Fibromyalgia syndrome (FMS) is an abnormal pain processing disorder which causes widespread pain throughout the body, as well as chronic fatigue and cognitive problems. Fibromyalgia affects the central nervous system (the brain and spinal cord), resulting in nerve pain that is most often felt in the muscles, joints, and skin of the patient.
Symptoms of Fibromyalgia
The effects of fibromyalgia vary from person to person, but common symptoms include:
The effects of fibromyalgia vary from person to person, but common symptoms include:
- Widespread pain, stiffness, and tenderness
- Hypersensitivity to heat and cold
- Numbness in limbs
- Fatigue and tiredness
- Depression and anxiety
- Problems with concentration and memory
- Disordered and non-restorative sleep
- Digestive problems
- Pelvic floor problems
- Temporomandibular joint disorder
Fibromyalgia causes widespread nerve pain throughout the body due to central sensitization, which is when the central nervous system becomes hypersensitive to certain stimuli. Some researchers believe this is due to an overabundance of neurons that detect pain, and a dearth of the nerve cells which normally slow pain signals down.
Fibromyalgia is also characterized by “flare-ups”, a period during which constant pain symptoms worsen, often to a debilitating degree. Flare-ups are commonly triggered by stress, temperature changes, and lack of sleep.
Because it is neurological, the pain can occur anywhere in the body and feel very different at any given moment, even for the same patient. Fibromyalgia pain has been described as throbbing, aching, shooting, stabbing, tingly, and itchy. There are seven types of fibromyalgia pain:
Recent studies have shown that fibromyalgia causes demyelination of nerve cells, similar to multiple sclerosis (MS). Demyelination destroys the myelin sheath which insulates nerve cells from electrical impulses. This leads to neuropathy (pain from damaged nerve cells) and neuroinflammation in the brain.
Fibromyalgia is also characterized by “flare-ups”, a period during which constant pain symptoms worsen, often to a debilitating degree. Flare-ups are commonly triggered by stress, temperature changes, and lack of sleep.
Because it is neurological, the pain can occur anywhere in the body and feel very different at any given moment, even for the same patient. Fibromyalgia pain has been described as throbbing, aching, shooting, stabbing, tingly, and itchy. There are seven types of fibromyalgia pain:
- Hyperalgesia – increased levels of pain, believed to be caused by hypersensitivity to pain signals
- Widespread muscle pain
- Temporomandibular joint pain – pain in the face and jaw, as well as “clicking” in the jaw joint
- Allodynia – caused by central sensitization; a type of skin pain where even the lightest pressure can hurt
- Neuropathic pain – sensations of crawling, tingling, burning, itching, or numbness, caused by damage to nerve cells
- Tension headaches and migraines
- Abdominal and pelvic pain – includes irritable bowel syndrome (IBS), acid reflux, and interstitial cystitis
Recent studies have shown that fibromyalgia causes demyelination of nerve cells, similar to multiple sclerosis (MS). Demyelination destroys the myelin sheath which insulates nerve cells from electrical impulses. This leads to neuropathy (pain from damaged nerve cells) and neuroinflammation in the brain.
Potential Causes and Risk Factors of Fibromyalgia
The exact causes of fibromyalgia syndrome are unknown. Some researchers believe that FMS is caused by communication problems in the brain and spinal cord, and that repeated pain signals from a specific site may change the way the nervous system responds to pain, instead dispersing it throughout the body.
The exact causes of fibromyalgia syndrome are unknown. Some researchers believe that FMS is caused by communication problems in the brain and spinal cord, and that repeated pain signals from a specific site may change the way the nervous system responds to pain, instead dispersing it throughout the body.
It is very common for FMS patients to have had chronic pain in other regions of the body earlier in life, especially from conditions such as:
There is evidence that fibromyalgia syndrome may also be triggered by emotional or physical abuse in childhood, traumatic events (resulting in PTSD or prolonged emotional distress), or other rheumatic diseases (such as rheumatoid arthritis, osteoarthritis, and lupus). It also appears to run in families, though genetics alone are not believed to be responsible for FMS.
