In simple terms, it can be described as the volume of the neurons being set too high and this hyper-excitability of pain-processing pathways and under-activity of inhibitory pain pathways in the brain results in the affected individual experiencing pain. Some neurochemical abnormalities that occur in fibromyalgia also regulate mood, sleep, and energy, thus explaining why mood, sleep, and fatigue problems are commonly co-morbid with fibromyalgia.
A mode of inheritance is currently unknown, but it is most probably polygenic.
The Patient's Guide to Chronic Fatigue Syndrome & Fibromyalgia
Stress may be an important precipitating factor in the development of fibromyalgia. Some authors have proposed that, because exposure to stressful conditions can alter the function of the hypothalamic-pituitary-adrenal HPA axis , the development of fibromyalgia may stem from stress-induced disruption of the HPA axis. Poor sleep is a risk factor for fibromyalgia. There is strong evidence that major depression is associated with fibromyalgia as with other chronic pain conditions ,  although the direction of the causal relationship is unclear.
Accordingly, a study that employed functional magnetic resonance imaging to evaluate brain responses to experimental pain among people with fibromyalgia found that depressive symptoms were associated with the magnitude of clinically induced pain response specifically in areas of the brain that participate in affective pain processing, but not in areas involved in sensory processing which indicates that the amplification of the sensory dimension of pain in fibromyalgia occurs independently of mood or emotional processes. Non-celiac gluten sensitivity NCGS may be an underlying cause of fibromyalgia symptoms but further research is needed.
Abnormalities in the ascending and descending pathways involved in processing pain have been observed in fibromyalgia. There is also some data that suggests altered dopaminergic and noradrenergic signaling in fibromyalgia. Studies on the neuroendocrine system and HPA axis in fibromyalgia have been inconsistent. One study found fibromyalgia patients exhibited higher plasma cortisol , more extreme peaks and troughs, and higher rates of dexamethasone non suppression.
However, other studies have only found correlations between a higher cortisol awakening response and pain, and not any other abnormalities in cortisol. Autonomic nervous system abnormalities have been observed in fibromyalgia, including decreased vasoconstriction response, increased drop in blood pressure and worsening of symptoms in response to tilt table test , and decreased heart rate variability. Heart rate variabilities observed were different in males and females.
Disrupted sleep, insomnia , and poor-quality sleep occur frequently in FM, and may contribute to pain by decreased release of IGF-1 and human growth hormone , leading to decreased tissue repair. Restorative sleep was correlated with improvement in pain related symptoms.
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Neuroimaging studies have observed decreased levels of N -acetylaspartic acid NAA in the hippocampus of people with fibromyalgia, indicating decreased neuron functionality in this region. Altered connectivity and decreased grey matter of the default mode network ,  the insula , and executive attention network have been found in fibromyalgia. Increased levels of glutamate and glutamine have been observed in the amygdala, parts of the prefrontal cortex , the posterior cingulate cortex , and the insula, correlating with pain levels in FM.
Decreased GABA has been observed in the anterior insular in fibromyalgia. However, neuroimaging studies, in particular neurochemical imaging studies, are limited by methodology and interpretation. Overlaps have been drawn between chronic fatigue syndrome and fibromyalgia. One study found increased levels of pro-inflammatory cytokines in fibromyalgia, which may increase sensitivity to pain, and contribute to mood problems. There is no single test that can fully diagnose fibromyalgia and there is debate over what should be considered essential diagnostic criteria and whether an objective diagnosis is possible.
In most cases, people with fibromyalgia symptoms may also have laboratory test results that appear normal and many of their symptoms may mimic those of other rheumatic conditions such as arthritis or osteoporosis. The most widely accepted set of classification criteria for research purposes was elaborated in by the Multicenter Criteria Committee of the American College of Rheumatology. These criteria, which are known informally as "the ACR ", define fibromyalgia according to the presence of the following criteria:.
The ACR criteria for the classification of patients were originally established as inclusion criteria for research purposes and were not intended for clinical diagnosis but have now become the de facto diagnostic criteria in the clinical setting. The number of tender points that may be active at any one time may vary with time and circumstance. A controversial study was done by a legal team looking to prove their client's disability based primarily on tender points and their widespread presence in non-litigious communities prompted the lead author of the ACR criteria to question now the useful validity of tender points in diagnosis.
In , the American College of Rheumatology approved provisional revised diagnostic criteria for fibromyalgia that eliminated the criteria's reliance on tender point testing. The WPI counts up to 19 general body areas [a] in which the person has experienced pain in the preceding two weeks.
The SS rates the severity of the person's fatigue, unrefreshed waking, cognitive symptoms, and general somatic symptoms, [b] each on a scale from 0 to 3, for a composite score ranging from 0 to The revised criteria for diagnosis are:. Some research has suggested not to categorise fibromyalgia as a somatic disease or a mental disorder, but to use a multidimensional approach taking into consideration somatic symptoms, psychological factors, psychosocial stressors and subjective belief regarding fibromyalgia.
