What is fibromyalgia?
Fibromyalgia (FMS) is a common musculoskeletal condition that affects muscles, joints, tendons, ligaments and other soft tissues of the body. People who suffer from fibromyalgia often report changes or alterations in the sleeping pattern, muscle aches, joint issues and similar ailments.
Research and statistical data published in the peer reviewed journal Arthritis & Rheumatism (1) indicates that the overall prevalence of fibromyalgia is 2% and it is much more common in females as compared to males. It has been observed that lifestyle modification and certain changes in the nutrition can minimize the dosage and dependence on medications.
What Are The Classic Symptoms Of Fibromyalgia?
Although the severity, frequency and onset of symptoms vary significantly in different individuals, it has been observed that fibromyalgia present with these classic symptoms:
It is indeed the most commonly reported symptom that is observed in over 97% patients. The muscle or joint pain of fibromyalgia can be differentiated from other infectious and inflammatory conditions by:
- Pain involving widespread areas of the body instead of involving just one joint or tissue
- The character of pain is highly variable during the course of management (throbbing, constricting, sharp, dull or aching)
- Tender spots
Fibromyalgia patients also complain of tender spots in certain areas of the body that are highly painful and very sensitive to touch and pressure.
Major depression is reported in 25% of all fibromyalgia patients. At such, treatment that involve psychotherapy and anti-depressants may be required.
Fatigue is another characteristic symptom that is reported in the earlier course of disease process and worsens as the condition advances. The feeling of tiredness or fatigue is not associated with any physical activity or exertion. Individuals report fatigue in these situations:
- Upon waking up in the morning
- Mild activities that does not otherwise cause exertion like ironing clothes, grocery shopping
- Alteration in the normal physical activity or exercise due to fatigue
- Patients report aggravation of the feeling of fatigue with exercise or even sexual intercourse
- Morning stiffness
About 75% of all fibromyalgia patients report significant morning stiffness that makes it impossible for these individuals to resume morning activities soon after waking up. The stiffness is different from the morning stiffness reported in rheumatoid arthritis in these respects:
- Noticeable stiffness that lasts for at least 20 to 25 minutes and resolves spontaneously (as opposed to stiffness lasting for 2 to 3 minutes in RA)
- Generalized stiffness that involvers back muscles, limb and spinal muscles, neck and arms
- Sleep problems
Almost 60 to 68% people with fibromyalgia report moderate to severe sleep problems that include difficulty in maintaining sleep and achieving a deep sleep. Most people are light sleepers and the EKG findings suggest spikes of high brain activity at intervals throughout the sleep. The sleep EKG findings are pretty similar to the EKG findings of an awake person. The poor quality and depth of sleep also contributes to the excessive fatigue.
Almost 50% of all the fibromyalgia patients also report feeling of tingling, paresthesia and numbness in different parts of the body (especially hands, arms, legs and feet).
- Other minor classic symptoms are as follow:
- Headaches are reported in at least 70 to 74% of all the patients who experience recurrent and periodic migraine, vascular or tension type headaches.
- Irritable bowel syndrome is experienced by 40 to 70% of all the patients, marked by nausea, vomiting, diarrhea alternating with constipation, acid reflux disease and other similar ailments.
- Urinary incontinence (due to increased frequency and heightened urge) is reported in 25% patients.
- Restless leg syndrome affects the quality and depth of sleep and adds to the fatigue.
- Painful menstrual cramps are experienced by almost 40 to 55% female fibromyalgia patients that may require treatment.
- Memory impairments and concentration issues affect day to day life and may contribute to pre-mature signs of aging.
What Are The Causes Of Fibromyalgia?
The actual cause of fibromyalgia is not yet known despite a lot of scientific research and extensive medical studies performed by investigators. So far, researchers believe that fibromyalgia has multi-factorial origin and following factors contribute to the pathogenesis.
- Genetical factors
Genetical factors contribute to the pathogenesis of disease process since the condition run in families. Genetic mutation of certain genes increase the risk of developing fibromyalgia.
- Prior infections or traumatic events
Certain traumatic or infectious events also contribute to the fibromyalgia. According to the research conducted by DA Gordon (4), post-traumatic stress disorder is often implicated in the pathogenesis of fibromyalgia.
- Neuro-humoral irregularities
Alterations or aberrations in the secretion of certain hormones or growth factors can also contribute to the pathogenesis of fibromyalgia. Robert M. Bennett (5) conducted a study on 70 fibromyalgia patients and 55 normal control subjects to assess the role of neuro-humoral irregularities in the pathogenesis of this condition. He concluded that the serum levels of somatomedin C are significantly lower in fibromyalgia patients (that also explains alterations in the normal sleeping pattern and muscle pain observed in fibromyalgia patients). This is because somatomedin C (obtained from metabolism of Growth Hormone) is responsible for maintainence of muscle metabolic and anabolic functions.
- Lowered pain threshold
A relatively new theory suggest that the pain and aching discomfort of joints and muscles is due to lowered pain threshold due to inherent or acquired changes in the secretion of some neurotransmitters, pain mediators or pain signaling. These changes are most often mediated by primary neuro-endocrine glands like pituitary, adrenal and hypothalamus (7).