- Dysmenorrhea
- Temporomandibular joint disorder
- IBS and other functional gastrointestinal tract disorders
- Interstitial cystitis or painful bladder syndrome
- Endometriosis
- Other regional pain syndromes (especially back and neck pain)
There is evidence that fibromyalgia syndrome may also be triggered by emotional or physical abuse in childhood, traumatic events (resulting in PTSD or prolonged emotional distress), or other rheumatic diseases (such as rheumatoid arthritis, osteoarthritis, and lupus). It also appears to run in families, though genetics alone are not believed to be responsible for FMS.
How Fibromyalgia is Diagnosed
Fibromyalgia syndrome was previously diagnosed much more often in women than men (a ratio of 9:1), based on criteria of having 18 “tender points”. The diagnostic criteria were changed in 1990, so doctors diagnosing FMS now rely on the presence of somatic symptoms instead of solely checking for tender points. The ratio of women to men diagnosed has since fallen to 2:1, which is similar to the gender ratio for most chronic pain diagnoses.
Fibromyalgia syndrome was previously diagnosed much more often in women than men (a ratio of 9:1), based on criteria of having 18 “tender points”. The diagnostic criteria were changed in 1990, so doctors diagnosing FMS now rely on the presence of somatic symptoms instead of solely checking for tender points. The ratio of women to men diagnosed has since fallen to 2:1, which is similar to the gender ratio for most chronic pain diagnoses.
There are currently no X-rays or blood tests that can detect fibromyalgia. FMS is a diagnosis of exclusion, meaning that conditions that present similar symptoms (usually hypothyroidism, multiple sclerosis, and rheumatoid arthritis) must first be ruled out through a variety of tests, including X-rays, blood tests, and MRIs. It takes 5 years on average to receive a diagnosis for fibromyalgia.
Treatment and Management of Fibromyalgia
There is currently no cure or direct treatment for fibromyalgia. Most doctors recommend gentle aerobic exercise, medication, and psychological therapy for pain management.
Anti-inflammatory medication such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) do not work for fibromyalgia pain, as it is neurological. Opioid narcotics may actively make the pain worse.
Instead, doctors commonly prescribe antidepressants to help control pain levels by changing levels of serotonin and norepinephrine in the brain. Some of these are selective norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) and milnacipran (Savella), while others are tricyclic antidepressants like amitriptyline (Elavil). Antiseizure medications such as pregabalin (Lyrica) and gabapentin (Neurontin) block overactivity of the nerve cells involved in pain transmission.
Some individuals with fibromyalgia find a combination of exercise, drug therapies, and counselling helpful; but for many patients, none of these options are able to treat their pain effectively.
There is currently no cure or direct treatment for fibromyalgia. Most doctors recommend gentle aerobic exercise, medication, and psychological therapy for pain management.
Anti-inflammatory medication such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) do not work for fibromyalgia pain, as it is neurological. Opioid narcotics may actively make the pain worse.
Instead, doctors commonly prescribe antidepressants to help control pain levels by changing levels of serotonin and norepinephrine in the brain. Some of these are selective norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) and milnacipran (Savella), while others are tricyclic antidepressants like amitriptyline (Elavil). Antiseizure medications such as pregabalin (Lyrica) and gabapentin (Neurontin) block overactivity of the nerve cells involved in pain transmission.
Some individuals with fibromyalgia find a combination of exercise, drug therapies, and counselling helpful; but for many patients, none of these options are able to treat their pain effectively.
New Research into Fibromyalgia
Within the past few years, research has begun pointing towards a potential cause for fibromyalgia. A 2021 study by King’s College London links FMS to the immune system, which challenges the current assumption that it originates in the brain. Researchers injected one group of mice with antibodies from FMS patients, and injected a control group of mice with antibodies from healthy participants. The researchers observed that the mice in the test group became more sensitive to pressure and cold, and had weaker grip strength than before. In contrast, the control group mice were unaffected. After a few weeks, when the test group mice no longer had the antibodies in their systems, they stopped exhibiting fibromyalgia symptoms.
