When Melissa Talwar wakes up each day, she’s not sure how she’ll feel. “Some days are easier than others,” said the 33-year-old freelance Web developer who lives in Pasadena, Calif. The hard days are filled with digestion woes like cramping, severe abdominal pain, constipation, and sensitivities to foods.
Talwar has both fibromyalgia and irritable bowel syndrome (IBS). She was diagnosed with fibromyalgia when she was 15 and IBS when she was 19, “but I was already having stomach issues by age 16, when I had my first endoscopy,” she said.
Her case is not unusual. Fibromyalgia and IBS frequently co-exist in the same people. As many as 60 percent of people with IBS also have fibromyalgia, and up to 70 percent of people with fibromyalgia also have IBS.
“Both conditions are very unpredictable, so I make sure I’m patient with myself,” Talwar said. “I’ve really focused on my stress-management skills and learned to take a real break with meditation and breathing exercises. Overall, I’ve accepted what I have to go through.”
The Physiology Behind Fibromyalgia and IBS
Both IBS and fibromyalgia are chronic pain syndromes. IBS is a common gastrointestinal disorder that causes digestive discomfort, abdominal pain, and alternating diarrhea and constipation. Fibromyalgia is a nervous system disorder that causes widespread pain throughout the body.
“IBS and fibromyalgia have a shared mechanism in that both are associated with hypersensitivity of the brain cells to stimuli, be it touch, light, or temperature changes,” explained Dennis Ang, MD, an associate professor of rheumatology and immunology at Wake Forest Baptist Medical Center in Winston-Salem, N.C. The main difference is that people with IBS have hypersensitivity in their intestines, and people with fibromyalgia have hypersensitivity in their skin and muscle tissues.
“The brain has two parts when it comes to pain — one part that suppresses pain and one part that facilitates pain," Dr. Ang said. "In people with IBS and/or fibromyalgia, the part that reduces pain doesn’t function properly in order to reduce painful stimuli." As a result, the body feels increased sensations of pain.
Anyone can get fibromyalgia and IBS, "but the typical patient who comes in with both is a young to middle-aged female,” said Frank Malkin, MD, a gastroenterologist at Metrowest Medical Center in Natick, Mass. “These patients exhibit the mind-gut connection — symptoms of anxiety will show up in their abdomens, while in others it may show up as chest pain."
Symptoms of IBS and fibromyalgia can overlap. “The number one symptom that overlaps between the two conditions is pain,” Ang said. “People with IBS tend to have a lot of digestion and pelvic-type pain. And people with fibromyalgia can have pain in their legs, arms, back, neck, and feet — all different places throughout the body."
Ideas for Better Fibromyalgia and IBS Management
Both drug and non-drug treatments are available to target IBS and fibromyalgia. “Many of the treatments for fibromyalgia and IBS treat the symptoms of the conditions — they don’t impact the actual physiological mechanisms behind them,” Ang said. Nevertheless, these management techniques can make a significant difference in the quality of life of people with fibromyalgia and IBS.
Drug therapies for fibromyalgia and IBS include:
Tricyclic antidepressants. “One treatment option for people with IBS and fibromyalgia is a tricyclic antidepressant medication, such as amitryptiline (Elavil),” Ang said. Tricyclic antidepressants work by increasing concentrations of the neurotransmitters norepinephrine and serotonin in the brain, and they can help with pain, fatigue, and sleep problems in people with fibromyalgia, and pain in people with IBS.
Duloxetine (Cymbalta). This drug is a member of a class of antidepressant medications called serotonin norepinephrine reuptake inhibitors (SNRIs). “Cymbalta is approved by the United States Food and Drug Administration (FDA) for fibromyalgia,” Ang says. “And although Cymbalta is not FDA-approved for IBS, some gastroenterologists prescribe it for people with IBS who have a lot of pain.” Other classes of antidepressants may help people with fibromyalgia and IBS as well, including selective serotonin reuptake inhibitors (SSRIs).
Non-drug therapies for fibromyalgia and IBS include:
Cognitive behavioral therapy (CBT). A form of talk therapy that helps people focus on the relationship between their thoughts, feelings, and behaviors, CBT can help people with fibromyalgia and IBS deal with pain and help them manage stress, which can aggravate both conditions, Ang said. When people with these kinds of chronic conditions manage their stress with tools like CBT, their symptoms tend to occur less often.
Exercise. “Being sedentary magnifies the symptoms of both fibromyalgia and IBS,” Ang pointed out. “Low-intensity aerobic exercise is very helpful for both fibromyalgia and IBS, so I definitely encourage people with these conditions to increase their physical activity.”
De-stressing. Because fibromyalgia and IBS are fueled by stress, one of the best things you can do is take that stress away. “Do whatever works for you, be it acupuncture, swimming, counseling, or going to a gym," Dr. Malkin advised. "Anything that relives the stress will certainly be helpful."
Talwar has her own advice to others who battle both fibromyalgia and IBS: “Be patient and kind to yourself. When you feel overwhelmed by self-doubt and destructive thoughts, try to focus on a positive thought or something that will make you laugh.”
Last Updated: 8/7/2013