Fibromyalgia and arthritis: key differences and tips for relief

Arthritis and fibromyalgia are two distinct yet often coexisting conditions that are frequently misunderstood.

Despite their differences, both conditions are bound by pain, and affect one’s physical and mental health. This article, inspired by our Arthritis Talks webinar led by Dr. Mary-Ann Fitzcharles, rheumatologist at the McGill University Health Centre Division of Rheumatology and Alan Edwards Pain Management Unit, delves into the differences between arthritis and fibromyalgia, provides guidance on the often-frustrating path to getting a diagnosis and offers tips for managing fibromyalgia.

The complexity of pain 

Pain is an unpleasant sensory and emotional experience that occurs through a complex process involving multiple pathways and regions of the brain – it’s more intricate than one might expect.

There are three primary types of pain:

1. Nociceptive pain is caused by physical damage or inflammation in tissues, such as osteoarthritis or rheumatoid arthritis, where the body responds to structural changes or injury.
2. Neuropathic pain stems from nerve damage or dysfunction, which can be observed in conditions like peripheral neuropathy.
3. Nociplastic pain, a hallmark of fibromyalgia, occurs when the nervous system’s ‘volume controls’ are turned up too high, amplifying pain without any apparent damage or inflammation. Examples of nociplastic pain include chronic visceral pain (such as irritable bowel syndrome or chronic pelvic pain) or chronic headaches and facial pain. 

Arthritis vs fibromyalgia: key differences

Arthritis causes nociceptive pain, occurring as a response to inflammation or structural change to a joint. When this happens, a nerve signal travels from the affected area through nerves to the spinal cord and the brain, where a ‘dimming switch’ adjusts the severity of the pain. This pain is a crucial survival mechanism, helping you act quickly when in danger – such as pulling your hand away from a hot stove. 

In contrast, fibromyalgia is associated with nociplastic pain, where our body’s pain ‘volume controls’ are malfunctioning. This results in an exaggerated pain response to stimuli that wouldn’t typically cause pain, such as light touch or slight temperature changes. Chronic pain in fibromyalgia is not just physically debilitating; it has a profound emotional component. It often occurs alongside fatigue, sleep disturbance and mood changes. 

Fibromyalgia triggers and diagnosis

Fibromyalgia may develop following a physical or psychological trigger in about 30 percent of cases, such as a viral infection or a traumatic event. For the remaining majority, it appears without an obvious cause. Additionally, 20 to 50 percent of people with arthritis may experience secondary fibromyalgia. This means that even if their arthritis is well-managed, they continue to experience pain due to a hyperactive nervous system.

Getting a fibromyalgia diagnosis can be frustrating for patients because physical exams and lab tests often appear normal. In these cases, the story of the pain is critical. The hallmark of fibromyalgia is chronic pain that affects multiple parts of the body for over three months. 

People with fibromyalgia have pain that is experienced diffusely throughout the body and is classified as chronic widespread pain. There are commonly also additional symptoms of fatigue and sleep disturbance. Some people may also experience brain fog, hypersensitivity  to environmental stimuli such as loud noises or bright lights, and also other chronic pain conditions such as headaches or irritable bowel syndrome 

Managing fibromyalgia: seven tips for relief

 “Treatments should always be tailored to each individual – what works for one person may not work for another,” says Dr. Fitzcharles.  “There is no cure, so the focus must be on managing symptoms with the overarching principle of improving function and quality of life.”

Lifestyle changes like modifying diet and exercising should be the starting point before turning to drug treatments. Dr. Fitzcharles says, “It’s important to note that drugs only give a modest effect and there is no single drug that works for every person.” 

Here are some practical tips that address the physical and emotional aspects of fibromyalgia:

1. Exercise: It may seem counter-intuitive to move when in pain, but physical activity, even in small amounts, is strongly recommended. Gentle activities like walking, swimming, or tai chi can reduce pain and improve well-being.
2. Sleep: Good sleep hygiene is essential. Poor sleep causes heightened sensitivity to pain and people who struggle with insomnia have a higher susceptibility to developing fibromyalgia.  Read these six tips to support better sleep.
3. Diet: There is growing evidence that a balanced diet rich in fruits, vegetables, lean proteins, and whole grains can help manage chronic pain. Mindful eating and paying attention to how food affects you are important. Start by keeping a food journal to track symptoms that occur after consuming certain foods. Maintaining a healthy balance of gut bacteria is also crucial; read more about microbiota and arthritis here.
4. Use medications with caution: Be cautious with medications - there is no one-size-fits-all solution and medication on its own, without lifestyle modifications, is rarely the solution. Antidepressants like amitriptyline or anti-seizure drugs such as gabapentin can help manage mood and pain, and improve sleep, but opioids are generally discouraged. Always consult with a healthcare provider to find the best regimen. For a more comprehensive guide on pain medication, read our article exploring some tough questions about pain treatments.
5. Stress management: Mindfulness practices, such as meditation, yoga, and deep breathing, can help manage stress, a common trigger for fibromyalgia.  – Breaking activities and tasks down into manageable parts with periods of rest is also important to make them less overwhelming.  
6. Psychological support: Cognitive-behavioral therapy (CBT) can help address the emotional aspects by changing negative thought patterns. Support groups offer emotional support and practical tips from others who understand the condition.
7. Stay engaged: Keeping yourself busy with activities you enjoy can help distract you from pain and improve your mood. Whether it’s volunteering, crafting, gardening, reading, or listening to music – find what brings you purpose and joy to help you stay connected to community. 

Although arthritis and fibromyalgia have different pain mechanisms, they share common challenges. Both conditions require individualized treatment plans – what works for one may not work for another. 

For those living with arthritis, understanding the potential overlap with fibromyalgia is crucial to finding the right treatment approach. Getting a diagnosis can empower you to improving your quality of life and finding the right treatment plan that address your physical, emotional and mental symptoms

This article should not be substituted for professional medical advice. Arthritis Society Canada strongly recommends connecting with your healthcare provider if you suspect you have fibromyalgia. 

Arthritis Talks Webinar

Fibromyalgia, arthritis and pain