Within the past few years, research has begun pointing towards a potential cause for fibromyalgia. A 2021 study by King’s College London links FMS to the immune system, which challenges the current assumption that it originates in the brain. Researchers injected one group of mice with antibodies from FMS patients, and injected a control group of mice with antibodies from healthy participants. The researchers observed that the mice in the test group became more sensitive to pressure and cold, and had weaker grip strength than before. In contrast, the control group mice were unaffected. After a few weeks, when the test group mice no longer had the antibodies in their systems, they stopped exhibiting fibromyalgia symptoms.
The results of this study demonstrate that the symptoms typical of FMS – including increased pain sensitivity, muscle weakness, limited movement, and reduced amounts of small nerve-fibres in the skin – were caused by the patients’ antibodies.
Another study from 2019, by Ilke Coskun Benliyadi, found that the neuroinflammation and demyelination seen in fibromyalgia has an immunological background. The study points to cytokines, lipid mediators, oxidative stress, and plasma-derived factors as the cause of inflammation in fibromyalgia.
Another study from 2019, by Ilke Coskun Benliyadi, found that the neuroinflammation and demyelination seen in fibromyalgia has an immunological background. The study points to cytokines, lipid mediators, oxidative stress, and plasma-derived factors as the cause of inflammation in fibromyalgia.
Along with similar research, these studies have shown that fibromyalgia is likely an autoimmune disease in which antibodies mistake the body's own nerve cells for pathogens and attack them, causing damage and inflammation in a similar way to multiple sclerosis.
Prognosis for People Living with Fibromyalgia
Fibromyalgia is not currently considered a progressive illness, although recent research showing demyelination, damage to nerve cells, and neuroinflammation may suggest otherwise. FMS is considered to be medically benign, as it does not directly cause heart attacks, stroke, cancer, or death. However, people with fibromyalgia may have lower quality of life due to their chronic pain, and are at a higher risk of dying by suicide or in accidents than the general population.
Though there is no cure, symptoms may be alleviated by getting regular exercise, maintaining a healthy sleep schedule, and taking time to relax each day. Pain management through drugs and counselling can also be beneficial for some patients.
The uncertainty surrounding fibromyalgia is caused by three major aspects: what causes it, how to treat it, and how to diagnose it. For a long time, the unknowns in these areas have made living with the condition frustrating for many patients.
However, as medical researchers find more evidence for a potential immunological cause, there is now hope for better treatment and diagnostic tools on the horizon. Immunosuppressant therapies that reduce antibody levels in patients, which are already available and used to treat other autoimmune diseases, are likely to be effective treatments for fibromyalgia. The presence of these antibodies could also be used in the development of a diagnostic blood test for the disease in the near future.
Fibromyalgia is not currently considered a progressive illness, although recent research showing demyelination, damage to nerve cells, and neuroinflammation may suggest otherwise. FMS is considered to be medically benign, as it does not directly cause heart attacks, stroke, cancer, or death. However, people with fibromyalgia may have lower quality of life due to their chronic pain, and are at a higher risk of dying by suicide or in accidents than the general population.
Though there is no cure, symptoms may be alleviated by getting regular exercise, maintaining a healthy sleep schedule, and taking time to relax each day. Pain management through drugs and counselling can also be beneficial for some patients.
The uncertainty surrounding fibromyalgia is caused by three major aspects: what causes it, how to treat it, and how to diagnose it. For a long time, the unknowns in these areas have made living with the condition frustrating for many patients.
However, as medical researchers find more evidence for a potential immunological cause, there is now hope for better treatment and diagnostic tools on the horizon. Immunosuppressant therapies that reduce antibody levels in patients, which are already available and used to treat other autoimmune diseases, are likely to be effective treatments for fibromyalgia. The presence of these antibodies could also be used in the development of a diagnostic blood test for the disease in the near future.
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https://www.sciencedaily.com/releases/2021/07/210701120703.htm.
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Rath, Linda. “Fibromyalgia: Possible Causes and Risk Factors.” Edited by David Zelman, WebMD, WebMD, 11 Aug. 2021, https://www.webmd.com/fibromyalgia/guide/fibromyalgia-causes.