{"id":1492,"date":"2024-03-12T17:10:25","date_gmt":"2024-03-12T21:10:25","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/?post_type=chapter&p=1492"},"modified":"2025-10-17T19:31:06","modified_gmt":"2025-10-17T23:31:06","slug":"fibromyalgia","status":"web-only","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/chapter\/fibromyalgia\/","title":{"raw":"Fibromyalgia","rendered":"Fibromyalgia"},"content":{"raw":"

Fibromyalgia:<\/strong><\/h1>\r\nFibromyalgia is a neurosensory disorder that is characterized by chronic widespread pain and stiffness accompanied by fatigue, cognitive difficulties, headaches, and sometimes anxiety or depression.\u00a0 It's name was coined by Yunus et al (1981).\u00a0 The Greek word myo<\/em> meaning muscle, the Latin root fibro<\/em> referring to fibrous tissue and -algia is frequently used as a suffix in pathologies, coming from the Greek word algos<\/em> for pain.\r\n\r\nSome symptoms overlap with other central sensitivity syndromes such as chronic fatigue syndrome, irritable bowel syndrome (IBS), posttraumatic stress disorder (PTSD).\u00a0 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.\u00a0 Usually, the individual ends up going through the process of eliminating all other possible causes for the signs and symptoms observed first.\u00a0 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.\r\n

Risk Factors - Fibromyalgia<\/strong><\/h3>\r\nAlthough middle-aged females (aged 20-50) are most often diagnosed, any individual of any age group may be affected.\u00a0 Fibromyalgia is estimated to affect 3.5-6% of females and 0.5-3.5% of males within the general population of developed nations.\r\n\r\nIt is thought that fibromyalgia is multifactorial with both genetic and environmental factors contributing.\u00a0 Biological sex is a risk factor as is stress, and age with the highest prevalences of cases occurring between 60-79 years of age.\r\n

Pathogenesis - Fibromyalgia<\/strong><\/h3>\r\nIt 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.\u00a0 Fibromyalgia is described as a hypersensitivity disorder with mechanisms that are not fully understood.\r\n\r\nVarious 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.\u00a0 Substance P is known to induce a heightened sensitivity to pain.\u00a0 Low levels of serotonin are associated with sleep problems, headaches, pain and mood disorders.\r\n\r\nIt has also been noted that altered hormone levels may be a contributing factor.\u00a0 Low levels of cortisol and growth hormone (GH) have been observed in individuals with fibromyalgia.\u00a0 Cortisol has many roles including helping to regulate circadian rhythm and sleep cycles.\u00a0 GH is required for tissue repair and maintenance.\u00a0 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.\r\n

Signs and Symptoms - Fibromyalgia<\/strong><\/h3>\r\nProblems 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.\r\n\r\nCognitive impairment with fibromyalgia takes the form of poor short-term memory and feelings of brain fog.\r\n\r\nPain can become stronger as a result of stress, coldness, activity and are often termed \"flare-ups\".\r\n

Diagnosis - Fibromyalgia<\/strong><\/h3>\r\nOften, there are many tests done to rule out other conditions that have overlapping signs and symptoms.\u00a0 A physical examination to check for pain and tenderness in 18 tender-point sites is often performed.\u00a0 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.\r\n

Treatment - Fibromyalgia<\/strong><\/h3>\r\nOften includes both non-pharmacological and pharmacological strategies.\u00a0 Medications used are aimed at correcting imbalances that may be occurring in the levels of neurotransmitters.\u00a0 Medications may include NSAIDs or low doses of antidepressants (serotonin norepinephrine reuptake inhibitors, SSNRIs).\r\n\r\nAt home care recommendations include: avoiding triggers of flare-ups, sleep hygiene, healthy diet, daily physical activity including stretching, resistance and aerobic activity.\u00a0 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.\r\n\r\n \r\n

