Find comprehensive information on fibromyalgia, including symptoms, causes, diagnosis, and treatment options. Learn about how fibromyalgia affects females

Fibromyalgia

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Ismail Munir

Overview

Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, tenderness, fatigue, sleep disturbances, and cognitive issues. 
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The term &quot;fibromyalgia&quot; is derived from the Latin words &lsquo;fibro&rsquo; meaning fibrous tissues, &lsquo;my&rsquo; meaning muscles, and &lsquo;algia&rsquo; meaning pain<a href="#accordion">[1]</a>. Hence, it is a condition that affects the musculoskeletal system and can cause a range of symptoms such as sleep disturbances, cognitive difficulties, and mood disturbances. It most commonly affects young or middle-aged women. 
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Approximately 1 in every 25 individuals worldwide is affected by fibromyalgia<a href="#accordion">[1]</a>. It is the second most common rheumatological disorder<a href="#accordion">[2]</a>. 
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The prevalence of fibromyalgia varies across different populations and countries. In the United States, fibromyalgia affects approximately 3-5% of women and 0.5-1.6% of men<a href="#accordion">[2]</a>. These numbers are based on the 1990 American College of Rheumatology (ACR) classification criteria. However, it is believed the actual prevalence may be higher, especially in men. Internationally, the prevalence of fibromyalgia has been estimated to be 4.7% in Europe, with higher rates in women than men. In Canada, the prevalence is estimated to be 3.3%, and in Brazil, it is estimated to be 4.5%. However, these estimates may be affected by the criteria used to diagnose fibromyalgia, and more research is needed to better understand the true prevalence of the condition<a href="#accordion">[2]</a>. 
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Since the symptoms of fibromyalgia can often mimic those of other conditions, diagnosis is either delayed or misdiagnosed. Moreover, physicians may dismiss the patient&rsquo;s symptoms due to the absence of findings on imaging scans or laboratory tests. Therefore, getting treated for fibromyalgia can be challenging. 
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There are no specific subtypes of fibromyalgia. 
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Signs and Symptoms

Widespread, persistent pain is the most common symptom of fibromyalgia. It is often described as soreness, tenderness, stiffness, burning, or a deep muscular ache. The pain may be confined to certain areas in the body, such as the neck, shoulders, waist, lower back, or arms. 
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People with fibromyalgia have tender points, which are specific areas of the body that are more sensitive to touch in these patients. Even slight pressure can cause pain in these areas. They tend to be symmetrically located across the body and are present both above and below the waist. There are 18 tender points for fibromyalgia. These include:

<ul>
	<li>Front of the neck, above the collarbone.</li>
	<li>Back of the neck behind the ear.</li>
	<li>Base of the skull in the back</li>
	<li>Back of the shoulders</li>
	<li>Both forearms near the elbow.</li>
	<li>Edge of upper breasts.</li>
	<li>Behind the knees.</li>
	<li>Just above each buttock.</li>
	<li>Hip bone 
	&nbsp;</li>
</ul>

Other common symptoms of fibromyalgia include<a href="#accordion">[4]</a>:

<ol>
	<li>Fatigue: Many people with fibromyalgia experience a persistent feeling of tiredness, even after getting enough rest. 
	&nbsp;</li>
	<li>Sleep Disturbances: People with fibromyalgia often have trouble falling asleep, staying asleep, or getting restful sleep. This can lead to daytime sleepiness, irritability, and difficulty concentrating. 
	&nbsp;</li>
	<li>Headaches: Some people with fibromyalgia experience frequent headaches or migraines. 
	&nbsp;</li>
	<li>Cognitive Difficulties: Some people with fibromyalgia experience a phenomenon called &quot;fibro fog,&quot; which includes memory problems, difficulty concentrating, and trouble with problem-solving and decision-making. 
	&nbsp;</li>
	<li>Irritable Bowel Syndrome (IBS): Fibromyalgia can also cause digestive symptoms, including bloating, constipation, and diarrhea, which are similar to the symptoms of IBS. 
	&nbsp;</li>
	<li>Depression And Anxiety: Many people with fibromyalgia also experience depression and/or anxiety, which can be related to chronic pain and other symptoms of the condition. 
	&nbsp;</li>
	<li>Other Symptoms: Some people with fibromyalgia also experience dry eyes, skin rashes, itching, and pain or a dull ache in the lower abdomen. Bladder problems, such as interstitial cystitis, can also be associated with fibromyalgia.</li>
</ol>

Note: Not everyone with fibromyalgia experiences all of these symptoms, and the severity of symptoms can vary widely from person to person. 
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Causes

The cause of fibromyalgia is not fully understood, but research suggests it involves a combination of genetic predisposition and environmental triggers.&nbsp; 
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<h5>I. Genetic Factors</h5>

