Can Weight Gain Associated With Fibromyalgia Be Prevented?

Fibromyalgia is a disease seemingly without any known cause and cure. If one suffers from this pain disorder affecting muscles and bones, along with exquisite sensitivity to touch in several places on the body, quality of life seems to deteriorate without hope of improvement. Depression is not uncommon, fatigue may be a constant, sleep is often disturbed, and cognitive ability is sometimes lost in something called fibrofog or brain fog.

Fibromyalgia affects about 3% to 5% of the U.S. population. The debilitation associated with fibromyalgia is exacerbated by excess weight. Unfortunately, obesity is common among fibromyalgia patients: 32% to 50% are obese, and an additional 21% to 28% are overweight, according to a study on the relationship between obesity and symptoms of this disease. When body mass index ("BMI") is in the overweight or obese range, those with fibromyalgia experience more pain and sensitivity to touch, difficulty in doing any type of exercise without pain, and sleep disturbances. The researchers found that obesity led to a shorter duration of sleep and increased awakenings. The effect was to increase daytime fatigue and pain sensitivity.

Weight loss among those with fibromyalgia can be extremely difficult to achieve. The factors that trigger overeating among a healthy population, i.e., mood changes like depression, inadequate sleep, inability to exercise for more than a few minutes because of orthopedic or muscular pain and fatigue, as well as food cravings, are amplified among those with fibromyalgia.

As with individuals whose obesity is associated with antidepressants that cause overeating, obese fibromyalgia sufferers are often not given weight loss support tailored to their physical and emotional needs. Suggesting a particular diet, usually without considerable clinical evidence to confirm its efficacy, or not understanding that eating may be a way of temporarily diminishing the considerable discomfort of the disease, may hinder weight loss efforts. Strenuous exercise regimens may hurt too much to be followed consistently, and flare-ups bring exercise to a halt when the pain makes moving unbearable. However, low-impact activities such as yoga, Pilates, walking, slow biking, and water aerobics are considered most compatible with fibromyalgia-imposed limitations. As important as these are for building stamina and in often easing pain, they probably won’t cause enough caloric expenditure to hasten weight loss.

Drugs that decrease pain perception—“pain volume”—in the central nervous system have been developed for fibromyalgia, as well as for other muscular and skeletal pain. According to the Arthritis Foundation, these drugs may decrease fatigue, improve mood, reduce sleep disturbances, and increase the quality of life of people suffering from fibromyalgia. Lyrica (pregabalin) is an anti-epileptic drug that may reduce the pain of fibromyalgia and improve sleep and overall quality of life. However, one of the side effects is weight gain and the other, brain fog, may exacerbate cognitive problems already experienced by patients with this disorder.

Cymbalta (duloxetine) increases activity of two neurotransmitters in the brain, norepinephrine and serotonin, and is effective in reducing pain perception. Weight gain does not seem to be a side effect but fatigue is, again possibly exacerbating a symptom of fibromyalgia.

Savella (milnacipran) is the most recent drug approved by the FDA for the treatment of fibromyalgia but, like the others, does not improve all symptoms and comes with its own bag of side effects. Headache and nausea are the most common side effects, although increased risk of suicide has been found associated with this drug. The drug also increases the activity of norepinephrine and serotonin.

Weight loss was seen during the early months of treatment with Savella in a study comparing its effects with patients given a placebo. Almost twice as many patients on Savella lost weight, and their reduced weight was maintained until about 30 months after which it was gradually regained. Interestingly, nausea, a common side effect, was not as prevalent among those who lost weight as those whose weight remained unchanged.

Obviously what drugs are prescribed may depend on which symptoms they best reduce; each has its own strengths and weaknesses. And the weight loss potential of Savella may still not make the best choice for patients whose symptoms the drug may not help.

However, preventing or minimizing weight gain would seem to be an important objective in the treatment of this disease because obesity can have such a significant negative effect on its symptoms. Reducing pain, sleep disturbances, and fatigue as soon as possible after diagnosis should help prevent weight gain. And if the patient is already overweight, choosing a drug that will not cause further weight gain must be considered.

But how available are centers devoted to preventing or minimizing weight gain among fibromyalgia patients? Are there dedicated dieticians, physical therapists, sleep specialists, and mental health therapists who will work with such patients to identify triggers that will cause weight gain and develop strategies to prevent it? Will the patient be referred to a support group to help with the possible isolation the disease causes because of chronic pain, lack of sleep, fatigue, and depression?

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If such support is absent or too costly to be available to most, is it any wonder that eating is turned to as a readily available emotional support? It is not sufficient to identify obesity as the cause of increased morbidity among patients with fibromyalgia. It should be halted before its impact on the symptoms of this disease may be irreversible.