Fibromyalgia Summary<\/span><\/h1>\r\n
    \r\n \t
  • <\/li>\r\n<\/ul>\r\n
    \r\n

    Key Take Aways - Specific Learning Objectives Study Guide<\/strong><\/p>\r\n\r\n<\/header><\/header>\r\n

    \r\n
    \r\n

    Fibromyalgia:<\/strong><\/h2>\r\nA syndrome characterized by idiopathic chronic pain, numbness, tingling, stiffness, cognitive and memory problems; fatigue and sleep disturbances, anxiety, depression, possible irritable bowel syndrome and possible jaw pain;\u00a0 with no obvious inflammation or atrophy.\r\n
    \r\n\r\nRisk factors:<\/strong>\r\n
      \r\n \t
    • biological females; 20-50yrs;<\/li>\r\n \t
    • history of auto-immune disease (e.g. Rheumatoid Arthritis, Lupus, Ankylosing Spondylitis)<\/li>\r\n \t
    • physical\/psychological trauma, or chronic pain<\/li>\r\n<\/ul>\r\n
      Signs & Symptoms:<\/strong><\/div>\r\n
      \r\n
        \r\n \t
      • chronic pain in soft tissues<\/li>\r\n \t
      • characterized by widespread pain, fatigue, stiffness<\/li>\r\n<\/ul>\r\n<\/div>\r\n
        Pathogenesis:\u00a0 <\/strong>Causes unknown, hypothesized neurotransmitter imbalance.<\/span><\/div>\r\n
        <\/div>\r\n
        Diagnostic Tests:\u00a0\u00a0<\/strong>tender points examination, blood tests, elimination of other possible diseases\/disorders.<\/div>\r\n
        <\/div>\r\n
        Treatments:<\/strong><\/div>\r\n
          \r\n \t
        • \r\n
          Stress avoidance or reduction<\/div><\/li>\r\n \t
        • \r\n
          Regular exercise in the morning (when pain is often lower)<\/div><\/li>\r\n \t
        • Pace activity & rest as needed<\/li>\r\n \t
        • Applications of heat or massage<\/li>\r\n \t
        • Analgesic drugs, NSAIDs, new drugs<\/li>\r\n \t
        • Low doses of antidepressants (SSNRIs,\u00a0Serotonin Norepinephrine Reuptake Inhibitors)<\/li>\r\n \t
        • Massage therapy<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n ","rendered":"

          Fibromyalgia:<\/strong><\/h1>\n

          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.\u00a0 It’s name was coined by Yunus et al (1981).\u00a0 The Greek word myo<\/em> meaning muscle, the Latin root fibro<\/em> referring to fibrous tissue and -algia is frequently used as a suffix in pathologies, coming from the Greek word algos<\/em> for pain.<\/p>\n

          Some symptoms overlap with other central sensitivity syndromes such as chronic fatigue syndrome, irritable bowel syndrome (IBS), posttraumatic stress disorder (PTSD).\u00a0 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.\u00a0 Usually, the individual ends up going through the process of eliminating all other possible causes for the signs and symptoms observed first.\u00a0 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.<\/p>\n

          Risk Factors – Fibromyalgia<\/strong><\/h3>\n

          Although middle-aged females (aged 20-50) are most often diagnosed, any individual of any age group may be affected.\u00a0 Fibromyalgia is estimated to affect 3.5-6% of females and 0.5-3.5% of males within the general population of developed nations.<\/p>\n

          It is thought that fibromyalgia is multifactorial with both genetic and environmental factors contributing.\u00a0 Biological sex is a risk factor as is stress, and age with the highest prevalences of cases occurring between 60-79 years of age.<\/p>\n

          Pathogenesis – Fibromyalgia<\/strong><\/h3>\n

          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.\u00a0 Fibromyalgia is described as a hypersensitivity disorder with mechanisms that are not fully understood.<\/p>\n

