All you need to know about Fibromyalgia

Last updated date: 06-Oct-2022

CloudHospital

17 mins read

Fibromyalgia

Fibromyalgia definition

Fibromyalgia is a condition that is set apart by musculoskeletal pain throughout the body, which is often accompanied by exhaustion, sleep, memory, and mood problems. Scientists consider that fibromyalgia is actually intensifying the feeling of pain, as it alters the brain and spinal cord's way of processing both painful and non-painful signals.

Fibromyalgia could occur after a significant event, which has led to a physical trauma: after a surgery or an infection, for example, or due to a psychological condition, even stress. Sometimes, the symptoms might increase in time slowly, without evidence of a provoking event.

Studies show that fibromyalgia is more common among women than men.

Those who suffer from fibromyalgia, also report having headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, or even anxiety and depression.

It is difficult to specify if fibromyalgia is a disability or not. There are suffering persons that have been able to demonstrate that their fibromyalgia condition is limiting their body abilities, while others have not managed to prove it. Therefore, fibromyalgia could be a disability, in some cases.

 

Is fibromyalgia an autoimmune disease? 

Even if fibromyalgia has symptoms and characteristics similar to autoimmune diseases, it is not classified as one of them.

 

Epidemiology

Fibromyalgia is more frequent in women than in males, with a frequency of 2 to 3 percent in the United States and other nations. It rises with age. Fibromyalgia is the most common cause of widespread, musculoskeletal pain in women between the ages of 20 and 55.

Many studies have revealed that the prevalence in teenagers is similar to that in adults. More than 40% of individuals sent to a tertiary care pain clinic satisfied the criteria for fibromyalgia. If you have a rheumatic condition, you are more likely to develop fibromyalgia. 

 

Fibromyalgia causes

It is not exactly known what causes fibromyalgia. Researchers have recently come up with a theory consisting of genetic predisposition accompanied by one or more triggers, such as trauma, infection or stress.

Fibromyalgia can be stimulated by past health problems, such as flu, pneumonia, or even gastrointestinal infections, such as Salmonella or Shigella bacteria, or the Epstein-Barr virus.

Fibromyalgia is considered to be related to serious physical or emotional trauma. Therefore, those who suffer from post-traumatic stress disorders are more likely to develop fibromyalgia.

Another cause of fibromyalgia is stress. Stress can leave deep scars on your body and mental health. It is also related to hormonal changes that might stimulate fibromyalgia.

Doctors do not totally comprehend what is the cause of the spreading pain, characteristic of fibromyalgia. One of the assumptions is that the brain is lowering the pain threshold, in order to protect us from severe pains. Therefore, some sensations that were unnoticeable before are intensified and become painful. Another assumption is that the nerves become considerably more sensitive, as they overreact to pain signals so low that they can cause unnecessary or exaggerated pain.

 

Is fibromyalgia hereditary? / Is fibromyalgia genetic?

It has been proven that fibromyalgia is genetic. In other terms, if your family has a history of fibromyalgia, or you have a relative who suffers from it, your chances to be affected by it as well are higher.

 

Pathophysiology

There appears to be a difficulty with pain processing in the brain in fibromyalgia. Patients frequently develop hypersensitivity to pain perception. Constant pain vigilance is also linked to a slew of psychological disorders. Fibromyalgia is characterized by the following abnormalities:

  • Elevated levels of excitatory neurotransmitters such as glutamate and substance P decreased levels of serotonin and norepinephrine in the spinal cord's descending anti-nociceptive pathways.
  • Pain feelings are heightened over an extended period of time.
  • Dopamine dysregulation
  • Changes in the activity of endogenous opioids in the brain.

Fibromyalgia is more common in women than men because of the following:

  1. Higher levels of anxiety
  2. Use of maladaptive coping methods
  3. Altered behavior in response to pain
  4. Higher levels of depression
  5. Altered input to the CNS and hormonal effects of the menstrual cycle

 

Fibromyalgia symptoms

Fibromyalgia is known to cause the well-known “regions of pain''. These areas of the body may also be referred to as “trigger points” or “tender points'', as they are considerably more sensible.

Fibromyalgia pain feels just as continuous tiresome soreness. Besides pain, symptoms of fibromyalgia are also represented by:

  • Fatigue;
  • Sleeping trouble or even sleeping for extended time periods without feeling your energy restored (nonrestorative sleep);
  • Headaches;
  • Depression;
  • Anxiety;
  • Limited concentration or inability to focus or pay attention;
  • Pain or a tiresome ache in the lower part of the belly;
  • Dry eyes;
  • Bladder problems, including interstitial cystitis.

