The risk of dizziness and falls in fibromyalgia

By Adrienne Dellwo 

In fibromyalgia, dizziness, lack of balance and falls are common complaints. For some people, they are a minor annoyance that arises on occasion. In others, they can be severely debilitating and cause regular injuries.

The fall, and especially the frequent fall, is a serious problem. The last thing you need when you already have a constant pain is to hurt yourself all the time. Frequent falls or balance problems can also lead to fear of falling.

That fear can, in turn, make you afraid to stay active, even within your limits. According to a study in   Clinical Rheumatology,   73 percent of people with fibromyalgia are afraid of physical activity, and almost 75 percent have problems with balance.

The fall is less a symptom and more a consequence of the symptoms of dizziness and lack of balance. In this condition, falls and balance problems may also be related to changes in the way we walk.

So, why does fibromyalgia involve these problems? And what can we do about it?

Fibromyalgia and dizziness

In fibromyalgia, dizziness occurs more frequently when you first get up. It is similar to the feeling of “head rushing” when you stand up too fast, it can only happen every time you lie down or stand up. The sudden onset of dizziness may cause him to sway on his feet, wobble, or even cause him to fall or faint.

Dizziness and fainting in this condition may be related to a particular subgroup, according to a 2017 study published in the   European Journal of Pain  . In addition to dizziness and fainting, this subgroup also had the highest levels of pain, as well as a variety of overlapping symptoms and conditions, including cognitive dysfunction (“fibro fog”), irritable bladder, vulvodynia, and leg syndrome. restless

Research suggests that this symptom is due to autonomic nervous system dysfunction (SNA), which is called dysautonomia. The SNA is involved with many critical functions in your body, including heart rate, blood pressure, respiratory rate, body temperature, metabolism and digestion.

Dizziness caused by dysautonomia may be called orthostatic intolerance, neural mediated hypotension, or postural orthostatic tachycardia syndrome (POTS). Essentially, these things mean that the heart and the brain do not communicate properly with each other.

What should happen is that when you get up from a recumbent or sitting position, the SNA increases your blood pressure to combat the severity and maintain a sufficient supply of blood in your brain. With dysautonomia, this does not happen as it should. Instead, blood pressure can actually go down when standing, and the result is dizziness or lightheadedness. In POTS, the heart rate accelerates as blood pressure drops.

Dizziness may be associated with heart palpitations, blurred vision, increased pulse rate, chest pain, and a type of fainting called vasovagal syncope.

However, not everyone who has dizziness associated with fibromyalgia faints. In a 2008 study, researchers say that dizziness and palpitations were more common than fainting. They also say that POTS was one of the most common symptoms of fibromyalgia they observed during inclined table tests, which measure their response to changes in position.

Balance and gait problems

In addition to the possibility of falls, research suggests that people with fibromyalgia walk differently from healthy people. A 2009 study found that about 28 percent of people with this disease have an abnormal gait (way of walking).

In a functional performance study of 2017, the researchers said that gait and balance were severely damaged in this condition. The differences include:

• Significantly shorter stride length
• Slower pace
• The way the body swings when walking.

The researchers observed that differences in gait and balance were worse in people who had more pain, stiffness, fatigue, anxiety and depression. They recommended that doctors evaluate the progress and position of their patients with fibromyalgia to find the best type of rehabilitation and prevention of falls for them.

This study is part of a growing body of scientific literature that demonstrates balance and gait problems in this condition that can lead to falls. However, evaluating and treating these symptoms may not be a high priority for your doctor. If you are concerned, be sure to mention them at your next appointment.

Alleviate dizziness and risk of falls in fibromyalgia

The more successful you are in treating your fibromyalgia, the less these symptoms should be a problem. However, if you need more attention or if you have not been able to find effective treatments for fibromyalgia, you have several options.

For POTS dizziness, orthostatic hypotension, or brain-mediated hypotension, your doctor may recommend medications that help. These may include SSRI / SNRI, benzodiazepines and beta blockers. Some of these medications may also help relieve other symptoms of fibromyalgia: SSRIs and SNRIs are commonly prescribed for this disease. Your doctor may also recommend changes in lifestyle.

If you smoke, research published in the joint rheumatology journal   , Bone, Spine suggests that quitting smoking can help relieve fainting and other symptoms of fibromyalgia.

When it comes to balance and gait, physical therapy is a common treatment. You may also want to ask your doctor if something like yoga, tai chi or qigong is safe for you.

Until you find ways to improve these symptoms, it’s worth being careful. Assistive devices, such as a cane or walker, can help keep you standing. Seated exercises can be the safest option, and they are certainly a better option than being less active than you can be.