What is the Fibromyalgia Impact Questionnaire (FIQ)

The Fibromyalgia Impact Questionnaire is something that I encounter a lot when reviewing research into fibromyalgia as it is often used in studies to see how something affects a person's fibromyalgia symptoms. This explains what it is, what it scores and how it is measured and you can also get a copy. 

The Thyroid-Fibromyalgia Connection

The thyroid is a small but incredibly influential gland located in the front of the neck. Those who are familiar with this powerful piece of anatomy know that it has a significant impact on numerous regions including the metabolism, brain, and weight regulation. Because of the thyroid’s broad influence, dysfunction of this system can result in the development or continuation of many serious conditions such as fibromyalgia.

Unfortunately, the relationship between the thyroid and fibromyalgia is frequently overlooked. 

I personally had hypothyroidism, or low thyroid, diagnosed many years before I developed fibromyalgia. In fact it was my thyroid doctor who diagnosed me with fibromyalgia. As I was diagnosed with Hashimoto's thyroiditis quite young I always suspected new symptoms were connected with it and went to check with my thyroid specialist. This time he examined me, did the blood tests, and then later reported that it was not my thyroid that was causing the new feelings of stiffness and increased fatigue but most likely fibromyalgia. 

I have both hashimoto thyroid and fibromyalgia, the thyoid condition was diagnosed first.

Thyroid dysfunction shares many similarities with a hypothalamic condition known as fibromyalgia. Those suffering from hypothyroidism, and to a lesser degree hyperthyroidism, frequently develop fibromyalgia or at the very least exhibit symptoms similar to it.

Is the HPA Axis the Missing Link?

The connection between thyroid disease and fibromyalgia is an important part of understanding both conditions.

Fibromyalgia is caused by dysfunction of the hypothalamus.

The hypothalamus exerts substantial influence over essential bodily functions including sleep, hormone balance, temperature, and autonomic nervous systems that regulate blood pressure, blood flow, and the transport of food through the gut.

As part of the HPA axis, the hypothalamus works together with the pituitary, adrenals, and the thyroid to regulate hormones throughout the body.

The components of the HPA are closely interrelated meaning that malfunction in one area can have a significant negative impact on the others.

Dr. J. Teitelbaum, MD, is an expert in chronic conditions, specifically chronic fatigue syndrome and fibromyalgia. He believes that hypothyroidism and fibromyalgia are linked through the origin of the dysfunction.

The thyroid is highly influential over the hypothalamus and pituitary. Therefore, reduced thyroid activity can contribute to fibromyalgia-like symptoms and may increase the risk of developing the condition itself.

Many symptoms are shared between hypothyroidism and fibromyalgia including fatigue, exhaustion, depression, brain fog, and a variable severity of muscle and joint pain.

Regardless if thyroid malfunction is a co-factor of fibromyalgia, a prominent component of its symptoms is reduced thyroid function.

When thyroid disease is left untreated, already reduced tissue levels of thyroid hormone can continue to decrease resulting in greater symptom severity.

Thyroid hormone, specifically T3, is an essential part of maintaining cellular energy level and activity. Inhibited levels of thyroid hormone contribute to reduced mitochondrial energy levels resulting in poor cellular activity.

Both the hypothalamus and pituitary are particularly sensitive to cellular fatigue.

As cellular energy levels decrease, the risk of developing fibromyalgia increases. Therefore, it is important to assess properly assess the thyroid and provide treatment as necessary if a patient is suffering from fibromyalgia.

Supporting the Thyroid to Resolve Fibromyalgia

The link between hypothyroidism and fibromyalgia is strong. Therefore, if you are a thyroid patient experiencing symptoms of fibromyalgia it is quite possible that your thyroid is malfunctioning or is not being treated effectively.

Dr. John Lowe, one of the leading practitioners in the field of fibromyalgia research, found that the chronic symptoms associated with hypothyroidism and fibromyalgia were partially or entirely due to lack of or under treatment of the thyroid.

If you have been diagnosed with fibromyalgia but have not had your thyroid assessed or treated, speak with your doctor about testing and optimizing your thyroid.

READ FULL ARTICLE

ADDITIONAL RESOURCES.

Want to learn more about the thyroid Fibromyalgia connection, or do more medical research into the topic? Here are some additional resources: 

Fibromyalgia in patients with thyroid autoimmunity: prevalence and relationship with disease activity. 2017 PUBMed article 

2010 set of criteria for diagnosing fibromyalgia

In 2010, the American College of Rheumatology endorsed a new set of criteria for diagnosing fibromyalgia. Here is an excerpt from it:

A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met:
1. Widespread pain index (WPI) > 7 and symptom severity > 5 or WPI 3-6 and SS scale score > 9
2. Symptoms have been present at a similar level for at least 3 months.
3. The patient does not have a disorder that would otherwise explain the pain.

