What Is Fibromyalgia?
Fibromyalgia is a chronic, widespread pain condition involving abnormal pain processing in the central nervous system.
Instead of the body responding normally to pain signals, the brain and spinal cord amplify them — a phenomenon known as central sensitisation.
Common symptoms include:
- Widespread muscle and joint pain (on both sides of the body)
- Deep aching, burning, or throbbing sensations
- Extreme fatigue and unrefreshing sleep
- Cognitive difficulties (“fibro fog”)
- Heightened sensitivity to touch, noise, and temperature
- Headaches or migraines
- Anxiety or depression related to chronic pain
Fibromyalgia often develops gradually and isn’t usually linked to one specific injury. It is more common in women and often co-exists with conditions such as IBS, TMJ dysfunction, chronic fatigue syndrome, and pelvic pain.
What Is Complex Regional Pain Syndrome (CRPS)?
CRPS is a severe, localised neurological pain disorder that typically affects one limb — usually after an injury, fracture, surgery, infection, or even a minor trauma like a sprain or injection.
It involves a malfunction of pain, immune, and autonomic (temperature, blood flow, sweating) systems in the affected area.
Typical symptoms include:
- Intense burning or stabbing pain in one arm or leg
- Pain far greater than expected from the original injury
- Swelling and temperature changes
- Skin colour changes (red, purple, blue)
- Abnormal sweating in the affected limb
- Hair or nail growth changes
- Extreme sensitivity to touch (allodynia)
- Difficulty using or moving the limb
CRPS progresses through stages, and early intervention is crucial to prevent long-term disability. It affects fewer people than fibromyalgia but can be far more debilitating if not caught early.
Comparing Causes and Triggers
Fibromyalgia
The exact cause remains uncertain, but contributing factors may include:
- Central sensitisation
- Genetic predisposition
- Chronic stress or trauma
- Hormonal influences
- Sleep disturbances
Fibromyalgia does not arise from tissue damage — it’s a disorder of pain processing.
CRPS
Usually triggered by a specific event, such as:
- Fractures
- Surgical procedures
- Sprains or soft tissue injuries
- Nerve damage
- Injections or IV complications
CRPS is post-injury, even when the injury seems mild. The abnormal response happens in the limb’s local nervous and immune systems.
Differences in Symptoms
Below is a simple, clear comparison:
|
Feature |
Fibromyalgia |
CRPS |
|
Pain distribution |
Widespread, both sides of the body |
Localised to one limb |
|
Pain type |
Aching, burning, diffuse |
Severe burning, stabbing, extreme sensitivity |
|
Swelling |
Uncommon |
Very common |
|
Skin changes |
Rare |
Frequent (colour, texture, sweating) |
|
Temperature changes |
General sensitivity |
Hot/cold changes in affected limb |
|
Fatigue |
Very common |
Secondary, due to pain |
|
Sleep problems |
Core symptom |
Possible but not defining |
|
Movement difficulty |
From pain + fatigue |
From pain + stiffness + limb dysfunction |
|
Trigger |
No clear event |
Injury, surgery, or trauma |
|
Progression |
Gradual |
Rapid if untreated |
While both conditions involve heightened pain processing, CRPS is regional and physical, while fibromyalgia is systemic and neurological.
Diagnosis of Each Condition
Fibromyalgia Diagnosis
There is no single test for fibromyalgia. Diagnosis is clinical and based on:
- Widespread pain for at least 3 months
- Presence of fatigue, sleep issues, cognitive symptoms
- Exclusion of conditions like arthritis, autoimmune disease, or neuropathy
Blood tests or scans may be done to rule out other causes.
CRPS Diagnosis
CRPS diagnosis uses the Budapest criteria, focusing on:
- Prolonged pain disproportionate to injury
- At least three of the following: swelling, colour change, sweating changes, temperature difference, movement restriction
- Signs visible on physical examination
Additional investigations may include:
- Triple-phase bone scan
- Thermography
- X-ray or MRI for bone or tissue changes
Early diagnosis leads to better recovery.
Treatment Options in South Africa
Fibromyalgia Treatment Options
Treatment is multimodal and aims to calm the nervous system:
Lifestyle:
- Graded exercise therapy
- Sleep optimisation
- Stress reduction
- Anti-inflammatory diet
Medical treatments:
- Low-dose antidepressants (amitriptyline, duloxetine)
- Anticonvulsants (pregabalin)
- Trigger point therapy
- Pain neuroscience education
- Psychological support (CBT)
Pain clinic interventions:
- Occipital nerve blocks for migraine-type symptoms
- Myofascial trigger point injections
- TENS or neuromodulation
CRPS Treatment Options
Because CRPS can worsen quickly, early multidisciplinary treatment is essential.
Physical therapies:
- Desensitisation therapy
- Graded motor imagery and mirror therapy
- Physiotherapy focusing on mobility
Medical management:
- Neuropathic pain medication (gabapentin, pregabalin)
- Vitamin C post-fracture (preventative effect)
Interventional pain procedures:
- Sympathetic nerve blocks
- Stellate ganglion block (upper limb CRPS)
- Lumbar sympathetic block (lower limb CRPS)
- Pulsed radiofrequency neuromodulation
- Spinal cord stimulation for severe cases
Psychological support:
CRPS commonly involves emotional strain and requires holistic management.
Living with Chronic Pain: Fibromyalgia vs CRPS
Both conditions require long-term self-management strategies, including:
- Pacing activities
- Maintaining movement
- Joining support groups
- Treating anxiety or depression
- Setting realistic expectations
- Consistent follow-up with pain specialists
The emotional burden can be significant, but with the right support, patients often regain quality of life.
When to See a Pain Specialist
Seek specialist care if you experience:
- Sudden, severe limb pain after an injury
- Swelling and temperature changes in one arm or leg
- Widespread pain lasting more than 3 months
- Pain that disrupts sleep or daily functioning
- Increasing sensitivity to touch
- Lack of improvement after physiotherapy or medication
Early diagnosis improves outcomes — especially with CRPS.
Final Thoughts
Fibromyalgia and CRPS both involve chronic pain, but they differ in cause, pattern, severity, and treatment needs. Understanding these differences is the first step toward getting the right diagnosis and care.
Whether your pain is widespread or focused on one limb, help is available. Modern pain clinics in South Africa offer evidence-based treatments that can dramatically improve quality of life.
If you’re unsure which condition you may have, a pain specialist can guide you through a personalised plan toward relief and recovery.
FAQs
-
How can I tell if I have fibromyalgia or CRPS?
Fibromyalgia causes widespread pain; CRPS affects one limb and includes swelling, temperature changes, and skin sensitivity. -
What triggers CRPS after surgery or injury?
A malfunction in the nervous and immune systems following trauma, even minor trauma. -
Is fibromyalgia considered a neurological disorder?
Yes — it involves central nervous system hypersensitivity and altered pain processing. -
Can CRPS go away on its own?
It sometimes improves, but early treatment offers the best chance for recovery. -
What are the treatment options for fibromyalgia in South Africa?
Exercise therapy, pain education, CBT, medications, rehabilitation, and multidisciplinary pain clinic support.