As many as two out of every three people who are told that they have fibromyalgia by a rheumatologist may have some other medical condition instead. The differential diagnosis is made during the evaluation on the basis of the person's medical history , physical examination, and laboratory investigations.
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As with many other medically unexplained syndromes , there is no universally accepted treatment or cure for fibromyalgia, and treatment typically consists of symptom management. Developments in the understanding of the pathophysiology of the disorder have led to improvements in treatment, which include prescription medication, behavioral intervention, and exercise. Indeed, integrated treatment plans that incorporate medication, patient education, aerobic exercise and cognitive behavioral therapy have been shown to be effective in alleviating pain and other fibromyalgia-related symptoms.
Antidepressants are "associated with improvements in pain, depression, fatigue, sleep disturbances, and health-related quality of life in people with FMS. A small number of people benefit significantly from the SNRIs duloxetine and milnacipran and the tricyclic antidepressants TCAs , such as amitriptyline. However, many people experience more adverse effects than benefits. It can take up to three months to derive benefit from the antidepressant amitriptyline and between three and six months to gain the maximal response from duloxetine, milnacipran, and pregabalin.
Some medications have the potential to cause withdrawal symptoms when stopping so gradual discontinuation may be warranted particularly for antidepressants and pregabalin. There is tentative evidence that the benefits and harms of selective serotonin reuptake inhibitors SSRIs appear to be similar. Tentative evidence suggests that monoamine oxidase inhibitors MAOIs such as pirlindole and moclobemide are moderately effective for reducing pain.
The anti-convulsant medications gabapentin and pregabalin may be used to reduce pain. The use of opioids is controversial. As of , no opioid is approved for use in this condition by the FDA. They strongly advise against using strong opioids. They discourage the use of strong opioids and only recommend using them while they continue to provide improved pain and functioning. Healthcare providers should monitor people on opioids for ongoing effectiveness, side effects and possible unwanted drug behaviors.
The European League Against Rheumatism in recommends tramadol and other weak opioids may be used for pain but not strong opioids. A large study of US people with fibromyalgia found that between and A review concluded that a period of nine months of growth hormone was required to reduce fibromyalgia symptoms and normalize IGF However, this medication was not approved by the FDA for the indication for use in people with fibromyalgia due to the concern for abuse. The muscle relaxants cyclobenzaprine , carisoprodol with acetaminophen and caffeine and tizanidine are sometimes used to treat fibromyalgia; however as of they are not approved for this use in the United States.
Dopamine agonists e. There is some evidence that 5HT 3 antagonists may be beneficial. Very low-quality evidence suggests quetiapine may be effective in fibromyalgia.
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No high-quality evidence exists that suggests synthetic THC nabilone helps with fibromyalgia. Intravenous Iloprost may be effective in reducing frequency and severity of attacks for people with fibromyalgia secondary to scleroderma. Due to the uncertainty about the pathogenesis of FM, current treatment approaches focus on management of symptoms to improve quality of life,  using integrated pharmacological and non-pharmacological approaches.
Non-pharmacological components include cognitive-behavioural therapy CBT , exercise and psychoeducation specifically, sleep hygiene. A systematic review of 14 studies reported that CBT improves self-efficacy or coping with pain and reduces the number of physician visits at post-treatment, but has no significant effect on pain, fatigue, sleep or health-related quality of life at post-treatment or follow-up.
Depressed mood was also improved but this could not be distinguished from some risks of bias. Mind-body therapies focus on interactions among the brain, mind, body and behaviour. The National Centre for Complementary and Alternative Medicine defines the treatments under holistic principle that mind-body are interconnected and through treatment there is improvement in psychological and physical well-being, and allow patient to have an active role in their treatment.
There is only weak evidence that psychological intervention is effective in the treatment of fibromyalgia and no good evidence for the benefit of other mind-body therapies. There is strong evidence indicating that exercise improves fitness and sleep and may reduce pain and fatigue in some people with fibromyalgia. A recommended approach to a graded exercise program begins with small, frequent exercise periods and builds up from there. These programs also employ counseling, art therapy, and music therapy.
Although in itself neither degenerative nor fatal, the chronic pain of fibromyalgia is pervasive and persistent.
Most people with fibromyalgia report that their symptoms do not improve over time. An evaluation of consecutive new people with fibromyalgia found that disease-related factors such as pain and psychological factors such as work status, helplessness, education, and coping ability had an independent and significant relationship to FM symptom severity and function. Chronic widespread pain had already been described in the literature in the 19th century but the term fibromyalgia was not used until when Dr P.
Hench used it to describe these symptoms. Historical perspectives on the development of the fibromyalgia concept note the "central importance" of a paper by Smythe and Moldofsky on fibrositis. In , an interconnection between fibromyalgia syndrome and other similar conditions was proposed,  and in , trials of the first proposed medications for fibromyalgia were published. A article in the Journal of the American Medical Association used the term "fibromyalgia syndrome" while saying it was a "controversial condition".
People with fibromyalgia generally have higher health-care costs and utilization rates. A study of almost 20, Humana members enrolled in Medicare Advantage and commercial plans compared costs and medical utilizations and found that people with fibromyalgia used twice as much pain-related medication as those without fibromyalgia. Furthermore, the use of medications and medical necessities increased markedly across many measures once diagnosis was made.
