Fibromyalgia: Definition, Symptoms, and Treatments

What is Fibromyalgia?

Fibromyalgia, often referred to as fibromyalgia syndrome (FMS), is a long-term condition characterised by widespread pain and a plethora of other symptoms. It’s as if the body’s volume knob for pain is turned up too high, making even the slightest touch feel overwhelmingly painful. 

Beyond the pervasive pain, individuals with fibromyalgia may also experience profound fatigue, sleep disturbances, memory issues, and mood swings. This condition bewilderingly blurs the lines between physical and psychological health, leaving sufferers seeking answers in a maze of symptoms. 

The commonality of this syndrome affects quite a number of individuals. In terms of its prevalence, specifically within Australia, it’s noted that fibromyalgia affects roughly 2% of the population, with a higher incidence in women, and specific groups such as Irritable Bowel Syndrome (IBS) sufferers and people with rheumatologic conditions. There is a need for awareness and supportive treatments for those living with this condition. 

This statistic is echoed in the experiences shared across various healthcare platforms, indicating a need for both awareness and supportive treatments tailored to those living with this condition.

Fibromyalgia In Females & Symptoms

Symptoms of fibromyalgia

Fibromyalgia syndrome demonstrates a markedly higher prevalence among women compared to men, a disparity attributed to various biological, psychological, and possibly sociocultural factors. The observed gender ratio in fibromyalgia prevalence is significantly skewed towards women, with studies indicating ratios as high as 9:1. 

Research suggests that women with fibromyalgia report more severe symptoms across several domains, including fatigue, morning fatigue, overall pain, and the presence of irritable bowel syndrome, alongside a higher count of tender points compared to men. These findings highlight not only the differences in how common fibromyalgia is between men and women, but also the differences in symptoms and possibly the basic causes of the condition between the genders.

The process of diagnosing fibromyalgia is detailed and requires professional medical assessment because there are no specific laboratory tests for it. The diagnosis is often made based on clinical criteria, primarily the patient’s reported history of symptoms. 

More common in females: 

  • Often include widespread pain
  • Fatigue
  • “Fibro fog” affecting cognitive and memory functions
  • Painful menstrual periods
  • Women may experience more severe symptoms like morning fatigue and irritable bowel syndrome compared to men​​.

The most commonly reported symptoms of Fibromyalgia: 

  • Difficulty sleeping
  • Mood issues
  • Muscle twitches or cramps
  • Headaches
  • Numbness or tingling in hands and feet
  • Restless legs syndrome
  • Temperature sensitivity
  • Sensitivity to loud noises or bright lights

However, given the intricacies involved in diagnosing fibromyalgia, including the necessity to exclude other conditions that could cause similar symptoms, it is clear that self-diagnosis of fibromyalgia is not advisable. Professional healthcare providers use specific criteria and their clinical judgement to make a diagnosis, taking into account the wide range of symptoms and the absence of a definitive diagnostic test. It’s crucial for individuals suspecting they might have fibromyalgia to seek a professional diagnosis to ensure accurate identification of their condition and to receive appropriate care and treatment.

Fibromyalgia Causes

Causes of fibromyalgia

The causes of fibromyalgia are complex and involve a mix of genetic, brain-related, psychological, and environmental factors.

Central Sensitisation

A key feature in fibromyalgia is central sensitisation, where the central nervous system undergoes a process leading to an increased response to stimuli, contributing significantly to pain perception. This dysfunction involves the perception, transmission, and processing of afferent nociceptive stimuli (pain signals that travel from the body to the brain), manifesting predominantly as musculoskeletal pain. 

However, a study led by King’s College London, in collaboration with the University of Liverpool and the Karolinska Institute, suggested many symptoms of fibromyalgia syndrome (FMS) may be caused by antibodies that increase the activity of pain-sensing nerves throughout the body. This groundbreaking research implies that fibromyalgia could primarily be a disease of the immune system rather than originating in the brain. Whilst evidence continues to emerge, it is essential the associated symptoms such as pain and insomnia are managed to improve quality of life.

Genetic Factors

Genetic predisposition plays a crucial role, with studies indicating familial aggregation of fibromyalgia and associated conditions. Certain genetic variations that affect the brain’s pain processing systems are involved, although the specific genetic factors are not yet fully understood.

Neuroendocrine and Autonomic Dysfunction

Neuroendocrine and autonomic dysfunction refers to problems with the parts of the nervous system that control hormones and automatic body functions like heart rate and digestion. Essentially, these systems aren’t working as they should, which can affect various bodily functions and overall health.

Imbalances in certain nervous system parts, like the ones that control stress hormones and the fight-or-flight response, may play a role in fibromyalgia. These imbalances can change how we feel pain, react to stress, and sleep.

Psychological and Behavioural Factors

Psychological stress, trauma, and mood disorders, such as anxiety and depression, are frequently associated with fibromyalgia. These factors may not only predispose individuals to the development of fibromyalgia but also exacerbate its symptoms.

Sleep Disturbances

Non-restorative sleep and sleep disorders, such as sleep apnea and restless legs syndrome, are common in fibromyalgia patients and may play a role in the pathophysiology of the condition. Poor sleep quality can exacerbate pain and fatigue, forming a vicious cycle.

Environmental and Infectious Triggers 

Environmental factors, including physical and emotional trauma, and certain infections, have been suggested to trigger the onset of fibromyalgia in susceptible individuals. However, the evidence linking specific infections or vaccinations to fibromyalgia is not definitive and requires further research.

The exact causes of fibromyalgia remain unclear; however, it is believed to involve a combination of genetic, environmental, and psychological factors. Genetics may predispose individuals to the condition, while certain infections and physical or emotional trauma could trigger its onset. Abnormalities in how the brain processes pain signals may play a significant role. This complex interplay suggests that fibromyalgia arises from multiple factors contributing to increased pain sensitivity and the wide range of symptoms experienced by those affected.

