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Fibromyalgia

Fibromyalgias

Fibromyalgia is characterised by persistent widespread pain. Other symptoms include fatigue, sleep disturbance, stiffness, cognitive difficulties, multiple somatic symptoms, anxiety and depression.


Presentation

The main symptoms are pains presented in many parts of the body as well as tiredness [6]. Many people develop some of the symptoms covered below but the severity varies from person to person.

Other symptoms present in patients with fibromyalgia:

Fatigue
  • Capuron L, Welberg L, Heim C, et al: Cognitive dysfunction relates to subjective report of mental fatigue in patients with chronic fatigue syndrome. Neuropsychopharmacology 2006;31:1777-1784.[dx.doi.org]
  • Keywords Chronic Fatigue Syndrome Cognitive Dysfunction Chronic Pain Patient Mental Fatigue Chronic Fatigue Syndrome Patient These keywords were added by machine and not by the authors.[doi.org]
  • Gains in second rib, occiput, and supraspinatus pairs of the tender points predict improvements in the functional capacity, pain, and fatigue.[ncbi.nlm.nih.gov]
  • We proceeded with the study of the patients' history, a physical examination, an evaluation of chronic widespread pain using the Visual Numeric Scale and an evaluation of the fatigue using the Fatigue Severity Scale were also performed.[ncbi.nlm.nih.gov]
  • Pain, fatigue, sleep problem with Visual Analog Scales, health status with Fibromyalgia Impact Questionnaire (FIQ), and quality of life with Short Form-36 were evaluated.[ncbi.nlm.nih.gov]
Chronic Fatigue Syndrome
  • Komaroff AL: Clinical presentation of chronic fatigue syndrome. Ciba Found Symp 1993;173:43-54; discussion 54-61. Afari N, Buchwald D: Chronic fatigue syndrome: a review. Am J Psychiatry 2003;160:221-236.[dx.doi.org]
  • Keywords Chronic Fatigue Syndrome Cognitive Dysfunction Chronic Pain Patient Mental Fatigue Chronic Fatigue Syndrome Patient These keywords were added by machine and not by the authors.[doi.org]
  • Hypermobility & Fibromyalgia This site provides information and support for people with both joint hypermobility and fibromyalgia or chronic fatigue syndrome.[curlie.org]
  • Fibromyalgia may coexist and/or overlap with other conditions that may involve central sensitivity, including chronic fatigue syndrome, irritable bowel syndrome, irritable bladder syndrome or interstitial cystitis, and temporomandibular disorder.[ncbi.nlm.nih.gov]
  • ., irritable bowel syndrome, chronic fatigue syndrome, migraine). Screening questions based on published criteria can be used as a first approach in diagnosing functional illnesses.[ncbi.nlm.nih.gov]
Arm Pain
  • RESULTS: Reflexology affected the symptom of pain in multiple areas such as head, neck and arms. Pain started to isolate and decrease. CONCLUSION: Reflexology may be helpful to decrease fibromyalgia symptoms.[ncbi.nlm.nih.gov]
Painter
  • Painter and Leslie J. Crofford, Chronic Opioid Use in Fibromyalgia Syndrome, Journal of Clinical Rheumatology, 10.1097/RHU.0b013e3182863447, 19, 2, (72-77), (2013).[doi.org]
Non-Cardiac Chest Pain
  • Typically, the problems are related to the muscles and ligaments surrounding the jaw joint and not necessarily the joint itself. 23 Other Common Symptoms - Non-cardiac chest pain, acid reflux, irregular heart beat or palpitations, shortness of breath,[afsafund.org]
Jaundice
  • […] thinking or remembering; easy bruising; hives or welts; itching; rash; loss of hair; red, white, and blue skin color changes in fingers on exposure to cold or with emotional upset; sun sensitivity (unusual skin reaction, not sunburn); yellow skin or eyes (jaundice[jrheum.org]
Heart Rate Irregular
  • Rate Irregular: 3 people, 42.86% Face Oedema (swelling of face): 3 people, 42.86% Muscle Spasms (muscle contraction): 3 people, 42.86% * Approximation only.[ehealthme.com]
Back Pain
  • A literature search was performed through PubMed and Ovid using the terms fibromyalgia, temporomandibular joint disorder, irritable bowel syndrome, irritable bladder/interstitial cystitis, headache, chronic low back pain, chronic neck pain, functional[ncbi.nlm.nih.gov]
  • This phenomenon yields pain-relieving effect for rheumatoid arthritis, low back pain, sciatic neuralgia, fibromyalgia, etc.[ncbi.nlm.nih.gov]
  • Nearly 60 % (59.81%) patients had less than college education, 58.88% did not have a full-time job, and 41.12% had low-back pain. Out of 86 patients, 58 (67.4%) had anxiety and 75 (87.2%) had depression.[ncbi.nlm.nih.gov]
