Fibromyalgia

Many adults experience chronic pain. One of the most common conditions that cause chronic pain throughout the body is Fibromyalgia. People with Fibromyalgia experience pain, fatigue, cognitive and psychiatric issues. Currently, there is no specific explanation for what causes Fibromyalgia. Health care providers diagnose Fibromyalgia based off of a patient’s reported symptoms and an examination, as there are no definitive tests that can detect Fibromyalgia. Other conditions that may be present in association with Fibromyalgia include IBS, Restless Leg Syndrome, and depressive disorders, among others. Getting a diagnosis of Fibromyalgia is sometimes difficult, as it involves ruling out other causes of pain. Many people go for long periods of time without relief. Pain management specialists are very familiar and skilled with this condition that causes significant muscle pain.

What is Fibromyalgia?

The telltale sign of Fibromyalgia is whole body musculoskeletal pain. This means the patient has pain in a variety of places over their entire body (above and below the waist, as well as both the left and right sides). The pain feels as if it is within the muscles and at joints (focused on soft tissue). However, there is no inflammation involved with Fibromyalgia and all imaging or bloodwork appears normal.

There is no way to “see” Fibromyalgia. Nothing on the outside of the body would indicate an issue. Even most examinations and tests do not point to an abnormality. However, the patient is experiencing symptoms of pain, extreme fatigue, issues with thinking and possibly experiencing depression or anxiety. At one time, doctors believed these symptoms were psychological (i.e. all in the patient’s mind.) These days, with more research, doctors believe Fibromyalgia is a real condition and is likely due to altered pain receptors.

Who can have Fibromyalgia?

Fibromyalgia and muscle pain are one of the most common causes of chronic, whole body pain. It can affect children but usually affects adults and is more likely to occur the older a person gets. Fibromyalgia is more prevalent in women than men.

Although Fibromyalgia is a very common issue, there is a high likelihood that it is underdiagnosed. 10% of the population experiences chronic whole body pain. At least 2-3% of the population has been officially given a diagnosis of Fibromyalgia as the cause of their pain. Since the symptoms of Fibromyalgia look similar to other disorders, it is essential to get a proper diagnosis from a healthcare professional.

What are common symptoms of Fibromyalgia?

• Pain:The most common symptom of Fibromyalgia is pain that occurs throughout different areas, all over the body. It usually starts in one place (like the neck or shoulders) and gradually starts to spread to other areas. It is very common for patients to describe the feeling as, “I hurt all over.” The pain can feel like it is running through muscles and affecting joints.
• Fatigue: The level of tiredness that occurs with Fibromyalgia is more extreme than mild fatigue. Many patients feel tired most of the day. They often experience a feeling of stiffness upon waking. Even with more than the recommended amount of sleep (8 hours), patients do not feel refreshed. Fibromyalgia can cause patients to wake up multiple times a night and it is generally harder for them to fall back asleep. Patients report that no matter how much sleep they get, they never feel rested.
• Cognitive issues: Cognitive skills involve the brain’s ability to think, remember and learn. Patients with Fibromyalgia will often exhibit issues with their memory and attention span. This is referred to as “Fibro Fog”. The patient feels as if they are in a bit of a daze. They often have issues paying attention to tasks and having a hard time going from one task to the next.
• Psychiatric symptoms: Depression/anxiety is often seen in conjunction with Fibromyalgia. Up to half of all patients with Fibromyalgia experience some level of depression or anxiety. The severity of the patient’s psychiatric issues typically corresponds to the severity of their other symptoms (i.e. a patient with more severe pain or fatigue is likely to have worse anxiety or depression).
• Headaches: Migraine and tension headaches are reported by more than 50% of Fibromyalgia patients, especially those with episodic migraines.
• Paresthesias: Some patients with Fibromyalgia experience “strange sensations”. These include numbness, tingling, burning, and “crawling” sensations within the body. It is particularly common for these sensations to be felt in the arms or legs.

What Causes Fibromyalgia?

Medical science has yet to identify the underlying cause of Fibromyalgia. The current theory, supported by research, is that Fibromyalgia is due to a process called “central sensitization”. The basic idea is that people with Fibromyalgia experience this pain because they have a lower pain threshold (i.e. they feel pain more easily than a person without Fibromyalgia.) The central nervous system (the brain, spinal cord and associated nerves) became too active at some point and the chemistry of the system was altered. The patient now experiences higher pain levels than they would have before since the pathways (nerves to the brain and vice versa) are altered, making their perception of the stimulation (pain) more intense.