Fibromyalgia was defined relatively recently. It continues to be a disputed diagnosis. Frederick Wolfe, lead author of the paper that first defined the diagnostic guidelines for fibromyalgia, stated in that he believed it "clearly" not to be a disease but instead a physical response to depression and stress. Some members of the medical community do not consider fibromyalgia a disease because of a lack of abnormalities on physical examination and the absence of objective diagnostic tests.
Neurologists and pain specialists tend to view fibromyalgia as a pathology due to dysfunction of muscles and connective tissue as well as functional abnormalities in the central nervous system.
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Rheumatologists define the syndrome in the context of "central sensitization" — heightened brain response to normal stimuli in the absence of disorders of the muscles, joints, or connective tissues. On the other hand, psychiatrists often view fibromyalgia as a type of affective disorder , whereas specialists in psychosomatic medicine tend to view fibromyalgia as being a somatic symptom disorder. These controversies do not engage healthcare specialists alone; some patients object to fibromyalgia being described in purely somatic terms. There is extensive research evidence to support the view that the central symptom of fibromyalgia, namely pain, has a neurogenic origin, though this is consistent in both views.
The validity of fibromyalgia as a unique clinical entity is a matter of contention because "no discrete boundary separates syndromes such as FMS, chronic fatigue syndrome, irritable bowel syndrome, or chronic muscular headaches". Investigational medications include cannabinoids and the 5-HT3 receptor antagonist tropisetron.
From Wikipedia, the free encyclopedia. Chronic disorder of unknown cause characterized by pain, stiffness, and widespread tenderness in muscles.
Collins Dictionaries. Archived from the original on 4 October Retrieved 16 March American Academy of Neurology". October Retrieved 1 June Int J Rheum Dis. July Archived from the original on 15 March Retrieved 15 March Chapter F. The Cochrane Database of Systematic Reviews. Genetic aspects of fibromyalgia syndrome". American College of Rheumatology. May Archived from the original on 17 March Mayo Clinic Proceedings Review.
Handbook of Clinical Neurology. Dtsch Arztebl Int. Expert Review of Neurotherapeutics. Neurobiological foundations for EMDR practice. Mayo Clin Proc. Rheumatol Int. Journal of the American Osteopathic Association. Archived from the original on 4 January Retrieved 26 August Curr Pain Headache Rep. Psychosom Med. Retrieved 21 May Curr Rheumatol Rep. J Clin Rheumatol. Best Pract Res Clin Rheumatol. Front Biosci. Arthritis Rheum. Eur Psychiatry. Catherine 1 October He says the drug helps to curb most of his pain.
Exercise and stress-reduction have also helped to keep Mr. Collins active.
The Prevalence and Characteristics of Fibromyalgia in the National Health Interview Survey
Collins says one of the harder things for him is figuring out when certain body pains are symptoms of fibromyalgia or a byproduct of aging. Still, he is happy to be fully active once again. Christine Wysocki, a librarian, learned in that she had fibromyalgia. It was three years earlier, however, that she began to feel pain in her right elbow, hands and wrists. Wysocki says the fibromyalgia makes her feel achy all over, but it is worst in her hands, elbows and back.
While it would be ideal if she could sleep 12 hours every night, Ms. Wysocki knows that is not practical, so midday naps help her feel refreshed. She says she benefits most from weekly physical therapy massage, which is covered by her insurance. Wysocki said. Wysocki runs a custom adult hula hoop business out of her home, making about hula hoops a year by hand. Dividing the work into stages helps her complete her orders despite the pain in her hands and arms. Wysocki says she draws much support and comfort from her husband and two pets.
Amy McMullen believes she may have had symptoms of fibromyalgia as far back as 20 years ago.
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Several more years of feeling ill finally convinced her that he may have been right. Still, Ms. With much research, she discovered a link between fibromyalgia and hypothyroidism. And tests revealed that Ms. McMullen was suffering from low levels of thyroid hormone. For the past seven months, Ms. McMullen has been taking supplements for her thyroid hormones. She says she is beginning to feel an improvement in her symptoms, but is not percent better yet.
Aliza Hausman, a freelance writer and blogger, recalls having generalized pain starting at But for years, she was unable to find any answers for the cause of her severe pain. After visiting many doctors, some of whom dismissed her complaints, Ms. Hausman was finally told she had fibromyalgia. Simply putting a name to her symptoms was a relief at first.
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Hausman takes medication daily to lessen her pain. Still, some days are worse than others. She says yoga and stretching help, but she finds it difficult to exercise on a routine basis. Hausman says some of her worst pain is in her hands and jaw, making routine tasks like combing her hair and even chewing difficult. Hausman jokes that to ease her pain, she hopes to one day be able to afford a live-in acupuncturist, maid and hair stylist.
Please upgrade your browser. Site Navigation Site Mobile Navigation With its generalized symptoms of pain, fatigue and digestive issues, fibromyalgia can often hide as something else for many years. Erik S.