Fibromyalgia often runs in families, indicating that genetic factors may contribute to the development of the condition. Researchers have identified possible gene mutations that affect the transmission of chemical pain signals between nerve cells. 
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<h5>II. Environmental Triggers</h5>

A.Infections: Past infections like flu, pneumonia, Epstein-Barr virus, and gastrointestinal infections like those caused by Salmonella and Shigella, can trigger fibromyalgia or make its symptoms worse. 
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B.Trauma: People who have experienced severe physical or emotional trauma may develop fibromyalgia. The condition has been linked to <a href="https://merisehat.pk/disease/ptsd-post-traumatic-stress-disorder">PTSD (post-traumatic stress disorder).</a> 
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C.Stress: Stress has been linked to hormonal changes that can contribute to fibromyalgia. 
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<h5>III. Pain Processing Abnormalities</h5>

Experts do not fully understand why fibromyalgia causes chronic widespread pain, but theories suggest that the brain and nerves may misinterpret or overreact to normal pain signals. The condition may be due to a chemical imbalance in the brain or an abnormality in the dorsal root ganglion, which is a cluster of neurons in the spine. Another theory is that the brain lowers the pain threshold, and sensations that were not painful before become very painful over time. 
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Diagnosis

There are currently no screening tests for fibromyalgia.

Fibromyalgia is a complex condition that can be difficult to diagnose. The process involves ruling out other possible causes of the symptoms and evaluating the characteristic widespread pain and other associated symptoms. Here are the steps involved in diagnosing fibromyalgia: 
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Medical History And Physical Exam: The doctor will ask about the patient&rsquo;s symptoms, medical history, and any medications. They will also perform a physical exam to evaluate the tender points and check for other signs of fibromyalgia. 
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Rule Out Other Conditions: The doctor may order blood tests and imaging studies to rule out other conditions that can cause similar symptoms, such as <a href="https://merisehat.pk/disease/systemic-lupus-erythematosus">lupus</a>, <a href="https://merisehat.pk/disease/rheumatoid-arthritis">rheumatoid arthritis</a>, or<a href="https://merisehat.pk/disease/multiple-sclerosis"> multiple sclerosis</a>. 
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Evaluating Pain And Associated Symptoms: Fibromyalgia is characterized by widespread pain and other symptoms such as fatigue, sleep problems, and cognitive difficulties. The doctor will evaluate the severity and duration of these symptoms and check for other associated conditions, such as irritable bowel syndrome or chronic headaches. 
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Diagnostic Criteria: The American College of Rheumatology has established diagnostic criteria for fibromyalgia, which include widespread pain and tenderness in at least 11 out of 18 specified tender points. However, these criteria are not always used in clinical practice, and some doctors may make a diagnosis based on symptoms alone. 
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Referral To A Specialist: If the doctor suspects fibromyalgia but is unsure, they may refer the patient to a specialist such as a rheumatologist or a pain management specialist for further evaluation and treatment. 
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Treatment

Fibromyalgia symptoms can vary from person to person, and there is no specific treatment that works for everyone. However, the healthcare provider can work with the patient to create a treatment plan that best suits their needs. The following are some of the treatment options available for fibromyalgia: 
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<h5>Stages Of Treatment:</h5>

Fibromyalgia may be treated in stages based on the severity of the symptoms. These stages are not a strict treatment plan, but rather a way to understand the different treatments one may need to manage their symptoms. 
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Non-Pharmacological Treatments: A doctor or a physical therapist may suggest stretches and exercises to help loosen, relax, and strengthen the muscles and joints. 
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Psychological Treatments: A mental health professional can help identify ways to maintain a healthy self-image and suggest strategies to manage the emotional and mental symptoms of fibromyalgia. 
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Pharmacological Treatment: The doctor may recommend over-the-counter or prescription medications to help relieve pain. 
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Daily Functioning: If the symptoms make it difficult to carry out daily activities, an occupational therapist can help navigate a person&rsquo;s daily routine. 
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<h5>Medications For Fibromyalgia</h5>

Pain Relievers: Common over-the-counter pain relievers can be helpful, but opioid medications are not recommended due to side effects and the potential for dependence. 
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Antidepressants: Duloxetine, milnacipran, amitriptyline, and cyclobenzaprine may be prescribed to ease pain and promote sleep. 
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Anti-Seizure Drugs: Gabapentin and pregabalin can be useful in reducing fibromyalgia symptoms. 
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<h5>Alternative Treatments:</h5>

Acupuncture And Complementary Treatments:

Complementary treatments, such as acupuncture and massage, may help alleviate pain symptoms, but evidence of their effectiveness is typically anecdotal and lacks full scientific assessment. 
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Psychotherapy:

<ul>
	<li>Psychotherapy sessions may help those with fibromyalgia cope with pain symptoms.</li>
	<li>Behavior modification therapy is a form of CBT (Cognitive Behavioral Therapy) that aims to reduce stress- or pain-increasing behaviors and improve positive behaviors.</li>
	<li>CBT exercises can help reduce pain symptoms and aid the long-term management of fibromyalgia.</li>
	<li>Emotional awareness and expression therapies can also have a positive impact on pain symptoms in individuals with fibromyalgia.</li>
	<li>Some people may find that meditation can help alleviate stress and pain sensations. 
	&nbsp;</li>
</ul>

Diet:

<ul>
	<li>Certain dietary changes may help an individual with fibromyalgia live with and manage their condition.</li>
	<li>Eating high-energy foods that are low in sugar can help boost energy throughout the day.</li>
	<li>Removing foods that have gluten may help reduce fibromyalgia pain, even in people who do not have celiac disease.</li>
	<li>A diet low in FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) can have promising effects on pain levels in people with fibromyalgia.</li>
	<li>Avoiding additives and excitotoxins may also reduce symptoms of fibromyalgia. 
	&nbsp;</li>
</ul>
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Fibromyalgia can lead to pain, disability, and a decreased quality of life. Individuals with fibromyalgia may experience complications including<a href="#accordion">[6]</a>: 
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<ul>
	<li>More frequent hospitalizations (twice as likely as those without fibromyalgia)</li>
	<li>Lower quality of life (especially in women)</li>
	<li>Higher risk of major depression (more than 3 times the risk)</li>
	<li>Higher rates of death from suicide and injuries</li>
	<li>Higher rates of other rheumatic conditions (such as osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis) 
	&nbsp;</li>
</ul>

There are several risk factors for fibromyalgia, including

Gender: Women are more likely than men to develop fibromyalgia.

Age: Fibromyalgia can occur at any age, but it typically develops during middle age.

Family History: A family history of fibromyalgia increases the risk of developing the condition.

Other Rheumatic Diseases: People with rheumatoid arthritis, lupus, or other rheumatic diseases may be more likely to develop fibromyalgia.

Physical Or Emotional Trauma: Physical or emotional trauma, such as car accidents, infections, or emotional stress, may trigger the onset of fibromyalgia.

Repetitive Injuries: Repetitive injuries can lead to the development of fibromyalgia in some cases.

Sleep Disturbances: Sleep disorders, such as sleep apnea or restless leg syndrome, can increase the risk of fibromyalgia. 
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Some lifestyle modifications may help reduce the risk of developing chronic pain conditions, including fibromyalgia. These include:

<ul>
	<li>Maintaining a healthy weight</li>
	<li>Practicing good sleep habits</li>
	<li>Managing stress</li>
	<li>Quitting smoking and alcohol consumption</li>
	<li>Staying physically active through moderate exercise 
	&nbsp;</li>
</ul>

Additionally, early diagnosis and prompt treatment of conditions that can lead to chronic pain, such as infections, injuries, or autoimmune disorders, may help prevent the development of fibromyalgia. 
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Key Points

<ul>
	<li>Fibromyalgia is a chronic condition that causes widespread pain, fatigue, and other symptoms.</li>
	<li>The exact cause of fibromyalgia is unknown, but it is believed to involve a combination of genetic, environmental, and psychological factors.</li>
	<li>There is no cure for fibromyalgia, but treatment can help manage symptoms.</li>
	<li>Treatment options may include medication, exercise, physical therapy, and cognitive-behavioral therapy.</li>
	<li>Fibromyalgia can be difficult to diagnose, as there are no specific tests for it.</li>
	<li>Diagnosis is usually made based on a patient&#39;s symptoms and medical history.</li>
	<li>Fibromyalgia can coexist with other conditions such as depression, anxiety, and irritable bowel syndrome.</li>
	<li>Women are more likely to develop fibromyalgia than men.</li>
	<li>Fibromyalgia is not a progressive disease and does not cause joint damage or deformity. 
	&nbsp;</li>
</ul>
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[1]  Mandal DA. What is fibromyalgia? News. https://www.news-medical.net/health/What-is-Fibromyalgia.aspx#:~:text=Fibromyalgia%20is%20short%20for%20fibromyalgia,%E2%80%9Calgia%2C%E2%80%9D%20meaning%20pain. Published February 27, 2019. Accessed April 26, 2023.

[2] Chad S Boomershine MD. Fibromyalgia. Practice Essentials, Background, Pathophysiology.

[3] Borenstein D. Prevalence and treatment outcome of primary and secondary fibromyalgia in patients with spinal pain. Spine (Phila Pa 1976). 1995;20(7):796-800. doi:10.1097/00007632-199504000-00011