Fibromyalgia is a condition that’s associated with widespread, chronic debilitating pain. People with the condition have sore necks, backs, and shoulders, as well as aching muscles. They usually sleep poorly and are stiff when they wake up or move after sitting for prolonged periods. The location and intensity of the pain, as well as the intensity of fatigue, may vary from one day to the next and become worse with stress and excessive exercise.
It is believed that fibromyalgia affects close to 5 million people in America over 18 years of age. Women are affected most by fibromyalgia at between 80 and 90 percent of cases, but men and children too can be affected. People with certain health conditions affecting bones, muscles, and joints such as lupus and arthritis may also have a higher risk of fibromyalgia. For most rheumatologists (doctors that specialize in rheumatic diseases), fibromyalgia is the second or third most diagnosed condition.
The fatigue, pain, and many other symptoms associated with the condition can frustrate patients and doctors alike. Fibromyalgia usually makes the affected person miserable but doesn’t cause visible damage or inflammation to the affected tissues. While pain and other symptoms may come and go randomly, they never progress to a disease state or remit over time. While depression is at times associated with the condition, it doesn’t cause fibromyalgia; the prevalence of depression is the same as it is with other chronic conditions.
Healthcare practitioners that know about fibromyalgia can make a diagnosis using the criteria established by the American College of Rheumatology (ACR) back in 2010. New research into understanding fibromyalgia is mostly centered on how pain is processed in the spinal cord and brain as opposed to the pain receptors in the rest of the body. The change in perspective is hoped to bring forth a new way of diagnosing the condition in the future.
Currently, there isn’t any cure for fibromyalgia, but treatments are available to manage it. People with the condition may require treatment by a team of professionals, which includes a physical therapist, general practitioner, and perhaps even a rheumatologist. You can usually find such teams at pain clinics that specialize in the treatment of arthritis, along with other rheumatic conditions.
While no single cause of the condition has been identified, it is believed that there are both environmental and genetic components, i.e., something acts as a trigger in those predisposed to the condition. There’s a higher incidence of the condition in some families than in others. Some cases appear to start with a severe illness or physical trauma, while other cases arise without any discernible “event.”
Some researchers believe that symptoms could be linked to sleep disorders, while others think that the condition could be due to a microorganism. Still, others suspect the cause to be either chronic overreaction of the immune system or altered skeletal muscle metabolism. Current research focuses more on abnormalities in pain processing pathways and neural processes as the cause of fibromyalgia symptoms. Answers to the cause of the condition might be years away, but healthcare practitioners can identify those with the condition and try to help them lead somewhat normal lives.
Signs and Symptoms
While there are numerous signs and symptoms associated with the condition, fibromyalgia almost always starts with:
- Some degree of chronic fatigue as well as interrupted sleep
- Pain upon the application of pressure in specific areas referred to as “tender points.”
- Chronic widespread pain
Other common symptoms of the condition include:
- Paresthesia (Tingling and numbness in the feet and hands)
- Painful menstruation
- Memory lapses, difficulty concentrating
- Anxiety and depression (may co-exist)
The people affected may also experience one or more of the following:
- Irregular heartbeat, chest pain, shortness of breath
- Painful sexual intercourse
- Neurally mediated hypotension, i.e., Blood pressure that lowers when standing
- Localized edema
- Abdominal pain, cramping, and gas
- Dry mouth
- Difficulty concentrating, dry eyes
- Balance problems, dizziness
- Difficulty swallowing
- Dry, itchy, or blotchy skin
- Irritable bowel syndrome
- Urinary frequency, irritation, and urge
- Temporomandibular joint dysfunction (TMD), pain in jaw joints as well as surrounding muscles
- Sensitivity to medications
- Sensitivity to sound, light, odors, temperature, and touch
- Rhinitis that consists of sinus pain and nasal discharge/congestion (but without an allergic immune response)
- Restless legs syndrome as well as periodic limb movement during sleep
Fibromyalgia is a condition that may and sometimes actually co-exists with numerous other chronic illnesses such as rheumatoid arthritis, chronic fatigue syndrome, Sjögren syndrome, multiple sclerosis, thyroid disease, lupus, and ankylosing spondylitis. The symptoms of these conditions can be mingled with the ones associated with fibromyalgia, which can make diagnosis increasingly challenging.
The condition is typically diagnosed by documenting the medical history of the patient, ruling out diseases and disorders that could be exacerbating or mimicking fibromyalgia, and utilizing the criteria that the American College of Rheumatology (ACR) last updated in 2010.
The criteria outlined by the ACR evaluates pain severity and location. It also considers the symptoms or how the individual feels. A person would be diagnosed with fibromyalgia if he/she met the following:
- Number of painful areas out of 19 parts of the body
- Has experienced pain and symptoms over the past week
Plus, how severe the following symptoms are:
- Waking unrefreshed
- Cognitive (thought or memory) problems
Plus, the number of other general physical symptoms:
- The individual doesn’t suffer from any other condition that might explain the pain
- Symptoms have been present at the same level of severity for not less than three months
A laboratory test can be incredibly helpful when it comes to diagnosing conditions that have symptoms like fibromyalgia, which include Sjögren syndrome, rheumatoid arthritis, lupus, and thyroid disease. It usually isn’t necessary or effective to do the extensive screening. General test that may be ordered include:
- CK (Creatine Kinase): For ruling out other conditions that may be causing muscle pain or weakness
- ANA (Anti-Nuclear Antibody): For ruling out autoimmune disorders such as Sjögren syndrome or lupus
- TSH (Thyroid Stimulating Hormone) and/or another thyroid testing because hypothyroidism may cause symptoms like fibromyalgia
- CBC (Complete Blood Count): To look for anemia, which is a possible cause of fatigue and weakness
- CMP (Comprehensive Metabolic Panel): For examining proteins, electrolytes, glucose, calcium, liver, and kidney function.
A healthcare practitioner will usually consider the following when coming up with a diagnosis:
- The patient’s history (including risk factors for certain diseases and family history)
- Results of general tests
- Results of the physical examination
Based on these findings, additional tests may be ordered.