  • Tossing and turning has never been more comfortable despite your arthritis, back pain or hip pain. Simply lie down, roll over and slide back into your dream.[thesnoozle.com]
Myalgia
  • Abstract The eosinophilia-myalgia syndrome (EMS) caused by intake of contaminated L-tryptophan resembles in its clinical presentation the fibromyalgia syndrome (FMS).[ncbi.nlm.nih.gov]
  • Both the hypercortisolemia and hypothyroidism completely resolved after the patient underwent surgery to treat Cushing's disease, but she continued to experience unresolved myalgia and met the diagnostic criteria for fibromyalgia.[ncbi.nlm.nih.gov]
  • A therapeutic trial of baclofen did result in improvement of her subjective myalgias. We raise the possibility of an autoimmune contribution to myalgic symptoms in a portion of SLE patients.[ncbi.nlm.nih.gov]
  • […] compartment syndrome Congenital Myopathy with Neuropathy and Deafness Contracture Craniomandibular Disorders diaphragm disease Dimauro Disease Early-Onset Myopathy with Fatal Cardiomyopathy EHLERS-DANLOS SYNDROME, KYPHOSCOLIOTIC TYPE, 2 eosinophilia-myalgia[rgd.mcw.edu]
  • A common nonarticular rheumatic syndrome characterized by myalgia and multiple points of focal muscle tenderness to palpation (trigger points). Muscle pain is typically aggravated by inactivity or exposure to cold.[ncbi.nlm.nih.gov]
Neck Pain
  • A literature search was performed through PubMed and Ovid using the terms fibromyalgia, temporomandibular joint disorder, irritable bowel syndrome, irritable bladder/interstitial cystitis, headache, chronic low back pain, chronic neck pain, functional[ncbi.nlm.nih.gov]
  • The authors suggest a “strong trigemino-cervical relationship to neck pain and headache.” There’s that reference to neck (cervical) pain again![clearhealthchiropractic.com]
  • Through therapy, massage therapists can help their clients experience improved sleep, less neck pain, better balance, a decrease in the body’s sensitivity to pain, along with an increase in mobility and flexibility.[massagemag.com]
  • People often have pain between the shoulder blades and at the bottom of the neck. Pain may be either a general soreness or a gnawing ache, and stiffness is often worst in the morning.[drugs.com]
  • pain; weakness of muscles; tiredness (fatigue); depression; insomnia; nervousness (anxiety); seizures or convulsions; trouble thinking or remembering; easy bruising; hives or welts; itching; rash; loss of hair; red, white, and blue skin color changes[jrheum.org]
Shoulder Pain
  • CONCLUSIONS: Fibromyalgia occurs relatively frequently in patients who complain of shoulder pain and it can be a cause of failure in the treatment of concomitant painful shoulder conditions.[ncbi.nlm.nih.gov]
  • Aman Damir BPTh/BPT Physiotherapist - Specializes in Treatment of Fibromyalgia 168/8 Behind Allahabad Bank, Old Nehru Colony, Dehradun, Uttarakhand 248001 Old Nehru Colony , Dehradun Recently consulted for: Slip Disc, Shoulder Pain, Buttock Pain 4 patient[lybrate.com]
  • These spasms I believe cause the neck, back and shoulder pain associated with FMS. Further atrophy (wasting) of these muscles due most probably to reduced blood flow just compounds the painful problem.[clearhealthchiropractic.com]
  • Women tend to experience more widespread problems, while men more often develop localized fibromylagia symptoms, such as pain in the shoulder. Pain.[drweil.com]
Torticollis
  • Outcome measures included the Toronto Western Spasmodic Torticollis Rating Scale, or TWSTRS, and the frequency of AEs.[ncbi.nlm.nih.gov]
Sleep Disturbance
  • Antidepressant medications are associated with improvements in pain, depression, fatigue, sleep disturbances, and health-related quality of life in patients with FMS.[ncbi.nlm.nih.gov]
  • It has been suggested that sleep disturbances, which are common in fibromyalgia patients, may actually cause the condition.[web.archive.org]
  • Fibromyalgia is a common chronic syndrome defined by core symptoms of widespread pain, fatigue, and sleep disturbance. Other common symptoms include cognitive difficulty, headache, paresthesia, and morning stiffness.[ncbi.nlm.nih.gov]
  • It is a multisystem disease characterized by sleep disturbance, fatigue, headache, morning stiffness, paresthesias, and anxiety.[ncbi.nlm.nih.gov]
  • Fibromyalgia Syndrome (FMS) is a frequent idiopathic condition in which patients experience intense pain in specific tender points, profound fatigue and sleep disturbances.[ncbi.nlm.nih.gov]

