Fibromyalgia (FM) is a disorder characterised by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain and spinal cord process painful and nonpainful signals.
Symptoms often begin after an event, such as physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.
Women are more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression.
While there is no cure for fibromyalgia, a variety of medications can help control symptoms. Exercise, relaxation and stress-reduction measures also may help.
Further to the above:
As mentioned above the causes of FM remain unclear and may differ from patient to patient. Research suggests involvement of the nervous system, particularly the central nervous system (brain and spinal cord). Fibromyalgia may run in families, and although there is likely a genetic component to the illness, genes alone do not cause FM. There likely are certain genes that can make people more prone to getting fibromyalgia and other comorbid conditions associated with it.
There are often ‘triggering factors’ which sets off FM. Injury, spinal conditions, physical stress, underlying rheumatic conditions, etc. The result is a change in the way the body “talks” with the spinal cord and brain. Levels of brain chemicals and proteins may change. More recently, fibromyalgia has been described as Central Pain Amplification disorder, meaning the volume of pain sensation in the brain is turned up too high.
[Sources: Bateman Horne Center & American College of Rheumatology]
Symptoms include a lower pain threshold —although not necessarily a lower pain tolerance— and an amplified pain response that causes not only musculoskeletal pain, but may also contribute to headaches, tingling, chest and bowel or bladder pain. Fatigue, sleep dysregulation, and cognitive impairment/brain fog- termed “Fibro Fog” are also reported.
Common manifestations of sensory amplification disorders (FM):
- Muscle and joint pain and tenderness
- Migraine and tension headaches, TMJ/TMD
- Paresthesia (numbness and tingling)
- Restless legs syndrome
- Irritable bowel syndrome, IBS-D, IBS-C
- Irritable bladder, interstitial cystitis, painful menstruation, pelvic pain, vulvodynia
- Sensory (light, noise, olfactory, chemical, etc) sensitivities
- Sicca syndrome (dry eyes and mouth)
- Heart palpitations, sinus tachycardia, low HRV
- Research shows nonspecific changes in autonomic nervous system function, dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, and elevation of Substance P, glutamate and other pain neurotransmitters in the cerebrospinal fluid.
Functional MRI scans demonstrate more areas of pain processing in the brain for a given stimulus compared to normal people.
Sleep studies show profound alterations of brain waves during the stages of sleep.
Symptoms can become chronic and very difficult to treat, even after the “stress” is relieved and mood symptoms are well compensated. Poor coping skills or maladaptive behaviors, often related to lack of disease recognition and education, may compound FM symptoms and worsen prognosis.
An adult meets criteria for being diagnosed with Fibromyalgia when all of the following criteria are met:
- Generalised pain, defined as pain in at least 4 of 5 regions, is present.
- Symptoms have been present at a similar level for at least 3 months.
- Widespread pain index (WPI) ≥ 7 and symptom severity scale (SSS) score ≥ 5 OR WPI of 4–6 and SSS score ≥ 9.
- A diagnosis of fibromyalgia is valid irrespective of other diagnoses. A diagnosis of fibromyalgia does not exclude the presence of other clinically important illnesses.
- FIQR (Fibromyalgia Impact Questionnaire-Revised) FIQR http://bhc18.wpengine.com/wp-content/uploads/2020/07/FIQR-FORM.pdf
- FM 2016 Diagnostic Criteria [PDF] https://bhc18.wpengine.com/wp-content/uploads/2020/05/2016FMS.pdf
- Pain Diagrams
- Visual Analog Scales (VAS)
- MFI (Multidimensional Fatigue Inventory) http://bhc18.wpengine.com/wp-content/uploads/2020/05/Multidimensional-Fatigue-Inventory-MFI.pdf
- RAND 36- Item Health Survey Sub-Scale Scores (SF-36)