traditional disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate, as well as biologic DMARDs like etanercept or infliximab.

DMARDs are often very effective and help many patients reach low disease activity or remission, but not everyone benefits from these medications equally. While many factors may explain why DMARDs don’t work well in some people, a new study published in the journal Rheumatology International finds that a co-existing diagnosis of fibromyalgia might have something to do with it.

This study was a literature review that analyzed several smaller studies that had previously examined the connection between fibromyalgia and inflammatory rheumatic conditions. The authors identified eight relevant studies and found that “fibromyalgia was a significant predictor of not achieving remission” with a traditional DMARD. They also found that arthritis patients who also had fibromyalgia were more apt to be given a biologic drug.

Although it is possible that many patients who were given a biologic really needed it, the authors expressed some concern that fibromyalgia symptoms (which DMARDs are not specifically designed to address) might be spiking arthritis disease activity scores and leading to extra use of biologics.

“Comorbid fibromyalgia interferes not only with the [arthritis] disease activity scores but also with the treatment outcomes and management plan,” they wrote. “Further evidence is warranted in order to determine the potential benefits of biological disease-modifying anti-rheumatic drugs on fibromyalgia-related symptoms in patients with inflammatory rheumatic diseases.”

Use Our ArthritisPower App to Track Your Symptoms, Disease Activity, and More

Join CreakyJoints’ patient-centered research registry to track your symptoms, disease activity, and medications — and share with your doctor. Learn more and sign up here.

Keep Reading

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