Fibromyalgia

 

What is Fibromyalgia?

The sensation of pain is an essential part of human experience. Pain functions as a primary method for protection from and avoidance of harmful factors. When one feels pain, the body responds physically and emotionally. Physically, pain sensations travel from the source, through peripheral nerves and into the central nervous system (CNS). Once it reaches the brain, the body responds with a reflex, or involuntary response away from the source, and commits the incident to memory. Emotionally, feelings such as discomfort, fear or aversion are associated with the brain’s reflex mechanisms and contribute to an awareness of pain. Together, these processes are expected to end the offending pain, allow for healing time and prevent further discomfort.1

Chronic pain becomes a problem when the interrelationship between the physical and emotional responses doesn’t function properly.

Fibromyalgia is characterized by a state of chronic pain. When injury or inflammation generates pain impulses, the body’s reflex mechanism can improperly perceive the severity and increase the sensation. With this type of pain, called “central sensitization,” nerves in the CNS become over-sensitized, responding to painful and non-painful stimulations in the same way and send stronger, constant pain impulses to the brain. In fibromyalgia pain, this is irreversible and perpetuated by altered emotional responses. Since the brain associates specific mood states with the senses, protective emotions such as fear and aversion become chronic as well in Fibromyalgia. The emotions related to pain and coping with fibromyalgia can then amplify the sensation as well, leading to increased pain and additional problems of anxiety and depression.2

The role of inflammation management in fibromyalgia is also of growing importance. Cytokines are chemical messengers, working with the immune system to help regulate inflammatory responses whose presence may be indicative of a more persistent problem. Researchers are finding connections between elevated cytokine levels, compromised immune function and fibromyalgia. The presence of excess cytokines in autoimmune disorders has been associated with symptoms like pain and fatigue. Elevated cytokines levels have been demonstrated in a number of fibromyalgia patients as their symptoms worsen.3

Fibromyalgia Causes and Risk Factors

Fibromyalgia is considered a ‘syndrome,’ meaning many symptoms occur together. No single causation can be properly defined. However, it is believed there are a number of contributing factors, including:

  • Inflammation: elevated cytokine levels
  • Disturbed sleep patterns: sleep apnea, nighttime muscle spasms, restless leg syndrome
  • Infections: can trigger or aggravate fibromyalgia
  • Rheumatic disease: the presence of a preexisting rheumatic condition, such as rheumatoid arthritis or lupus, increases the likelihood of developing fibromyalgia
  • Physical or emotional trauma: Post Traumatic Stress Disorder has been linked to fibromyalgia
  • Genetics: fibromyalgia tends to run in families; however, no specific gene mutation has been identified

Fibromyalgia Symptoms

The primary symptom of fibromyalgia syndrome is pain. The pain is primarily in the muscles, and is described as chronic and widespread (the classification of widespread requires its presence on both sides of the body and above and below the waist).

The most common symptoms of fibromyalgia include:

  • Incapacitating fatigue
  • Decreased pain threshold
  • Multiple tender points
  • Sleep disturbances
  • Memory problems and difficulty concentrating (“fibro fog”)
  • Anxiety or depression

Symptoms vary from person to person, and external factors such as changes in weather, stress levels or physical activity can affect their severity.

Fibromyalgia Complications and Prognosis

Fibromyalgia is not progressive. While some symptoms may be attributed to overlapping, preexisting conditions such as depression or rheumatic diseases, fibromyalgia does not typically lead to other conditions or diseases. Despite this, living with fibromyalgia can cause physical and psychological strains that continually impact the lives of those affected by it. The struggle with chronic widespread pain, depression and lack of sleep can interfere with one’s ability to function at home or work, as well as in personal relationships. Often times, understanding and coping with such a debilitating disorder can be a complication in itself.

Fibromyalgia Treatment

There is no cure for fibromyalgia and no single treatment capable of addressing all symptoms. Therapies and treatment plans have been established to help reduce pain, alleviate symptoms and improve quality of life. The most successful treatment plans include a combination of medications, exercise and behavioral counseling.

Many types of medication have been established as treatments for fibromyalgia symptoms.  These include:

  • Analgesics: often used to help ease pain and stiffness; non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to be ineffective in treating fibromyalgia pain
  • Anti-seizure drugs
  • Antidepressants: shown to promote sleep and lessen the effects of depression associated with fibromyalgia

The inclusion of moderately intense aerobic exercise 2-3 times a week has been shown to reduce muscle pain. Counseling and cognitive behavioral therapies help people cope with pain and provide emotional support. Alternative treatments such as Tai Chi, acupuncture, massage therapy and chiropractic manipulations are also endorsed methods.

 

References:

  1. Mease P. Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment. J Rheumatology. 2005; 75:6-21.