Fibromyalgia is a chronic condition primarily associated with widespread pain, stiffness and tenderness of the muscles and soft tissues around joints. The pain of fibromyalgia is not accompanied by inflammation in the affected tissues, and therefore does not lead to joint deformity or other tissue damage.
In this regard fibromyalgia differs from many other rheumatic conditions (diseases that affect the muscles, joints or associated tissues). Fibromyalgia may occur in isolation, but many people with the condition also have other musculoskeletal disorders such as rheumatoid arthritis.
The cause of fibromyalgia is unknown, but medical experts generally agree that a number of different factors contribute to its development and ongoing symptoms. These factors may include the following:
Disturbed sleep patterns may be a cause rather than only a symptom of fibromyalgia. Studies have shown that people with fibromyalgia have abnormally low levels of the hormone somatomedin C, believed to be essential in rebuilding tissues. Somatomedin C is secreted during the deep restorative stage of sleep, which is often disturbed in fibromyalgia. There is a reduction in stage 4 sleep, with relative reduction in dream phase sleep. People wake up feeling unrested.
Abnormal production and regulation of pain-related chemicals in the nervous system
Studies indicate that people with fibromyalgia have abnormal levels of the neurotransmitter serotonin (associated with depression, migraines and gastrointestinal problems) and substance P (associated with pain, stress, anxiety and depression) in their central nervous system (brain and spinal cord). These abnormalities may result in a lower pain threshold, or a heightened perception of pain.
Injury or trauma
Injury to the upper spinal region appears to trigger the development of fibromyalgia in some people. Many people with fibromyalgia report that they began experiencing symptoms after a traumatic event, such as a car accident or fall.
Fibromyalgia may be triggered by a viral or bacterial infection, although no such agent has yet been identified.
Hormonal, metabolic and immunological abnormalities
Tenderness in certain areas may be associated with changes in muscle metabolism, such as decreased blood flow, causing fatigue and weakness.
Stressful life events may trigger fibromyalgia, or worsen its symptoms. Clinical depression and anxiety precede or accompany fibromyalgia in many cases, and may also contribute to its development. However, fibromyalgia is not simply stress and depression alone. It is a real problem.
There appears to be a significant increase of likelihood in families.
Who’s at risk?
Fibromyalgia is common, affecting an estimated six to eight million people worldwide. Risk factors for fibromyalgia include:
- Gender and age. Fibromyalgia occurs more commonly in women of childbearing or middle age, although any age and both sexes can be affected. The condition is estimated to occur about seven times more frequently in women than in men: approximately 80 percent of people affected are female. 20 percent are males.
- Family history. You may be more likely to develop fibromyalgia if a relative has the condition.
- Disturbed sleep patterns. It is unclear whether sleep disturbances are a cause or result of fibromyalgia, but people with certain sleep disorders can also develop fibromyalgia.
- Other conditions. Other chronic musculoskeletal disorders, such as rheumatoid arthritis, may increase the risk for developing fibromyalgia.
The severity of fibromyalgia signs and symptoms vary, and occur in different combinations in different individuals, but commonly include the following:
- Widespread musculoskeletal pain
- Tender points on the back of the head, neck, upper and lower back, shoulders, upper chest, elbows, hips and knees
- Fatigue and sleep disturbance
- Waking feeling tired and unrefreshed, sometimes with muscle aches
- Trouble falling asleep, or waking repeatedly at night
- Sleep apnoea and restless legs syndrome
- Constipation, diarrhoea, and abdominal pain and bloating
- Chronic headaches, jaw and facial pain
- Heightened sensitivity (such as odours, noises, bright lights, certain foods and weather changes Numbness, tingling or a swollen sensation in the hands and feet
- Chest or pelvic pain
- Irritable bladder and frequent painful urination
- Dry eyes and mouth
- Mental and/or emotional disturbances
- Poor concentration, forgetfulness, mood changes, irritability, depression and anxiety
There are no tests to help determine the presence of fibromyalgia, and diagnosis must be based on a complete medical history and physical examination.
Diagnosis depends on the doctor making the following findings:
- Presence of widespread pain, experienced for at least three months.
- Presence of tender points, not accompanied by tissue swelling or inflammation. At least 11 or more of 18 specific locations of the body must be tender. (Patients with fewer than 11 points may still be diagnosed with fibromyalgia if other symptoms and signs are present.)
