Fibromyalgia is a chronic pain and central nervous system disorder involving widespread musculoskeletal pain, fatigue, sleep problems, and cognitive difficulties. A tremor is an involuntary, rhythmic muscle contraction leading to shaking in one or more body parts. The question of whether fibromyalgia can cause this shaking is common. Investigation into the neurological underpinnings of the disorder reveals a direct link between the two. This article explores the nature of tremors experienced by people with fibromyalgia and explains the underlying biological mechanisms.
Tremors as a Recognized Fibromyalgia Symptom
Tremors are a documented, though not universal, symptom reported by a significant number of people who have fibromyalgia. Estimates suggest that approximately 25% of individuals with the condition experience some form of involuntary shaking or twitching. These tremors are generally described as being mild, or low-amplitude, and they often present alongside other difficulties like problems with coordination and balance.
The type of tremor associated with fibromyalgia is usually an action tremor, meaning it occurs when a muscle is voluntarily moved or held in a position against gravity. For instance, people may notice shaking when they reach for a glass, try to write, or hold their arms outstretched. Some patients also report an “internal tremor,” which is a sensation of shaking felt inside the body without much visible external movement.
The Neurological Mechanism Explaining the Connection
Fibromyalgia is fundamentally a disorder involving the central nervous system, and the tremors often originate from this neurological dysfunction. One primary factor is a phenomenon known as central sensitization, which is an amplified response of the central nervous system to both painful and non-painful signals. This heightened sensitivity means that the brain and spinal cord process normal sensory input, including motor commands, in an exaggerated way, contributing to motor instability.
The Autonomic Nervous System (ANS) is also frequently dysregulated in fibromyalgia. Many people show signs of sympathetic nervous system hyperactivity, the “fight or flight” response, which increases overall muscle tension and heightens involuntary muscle movements. Furthermore, imbalances in neurotransmitters involved in movement and coordination, such as dopamine, have been observed, contributing to tremor development.
The chronic pain and fatigue inherent to the condition further contribute to the shakiness. Muscles that are constantly tense, painful, or easily exhausted may respond to activity with trembling or twitching. This muscle weakness and fatigue, combined with the underlying nervous system hypersensitivity, create an environment where tremors are more likely to occur.
Distinguishing Fibromyalgia Tremors from Other Causes
While fibromyalgia is a source of tremors, this symptom is not exclusive to the condition. Many medications prescribed to manage fibromyalgia symptoms can cause or worsen tremors as a side effect. Drugs like certain antidepressants (SSRIs), anti-seizure medications, and corticosteroids are known to induce drug-related tremors. This type of tremor is often symmetrical and may be episodic or intermittent, sometimes appearing shortly after taking the medicine.
Other neurological or medical conditions can also mimic or coexist with fibromyalgia-related tremors. Essential tremor is a common movement disorder characterized by an action tremor, typically in the hands and arms, but it is a distinct condition not inherently tied to fibromyalgia. Thyroid issues, particularly an overactive thyroid, can cause an enhanced physiological tremor, which is a fine, rapid action tremor.
It is important to consult a healthcare provider for any new or changing tremor to rule out other potential causes, including anxiety, which can also trigger shaking. A medical evaluation helps determine if the tremor is a direct result of fibromyalgia’s pathology, a side effect of treatment, or a symptom of a separate, co-existing condition.
Management Approaches for Tremors Associated with Fibromyalgia
Management of tremors linked to fibromyalgia often focuses on addressing the underlying nervous system dysregulation and muscle tension. Since stress and anxiety can exacerbate the sympathetic nervous system hyperactivity, techniques aimed at reducing emotional arousal are beneficial. Practices such as mindfulness, deep breathing exercises, and meditation can help modulate the ANS and potentially decrease the frequency or intensity of shaking.
Reviewing current medications with a doctor is a practical first step, especially if the tremor began after starting a new drug. Adjusting the dosage or switching to an alternative medication may resolve drug-induced tremors. For tremors that persist, certain prescription medications, such as beta-blockers or anti-convulsants, may be considered to slow down nerve messages in the body, although their effect can be limited.
Physical interventions can also help improve motor control and reduce the impact of the tremor on daily life. Gentle strengthening exercises and physical therapy can help stabilize affected muscles and improve coordination. Using adaptive tools, such as weighted utensils or specialized writing aids, can provide external stability to compensate for the involuntary movements.