Fibromyalgia and Neck Pain

by pnadmin on April 22, 2011

fibromyalgia

What is Fibromyalgia?

Neck pain is a common symptom of fibromyalgia, with trigger points clustered around the base of the neck and in the shoulders.  Those suffering from fibromyalgia and neck pain may then assume that any neck pain is simply part of their overall condition when, in fact, it can be due to myriad problems including cervical spinal stenosis, temporomandibular joint syndrome, pinched nerve in neck, and rheumatoid arthritis, amongst others.  Any new incidence of neck pain, increase in severity, or otherwise troubling symptoms should be thoroughly checked by a doctor as ignoring a trapped nerve or other issue could lead to permanent damage.  For most fibromyalgia sufferers however neck pain is a simple fact of daily life and not a sign of spinal trauma or spinal stenosis.  Where these things do occur they are likely to be more acutely felt by those with fibromyalgia due to the heightened pain sensitivity of the condition, which may actually act as an early warning signal for a problem that would only be noticed at a more advanced stage in an otherwise healthy individual.

What is Fibromyalgia?



Fibromyalgia is a condition characterized by autonomic nervous system dysfunction which can have a negative impact on the delicate balance of the spine.  A multitude of muscles in the spine make tiny adjustments throughout the day to keep weight evenly distributed and to try to avoid stress on any particular spinal segment.  These spinal muscles are connected to the central nervous system which processes pain signals, and also to the spinal cord which has been shown to amplify pain sensations in fibromyalgia sufferers.  These constant tiny movements, particularly in the very active and mobile cervical spine, can result in increased muscle fatigue and pain and the neck may actually become hypermobile as some fibromyalgia patients have been found to have abnormal fatty deposits where muscle should be.  Increased adipose (fat) tissue also increases the sensation of pain throughout the body, and the loss of muscle mass compromises the support structure of the cervical spine, making the vertebrae, intervertebral discs, ligaments, and joints of the neck more liable to incur damage through excessive movement.

Sleep Disruptions and Postural Problems

Increased neck pain may also cause a fibromyalgia patient to become less active, and adopt a stiff position (either consciously or unconsciously) in an attempt to reduce pain from movement of the neck.  Combined with weak neck and shoulder muscles this can lead to abnormal posture and degeneration of the spine from poor weight distribution.  The disrupted sleep also common in fibromyalgia may mean that muscles and other elements of the spine degenerate faster as they are not being effectively repaired during quality sleep.  Fatigue felt by fibromyalgia patients can also lead to disordered sleeping and napping in awkward positions, such as on the sofa, or wherever an exhausted patient can find to lay their head.  Sleeping at a funny angle can itself lead to neck pain and stiffness and massaging the area may not be helpful as the trigger points in the neck and shoulders can simply be too painful to touch.  Radicular pain due to cervical spinal stenosis could be wrongly identified as muscular pain connected with fibromyalgia, and nerve dysfunction in one condition is easily exacerbated by the other leading to an increased amount of pain in the arms, hands, jaw, head, and upper body, as well as the neck and shoulders.  Those with temporomandibular joint disorder causing neck and jaw pain are also more likely to have pain across the whole body with some physicians connecting TMJ disorder with myofascial pain syndrome and fibromyalgia.


Chronic degeneration of the musculoskeletal system can, over time, lead to problems in the spine which then take over as the main cause of the neck pain felt by those with fibromyalgia.  Poor support of the neck may accentuate any forward curvature of the neck, putting strain on ligaments, leading to calcification and stiffness, and causing the intervertebral discs to be put under increasing pressure.  Cervical spinal disc herniation can lead to symptoms of spinal stenosis and neck pain through nerve compression or blood vessel impingement.

Neck Pain as a Trigger for Fibromyalgia

It is also possible that a patient has neck pain and cervical spinal stenosis prior to developing fibromyalgia and that the persistent pain and resulting fatigue from poor quality sleep are actually triggers for fibromyalgia.  Stress caused by chronic pain can lead to depression, hormonal disruption, and compromised immunity leaving a person extremely vulnerable to viral infection, adrenal fatigue, and an increased sensitivity to pain.  Fibromyalgia is a condition associated with stress, anxiety, and depression, and many of the symptoms overlap with chronic pain syndromes including neck pain.  It is important, therefore, that a physician does not simply dismiss neck pain and prescribe anti-inflammatories or further analgesics or antidepressants to a patient with suspected fibromyalgia as the patient’s condition may actually be a result of chronic pain rather than a cause of it.

fibromyalgia neck pain

Tender points from fibromyalgia

Treating neck pain attributed to cervical spinal stenosis may involve surgical intervention which will likely increase stress levels and may be particularly problematic for those with fibromyalgia.  The most common reason for failed back surgery syndrome is misdiagnosis and incorrect attribution of neck or back pain to a particular spinal segment that is then operated on to no effect.  Where fibromyalgia is also at work it is vital that surgery is only scheduled where there is definite nerve compression due to mechanical forces which may require use of selective nerve root blocks to identify the source of pain as cervical spinal stenosis.  Both rheumatoid arthritis and osteoarthritis can cause cervical spinal stenosis, nerve compression, and spinal cord compression and many of the other symptoms of RA can mirror fibromyalgia, such as morning stiff neck, fatigue, disordered sleep, and tender joints.

There is some speculation that neck pain from cervical spinal stenosis, and chiari malformation (CM) are more prevalent in those with fibromyalgia although there appears to be little evidence to suggest such an association at this time.  A review by Clauw (et al, 2000) found no correlation although they admit that their study sample size was too small to accurately detect small increases in prevalence.  Muscle tension and stiffness due to fibromyalgia may contribute to compression in the neck causing pinched nerves or blood vessels intermittently and leading to further pain, headaches, migraines, and other symptoms.  Patients with both cervical spinal stenosis and fibromyalgia may find it even more difficult to exercise which can then exacerbate their condition.  Many fibromyalgia sufferers actually find that exercise improves their symptoms but having the diagnosis of cervical stenosis or other condition causing neck pain may make them reticent to engage in vigorous exercise.  Cognitive behavioural therapy can be useful for those with fibromyalgia and neck pain in terms of alleviating stress and depression and as regards helping them accept their limitations without self-imposing excessive restrictions.  Working with a physical therapist can also help patients devise an appropriate regime of neck stretches and strengthening exercises and help identify other forms of suitable activity to manage symptoms.

Learn More About: Fibromyalgia


References

Clauw, D.J., Petzke, F., Rosner, M.J., Bennett, R.M.  Prevalence of Chiari

malformation and cervical spine stenosis in Fibromyalgia. Arth. Rheum. 43: S173, 2000

Nielsen LA, Henriksson KG. Pathophysiological mechanisms in chronic musculoskeletal pain (fibromyalgia): the role of central and peripheral sensitization and pain disinhibition. Best Pract Res Clin Rheumatol 2007; 21: 465–80.

Staud R, Smitherman ML. Peripheral and central sensitization in fibromyalgia: pathogenetic role. Curr Pain Headache Rep 2002;6: 259–66.

Gur A, Oktayoglu P. Central nervous system abnormalities in fibromyalgia and chronic fatigue syndrome: new concepts in treatment. Curr Pharm Des 2008; 14: 1274–94.

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