Morning Stiffness in Fibromyalgia
“When clinicians are asked which symptoms are the most debilitating in patients with fibromyalgia, the most common responses include pain, fatigue, and sleep disturbances,” states lead author of a recent study by Robert Bennett, M.D., of Oregon Health and Science University in Portland.1 He adds patients also report stiffness as an important symptom. And who wouldn’t complain about waking up each morning to a body that feels like the final stages of rigor mortis?
Indeed, 90% of the fibromyalgia patients in the Fibromyalgia Network’s recent survey of Fibro Over Time endorsed significant problems with morning stiffness. But what do most doctors think of your stiffness? Bennett says they “generally regard it as a minor symptom,” or a sign of inflammation unrelated to the fibromyalgia.
When doctors think of stiffness, they conjure up rheumatoid arthritis and other inflammation-related joint diseases that make it harder for these patients to get going in the morning. Yet studies in fibromyalgia patients also show stiffness is usually worse in the morning and Bennett points out, “morning stiffness has been rated as more severe in fibromyalgia than rheumatoid arthritis.” He says people with both conditions have worse stiffness than those with fibro alone. But why would fibromyalgia patients be troubled by stiffness?
As people age, they get arthritis, become less active, and expect a little morning stiffness. However, this does not explain why 25 or 45-year-old fibromyalgia patients showed signs of joint stiffness on a test involving the ankle.2 A detailed report was provided in our February 2011 eNews Alert, but suffice it to say, fibro patients showed twice as much stiffness as age-matched healthy controls.
Stiffness sometimes correlates with pain, and since Cymbalta is FDA-approved to treat the pain of fibromyalgia, Bennett and colleagues thought it might relieve the symptom of stiffness. The study was supported by Eli Lilly, the maker of Cymbalta, to see if the drug could help with this symptom. Stiffness did improve, but only by a tiny amount of 10%. This compares closely to the 13% benefit found in the trials of Lyrica.
If the pain of fibro was solely related to the stiffness, the FDA-approved drugs should be able to produce significant improvement in this symptom. Yet they don’t.
Fibromyalgia is a rather “messy” multi-system condition. There is the central nervous system component involved in processing pain, an area all three FDA-approved drugs work on (Cymbalta, Lyrica and Savella). People with fibro also have trigger points or knots in their muscles, which cause serious pain and restrictive movement.3 In addition, one has to remember the circulatory system, and fibromyalgia patients have increased arterial stiffness.4
Your arteries should be flexible, but studies show a reduction of the elastic-like qualities in fibro patients compared to age-matched controls. An overly active sympathetic nervous system is thought to be partly to blame.
Therapies to relax your sympathetic nerves, such as a hot shower and many other approaches, often ease morning stiffness. One of the three FDA-approved drugs may even help, but just don’t expect too much from them.
1. Bennett R, et al. Clin Ther 34(4):824-37, 2012.
2. Dierick F, et al. Eur J Appl Physiol 111:2163-71, 2011.
3. Ge HY, et al. Arthritis Res Ther 13(2):R48, Mar 22, 2011.
4. Cho KI, et al. Clin Rheumatol 30:647-54, 2011.