The change in the central nervous system is thought to be caused by things like genetics, traumatic past events, exposure to chronic high stress or a combination of these things. Seeing as Fibromyalgia may be a result of altered brain chemistry, this could explain some of the neurological issues (cognitive and psychiatric) that often accompany Fibromyalgia.

Getting a Diagnosis of Fibromyalgia

In the past, getting a diagnosis of Fibromyalgia was controversial as there are not definitive tests indicating a person has Fibromyalgia. However, guidelines have been developed by the American College of Rheumatology (ACR). With accurate patient information and a workup by a health care professional, other conditions that appear similar to Fibromyalgia are ruled out.

The first part of a complete workup for Fibromyalgia is compiling a detailed medical history. This will be used to determine risk factors for the development of Fibromyalgia as well as identifying conditions that can accompany Fibromyalgia. Issues that should be noted include: any pain that lasts for more than three months, feeling tired even after sufficient sleep, problems with attention, issues with balance, previous issues with depression or anxiety, sensitivity to sense perception (light, noise, odor, temperature, etc.), gastrointestinal problems (specifically IBS or GERD), issues with bladder control or irritability, sleep apnea or restless leg syndrome.

Chronic widespread pain is an immediate indicator that a patient may have Fibromyalgia. The diagnosis is typically based off of patient information. However, an examination for various tender areas may be necessary which will assess different sites of soft tissue. The provider will also test sites that are not made of soft tissue, in order to have a baseline of the patient’s pain.

In addition to looking for pain areas, practitioners should assess areas of the body for issues NOT related to Fibromyalgia. Things like inflammation or physical injuries should indicate to the provider that the issue is not Fibromyalgia. Should they discover any issues that could be related to a different condition, they will most likely refer the patient to a specialist.

Patients with Fibromyalgia will have normal bloodwork and imaging. Therefore, any tests used in the workup for Fibromyalgia are used to exclude other conditions. If blood is collected, testing will look to make sure there is no inflammation or infection, no rheumatic disease, and that the thyroid is functioning properly.

Changes in Diagnosing Fibromyalgia

The American College of Rheumatology (ACR) is the group that initially put together a standardized way of diagnosing Fibromyalgia. Their 1990 recommendations included:

• Widespread pain: Persistent pain in the upper and lower portions of the body and on both the left and right sides.
• 9 pairs of tender “points” at specific sites on the body were pressed with light pressure. If 11 or more of the 18 points were positive for pain, then Fibromyalgia could be diagnosed.

The ACR revised their criteria in 2010 with the main changes being:

• Elimination of the tender points test
• Adding a widespread pain index (WPI) which tests 19 generalized areas of the body
• Adding a severity of symptoms (SS) assessment which takes into account fatigue, sleep, and cognitive issues, in addition to pain<

The FibroDetect questionnaire helps to standardize the assessment for Fibromyalgia.

Other Conditions Associated with Fibromyalgia

It’s not certain whether these conditions can make the symptoms of Fibromyalgia worse or if it is Fibromyalgia that is contributing to these additional conditions.

• Functional somatic syndromes: These syndromes (like Fibromyalgia) are not marked by a specific disease process, but rather, the specific symptoms experienced by the patient. These can include chronic fatigue syndrome, irritable bowel syndrome, migraines, temporomandibular disorder, and chronic bladder/pelvic pain syndromes.
• Psychiatric Disorders: These include depressive disorders, anxiety disorders, and post-traumatic stress disorders.
• Sleep disorders: Nonrestorative sleep issues are common for Fibromyalgia patients. Sleep disturbances include sleep apnea, interruption in stage 4 sleep, restless leg syndrome and periodic limb movement disorders.
• Inflammatory rheumatic diseases: While Fibromyalgia does not have associated inflammation, other specific joints may exhibit issues. Rheumatoid arthritis, psoriatic arthritis and (potentially) osteoarthritis may be present in addition to the whole body issues associated with Fibromyalgia.

Where to Seek Care

Most board certified pain management specialists are able to give a Fibromyalgia diagnosis. However, Fibromyalgia is difficult to confirm with tests, therefore some providers may be reluctant to give a Fibromyalgia diagnosis. It’s common for patients to wait a year or more before seeing a clinician about their pain and then it can take some time before Fibromyalgia is formally diagnosed.

Conclusion

Fibromyalgia is a long-term, painful condition that used to be difficult to diagnose. With new research and standards, patients with widespread pain, fatigue, and cognitive or psychiatric problems should have an easier time receiving a proper diagnosis of Fibromyalgia. If you are suffering with symptoms and need help, contact us so that we may help with pain management and restoring quality of life.