          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.\u00a0 Substance P is known to induce a heightened sensitivity to pain.\u00a0 Low levels of serotonin are associated with sleep problems, headaches, pain and mood disorders.<\/p>\n

          It has also been noted that altered hormone levels may be a contributing factor.\u00a0 Low levels of cortisol and growth hormone (GH) have been observed in individuals with fibromyalgia.\u00a0 Cortisol has many roles including helping to regulate circadian rhythm and sleep cycles.\u00a0 GH is required for tissue repair and maintenance.\u00a0 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.<\/p>\n

          Signs and Symptoms – Fibromyalgia<\/strong><\/h3>\n

          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.<\/p>\n

          Cognitive impairment with fibromyalgia takes the form of poor short-term memory and feelings of brain fog.<\/p>\n

          Pain can become stronger as a result of stress, coldness, activity and are often termed “flare-ups”.<\/p>\n

          Diagnosis – Fibromyalgia<\/strong><\/h3>\n

          Often, there are many tests done to rule out other conditions that have overlapping signs and symptoms.\u00a0 A physical examination to check for pain and tenderness in 18 tender-point sites is often performed.\u00a0 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.<\/p>\n

          Treatment – Fibromyalgia<\/strong><\/h3>\n

          Often includes both non-pharmacological and pharmacological strategies.\u00a0 Medications used are aimed at correcting imbalances that may be occurring in the levels of neurotransmitters.\u00a0 Medications may include NSAIDs or low doses of antidepressants (serotonin norepinephrine reuptake inhibitors, SSNRIs).<\/p>\n

          At home care recommendations include: avoiding triggers of flare-ups, sleep hygiene, healthy diet, daily physical activity including stretching, resistance and aerobic activity.\u00a0 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.<\/p>\n

           <\/p>\n

          Fibromyalgia Summary<\/span><\/h1>\n
            \n
          • <\/li>\n<\/ul>\n
            \n
            <\/header>\n
            \n

            Key Take Aways – Specific Learning Objectives Study Guide<\/strong><\/p>\n<\/header>\n

            \n
            \n

            Fibromyalgia:<\/strong><\/h2>\n

            A syndrome characterized by idiopathic chronic pain, numbness, tingling, stiffness, cognitive and memory problems; fatigue and sleep disturbances, anxiety, depression, possible irritable bowel syndrome and possible jaw pain;\u00a0 with no obvious inflammation or atrophy.<\/p>\n

            \n

            Risk factors:<\/strong><\/p>\n

              \n
            • biological females; 20-50yrs;<\/li>\n
            • history of auto-immune disease (e.g. Rheumatoid Arthritis, Lupus, Ankylosing Spondylitis)<\/li>\n
            • physical\/psychological trauma, or chronic pain<\/li>\n<\/ul>\n
              Signs & Symptoms:<\/strong><\/div>\n
              \n
                \n
              • chronic pain in soft tissues<\/li>\n
              • characterized by widespread pain, fatigue, stiffness<\/li>\n<\/ul>\n<\/div>\n
                Pathogenesis:\u00a0 <\/strong>Causes unknown, hypothesized neurotransmitter imbalance.<\/span><\/div>\n
                <\/div>\n
                Diagnostic Tests:\u00a0\u00a0<\/strong>tender points examination, blood tests, elimination of other possible diseases\/disorders.<\/div>\n
                <\/div>\n
                Treatments:<\/strong><\/div>\n
                  \n
                • \n
                  Stress avoidance or reduction<\/div>\n<\/li>\n
                • \n
                  Regular exercise in the morning (when pain is often lower)<\/div>\n<\/li>\n
                • Pace activity & rest as needed<\/li>\n
                • Applications of heat or massage<\/li>\n
                • Analgesic drugs, NSAIDs, new drugs<\/li>\n
                • Low doses of antidepressants (SSNRIs,\u00a0Serotonin Norepinephrine Reuptake Inhibitors)<\/li>\n
                • Massage therapy<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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