Definition
Fibromyalgia is a long-term condition which causes widespread, chronic pain and tenderness in muscles and soft tissue across the body (1).
Typical symptoms include:
Pain in arms, neck, head, chest, abdomen, back, buttocks and legs – described as a burning, aching or throbbing feeling
Tenderness to touch across the body
Fatigue due to difficulties sleeping and frequent awakening
Cognitive difficulties – impaired ability to concentrate on mental tasks and problems with memory (often dubbed ‘fibro fog’)
Muscle and joint stiffness particularly in the morning, or after long periods of sitting down
Headaches and migraines
Anxious or depressive feelings
Irritable Bowel Syndrome (IBS) such as bloating, diarrhoea and constipation
Tingling, burning or numbness sensation often felt in hands and feet
Flare ups – pain is constant but may feel better or worse at different times (1–3)
What causes fibromyalgia?
It is currently understood is that fibromyalgia is associated with how the brain processes pain.
These individuals have an imbalance of chemicals related to pain within the brain; chemicals associated with pain are too high, whilst other chemicals which help to reduce pain are too low (4). Consequentially, these individuals experience hypersensitivity to pain.
There is no single root cause of fibromyalgia, but it has been suggested that the following factors may play a role:
Genetics
o Family history of fibromyalgia
o Sex – women are more likely to have fibromyalgia (2)
Environmental factors
o Pain causing diseases like rheumatoid arthritis or lupus
o Mental health issues like anxiety or depression
o Exposure to a virus or illness
Receiving a diagnosis
Whilst it is not an uncommon condition, affecting 5% of the global population (2), it is frequently missed by physicians due to its huge overlap in symptoms with other diseases associated with inflammation, hormonal imbalances and digestive issues.
In fact, it was labelled a ‘disease of exclusion’ in an article published by the World Health Organisation (3), as there is no single test which can confirm the disease, relying purely on clinical evaluation.
One method currently used to determine if a patient has fibromyalgia is by counting the tenderness points. The figure below shows the 18 points of tenderness linked to fibromyalgia; counting 11 or more tenderness points would indicate the patient has fibromyalgia.
Current treatment
Since there is no cure for fibromyalgia, treatment options focus on pain management to ease symptoms and improve patient quality of life.
Antidepressants e.g amitriptyline (5)
Anti-inflammatory medication e.g ibuprofen
Physical therapy – a range of stretching, light aerobic exercise and muscle strengthening exercise (6)
Dietry e.g omega-3 supplements, lean meats, fruits, vegetables and whole grains
Avoiding flare up triggers e.g stress, overexertion, long travel days, poor sleep schedule*
Talking therapies e.g Cognitive Behaviour Therapy (CBT) to help manage mental health aspects of the condition
*There are many other factors that can trigger flare ups which vary between each person, and often these cannot be controlled, e.g hormonal changes, weather, illness and injury
Summary
Living with fibromyalgia can be very physically and emotionally challenging for patients. The difficulties diagnosing fibromyalgia as previously discussed can leave patients feeling deflated due to the long process of diagnosing the condition, combined with previous misdiagnosis by physicians.
Fibromyalgia remains poorly understood by scientists, however, recent research brings promising new treatment options to better manage this condition.
Bibliography
1. Sarzi-Puttini P, Giorgi V, Marotto D, Atzeni F. Fibromyalgia: an update on clinical characteristics, aetiopathogenesis and treatment. Nat Rev Rheumatol. 2020 Nov;16(11):645–60.
2. Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. 1995 Jan;38(1):19–28.
3. Hablas S, Darwish N, Gaber R. Fibromyalgia, a disease or a subclinical presentation? A different perspective. Kasr Al Ainy Medical Journal. 2019;25(3):99.
4. Siracusa R, Paola R Di, Cuzzocrea S, Impellizzeri D. Fibromyalgia: Pathogenesis, Mechanisms, Diagnosis and Treatment Options Update. Int J Mol Sci. 2021 Apr 9;22(8).
5. Tzadok R, Ablin JN. Current and Emerging Pharmacotherapy for Fibromyalgia. Pain Res Manag. 2020;2020:6541798.
6. Araújo FM, DeSantana JM. Physical therapy modalities for treating fibromyalgia. F1000Res. 2019;8.