Workup

The entire diagnostic process is dependent on finding tenderness in certain areas of the body. The increased sensitivity to mild or tender pressure may be seen in different parts of the body or all over the body [7]. These are sites marked as generally fairly sensitive areas and they are also the easiest to check for the tenderness that is common with individuals suffering from fibromyalgia.

Examinations will not show any other abnormalities apart from areas of tenderness and there are no laboratory tests for confirming this condition. On the other hand, tests may be conducted in some cases so as to rule out conditions that post similar symptoms. For instance, blood tests may be used to rule oit an underactive thyroid and early cases of early arthritis.

Treatment

There is no cure for fibromyalgia and treatments are often aimed at reducing symptoms as much as possible [8]. Over the years, lots of treatment types have been advocated with each one offering varying degrees of success.

Regular exercise is one form of treatment without any medications while painkillers and antidepressants form the basis of medication based treatments.

Prognosis

According to long term follow up studies, fibromyalgia is chronic. However, the symptoms may wax and wane. The impact of fibromyalgia on daily activities including ability to do all daily tasks varies greatly amongst patients [5]. The condition is generally as disabling as rheumatoid arthritis and there is no lid as to how long an individual will have to live with it. People with this condition face the risk of losing their jobs, possessions, etc.

Etiology

The main causes of fibromyalgia remain unknown but many hypotheses have been postulated [2]. Some of the suspected causes are as follows:

  • Contributory and predisposing factors (like sleep disturbance, depression and chronic illness)
  • Psychological distress and a somatic manifestation of depression
  • Tissue trauma such as surgery or physical injury (between 14-23% of patients develop the condition after trauma or surgery)
  • Immunologic abnormalities (55% of patients developed fibromyalgia after infections with HIV, Lyme disease and coxsackievirus)
  • Changes in peripheral nociceptors leading to an increased perception of pain
  • Changes in muscle tissue at the cellular level in addition to changes in blood flow

Epidemiology

The diagnosis of this condition is largely subjective and therefore incidence and numbers should only be interpreted in this context [3].

The condition is seen in 20-30 individuals per 1000. It is spread evenly amongst individuals aged 18-70 years. But it is mostly prevalent in people within the 30-50 years age bracket.
Fibromyalgia occurs mostly in females and the ration to males is 9:1.

Till date, there has not been any conclusive evidence on the impact of genetics in fibromyalgia. However, first degree relatives of fibromyalgia have been noted to show an increased incidence of depression.