Another symptom, which is characteristic of fibromyalgia, is fibromyalgia fog, which is also referred to as “fibro fog” or “brain fog”.  The term describes a fibromyalgia-specific fuzzy feeling. Fibromyalgia fog usually consists of memory gaps; inability to concentrate and problems in being on guard. The mental effects of fibromyalgia could be more bothersome than the actual specific body pain.

In the case of fibromyalgia, the brain and nerves of the affected person are not able to correctly read and respond to normal pain. The link between the brain and the nerves is considered to be affected by a non balanced mixture of chemicals in the brain or due to an irregularity in the dorsal root ganglion, which is a trusted source that affects the brain’s sensitization. Moreover, fibromyalgia could majorly impact emotions and energy levels.

 

Fibromyalgia symptoms in females

Studies show that fibromyalgia symptoms are more serious in women than in men. The pain spreads more throughout the body, more severe bloating and diarrhea, and the morning fatigue is more pronounced than in men. Also, the adjustment to menopause might stimulate fibromyalgia symptoms to be more serious.  Moreover, there are common symptoms that menopause and fibromyalgia share and they may confuse the affected person.

 

Fibromyalgia in men

Though fibromyalgia is considered to be more as a women's disorder, men could also be severely affected by it, as they could also develop painful symptoms and emotional problems. Fibromyalgia can also heavily affect the quality of life, including relationships and career.

The number of men affected by fibromyalgia is unknown, due to the fact that it is generally a women’s disorder. So, men who feel pain are steered by society’s expectation to endure their feelings and symptoms, as they are considered to be tougher. Some of the complaints that men have due to fibromyalgia could seem embarrassing and not being taken seriously. Therefore, men are not generally presenting their fibromyalgia symptoms to doctors.

Though fibromyalgia is considered to be more as a women's disorder, men could also be severely affected by it, as they could also develop painful symptoms and emotional problems. Fibromyalgia can also heavily affect the quality of life, including relationships and career.

 

Fibromyalgia rash 

Among those who suffer from fibromyalgia, some of them also develop a specific fibromyalgia rash.

The fibromyalgia rash is red, lifted, and irregular. In the affected area, the skin might become more sensitive and there could also occur an itching feeling that is not accompanied by pain. Additionally, the rash could also cause a crawling sensation. If your skin is generally dry, it could be a reason to develop a more serious rash that is accompanied by severe itching.

The rash is considered to be a symptom of fibromyalgia only if there are other specific symptoms noticed, such as pain all over the body, you feel exhausted or you have digestive problems. 

 

Fibromyalgia trigger points/ fibromyalgia tender points/fibromyalgia pain points

The trigger points that are specific to fibromyalgia are:

  • Back of the head;
  • Tops of the shoulders;
  • Upper chest;
  • Hips;
  • Knees;
  • Outer elbows.

 

Fibromyalgia pain

Pain is considered to be the signature symptom of fibromyalgia. If you are affected by fibromyalgia, pain could be felt in multiple muscles and in other soft tissues throughout the body. The pain can be a light ache to severe and very insupportable suffering.

As fibromyalgia is considered to be activated by an irregular nervous system response, the body is overreacting to stimuli that should not be usually painful. Fibromyalgia pain can be felt in one or even more points of the body.

  • Fibromyalgia chest pain could be very similar to the pain that occurs due to a heart attack and it can make it difficult to catch your breath. Fibromyalgia chest pain is located in the center of the cartilage that links the ribs to the breastbone, but it can also diffuse to the shoulders and arms. Fibromyalgia chest pain could be felt like sharp and stabbing or like a burning sensation.
  • Fibromyalgia back pain is the most common out of the fibromyalgia symptoms. Though, if you have pain in your back it is not necessarily due to fibromyalgia, as it could be as well another medical condition, like a pulled muscle or arthritis. In order to be certain that the back pain is due to fibromyalgia, you should also have other symptoms, like “fibro fog” and feeling exhausted. Also, it is very possible to develop a combination of arthritis and fibromyalgia, for example.

In case you experience back pain due to fibromyalgia, you should consider performing stretching and strengthening exercises with the purpose of supporting the muscles and the other soft tissues of the back.

