Fibromyalgia: Definition, Causes, Symptoms, Diagnosis, Treatment and Prognosis

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in specific areas of the body. It is often accompanied by sleep problems, morning stiffness, and difficulty with memory and concentration. The exact cause of fibromyalgia is not known, but it is thought to be related to abnormal levels of certain chemicals in the brain and changes in the way the central nervous system processes pain. There is no cure for fibromyalgia, but a range of treatments, including medications, exercise, and therapy, can help manage the symptoms.

What is Fibromyalgia?

Fibromyalgia is a chronic pain condition that affects the muscles and soft tissues. It is characterized by widespread musculoskeletal pain, fatigue, and tenderness in specific areas of the body. Fibromyalgia is believed to be a pain regulation disorder.

Causes of Fibromyalgia

The exact cause of fibromyalgia is unknown, but it is thought to be related to a combination of genetic, environmental, and psychological factors. Researchers have identified several potential contributing factors to the development of fibromyalgia, including:

1. Changes in the way the central nervous system processes pain signals: Some people with fibromyalgia may have a heightened sensitivity to pain, known as central sensitization syndrome.
2. Abnormal levels of certain chemicals in the brain: Fibromyalgia may be related to abnormal levels of neurotransmitters (chemicals that transmit messages in the brain) and other substances that regulate pain.
3. Genetic factors: Fibromyalgia tends to run in families, suggesting that there may be a genetic component to the condition.
4. Environmental and psychological factors: Stressful or traumatic events, such as physical or emotional abuse, may contribute to the development of fibromyalgia.

It’s important to note that fibromyalgia is not caused by a specific injury or illness. It is a chronic pain condition that develops over time and is often triggered by a combination of factors.

Prevalence of Fibromyalgia

Fibromyalgia affects approximately 2% of the population with rates twice as high in women than men. 

Symptoms of Fibromyalgia

The main symptoms of fibromyalgia are widespread musculoskeletal pain and tenderness. 

People with fibromyalgia may also experience:

1. Fatigue
2. Sleep disturbances
3. Cognitive difficulties (also known as “fibro fog”)
4. Mood changes, such as depression and anxiety
5. Headaches
6. Irritable bowel syndrome (IBS)
7. Painful menstrual periods

The severity and specific symptoms of fibromyalgia can vary widely from person to person. Some people may have mild symptoms that come and go, while others may have severe, constant pain that interferes with their daily activities.

Diagnosing Fibromyalgia

There is no specific test for fibromyalgia, so the condition is usually diagnosed based on a combination of symptoms and a physical exam. 

The American College of Rheumatology (ACR) has developed diagnostic criteria for fibromyalgia to help healthcare providers identify the condition and distinguish it from other conditions that cause similar symptoms.

According to the updated ACR criteria, a person may be diagnosed with fibromyalgia if they have:

1. Widespread pain: This means pain in all four quadrants of the body (left and right sides, above and below the waist). The pain must have been present for at least 3 months.
2. Other symptoms characteristic of fibromyalgia: These may include fatigue, cognitive difficulties (also known as “fibro fog”), and sleep disturbances.
3. Other conditions have been ruled out: It is important to rule out other conditions that could be causing the person’s symptoms, such as rheumatoid arthritis or lupus.

It is important to note that fibromyalgia can be difficult to diagnose because its symptoms are similar to those of other conditions, and there is no specific test for it. It may take some time to receive a diagnosis, and it may involve seeing multiple healthcare providers.

Treatment of Fibromyalgia

There is no cure for fibromyalgia, but there are several treatments that can help manage the condition and improve symptoms. Treatment for fibromyalgia usually involves a combination of medications, lifestyle changes, and therapy. The specific treatment plan will depend on the severity of the condition and the individual’s symptoms and needs.

Medications

Medications that may be used to treat fibromyalgia include:

1. Pain relievers: Over-the-counter pain relievers, such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs), can help reduce pain.
2. Antidepressants: Some antidepressants, such as amitriptyline and fluoxetine (Prozac), can help improve sleep and reduce pain and fatigue in people with fibromyalgia.
3. Anticonvulsants: Drugs that are typically used to treat epilepsy, such as pregabalin (Lyrica) and gabapentin (Neurontin), can also be helpful in managing fibromyalgia pain.

Lifestyle Changes

Lifestyle changes that may help manage fibromyalgia include:

1. Exercise: Regular physical activity can help improve symptoms and reduce pain.
2. Stress management: Techniques such as relaxation techniques, yoga, and meditation can help reduce stress and improve symptoms.
3. Sleep hygiene: Establishing good sleep habits, such as going to bed and waking up at the same time every day and creating a relaxing bedtime routine, can help improve sleep quality.
4. Diet: Eating a healthy, well-balanced diet can help improve overall health and manage fibromyalgia symptoms.

Therapy

Therapy can also be an important part of treatment for fibromyalgia. Options may include:

1. Cognitive-behavioral therapy: This type of therapy can help people with fibromyalgia change negative thought patterns and behaviors that may be contributing to their symptoms.
2. Physical therapy: Physical therapy can help improve flexibility and strength, and teach people with fibromyalgia how to manage their symptoms.
3. Occupational therapy: Occupational therapy can help people with fibromyalgia learn ways to manage daily activities and reduce fatigue.

It is important to work with a healthcare provider to develop a treatment plan that is right for you.

Prognosis

Fibromyalgia is a condition that can be managed with treatment, but it is not curable. The prognosis for individuals with fibromyalgia varies depending on the severity of their symptoms and their response to treatment. Some people are able to effectively manage their symptoms and lead active, productive lives, while others may have more difficulty. The key to managing fibromyalgia is finding the right combination of treatments that work for you, which may include medications, lifestyle changes, and other therapies.

Sources

Clauw, Daniel J. “Fibromyalgia: a clinical review.” JAMA vol. 311,15 (2014): 1547-55. doi:10.1001/jama.2014.3266

Bhargava, Juhi. and John A. Hurley. “Fibromyalgia.” StatPearls, StatPearls Publishing, 10 October 2022.

Walitt, Brian et al. “The Prevalence and Characteristics of Fibromyalgia in the 2012 National Health Interview Survey.” PloS one vol. 10,9 e0138024. 17 Sep. 2015, doi:10.1371/journal.pone.0138024