ASCERTAINMENT 
1. WPI: note the number areas in which the patient has had pain over the last week. In how many areas has the patient had pain? Score will be between 0 and 19. 
Shoulder girdle, 
left Shoulder girdle, 
right Upper arm, 
left Upper arm, 
right Lower arm, 
left Lower arm, 
right Hip (buttock, trochanter), 
left Hip (buttock, trochanter), 
right Upper leg, 
left Upper leg, 
right Lower leg, 
left Lower leg, 
right Jaw, 
left Jaw, 
right Chest 
Abdomen 
Upper back 
Lower back 
Neck 

2. 
SS scale score: 
Fatigue 
Waking unrefreshed 
Cognitive symptoms 
For the each of the 3 symptoms above, indicate the level of severity over the past week using the following scale: 
0 = no problem 
1 = slight or mild problems, generally mild or intermittent 
2 = moderate, considerable problems, often present and/or at a moderate level 
3 = severe: pervasive, continuous, life-disturbing problems 

Considering somatic symptoms in general, indicate whether the patient has:* 
0 = no symptoms 
1 = few symptoms 
2 = a moderate number of symptoms 
3 = a great deal of symptoms 

The SS scale score is the sum of the severity of the 3 symptoms (fatigue, waking unrefreshed, cognitive symptoms) plus the extent (severity) of somatic symptoms in general. The final score is between 0 and 12.

* Somatic symptoms that might be considered: muscle pain, irritable bowel syndrome, fatigue/tiredness, thinking or remembering problem, muscle weakness, headache, pain/cramps in the abdomen, numbness/tingling, dizziness, insomnia, depression, constipation, pain in the upper abdomen, nausea, nervousness, chest pain, blurred vision, fever, diarrhea, dry mouth, itching, wheezing, Raynaud's phenomenon, hives/welts, ringing in ears, vomiting, heartburn, oral ulcers, loss of/change in taste, seizures, dry eyes, shortness of breath, loss of appetite, rash, sun sensitivity.

Read the complete article (in pdf) from the American College of Rheumatology.

See the Clinical Fibromyalgia Diagnostic Criteria in pdf 

The influence of weather on Fibromyalgia: a fibro survey

Do you think your fibromyalgia is affected by the weather? 

Do you hate hot weather or cold weather or weather extremes? 

Many people with fibromyalgia report feeling worse on stormy days, in extreme heat, or when the seasons shift. While science hasn’t always backed up these claims, our bodies often tell a different story. Whether it’s aching joints before a thunderstorm or increased fatigue in humid weather, the connection between climate and symptoms deserves attention—and respect.

I found a 2013 study about the influence of weather on daily symptoms of pain and fatigue in patients with fibromyalgia.

Abstract from Arthritis Care and Research:

While patients with fibromyalgia often report that specific weather conditions aggravate their symptoms, empirical studies have not conclusively demonstrated such a relation. Our aim was to examine the association between weather conditions and daily symptoms of pain and fatigue in fibromyalgia and to identify patient characteristics explaining individual differences in weather sensitivity.

Conclusion.

There is more evidence against than in support of a uniform influence of weather on daily pain and fatigue in female patients with fibromyalgia according to this study. While individuals appear to be differentially sensitive to certain weather conditions, there is no indication that specific patient characteristics play a role in weather sensitivity.

See the Methods and Results 

This demonstration of a lack of uniform effects of weather on symptoms does not, however, refute the notion that some fibromyalgia patients may be more sensitive to the weather or changes in the weather than other people.

Why Research Might Miss What Patients Feel or why  “lack of uniform effect” doesn’t mean “no effect at all.”

• Short study durations may miss seasonal effects

• Small sample sizes limit generalizability

• Individual variability is hard to measure in group data

• Subjective symptoms like pain and fatigue are influenced by many factors, including stress, sleep, and hormonal shifts

We decided to conduct our own survey with people who have fibro! We created a simple and quick, multiple-choice survey to get the real results on whether the weather affects people with fibromyalgia. We found that the majority of people who joined in the survey said that their fibromyalgia symptoms WERE affected by the weather. 

Community Survey Highlights

• 72% said weather changes definitely affect their symptoms

• 18% said sometimes

• 10% said not really

Most common triggers:

• Cold, damp weather

• Sudden barometric pressure drops

• Heatwaves and humidity

Whether or not science has caught up, your experience matters. If weather affects your fibromyalgia, you’re not imagining it—and you’re not alone. Listening to your body, adapting your environment, and connecting with others who understand can make all the difference.

Please share your own experiences in the comments on how the weather affects you. 

COMING SOON TIPS FOR COPING WITH WEATHER CHANGES.

My unresolved sleep problems when living with fibromyalgia

                                

This article is about my sleep issues, when living with fibromyalgia. 

If my thoughts seem unorganised it is most probably due to lack of sleep! (this is not a joke.)

I think that most people would know that pain and sleep affect each other: pain can be made worse by lack of sleep and also our sleep can be affected by having pain. Studies have been done on this. (See 1 and 2 below).

People have been tortured (for real) by not letting them sleep!

