Understanding Fibromyalgia: Symptoms, Causes & Treatment Explained

what is fibromyalgia

Pain bearing threshold varies in every individual; some endure higher magnitudes while some are susceptible to slight pain.

Whatever be the endurance, pain is always described as a feeling of discomfort.

Fibromyalgia is a condition characterized by widespread pain and tenderness in the body. This article covers the basic understanding of fibromyalgia to educate patient and their close ones.

This disorder was first described in the 19th century as ‘fibrositis’ by Gowers. Further, in the 1970s, the term ‘fibromyalgia’ was developed.

It is characterised by chronic pain at tender points, joint stiffness along with other symptoms like mood disorders, sleep disturbances, fatigue, etc.

It is considered as a disease of rheumatic origin but also presents with neurological and psychiatric symptoms.

The prevalence rate is 6-15% in the US, and it is 5-7 times more prevalent in women than men.

What Are The Symptoms Of Fibromyalgia?

Widespread chronic pain is the major symptom of this syndrome. The major areas where the pain is felt include neck, shoulders, hips, and thighs; but it may spread to hands and feet.

Normal activities may elicit a painful sensation such as a gentle hug. Joint swelling may be reported as a complaint but at times may not be visible on examination.

Chronic pain can cause fatigue. Patients may have poor sleep patterns, difficulty falling asleep and may be exhausted on waking up. Morning stiffness is common.

Neurological symptoms like numbness, photophobia, tingling sensation, weakness, the poor balance may also occur.

Fibro-fog is a term used to describe cognitive disturbances in fibromyalgia. It involves poor short term memory, confusion, lack of ability to concentrate, disorganized thinking, etc.. Raynaud’s syndrome, dry eyes and mouth may also occur in fibromyalgia.

Other conditions that may be comorbid with fibromyalgia include depression, irritable bowel syndrome, migraine, chronic fatigue syndrome temporomandibular disorder, hypothyroidism, autoimmune diseases like rheumatoid arthritis, lupus, etc.

What Causes Fibromyalgia?

Quite a bit of research has been directed to understanding the condition, but definite causative factors have not been identified yet.

A couple of trigger factors that may be responsible for the development of fibromyalgia include:

  • Infections: Viruses such as HCV, HIV, Coxsackie B, Parvovirus as well as bacteria like Borrelia may be involved in inducing fatigue and pain.
  • Physical trauma: Accidents or injuries may trigger chronic pain. A study involving 67 patients reported that 60.7% developed symptoms of fibromyalgia after a motor accident. Other physical trauma included post surgery, sports injury, work injury, etc.
  • Vaccination: Review studies link both infection and vaccination with the development of the syndrome.
  • Environmental factors: Exposure to environmental toxins and chemicals may activate the nervous system and increase sensitivity to pain.
  • Psychosocial factors: Psychological stress and distressing life events can trigger chronic pain. A study demonstrated that reading a sad text or discussing a stressful event increased pain sensitivity in fibromyalgia patients.

Apart from these trigger factors, disturbances occurring in multiple systems may contribute to disease progression, and these are listed below:

1.Central Nervous System Dysfunction is observed in Fibromyalgia

Various signals by the central nervous system contribute to our pain perception, and experimental studies show that development of these signals could be altered in fibromyalgia patients.

After experiencing the pain of certain intensity, further exposure to similar pain is found to be more painful in normal individuals.

But this sensation is heightened in fibromyalgia; after sensations are longer and more painful for them.

Also, pain inhibitory pathways are found to be impaired in the patients.

Immune cells in the nervous system are also stimulated which release inflammatory agents and contribute to over-excitation of the spinal cord; thus increasing pain sensitivity.

The balance of various neurotransmitters such as serotonin, norepinephrine, substance P is also found to be disturbed.

2.Hormonal abnormalities may contribute to disease development

Hypothalamus-pituitary-adrenal axis is a delicate feedback mechanism between major glands secreting various hormones, one of them being stress hormone, cortisol.