  • Fibromyalgia leg pain is comparable to a muscular spasm or the stiffness of arthritis. Fibromyalgia leg pain can be deep, burning, and pulsing. It can also be perceived as numbness or tingling. Moreover, you may feel the urgent need to move your legs, as restless legs syndrome can interfere with fibromyalgia. Additionally, you can experience fatigue within the legs, while the limbs might seem heavy.

 

Fibromyalgia diagnosis

In the past, those that had symptoms of fibromyalgia would have been diagnosed with it, only if they had the pain spread to 11 out of the 18 specific trigger points that were located all over the body. The doctors were softly pressing on them, in order to establish the diagnosis.

According to the 2016 revised diagnostic criteria, if you felt pain in 4 out of the 5 defined areas, and there is no other medical condition that could cause the pain, the doctor will most likely consider it to be fibromyalgia.

Nowadays, the necessary number of trigger points for fibromyalgia has decreased. The diagnostic protocol has been changed from “chronic widespread pain'' into '' multisite pain”.

In order for fibromyalgia to be diagnosed, there are 3 main characteristics that the suffering person needs to have:

  • The pain is acute in 3 to 6 different areas of the body, or the pain is mild in are up to 7 points in different areas of the body;
  • The symptoms have been the same for at least 3 months;
  • There is no other medical condition to blame for the symptoms.

 

Fibromyalgia test

There is no test that can detect fibromyalgia. Doctors may take blood samples to test other possible medical conditions. 

 

Differential Diagnosis

Because of its numerous vague symptoms, fibromyalgia might be mistaken for many other diseases: 

The laboratory results, together with the history and physical examination, can help distinguish fibromyalgia from other possible diagnoses.

 

Fibromyalgia treatment

As fibromyalgia can highly affect both your physical and mental health, fibromyalgia medication might consist of both painkillers and antidepressants.

Painkillers can be found in pharmacies and they are available over the counter. Paracetamol, for example, is usually effective in improving fibromyalgia symptoms. Before using paracetamol, you should consult the patient information leaflet, in order to be sure that it does not affect another already started treatment or that you do not have allergies.

In case that common painkillers do not manage to improve symptoms, your doctor might prescribe you stronger painkillers, such as codeine or tramadol. It is important to know that these stronger painkillers should be used only when you truly need them, as they can become addictive. Moreover, if consumed often, their effects might gradually become weaker.

The side effects of these painkillers consist of fatigue and diarrhea.

Antidepressants are also used to decrease the pain in case of fibromyalgia. The role of antidepressants is to raise the levels of neurotransmitters. Neurotransmitters are chemicals that help the transmission process of signals to and from the brain.

It is considered that low levels of neurotransmitters might be a cause of fibromyalgia.  Moreover, it is thought that by increasing the levels of neurotransmitters, the widespread area of pain could be reduced.

Basically, there is a great variety of antidepressants. Choosing the right one is strongly based on the stage of the disease and how intense the symptoms are.

Normally, the antidepressants that are used to treat fibromyalgia are:

  • Tricyclic antidepressants, for example, amitriptyline;
  • Serotonin-noradrenaline reuptake inhibitors (SNRIs), such as duloxetine and venlafaxine;
  • Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and paroxetine.

Sometimes, we can also use pramipexole, which is actually dopamine that can influence the nervous system. It is also used among those suffering from restless leg syndrome.

The side effects that can occur during treatment with antidepressants are:

  • Feeling sick;
  • A dry mouth;
  • Drowsiness;
  • Feeling agitated, shaky, or anxious;
  • Dizziness;
  • Weight gain;
  • Constipation.

As fibromyalgia can stimulate sleep troubles or disorders, you should consider taking sleep medicine. The better the quality of sleep is, the less severe the symptoms of fibromyalgia might get. Discuss with your doctor about this aspect of the treatment. The doctor might prescribe you a short course of stronger medication. Also, there are available over-the-counter remedies for sleep. Moreover, there are some antidepressants that can also positively influence the quality of your sleep.

In case fibromyalgia causes muscle contractions, the fibromyalgia specialist will prescribe, most often, diazepam, which is a muscle relaxant. Diazepam could also improve sleep, as it can have the effect of a sedative.

Some fibromyalgia patients also need the prescription of antiepileptic drugs, such as pregabalin or gabapentin, which are used to treat epilepsy. Studies show that anti-epileptic medicines can also decrease pain among some of those who suffer from fibromyalgia.

