Fibromyalgia: Understanding the symptoms, causes, and management
What is Fibromyalgia?
Fibromyalgia is a chronic pain condition that frequently results in physical and mental fatigue, extensive discomfort, and sleep disturbances. Fibromyalgia patients may be increasingly sensitive to sensations of pain than non-fibromyalgia patients. The process of abnormal pain perception is what is meant by this. Symptoms might appear and disappear, and they frequently worsen over time. Many individuals with fibromyalgia have severe symptoms that have an impact on their everyday activities. The condition affects around 4 million adults in the United States, accounting for approximately 2% of the total population of adults.
Types of fibromyalgia pain
Fibromyalgia pain comes in two different major categories:
- The heightened reaction to stimuli that are typically painful, experienced as a result of having fibromyalgia, is known medically as hyperalgesia. A headache or someone treading on the foot of a patient might be unpleasant when suffering from this condition.
- It is the sensation of pain in response to otherwise painless stimuli. Pain might be caused by the rubbing of the bedsheets. An adjacent fan’s breeze may feel like it’s scorching the skin. This form of discomfort is more difficult to describe or escape.
Causes of fibromyalgia
It is unknown why some people get fibromyalgia. The precise explanation is unknown, although a combination of variables is most likely at work.
Unusual pain signals
- One of the leading explanations is that individuals with fibromyalgia experience modifications in the central nervous system’s processing of pain signals sent throughout the body. This could be due to changes in the neurological system’s molecules.
- Through a network of specialized cells, the central nervous system communicates with the rest of the body. Variations in the way this system functions may reveal why fibromyalgia causes chronic pain and heightened sensitivity to it.
- Genetics may play a minor role in the occurrence of fibromyalgia, with certain individuals being more predisposed to the disorder than others.
- The onset of fibromyalgia often occurs due to an event that creates bodily or mental (psychological) stress.
Potential triggers include
- A major injury, such as those sustained in a vehicle accident
- Epstein-Barr virus infection
- A serious surgery
- Substantial emotional stress, such as after serving in the military services during a war
- Lyme disease
- Chronic, broad pain that occurs across the body or at many locations.
- Having difficulty sleeping
- Aching, searing, or stinging are common descriptors for pain.
- Fatigue or a strong sense of being exhausted.
- Stiffness in joints and muscles.
- Arms and legs tingling or feeling numb
- Increased sensitivity to temperature, smells, brightness, and sound.
- Sensitivity to touch.
- Difficulties with focus, clarity of thought, and recall
- Constipation and other digestive disorders, such as bloating.
Physical examination based on symptoms
- In order to receive a diagnosis of fibromyalgia, the individual must have had symptoms for a minimum of three months and medical professionals must have eliminated all other possible causes for these symptoms.
- After the three-month period of experiencing symptoms and ruling out other possible causes, the diagnosis of fibromyalgia is determined based on two main factors ; the severity of symptoms and the presence of widespread pain experienced by the patient during the previous week.
- For pain to be classified as widespread, it must occur on both sides of the body and be present in the upper and lower parts of the body.
- To assess the widespread pain experienced by the patient, they are usually asked if they have pain in any of the 19 tender points.
- Each tender point where they feel pain is counted as one point, and the resulting score ranges from 0 to 19.
- To evaluate the severity of other fibromyalgia-related symptoms, such as fatigue, unrefreshing sleep, and cognitive problems, a Symptom Severity Score is used. Additional symptoms associated with fibromyalgia are also recorded, but not ranked by severity. The total score on this assessment can range from 0 to 12.
The diagnosis of fibromyalgia reaches a significant milestone when the scores on the assessments match either of the following criteria:
- A Widespread Pain Index score of 7 or higher, along with a Symptom Severity Score of 5 or higher.
- A Widespread Pain Index score of 3 to 6, combined with a Symptom Severity Score of 9 or higher.
No specific tests are available to identify fibromyalgia. Most laboratory tests do not work very well on their own to diagnose fibromyalgia.
- A blood test termed FM/a can identify markers made by immune system blood cells in fibromyalgia patients. Patients of any age who exhibit at least four of the common fibromyalgia symptoms may take it.
- To help rule out further diseases and ailments, a doctor may prescribe laboratory testing, such as a complete blood count, testing for the kidneys and liver, cholesterol, calcium levels, thyroid function, anti-CCP antibodies, ESR, and rheumatoid factor.
Who are at risk?
- Fibromyalgia is commonly diagnosed during middle age, and the likelihood of being diagnosed with this condition increases with age.
- The chances of developing fibromyalgia are higher if an individual has rheumatoid arthritis (RA).
- Individuals who have an infection, for instance, viral infection.
- Overweight individuals
- The likelihood of developing fibromyalgia is twice as high in women as compared to men.
- Fibromyalgia can occur in individuals who have a family history of this condition.
- Individuals who have experienced emotionally distressing or overwhelming events, such as the death of a loved one, physical or emotional abuse, or a serious accident.
- Individuals who have had repetitive injuries, which occur as a result of continuous and repeated stress or strain on a specific joint or body part.
