89 Fibromyalgia

Fibromyalgia

Fibromyalgia is a neurosensory disorder that is characterized by chronic widespread pain and stiffness accompanied by fatigue, cognitive difficulties, headaches, and sometimes anxiety or depression.  It’s name was coined by Yunus et al (1981).  The Greek word myo meaning muscle, the Latin root fibro referring to fibrous tissue and -algia is frequently used as a suffix in pathologies, coming from the Greek word algos for pain.

Some symptoms overlap with other central sensitivity syndromes such as chronic fatigue syndrome, irritable bowel syndrome (IBS), posttraumatic stress disorder (PTSD).  Due to the difficulty in pinpointing a diagnosis, the average patient often is referred to many specialists over the course of months to years before achieving a diagnosis.  Usually, the individual ends up going through the process of eliminating all other possible causes for the signs and symptoms observed first.  To make things more complex, often comorbidities may be found including hypothyroidism, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Ankylosing Spondylitis, and other immune disorders.

Risk Factors – Fibromyalgia

Although middle-aged females (aged 20-50) are most often diagnosed, any individual of any age group may be affected.  Fibromyalgia is estimated to affect 3.5-6% of females and 0.5-3.5% of males within the general population of developed nations.

It is thought that fibromyalgia is multifactorial with both genetic and environmental factors contributing.  Biological sex is a risk factor as is stress, and age with the highest prevalences of cases occurring between 60-79 years of age.

Pathogenesis – Fibromyalgia

It is thought that fibromyalgia occurs as a result of central pain processing dysfunction, with individuals experiencing a lowered threshold of pain and of other stimuli including heat noise, strong odours.  Fibromyalgia is described as a hypersensitivity disorder with mechanisms that are not fully understood.

Various abnormalities in pain processing pathways have been found including: an excess of neurotransmitters (e.g., substance P and glutamate) in some areas of the central nervous system (CNS), and a low level of other neurotransmitters (e.g., serotonin and norepinephrine) in the CNS.  Substance P is known to induce a heightened sensitivity to pain.  Low levels of serotonin are associated with sleep problems, headaches, pain and mood disorders.

It has also been noted that altered hormone levels may be a contributing factor.  Low levels of cortisol and growth hormone (GH) have been observed in individuals with fibromyalgia.  Cortisol has many roles including helping to regulate circadian rhythm and sleep cycles.  GH is required for tissue repair and maintenance.  Additionally high levels of nerve growth factor (NGF) are observed which is known to increase Substance P production and heighten one’s sensitivity to pain.

Signs and Symptoms – Fibromyalgia

Problems with sleep, chronic pain, stiffness, and negative emotions (e.g. depression, anxiety, sadness, anger, lack of motivation), flulike symptoms (e.g., body aches) and cognitive impairment are common.

Cognitive impairment with fibromyalgia takes the form of poor short-term memory and feelings of brain fog.

Pain can become stronger as a result of stress, coldness, activity and are often termed “flare-ups”.

Diagnosis – Fibromyalgia

Often, there are many tests done to rule out other conditions that have overlapping signs and symptoms.  A physical examination to check for pain and tenderness in 18 tender-point sites is often performed.  Blood tests to check signs of rheumatoid arthritis and SLE (RF and ANA levels) as well as to check blood cell counts, electrolyte and hormone levels, and any abnormalities including signs of anemia.

Treatment – Fibromyalgia

Often includes both non-pharmacological and pharmacological strategies.  Medications used are aimed at correcting imbalances that may be occurring in the levels of neurotransmitters.  Medications may include NSAIDs or low doses of antidepressants (serotonin norepinephrine reuptake inhibitors, SSNRIs).

At home care recommendations include: avoiding triggers of flare-ups, sleep hygiene, healthy diet, daily physical activity including stretching, resistance and aerobic activity.  Participation in support groups and counselling involving developing methods to cope with stress (stress management) is often helpful. Massage therapy and applications of heat are useful in reducing pain.

Summary

• • Chronic pain disorder in soft tissues.
  • Characterized by widespread pain, fatigue, stiffness.
  • Causes unknown, hypothesized neurotransmitter imbalance.
  • Diagnosis: tender points examination, blood tests.
  • Treatment: stress management, exercise, analgesics, antidepressants.