Does fibromyalgia cause shoulder and arm pain? (+11 effects)

In this article, we will discuss the shoulder and arm pain caused by fibromyalgia. We will also discuss different factors that can trigger the occurrence of fibromyalgia-associated shoulder and arm pain. 

Does fibromyalgia cause shoulder and arm pain?

Yes, fibromyalgia causes shoulder and arm pain. Shoulder pain is one of the most common characteristics of fibromyalgia after back and neck pain. Fibromyalgia is known to affect 1-5% of the general population, amongst which 45% of patients experience shoulder and arm pain.

Fibromyalgia is a syndrome that is defined by tender point pain and widespread musculoskeletal pain. Pain from fibromyalgia can be felt in the deep tissues, such as muscles, joints, and ligaments of the shoulder and arm.

While pain is the primary symptom of fibromyalgia, patients experience shoulder and arm pain of varying degrees. The intensity and duration of pain may fluctuate over time and can intensify during stressful conditions or while lifting heavy things. 

How does fibromyalgia cause shoulder and arm pain?

The pain associated with fibromyalgia appears to be the result of a complex interaction between peripheral sensitization, autonomic dysfunction, and central sensitization.

In central sensitization, stimuli like temperature, light, and fabric can lead to mechanical allodynia. Once the central sensitization has been established, small nociceptive and non-nociceptive inputs might trigger the pain sensation in the shoulder and arm.

Sensitization of the nociceptive receptors at the periphery is known as peripheral sensitization. It causes a decrease in the threshold and an increase in the responsiveness of the nociceptor neurons.

Autonomic dysfunction has been reported to cause fibromyalgia-associated shoulder and arm pain. Shoulder and neck pain might be induced by hypoactive or hyperactive autonomic activity (1).

What does the research suggest?

In one of the research studies, 22 patients with fibromyalgia presented with multiple active and latent myofascial trigger points (MTrPs) present in the upper trapezius muscle.

The trapezius is a triangular, superficial muscle that extends from the neck and shoulders and goes down to the back. These active MTrPs in the upper muscle caused shoulder and neck pain in patients with fibromyalgia (2).

In another study, 23 female patients with fibromyalgia-associated shoulder and neck pain were given stressful tasks for 30 minutes and 60 minutes. The patients presented with reduced blood flow to the fingers.

An increase in diastolic pressure and heart rate was monitored in the patients. However, the severity of shoulder and arm pain was less due to the effect of analgesia given for the symptomatic treatment of fibromyalgia (3). 

What factors flare up fibromyalgia-associated shoulder pain?

Some disease conditions and genetic makeup might flare up the shoulder and arm pain associated with fibromyalgia.

• Rheumatoid arthritis: It causes inflammation and pain in the joints. However, these pains may not be persistent. But with fibromyalgia, the pain persists constantly.

Fibromyalgia happens more likely in patients who have inflammatory arthritis. This could be due, in part, to chronic pain. This chronic pain causes the brain to become hypersensitive not only to things that hurt but also to other stimuli which are not otherwise painful (4).

• Chronic fatigue syndrome: Fibromyalgia and chronic fatigue syndrome are characterized by excessive fatigue.

Patients who might have fibromyalgia often become fatigued before the symptoms begin to develop. According to the Aritirtic Foundation, 50-70% of the patients with fibromyalgia also meet the criteria for chronic fatigue syndrome (5).

• Psychosocial factors: Patients who are involved in monotonous work, and work dissatisfaction often report the onset of fibromyalgia. 

Such factors might include the lifting of heavy weights above the shoulder, or with one or both hands. Monotonous work, repetitive behaviours, and work stress can trigger the condition (6).

• Genetics: Given that pain is known to run strongly in families, it may have a genetic origin and increase the incidence of shoulder and arm pain. 

Several studies have establied a familial correlation (genetics) with the possibilty of developing fibromyalgia within a family. In one of the studies, 52% of the family members had clinical evidence of developing fibromyalgia (7). 

What are the other symptoms of fibromyalgia?

Apart from pain in the shoulder and arm, the patient might also experience chronic pain in the head, legs, buttocks, and lower back. Some other symptoms might also include:

• Fatigue,
• Cognitive impairement,
• Muscle stiffness,
• Bloating or constipation,
• Mood disturbance,
• Difficulty in thinking,
• Irregular sleeping patterns, and
• Increased sensitivity to temperature, light and noise.

How fibromyalgia-related shoulder and arm pain can be managed?

• Pain coping strategies: These psychological strategies are adopted by the patient to manage shoulder and arm pain.

Pain coping strategies can be categorized into cognitive and behavioural strategies. In cognitive strategy, the patient tries to distract himself with various tasks, such as praying, reading, eating, or motivating himself to fight the pain. 

In behavioural strategy, the patient convinces himself to take the medication for shoulder and arm pain associated with fibromyalgia (8).

• Physiotherapy: Tender and trigger points in fibromyalgia can be managed through physiotherapy.

Physiotherapy for fibromyalgia is a combination of physical exercise, patient education, and manual therapy to reduce pain sensitivity and improve muscle strength and flexibility. 

• Analgesics: Pain relievers can be given to the patients to reduce pain sensitivity and improve quality of life. 

Frequently prescribed analgesics include ibuprofen and naproxen. Although Ibuprofen is an over-the-counter (OTC) medication for mild pain, for high doses consult your doctor and ask for a prescription. Excess and prolonged use can cause gastrointestinal issues.

• Anticonvulsants: The Food and Drug Administration (FDA) has approved the use of pregabalin for the management of shoulder and arm pain associated with fibromyalgia. 
• Antidepressants: These can be given to the patient for the relief of fatigue and shoulder pain. Some examples include paroxetine and sertraline.

As a pharmacist, many of my customers with fibromyalgia report of pain in the neck and shoulder blade areas. They often ask for pain relievers. However, I believe that before going for an OTC drug, you should always consult your doctor.

Even OTC medicines can have side effects. Fibromyalgia is often an undiagnosed disease and patient confuse it with fatigue or an ordinary shoulder pain. However, early detection can prevent the worsening of the symptoms. 

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