- Exclusion of other medical conditions that may have similar symptoms.
Medical conditions that also cause pain in different areas of the body, or chronic fatigue, include:
- Hypothyroidism (low thyroid hormone level)
- Muscle diseases causing muscle pain
- Bone diseases causing bone pain
- Elevated blood calcium
- Certain infectious diseases (such as hepatitis, HIV/AIDS)
- Certain cancers
- Muscle inflammation
- Bursitis (inflammation of the protective tissue between the joints)
- Tendonitis (inflammation of the tendons)
- Neuropathies (diseases of the nerves, such as multiple sclerosis)
- Myasthenia gravis (muscular weakness and fatigue)
- Drug abuse
- Hypoadrenalism (adrenal insufficiency, which leads to weakness and fatigue)
- Parkinson’s disease
Blood tests may be important to exclude these medical conditions.
Fibromyalgia may also occur in association with other systemic rheumatic conditions. To complicate matters, fibromyalgia may be associated with (Raynauds phenomenon, where the peripheries (fingers, toes) change colour with cold temperature, and with a mild elevation of antinuclear factor antibodies, which can occur in autoimmune rheumatic diseases. Therefore the diagnosis is a clinical one, and not one where the laboratory is of much help.
There are also instances in which fibromyalgia develops in the context of metabolic or infectious diseases such as such as hypothyroidism, drug withdrawal, or bacterial and viral infection. Fibromyalgia has many features that overlap with chronic fatigue syndrome. The relationship between these two syndromes is not well established.
There is no known cure for fibromyalgia. However, the condition can be managed successfully in many cases by using a combination of medication, exercise, physical therapy, relaxation techniques and, if necessary, psychological counseling.
As the symptoms of fibromyalgia are diverse and variable, the treatment programme should be tailored to the individual and based on several factors, including overall health, medical history, and number of tender points, severity of pain and the presence of other symptoms. Treatment typically includes the following:
Aerobic exercise for at least 30 minutes three times a week improves muscle fitness and significantly reduces muscle pain and tenderness, and also promotes deep restful sleep. Low-impact aerobic exercises, such as walking, cycling, swimming and water aerobics are good activities to choose when starting your exercise programme. Muscle building exercises are not shown to be beneficial.
Coping with stress
Identifying stress factors and learning ways to cope with or modify these where possible may help improve fibromyalgia symptoms. Relaxation techniques can be used to relieve muscle tension and reduce stress.
Professionals trained in stress management can teach you these techniques, which might include modifying your lifestyle to reduce stress factors, biofeedback (learning to have greater control over aspects of the involuntary nervous system), relaxation tapes and psychological counseling. Anxiety and depression are often major contributors to stress and, if present, must be treated concurrently with fibromyalgia.
A physiotherapist can advise you as to other treatments that may help to ease fibromyalgia pain – such as heat treatments, occasional cold application, massage, and stretching and range-of-motion exercises.
Avoiding alcohol and caffeine before bedtime can help promote restful sleep.
Fibromyalgia is a chronic condition, but it is not progressive or life-threatening, nor is it associated with muscle, nerve or joint injury, or any serious tissue damage or disease. People with fibromyalgia are not at greater risk for other musculoskeletal diseases.
Although fibromyalgia symptoms will probably never disappear completely, they often improve with treatment. Medications that can alter the balance of pain-producing chemicals, such as anti-depressants, improve symptoms by about 30 percent.
When other forms of therapy and aerobic exercise are added, even greater improvement can be expected. Sometimes, if the situation that caused the initial stress is improved, fibromyalgia may improve spontaneously and medications may be unnecessary. A minority of people with fibromyalgia (about five percent) become chronically disabled by the condition.
When to call the doctor
Consult your doctor if you experience general aching or widespread pain that persists for several months. It is important to find a doctor who has a sound knowledge of fibromyalgia; feels empathy for chronic pain sufferers is willing to try different treatment combinations and, if necessary, will refer you for specialist evaluation.
Although most fibromyalgia cases can be successfully handled by a GP, about 30 percent are referred to a rheumatologist (a specialist dealing with muscle and joint conditions). It is important to educate families about the condition.
Most patients are accused of neurosis or of being hypochondriacs. In fact people need to understand that the pain is real and that the condition is not simply stress or depression. Patients, however, need to be focused on being positive and to try and maintain an active lifestyle and not to simply lie back and give in to the disease.
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