The side effects of using anticonvulsants are:

  • You may feel dizzy;
  • Drowsiness;
  • Your feet and hands could swell (edema);
  • You can gain weight.

Neuroleptics or antipsychotic medicines could work sometimes to help ease long-term pain. At this moment, there are just a few studies on this possibility in treating fibromyalgia, therefore further studies are needed.

The use of antipsychotics could result in side effects, such as:

  • Drowsiness;
  • Tremors (shaking);
  • Restlessness.

 

Fibromyalgia and CBD

There are chemical compounds, non psychoactive, such as cannabidiol (CBD), which could positively influence the symptoms of fibromyalgia. Cannabidiol is considered to be able to activate serotonin receptors. Therefore, it would play a significant role in how the brain perceives pain, in the process of maintaining the body temperature or even in reducing inflammation.

Additionally, this is a very effective alternative for such a painful disease as fibromyalgia, and it also helps in easing symptoms of depression and it is able to prevent symptoms of psychosis.

 

Fibromyalgia diet

Fibromyalgia diet

In order to improve fibromyalgia symptoms, you should consider following specific diets.

An overall diet for fibromyalgia should be rich in antioxidants and vitamin B12. These are known to improve fibromyalgia symptoms. Therefore, the basic fibromyalgia diet should contain the following:

  • Fresh fruits and vegetables;
  • Whole grains;
  • Healthy fats;
  • Low-fat dairy;
  • Lean protein, such as chicken or fish.

It is also important to keep the intake of salt and sugar limited.

Also, fatigue is another important symptom of fibromyalgia. You could add to your diet foods that can raise your energy bar. In order to do so, the foods you consume need to be high in fiber and low in sugars. For example, eating sweets will only give you a short time of energy, which is followed by an immediate and complete loss of energy.  In order to gain more energy throughout the day, your diet should include:

  • Nuts and seeds, like almonds;
  • Broccoli;
  • Beans;
  • Tofu;
  • Oatmeal;
  • Dark leafy greens;
  • Avocado.

There are also studies that show that a raw vegan diet can also improve sleep and relieve other fibromyalgia symptoms, such as stiff joints, for example.

A 2001 study published in the British Medical Journal Complementary and Alternative Medicine (now BMC Complementary Medicine and Therapies) revealed that those who regularly consumed raw and vegetarian foods felt less pain.

More recent studies also show that those who suffer from fibromyalgia and keep a vegetarian diet for a couple of months feel improvements in pain, sleep quality, morning stiffness, or emotional health.

In order to keep fibromyalgia under control, it is important to eat foods that are not triggering the symptoms. It is recommended to keep a food diary, in order to find out which are the ones that trigger your symptoms. Normally, if you suffer from fibromyalgia, you should avoid:

  • Fermentable oligosaccharide, disaccharide, monosaccharide, and polyols (FODMAPs);
  • Foods that contain gluten;
  • Excitotoxins, which are a category of food additives that stimulate the taste receptors of the tongue.

The FODMAPs are carbohydrates that are fermented in the digestive tract by gut bacteria and they can stimulate fibromyalgia symptoms, in some cases.

The foods that contain high amounts of these carbohydrates are:

  • Dairy products;
  • Beans;
  • Bread;
  • Pasta;
  • Barley and rye;
  • Cruciferous vegetables such as broccoli, brussels sprouts, or cauliflower;
  • Fruits such as apples, peaches, and pears.

Another recent study revealed that the persons suffering from fibromyalgia and who had a low intake of FODMAPs also noticed an improvement in their life quality. Another effect is that they noticed weight loss.

Even if there is no cure for fibromyalgia, adapting to a new and healthier diet could significantly improve the symptoms. In case you suffer from fibromyalgia, there are numerous reasons for which considering starting to follow a healthy diet is a must. Gluten, FODMAPs, and excitotoxins free and rich in magnesium, calcium, and vitamins diet could improve not only the symptoms of fibromyalgia but also the overall life quality. The healthier you eat, the stronger you are, both physically and mentally.

 

Treatment for persistent symptoms

In patients who do not respond to monotherapy, it is advised to adopt a combination medication therapy:

  • Encouraging patients to participate in a supervised physical exercise program if they are having trouble achieving an adequate amount of low-impact aerobic activity. 
  • In some cases, a referral to a physiatrist and/or a physical therapist might be beneficial. 
  • Water-based workouts and yoga have also been proven to be beneficial.
  • Psychosocial measures such as cognitive behavioral therapy might be effective. 
  • Specialty consultations with rheumatologists, physiatrists are indicated.
  • Treatment should be interdisciplinary and personalized, with a focus on the patient's symptoms.

