Dizziness, Balance and Falls During Fibromyalgia Flares

By Adrienne Dellwo

In fibromyalgia, dizziness, poor balance, and falls are common complaints. For some people, they’re a minor annoyance that crops up on occasion. In others, they can be severely debilitating and lead to regular injuries.

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

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

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

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

Fibromyalgia and Dizziness

In fibromyalgia, dizziness most often comes on when you first stand up. It’s similar to the feeling of a “head rush” from when you stand up too quickly, only it can happen any time you go from lying down or sitting to standing up. The sudden onset of dizziness can make you sway on your feet, stagger, or it may even make you fall or faint.

Dizziness and fainting in this condition may be tied 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 pain levels as well as a variety of symptoms and overlapping conditions including cognitive dysfunction (“fibro fog”), irritable bladder, vulvodynia, and restless legs syndrome.

Research suggests that this symptom stems from dysfunction of the autonomic nervous system (ANS), which is called dysautonomia.

The ANS is involved with a lot of critical functions in your body, including heart rate, blood pressure, respiratory rate, body temperature, metabolism, and digestion.

Dizziness resulting from dysautonomia can be called orthostatic intolerance, neurally mediated hypotension, or postural orthostatic tachycardia syndrome (POTS). Essentially, these things mean that the heart and the brain aren’t communicating properly with each other.

What should happen is that when you stand up from a lying or sitting position, the ANS increases your blood pressure in order to fight gravity and keep a sufficient supply of blood in your brain. With dysautonomia, this doesn’t happen like it should. Instead, the blood pressure can actually drop when you stand, and the result is dizziness or light-headedness. In POTS, the heart rate speeds up 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.

Not everyone with fibromyalgia-related dizziness faints, though. In a 2008 study, researchers say dizziness and palpitations were more common than fainting. They also say POTS was one of the most common fibromyalgia symptoms they observed during tilt-table tests, which measure your response to changes in position.

Balance and Gait Problems in Fibromyalgia

Adding to the possibility of falls, research suggests that people with fibromyalgia walk differently than healthy people. A 2009 study found that about 28 percent of people with this illness have an abnormal gait (manner of walking).

In a 2017 study of functional performance, researchers said that gait and balance were severely impaired in this condition. Differences included:

• significantly shorter stride length
• slower pace
• the way the body sways when walking

Researchers noted that gait and balance differences were worse in people who had more pain, stiffness, fatigue, anxiety, and depression.

They recommended that doctors assess the gait and posture of their patients with fibromyalgia in order to find the best type of rehabilitation and fall prevention for them.

This study is part of a growing body of scientific literature demonstrating balance and gait problems in this condition that can lead to falls. Still, evaluating and treating these symptoms may not be a high priority for your doctor. If they’re concerns for you, make sure to bring them up at your next appointment.

Alleviating Dizziness and Fall Risk in Fibromyalgia

The more successful you are at treating your fibromyalgia, the less these symptoms should be a problem. However, if they need more attention or you’ve been unable to find effective fibromyalgia treatments, you have several options.

For dizziness from POTS, orthostatic hypotension, or neurally mediated hypotension, your doctor may be able to recommend medications that help. These can include SSRI/SNRIs, benzodiazepines and beta blockers. Some of these drugs may help alleviate other fibromyalgia symptoms, as well—SSRIs and SNRIs are commonly prescribed for this illness. Your doctor may also recommend lifestyle changes.

If you smoke, research published in the rheumatologic journal Joint, Bone, Spinesuggests that quitting may help alleviate fainting and several other symptoms of fibromyalgia.

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

Until you find ways to improve these symptoms, it pays to be careful. Assistive devices such as a cane or walker may help keep you on your feet. Seated exercises may be the safest option, and they’re certainly a better choice than being less active than you can be.

Sources:

Costa ID, Gamundi A, Miranda JG, et al. Altered functional performance in patients with fibromyalgia. Frontiers in human neuroscience. 2017 Jan 26;11:14.

Lee SS, Kim SH, Nah SS, et al. Smoking habits influence pain and functional and psychiatric features in fibromyalgia. Joint, bone, spine. 2011 May;78(3):259-65.

Staud R. Autonomic dysfunction in fibromyalgia syndrome: postural orthostatic tachycardia.Current rheumatology reports. 2008 Dec;10(6):463-6.

Russek L, Gardner S, Maguire K, et al. A cross-sectional survey assessing sources of movement-related fear among people with fibromyalgia syndrome. Clinical rheumatology. 2015 Jun;34(6):1109-19.

Watson NF, Buchwalk D, Goldberg J, et al. Neurologic signs and symptoms in fibromyalgia.Arthritis and rheumatism. 2009 Sep;60(9):2839-44.

Yim YR, Lee KE, Park DJ, et al. Identifying fibromyalgia subgroups using cluster analysis: relationships with clinical variables. European journal of pain. 2017 Feb;21(2):374-384.