Fibromyalgia (FM) is a complex chronic disorder defined by widespread musculoskeletal pain, often accompanied by debilitating fatigue, unrefreshing sleep, and cognitive difficulties, sometimes referred to as “fibrofog.” The condition is rooted in how the central nervous system processes pain signals, leading to heightened sensitivity throughout the body. While general body aches are well-known, many people with FM experience lesser-known symptoms, including those affecting the throat muscles. Understanding this connection requires looking beyond typical symptoms to the underlying neurological and muscular changes that FM causes.
Fibromyalgia and Throat Symptoms
The direct answer to whether fibromyalgia can affect throat muscles is yes. It manifests in several distinct ways involving the pharynx and esophagus. Patients frequently report difficulty swallowing, medically termed dysphagia, which involves a sensation of food or liquid getting stuck. This difficulty affects a significant portion of the FM population, with research suggesting a prevalence in over 37% of those diagnosed.
Another common complaint is globus sensation, or globus pharyngeus, which is the feeling of a persistent lump or tightness in the throat. This sensation is often non-painful but is attributed to muscle spasms or tension in the throat. Swallowing can also be painful, a symptom called odynophagia, which may occur due to muscle stiffness in the pharyngeal area. These throat symptoms often fluctuate in severity, frequently worsening during a general fibromyalgia flare-up.
Underlying Mechanisms of Muscle Involvement
The throat-related symptoms in fibromyalgia are primarily explained by two interconnected mechanisms: central sensitization and localized muscle issues. Central sensitization is a neurological phenomenon where the central nervous system remains in a persistent state of heightened reactivity. This causes an amplification of sensory input, meaning the brain perceives normal sensations, like muscle movement during a swallow, as painful or difficult.
This process lowers the body’s pain threshold, causing a non-painful stimulus to be interpreted as painful (allodynia) or a mildly painful stimulus to be experienced as severely painful (hyperalgesia). Because the muscles used for swallowing are part of the musculoskeletal system, they become subject to this generalized hypersensitivity. The continuous signaling leads to chronic muscle tension in the head and neck region.
This chronic tension contributes to the development of myofascial trigger points (MTPs), which are hyperirritable spots, or knots, within taut bands of skeletal muscle. Individuals with fibromyalgia often also have Myofascial Pain Syndrome (MPS), where these trigger points cause localized pain or referred pain to distant areas. MTPs frequently develop in the neck and shoulder muscles, such as the sternocleidomastoid and suprahyoid muscles, which are involved in the mechanics of swallowing.
When these specific neck and throat muscles develop trigger points, they can directly restrict movement and cause spasms, felt as throat tightness or the globus sensation. The referred pain from these MTPs can also mimic pain originating in the throat, adding to swallowing difficulties. This localized muscular component works in tandem with central sensitization to produce the spectrum of throat symptoms experienced in FM.
Treatment and Symptom Management
Managing throat issues associated with fibromyalgia requires a multi-faceted approach that addresses both central pain amplification and localized muscle dysfunction. A crucial first step involves ruling out other potential causes, such as gastroesophageal reflux disease (GERD), thyroid issues, or structural problems, since symptoms can overlap. Once other conditions are excluded, treatment focuses on mitigating the FM-related mechanisms.
Pharmacological interventions often target the central nervous system to reduce heightened sensitivity. Certain medications, including low-dose tricyclic antidepressants like amitriptyline or anti-seizure drugs such as gabapentin and pregabalin, are commonly prescribed to modulate pain signals and improve sleep quality. Muscle relaxants may also be used during flares to help ease chronic spasms and tension in the neck and pharyngeal muscles.
Non-pharmacological strategies play a significant role in long-term symptom control, beginning with lifestyle adjustments. Maintaining consistent hydration is beneficial, as a dry throat can worsen the feeling of tightness and irritation. Managing stress through techniques like mindfulness or cognitive behavioral therapy (CBT) can help reduce the frequency and intensity of muscle clenching and central nervous system flares.
Referral to a Speech-Language Pathologist (SLP) is often recommended when dysphagia is a persistent issue. An SLP provides specialized swallowing therapy and exercises designed to improve the coordination and strength of the pharyngeal muscles. They also offer guidance on dietary modifications, such as choosing softer foods or altering liquid thickness during severe flares, to ensure proper nutrition and prevent aspiration.