Analgesics and anti-inflammatory medicines, as well as complementary and alternative treatments such as tai chi, yoga, and acupuncture, have insufficient evidence. Neuromodulation treatments such as transcranial stimulation, occipital and C2 nerve stimulation, and transcutaneous electrical nerve stimulation have been demonstrated to be beneficial in some studies.

 

Fibromyalgia vs Lupus

Though both fibromyalgia and lupus share similar symptoms they are totally different medical conditions. It is possible, actually, to live with both conditions.

In comparison with fibromyalgia, which is a disorder that generates widespread musculoskeletal pain, lupus is an autoimmune disease that stimulates the body to affect itself, by creating antibodies that attack and confuse healthy cells with harmful bacteria.

Moreover, some of the specific symptoms of lupus could also occur in the case of fibromyalgia. Common lupus symptoms are:

  • Joint pain;
  • Swelling;
  • Fatigue;
  • A butterfly-shaped rash on your face;
  • Skin lesions;
  • Body rashes;
  • Chest pain;
  • Headaches;
  • Shortness of breath.

The symptoms of fibromyalgia are:

  • Joint pain;
  • Chest pain;
  • Long-lasting dull aches;
  • Fatigue;
  • Anxiety;
  • Sleep disorder.

Furthermore, lupus and fibromyalgia are also differently treated. For fibromyalgia, treatments include pain killers, antidepressants or anti-epileptic medications. Also, there are physical and occupational therapies to improve muscle flexibility and counseling to improve mental health. For lupus, treatments include pain killers, antimalarial drugs, steroids, which reduce inflammation, and immunosuppressants that reduce the activity of the antibodies.

Though fibromyalgia and lupus have common traits, they are completely different diseases.

 

Prognosis

Most long-term research has found that the majority of patients continue to have chronic pain and exhaustion, however, the bulk of these studies have come from tertiary referral facilities. Patients treated by primary care physicians in the community, on the other hand, have a far better prognosis. Many demographic and behavioral variables have a substantial influence on the prognosis and outcome of fibromyalgia patients. The female gender, low socioeconomic level, unemployment, obesity, depression, and a history of abuse all had a negative impact on the result.

Many patients have a bad prognosis. Factors linked with a bad prognosis include:

  • An illness that lasts a long time
  • High levels of stress
  • Depression or anxiety that has not been appropriately addressed
  • Work has long been avoided.
  • Dependence on alcohol or drugs
  • Functional disability ranging from moderate to severe

 

Complications

Some fibromyalgia patients have developmental fog, also known as fibro fog, which involves cognitive impairments and long-term memory problems that impair their ability to focus. In addition, fibromyalgia sufferers are more prone than the general population to be hospitalized for any cause.

 

Consultations

In patients who are not responding satisfactorily to early therapy, specialty consultations such as those with rheumatologists, physiatrists, and psychiatrists are advised. Treatment should be interdisciplinary and tailored to the patient's specific symptoms.

 

Conclusion 

Fibromyalgia (FM) is a persistent and known musculoskeletal pain disorder. It is considered a pain control disease and is often classified as a kind of central sensitization syndrome.

Fibromyalgia is frequently accompanied by fatigue, cognitive dysfunction, mental symptoms, and various somatic symptoms. Fibromyalgia has an unclear origin as well as an unknown pathophysiology.

 Before medications are prescribed to fibromyalgia sufferers, it is essential that they understand their condition. Here are the most important aspects of patient education:

Stress and mood disturbances play a role, and people with fibromyalgia should be encouraged to learn relaxation techniques as well as participate in structured stress reduction programs since they have a high incidence of depression and anxiety disorders.

An interprofessional team dedicated to pain management, which should include the primary care physician, physician assistant, pain specialist, internist, mental health nurse, and nurse practitioner, is the best way to manage the disease.

Treatment includes painkillers along with antidepressants and sleep regulators. However, managing stress, improving sleep, eating well, exercising, and joining support groups are must-have parts of treatment.

Specialized consultations, such as those with rheumatologists, physiatrists and psychiatrists, are often appointed for people who do not respond well to early treatment.

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