Apparently over 90% of people with fibromyalgia report having non- restorative sleep i.e. waking unrefreshed after a night's sleep. It is now included amongst the diagnostic criteria as "waking unrefreshed".

"In fibromyalgia, all treatments are geared toward helping people sleep better. If we can improve their sleep, patients will get better." Steven Berney, MD, chief of rheumatology at Temple University Health System in Philadelphia via WebMD.

MY SLEEP PROBLEMS.
I think my sleep problems started after I gave birth to twins. I had difficulty getting them in a routine with each other so that they both awoke for feeds at the same time. Which meant I was woken up more often at night than a mother with 1 child. Hey, I even went to a residential place, run by nurses, to help babies and mothers when the twins were 9 months old. I stayed for 5 days but even these wonderful nurses could not get them to sleep or wake at the same time! I struggled on as you do and 4 years later I was a mess of aches and pains and restless legs and fatigue.  I also believe that being a mother of 5 children has taught me to be a light sleeper.

IMPROVING SLEEP.
Pregabaline (GABA) which has analgesic and sleep-modulating activities, has been an advance for the management of non-restorative sleep in fibromyalgia, and odium oxybate, a metabolite of dopamine, which increases GABA, has recently been proposed to increase slow-wave sleep and decrease sleep disruption. 

But what about people like me who don't fair well with medications in general?

Researchers, supported by NIAMS*, are investigating ways to improve sleep for people with fibromyalgia whose sleep problems persist despite treatment with medications.

One team has observed that fibromyalgia patients with persistent sleep problems share characteristics with people who have insomnia, such as having erratic sleep and wake schedules and spending too much time in bed. (Yes, I could have told them about this erratic sleep and the love hate relationship I have with my bed.)

This team is testing whether strategies developed to help insomnia patients will also help people with fibromyalgia achieve deep sleep, which eases pain and fatigue.

Preliminary results show that sleep education, which teaches good sleep habits, and cognitive behavioral therapy, which includes sleep education and a regimen to correct poor habits and improper sleep schedules, both reduce insomnia.

MY CONTINUING SLEEP PROBLEMS.
Now that my children are all grown I still have problems with sleep. I am even considering sleeping in a separate bed from my husband for my own health. This is a big step both emotionally and economically but I do notice I sleep so much better when I visit my mother. After about 4 days there, sleeping in my own bed by myself, my pain reduces. This is amazing occurence to anyone who suffers from chronic pain. So all the teaching about good sleep habits and providing cognitive behaviour therapy really does not help if you are a light sleeper yourself and sleep with a snorer, who has sleep apnea who constantly wakes and is rolling around the bed and pulling the covers off you!

Now I just have to work out if I can afford a new bed and where I can put it. But I still have the dilemma of the distancing from my husband...

QUESTIONS TO RESEARCHERS.

• Why is it that we need sleep but cannot sleep at night when we have Fibromyalgia and other chronic illnesses?

• Why do people with Fibromyalgia often feel a bit better late at night and get more energy, making getting to sleep more difficult?

• Are we better to take medications that "knock us out" and gives us a good night sleep or do these medications have long term bad side effects?

• What effect does not sleeping with your partner in the same bed, or even the same room, have on you marriage?

Is anyone studying these?

* National Institute of Arthritis and Musculoskeletal and Skin Diseases

REFERENCES

1.  Poor sleep and depression are independently associated with a reduced pain threshold. Results of a population based study. Pain. Chiu YH, Silman AJ, Macfarlane GJ, Ray D, Gupta A, Dickens C, et al. 2005;115:316–321.[PubMed]

2. Relationship between chronic painful physical condition and insomnia. J Psychiatr Res. Ohayon MM. 2005;39:151–159. [PubMed]

3. Pain-related diseases and sleep disorders. Braz J Med Biol Res. 2012 Aug; 45(9): 792–798. M. Roizenblatt, N.S. Rosa Neto, S. Tufik, and S. Roizenblatt [NCBI]

4. What Are Researchers Learning About Fibromyalgia?

Measuring symptoms - new Fibromyalgia Diagnostic Criteria

Written and published August 2010.

Measuring severity of symptoms would be a useful thing to do in any chronic condition, don't you think? Saying "how bad is the pain on a scale of 1 to 10" is useful, especially as a follow up tool, but how do you measure the many other symptoms of fibromyalgia including unrefreshed sleep, fatigue and cognitive symptoms? 

Has anyone with fibromyalgia been given a cognitive test? How many of us have undergone a sleep study? I certainly haven't. 

The widespread pain index (WPI) and the symptom severity (SS) scale score are 2 new measurements designed by The American College of Rheumatology.

The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity.  It includes many symptoms including Nervousness, Chest pain, Blurred vision, Fever, Diarrhea, Dry mouth, Itching, Wheezing, Raynauld’s, and Hives/welts.

New Clinical Fibromyalgia Diagnostic Criteria – Part 1: See the pdf here. 

Hopefully this criteria will help with getting a correct diagnosis and the monitoring of the symptoms in fibromyalgia.