Fibromyalgia is a complex condition with a diverse range of contributing factors. Understanding the interplay between these factors is crucial for developing effective treatment strategies.

Complications Associated With Fibromyalgia

Complications of fibromyalgia

Fibromyalgia is known to correlate to various complications, significantly impacting the lives of those affected. These complications can range from increased susceptibility to other rheumatic conditions, such as osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis, to mental health issues. 

Specifically, individuals with fibromyalgia have been observed to have higher death rates from suicide and injuries, though the overall mortality rate is comparable to the general population. The condition is also associated with higher rates of anxiety, depression, diabetes, heart disease, and high blood pressure, which may contribute to a lower quality of life and poorer overall health​​​​​​.

Fibromyalgia Treatment Options

The management of fibromyalgia involves a combination of pharmacological and non-pharmacological treatments, tailored to individual patient needs. The aim is to alleviate symptoms, improve function and quality of life, and address any co-existing conditions. 

While several drugs are recommended for treating fibromyalgia, only three have received approval by the US Food and Drug Administration (FDA) for this specific indication:

Pregabalin

An α2δ (alpha two delta) ligand that reduces calcium influx at nerve terminals, thereby decreasing the release of several neurotransmitters involved in pain processing. It has been shown to improve pain, sleep, and quality of life in patients with fibromyalgia. 

Known side effects include dizziness, drowsiness, swelling in the hands and feet, trouble concentrating, increased appetite, weight gain, dry mouth, and blurred vision. It’s essential for users to be aware that pregabalin can also cause serious allergic reactions, which may necessitate immediate medical attention. These reactions can include hives or blisters on the skin, difficulty breathing, and swelling of the face, lips, tongue, or throat. There are also more severe side effects such as weak or shallow breathing, blue-coloured skin, lips, fingers, and toes, confusion, extreme drowsiness or weakness, and vision problems.

It’s crucial for patients and caregivers to monitor for these effects and report any new or worsening symptoms to a healthcare provider.

Duloxetine and Milnacipran

Duloxetine and Milnacipran: Both are serotonin-norepinephrine reuptake inhibitors (SNRIs) that enhance neurotransmission in the descending pain pathways. These medications have demonstrated efficacy in reducing pain, improving sleep, and enhancing overall function in fibromyalgia patients

Duloxetine used for various conditions including fibromyalgia, may interact with a wide range of medications and can have side effects such as increased heart rate and blood pressure. It is important for individuals with certain medical conditions like liver disease, bipolar disorder, or bleeding problems to use it cautiously.

Complementary Treatments

Despite the availability of these approved treatments, no single drug is fully effective against all symptoms of fibromyalgia, such as pain, fatigue, sleep disturbances, and depression. Therefore, a combination therapy involving different drugs, along with non-pharmacological interventions, may be necessary to manage the condition effectively. These non-pharmacological treatments include:

Exercise: Regular physical activity, particularly aerobic exercise, has been shown to improve pain, physical function, and well-being in fibromyalgia patients.

Cognitive Behavioural Therapy (CBT): Helps in managing pain, fatigue, sleep problems, and psychological distress.

Patient Education: Understanding the condition and its management can empower patients to take an active role in their treatment.

Prescription medical cannabis: Medical cannabis has been explored as a complementary treatment for patients with fibromyalgia, a syndrome characterised by chronic generalised pain alongside various symptoms such as fatigue, sleep disturbances, and psychological distress. Medical cannabis has emerged as a potential adjunctive treatment option. 

A prospective observational study investigated the characteristics, safety, and effectiveness of medical cannabis therapy in fibromyalgia patients, observing 367 patients with fibromyalgia who were treated with medical cannabis. The results demonstrated that medical cannabis therapy led to significant improvements in pain intensity, with the majority of patients (81.1%) achieving a treatment response.

However, the same study recorded that this treatment option also comes with side effects such as mild and included dizziness (7.9%), dry mouth (6.7%), and gastrointestinal symptoms (5.4%). 

It is important for treatment to be individualised, taking into account the patient’s symptoms, co-existing conditions, and response to previous treatments. The optimal approach combines medication with physical therapy, psychological support, and lifestyle modifications to address the multifaceted nature of fibromyalgia.

Navigating the Complexities of Fibromyalgia Requires A Multifaceted Approach in Management & Care

In conclusion, fibromyalgia presents a complex and challenging landscape for both patients and healthcare professionals, characterised by its diverse symptomatology, multifactorial aetiology, and the personalised nature of its management strategies. As understanding of this condition deepens, it becomes increasingly clear that a multidisciplinary approach, integrating pharmacological treatments with physical, psychological, and lifestyle interventions, holds the key to alleviating the burden of fibromyalgia. 

The dedication to ongoing research, patient education, and the development of supportive communities will remain paramount in enhancing the quality of life for those affected by this pervasive syndrome. Bridging the gap between current challenges and future prospects requires a concerted effort from all stakeholders, underlining the importance of empathy, innovation, and collaboration in the quest to improve outcomes for individuals living with fibromyalgia.

Written by

Priyom holds a Ph.D. in Plant Biology and Biotechnology from the University of Madras, India. She is an active researcher and an experienced science writer. Priyom has also co-authored several original research articles that have been published in reputed peer-reviewed journals. She is also an avid reader and an amateur photographer.

Written by

Priyom holds a Ph.D. in Plant Biology and Biotechnology from the University of Madras, India. She is an active researcher and an experienced science writer. Priyom has also co-authored several original research articles that have been published in reputed peer-reviewed journals. She is also an avid reader and an amateur photographer.

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