Fibromyalgia is seen mostly in people within the middle and upper socioeconomic classes. However, this may be down to the fact that most individuals in the lower class will rather sit out symptoms consistent with fibromyalgia due to poor access to care and general poverty.

Sex distribution
Age distribution

Pathophysiology

Fibromyalgia is generally regarded as a disorder affecting the central pain processor and a syndrome affecting central sensitivity. Patients with this condition often have a diffuse problem of sensory volume control leaving them with a lower threshold for pain and relevant stimuli like noise, heat and strong odours [4].

Due to neurobiologic changes that affect the perception of pain or because of expectancy and hypervigilance, patients may have hypersensitivity. This may be related to certain psychological factors.

Even though the pathogenesis of fibromyalgia isn’t entirely understood, research has shown some immunoregulatory, biochemical and metabolic abnormalities. This has confirmed suspicions that fibromyalgia can no longer be regarded as a subjective pain condition.

Prevention

No proven methods of prevention but exercise reduces the chances of suffering from it [9] [10].

Summary

Fibromyalgia is a chronic musculoskeletal disorder. It is a condition with a pathophysiology that is poorly understood and there is very few pathognomonic findings concerning it [1].

Fibromyalgia is characterised by widespread pain with very distinct tender points and morning stiffness. There have not been any evidence of inflammatory causes and the condition is equally associated with sleep disorders, fatigue and depression.

Treatment for the condition is symptom-based, multidisciplinary and in many cases often unsatisfactory.

Patient Information

Fibromyalgia is a disorder that is known for the widespread pain in the skeleton and muscles that it causes. The pain is accompanied by fatigue and problems with memory, sleep and mood. 

In patients with Fibromyalgia the way the brain processes pain signals is affected amplifying any painful sensations. 

The symptoms of fibromyalgia kick in following surgery, infection, significant psychological stress and also physical trauma.  It also possible for the symptoms to  accumulate over a period of time without any known causes. 

Most people who have fibromyalgia also witness headaches, joint disorders, as well as depression and anxiety.

Presently, there is no total cure for fibromyalgia but a combination of relevant medications will help control the symptoms. Exercise, stress reduction activities as well as relaxation can also help.

References

Article

  1. López-Pousa S, Garre-Olmo J, de Gracia M, Ribot J, Calvó-Perxas L, Vilalta-Franch J. Development of a multidimensional measure of fibromyalgia symptomatology: The comprehensive rating scale for fibromyalgia symptomatology. J Psychosom Res. May 2013;74(5):384-92
  2. Yunus MB. Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes. Semin Arthritis Rheum. Jun 2007;36(6):339-56.
  3. Burgmer M, Pogatzki-Zahn E, Gaubitz M, et al. Altered brain activity during pain processing in fibromyalgia. Neuroimage. Jan 15 2009;44(2):502-8.
  4. Gracely RH, Petzke F, Wolf JM, Clauw DJ. Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis Rheum. May 2002;46(5):1333-43.
  5. Wolfe F, Cathey MA, Kleinheksel SM. Fibrositis (Fibromyalgia) in rheumatoid arthritis. J Rheumatol. Dec 1984;11(6):814-8. [Medline].
  6. Hassett AL, Gevirtz RN. Nonpharmacologic treatment for fibromyalgia: patient education, cognitive-behavioral therapy, relaxation techniques, and complementary and alternative medicine. Rheum Dis Clin North Am 2009; 35:393.
  7. Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA 2004; 292:2388.
  8. Carville SF, Arendt-Nielsen S, Bliddal H, et al. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis 2008; 67:536.
  9. Boomershine CS, Crofford LJ. A symptom-based approach to pharmacologic management of fibromyalgia. Nat Rev Rheumatol 2009; 5:191.
  10. Schmidt-Wilcke T, Clauw DJ. Fibromyalgia: from pathophysiology to therapy. Nat Rev Rheumatol 2011; 7:518.

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Last updated: 2017-08-09 17:21