What are the complications associated with fibromyalgia?
- Patients with fibromyalgia may experience a condition known as “fibro fog,” which includes cognitive problems and persistent memory issues that can impact their ability to concentrate.
- Additionally, individuals with fibromyalgia are more likely to be admitted to the hospital for any reason compared to the general population.
- In the absence of physical activity in this condition, individuals can experience deconditioning, which results in a swift decline in the strength of their muscles, bones, and cardiovascular system.
- This deconditioning, coupled with insufficient physical activity, can heighten the probability of obesity.
- Individuals who have fibromyalgia are roughly three times more inclined to experience major depression than those who do not have the condition.
- Individuals diagnosed with fibromyalgia may also experience metabolic syndrome, which is a group of coexisting medical conditions that raise the chances of developing type 2 diabetes, stroke, and cardiovascular disease.
- Historically, low doses of amitriptyline have been the preferred medication for addressing pain and sleep disruptions in individuals with fibromyalgia.
- Milnacipran works by impeding the reabsorption of serotonin and noradrenaline (norepinephrine).
- In individuals with fibromyalgia, the levels of glutamate and substance P, which are neurotransmitters that contribute to pain amplification, are elevated in the central nervous system.
- Pregabalin and gabapentin are drugs that target these neurotransmitters and may have pain-reducing, sleep-improving, and anxiety-reducing effects.
- There are no available clinical trial data indicating that paracetamol is effective when used on its own, and the evidence supporting the effectiveness of non-steroidal anti-inflammatory drugs is weak.
- Pure mu-opioid receptor agonists, including oxycodone, codeine, and fentanyl, should be avoided due to their inadequate clinical response and increased likelihood of opioid-induced hyperalgesia.
Diet in fibromyalgia
A discrepancy in the intake of essential dietary components, such as vitamins and minerals, may be a significant factor in the onset of fibromyalgia.
- Given that approximately 40% of individuals with fibromyalgia have been found to have a vitamin D deficiency, incorporating vitamin D supplementation into the management plan for fibromyalgia may be beneficial.
- Antioxidant vitamins, such as vitamin C and vitamin E, may be helpful in managing some common symptoms of fibromyalgia.
- These vitamins can aid in preserving various roles and activities performed by the cerebellum, the ability to acquire, store, and retrieve information in the brain, support muscle function, and have a positive effect on emotional well-being.
- Studies have suggested that with an increased dose of magnesium and a longer duration of treatment, there is a significant improvement in pain and tenderness associated with fibromyalgia.
- Magnesium supplementation may help alleviate fibromyalgia symptoms due to its ability to reduce inflammation, improve muscle function, and modulate pain perception.
- Recent studies have found that individuals with fibromyalgia may have an altered gut microbiota, which has led researchers to investigate the potential benefits of probiotics in the treatment of fibromyalgia.
Lifestyle modifications in fibromyalgia
To manage fibromyalgia, it is important to follow a healthy lifestyle that includes the following:
- Getting adequate sleep
- Engaging in regular physical activity at a manageable pace
- Managing stress levels
- Following a healthy diet
- Learning to balance activity and rest to prevent exacerbation of symptoms
- Developing an appropriate exercise plan with a physical therapist
- Attending cognitive behavioral therapy, a type of talk therapy that can be beneficial for individuals with fibromyalgia
Alternative therapies for fibromyalgia
There are alternative therapies that may be helpful in managing symptoms of fibromyalgia:
- Involves moving the body’s soft tissues in order to increase circulation, reduce stress, and encourage relaxation.
- Therapies, such as tai chi, yoga, and Pilates, can improve flexibility, balance, and muscle strength while also promoting relaxation and reducing stress.
- Involves using manual pressure to the joints and spine in order to reduce discomfort and enhance performance.
- Involves inserting tiny needles into particular bodily locations to activate the nerve system and improve healing.
Prevention of flare-ups
While there is no known way to prevent fibromyalgia since its cause is unknown, those with a diagnosis can take steps to prevent flare-ups of symptoms.
Emotional stress can trigger pain and tenderness in fibromyalgia patients, so it is important to learn stress management techniques through regular meetings with a mental health professional.
Other preventive measures include
- Eating a varied selection of nutrient-dense foods, such as fruits, vegetables, whole grains, lean protein sources, and healthy fats, as part of a balanced and healthy diet.
- Ensuring to get adequate sleep,
- Participating in low-impact physical activity on a regular basis,
- Performing deep breathing exercises, meditation, or yoga
- Engaging in hobbies that bring joy
- Allocating time to spend with people one cares about, and writing down thoughts in a journal.
Prognosis of fibromyalgia
- Symptoms may alleviate on certain occasions, but there are instances where the pain could intensify and persist for several months or even years.
- The prognosis is poor when considered overall limited access to resources, such as education, employment, healthcare, and housing, can lead to poor outcomes
- Additionally, lack of employment, being overweight, and having mental disorders can also have adverse effects on the prognosis.
- High levels of stress, chronic disease, and dependency on alcohol or drugs can also be the factors contributing to poor outcomes.