How Can You Diagnose Fibromyalgia?
The diagnosis of fibromyalgia is mainly clinical due to non-specific sign and symptoms. According to the classification criteria devised by American College of Rheumatology (ACR), the diagnosis of fibromyalgia is made on the basis of:
- If the patient has at least 11 tender spots (from 18 possible locations).
- History of moderate to severe pain lasting more than 3 months.
- Blood investigations can also be performed to rule out other connective tissue disorders or neurological conditions that mimic fibromyalgia in presentation.
What Are Some Conventional Treatments Of Fibromyalgia?
Management and treatment of fibromyalgia are both pharmacological and alternative. Conventional options include medications to suppress symptoms like:
- Pain-killers: Non-steroidal anti- inflammatory drugs are consumed to alleviate pain symptoms. In most cases the relief is satisfactory. In non-resolving cases, other treatment options can be sought.
- Anti-depressants: Anti- depressants are also advised to patients who develop signs of major depression, anxiety or other neurological issues. Goldenberg (8) suggests Tricyclic anti-depressants like fluoxetine and amitriptyline are superior to other anti-depressants.
- Anti-seizure drug: Seizure activity can be controlled or prevented with drugs like Gabapentin.
What Are Some Alternative Treatments Of Fibromyalgia?
It has been observed that lifestyle modification can also improve the symptoms of fibromyalgia. Following are a few recommendations to help the patient in such cases.
- Dietary modification
Research conducted by K. Kaartinen and K. Lammi (6) indicated that low fat, uncooked total vegan-diet can alleviate the symptoms of fibromyalgia (that can be tracked by improvements in the serum cholesterol levels, lowered urinary sodium levels and significant improvements in the quality of sleep, joint stiffness and pain). Avoid excessive caffeine intake.
- Lifestyle changes
Changes in the lifestyle can reduce the intensity and frequency of fibromyalgia episodes. For example:
- Maintain a stress-free lifestyle to alleviate stress and anxiety. Perform regular physical activity and meditate regularly to reduce stress.
- Modify your sleeping habits to get rid of stress and fatigue symptoms.
- You may require occupational therapy and modification to reduce the degree and intensity of physical activity.
- Acupuncture therapy
Acupuncture therapy is helpful in alleviating the symptoms of fibromyalgia (it is an ancient Chinese technique that involves introduction of fine needles at certain pressure points of the body to promote the free flow of energy). Research has proved that acupuncture changes the concentration and secretion of neurotransmitters in the brain and spinal cord, thereby helps in the alleviation of symptoms.
- Massage therapy
Massage therapy helps in the alleviation of pain, swelling and fatigue by inducing a soothing relief and improving total range of motion of joints. Healthcare providers advice massage therapy to improve the heart rate and in combination with pain killers, it helps in decreasing inflammation and muscle soreness.
- Exercise therapy
Exercises that are directed at improving the strength and stability of muscles are also suggested to patients of fibromyalgia. L Martin (9) conducted a study on 60 patients and concluded that exercise alleviate the symptoms during short term as well as long term duration.
1. Wolfe, F., Ross, K., Anderson, J., Russell, I. J., & Hebert, L. (1995). The prevalence and characteristics of fibromyalgia in the general population. Arthritis & Rheumatism, 38(1), 19-28.
2. Zoppi, M., & Maresca, M. (2011). Symptoms accompanying fibromyalgia. Reumatismo, 60(3), 217-220.
3. Martin, D. P., Sletten, C. D., Williams, B. A., & Berger, I. H. (2006, June). Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial. In Mayo Clinic Proceedings (Vol. 81, No. 6, pp. 749-757). Elsevier.
4. Gordon, D. A. (1999). Chronic widespread pain as a medico-legal issue. Best Practice & Research Clinical Rheumatology, 13(3), 531-543.
5. Bennett, R. M., Clark, S. R., Campbell, S. M., & Burckhardt, C. S. (1992). Low levels of somatomedin C in patients with the fibromyalgia syndrome. A possible link between sleep and muscle pain. Arthritis & Rheumatism, 35(10), 1113-1116.
6. Kaartinen, K., Lammi, K., Hypen, M., Nenonen, M., Hänninen, O., & Rauma, A. L. (2000). Vegan diet alleviates fibromyalgia symptoms. Scandinavian journal of rheumatology, 29(5), 308-313.
7. Griep, E. N., Boersma, J. W., & De Kloet, E. R. (1993). Altered reactivity of the hypothalamic-pituitary-adrenal axis in the primary fibromyalgia syndrome. The Journal of rheumatology, 20(3), 469-474.
8. Goldenberg, D., Mayskiy, M., Mossey, C., Ruthazer, R., & Schmid, C. (1996). A randomized, double‐blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia. Arthritis & Rheumatism, 39(11), 1852-1859
9. Martin, L., Nutting, A., MacIntosh, B. R., Edworthy, S. M., Butterwick, D., & Cook, J. (1996). An exercise program in the treatment of fibromyalgia. The Journal of rheumatology, 23(6), 1050-1053..