Fibromyalgia: How can the nurse help?

Fibromyalgia was once not very well understood. However as more research is being done and people with fibromyalgia are speaking out more people are becoming familiar with the diagnosis. What exactly is fibromyalgia and what can the nurse do to help her/his patient with a fibromyalgia diagnosis?

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Fibromyalgia: How can the nurse help?

Fibromyalgia is a condition which often effects more females than males however males can get fibromyalgia. In the past fibromyalgia was known as a “catch all” diagnosis since there were no conclusive tests for fibromyalgia. It was once a frustrating diagnosis because many people did not consider it a valid diagnosis and thought it was “all in the head”. This is essentially true among other locations throughout the body but not in the sense “all in your head” was meant to mean. It is not a psychosomatic condition that the person makes up to get sympathy, attention seeking behavior or avoiding dealing with life issues. It is in the head in the sense the brain emits alpha waves in deep sleep, the brain interprets increased level of pain, the brain neurons signals do not travel along the synapses in the “normal” fashion resulting in the neurological and cognitive symptoms. Tender points throughout the various parts of the body receives excess blood supply (in a similar fashion that occur in migraines) resulting in increased pain at the trigger point traveling to other parts of the body.

Fibromyalgia can be an emotionally draining and frustrating condition in the sense that the patient may not be able to perform physically and cognitively prior to developing the condition. This can lead to the grieving process and can even lead to depressive symptoms. The patient may become socially isolated due to physical and cognitive limitations as well as due to depressive symptoms. The patient may feel no one understands what she/he is going through. This then can cause tension and stain in social and family relationships.

What is Fibromyalgia?

Fibromyalgia (FM) is often a disabling condition which causes widespread chronic pain and increased fatigue. Other symptoms include difficulty with memory and concentration and mental cloudiness which is often referred by FM patients as “fibro fog”. The pain is often characterized as generalized aching, widespread tenderness of muscles, areas around tendon insertion sites (tender points), muscle stiffness, poor or unrefreshing sleep (likely due to intrusion of alpha waves in the delta waves) and thought to be triggered by extreme or chronic level of physical and/or psychological stress. Stress including physical or emotional trauma, poor sleep, cold or damp weather and being around chronic negativity from family, friends or coworkers can lead to exacerbations of symptoms. Other common comorbid conditions include irritable bowel syndrome, interstitial cystitis, headaches (tension or migraine) and paresthesias (Biundo). Depression and anxiety have also been linked to FM and the cause of FM is still unknown (Capriotti & Frizzell).

Diagnosis

Physical examination is unremarkable except that specific, discrete areas of muscle (tender points) often are tender when palpated. The tender areas are not swollen, red, or warm; such findings should suggest an alternative diagnosis. Diagnosis is clinical based on the patient’s medical history and symptoms. Treatment includes gentle exercise such as yoga, local heat, stress management, drugs to improve sleep, and non-opioid analgesics.

How can we help?

What can the nurse do? The nurse needs to include in the nursing assessment such things as asking the patient regarding rating the level of pain, description of pain, location and how long the pain has been present. The nurse can ask the patient of precipitating factors that causes an increase in pain and other associated symptoms. Trigger points at the base of the skull, around the neck and shoulders, around the side of the elbow, upper outer buttocks, hip and medial side of knees can be palpated for pain (Capriotti & Frizzell, 2016). The nurse will need to assess the quality of sleep, stress level, and coping skills.

The nurse needs to be empathetic, not judgmental, in approaching the patient (and even discussing the patient or condition with coworkers). The nurse will greatly benefit from learning about fibromyalgia and current research being done. The nurse should become familiar with local and online support groups so the nurse can provide this information to the patient as a means of increasing emotional support for the patient.

References

Biundo, J. J., (2018). Fibromyalgia: Myofascial pain syndrome; fibrositis; fibromyositis. Merck Manual Professional Version

Capriotti, T. & Frizzell, J. P. (2016). Pain. In Capriotti, T. & Frizzell (Eds.), Pathophysiology: introductory concepts and clinical perspectives (pp. 93-113). Philidelphia, PA: F. A. Davis

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LindaGracie

About LindaGracie, ADN, BSN

Linda Gracie RN BSN, I have an identical twin who has FM and had enrolled us in the University of Washington CFS/FM twin study back in the late 90's. I had learned a lot about FM from phase one and phase two of this study and doing research on FM afterwards to learn more.

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Specializes in LTC, Home Health, Med/Surg/Tele, ER.

Very nicely said. As an RN with Fibromyalgia, I especially like the part about being non judgmental. There is definitely a grieving process involved. When I had to leave bedside nursing because I could no longer handle 12 hour shifts, I definitely felt a loss. Thankfully I found Home Health and have been very happy here for 18 years. I have moved into the office, but still see patients from time to time. I always used to “love” it when nurses would say things about fibro patients that were very judgmental and then I would say that I have Fibromyalgia and watch them start back peddling very quickly. Remember that just because you can’t see it and you don’t have a definitive test for it, doesn’t mean it’s not real.

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Specializes in Tele Stroke.

Are there any bio markers we can look out for? Thanks!

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Specializes in LTC, Home Health, Med/Surg/Tele, ER.

Unfortunately, not yet. There is some promising research but nothing reliable yet.

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