Cortisol levels are high especially in the evening in fibromyalgia patients. Growth hormones levels are reduced during sleep.

3.Neuroinflammation may worsen pain

Mast cells are a type of white blood cells, and one of their functions is to contribute to neuroimmunity.

Research shows that these cells may be involved in disease progression and may contribute to pain and inflammation.

These cells secrete inflammatory agents, and various studies have observed the presence of such inflammatory agents in the cerebrospinal fluid of the patients.

4.Oxidative stress is more pronounced in fibromyalgia patients

Oxidative stress is an imbalance between pro-oxidant and antioxidant agents in the body.

Research studies have identified that oxidative stress is higher in fibromyalgia patients compared to normal counterparts.

5.Sleep disturbances worsen pain

The fourth phase of sleep is disturbed in fibromyalgia, and this leads to reduced production of hormones such as growth hormone which are crucial for muscle repair.

Reduced muscle repair leads to reduced muscle strength and increased pain sensitivity.

6.Genetic factors contribute to disease development

The main genes that are impaired in fibromyalgia are those associated with neurotransmitter production such as serotonin transporter gene, catechol-o-methyltransferase, dopamine D4 receptor gene, etc.

7.Mental health is impaired due to chronic pain and fatigue

The prevalence of psychiatric conditions is higher in patients with fibromyalgia compared to other rheumatic diseases.

Depression is more prevalent in fibromyalgia rather than other musculoskeletal diseases and also worsens its symptoms.

What Is The Treatment For Fibromyalgia?

The treatment goals for fibromyalgia include reduction of pain, improved sleep, reduction of symptoms and improving physical activity.

The treatment approach  includes various aspects as mentioned below:

Medications

Analgesics and NSAIDs may be prescribed but are not effective in controlling pain. Antidepressants are used in fibromyalgia treatment due to their action on serotonin.

These include tricyclic antidepressants and SSRIs which help to improve the symptoms moderately.

Other medications used include dopamine agonist, growth hormone therapy, anticonvulsant, etc.

Exercise

Aerobic exercise and muscle strength training can improve sleep, pain, and function in fibromyalgia.

Choosing exercises that one likes, starting with low-intensity exercise and using effective coping skills can help improve the effectiveness of exercise therapy.

Cognitive Behavioural Therapy

Cognitive Behavioural Therapy is found to be better than other psychological treatments for reducing pain and improving sleep in fibromyalgia.

It can help with better stress management and reduce feelings of depression, frustration, and anger in patients.

Other psychological treatments include relaxation training, biofeedback and group therapy.

rTMS

Repetitive Transcranial Magnetic Stimulation is a non-invasive procedure that stimulates brain via electromagnetic impulses.

Ten daily sessions of rTMS are found to reduce pain and improve health in fibromyalgia.

Pain relieving effect of rTMS is found to last for six months and also acts on other symptoms such as fatigue, stiffness, etc.

Alternative Treatment

Tai-chi is found to be beneficial in fibromyalgia treatment; stretching exercises in tai-chi improve symptoms, sleep, and functional mobility.

Aquatic exercises under the guidance of physiotherapist and in a heated pool are recommended. Balneotherapy or spa therapy helps in alleviating pain.

The effect of Chinese medications, Chinese herbal tea, hypnotherapy, massage, trigger point injections, yoga and acupuncture in fibromyalgia is being researched upon.

Ginseng, dietary supplements like coenzyme Q10, curcumin, acetyl L-carnitine, flavonoids, etc. are beneficial .

Conclusion

Fibromyalgia syndrome is a complex disorder involving multiple system dysfunctions.

Fatigue and pain are the prominent symptoms , but a multidisciplinary approach of treatment is required such that it tackles various factors to reduce pain.

Various data records indicate the involvement of Central Nervous System in the disease, and this makes it imperative to involve strategies that improve brain health in fibromyalgia.

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