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Spine University’s Guide to
Fibromyalgia
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Spine University's Guide to Fibromyalgia
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Spine University's Guide to Fibromyalgia
Introduction
much more to fibromyalgia than just muscle
pain.
The official name for fibromyalgia is fibromyalgia syndrome. Fibro means fiber and
myalgia means muscular pain or tenderness.
Fibromyalgia has been around for a long time.
There are reports that Florence Nightingale,
who died in 1910, had symptoms of fibromyalgia that first began to affect her in the mid
1850s.
What researchers do know is that people
who have fibromyalgia experience or feel
pain differently from those who do not have
it. There is some sort of alteration in the
processing of the pain from the painful area to
the brain.
Before fibromyalgia was recognized as a
medical syndrome, it often wasn’t taken seriously, particularly since more women suffered
from the symptoms than men. Those who were
living with it were often accused of faking
illness, being nervous or hysterical, or seeking
attention. Luckily, things have changed,
although there is still a lot to do in educating
the public. When it was recognized as a
medical problem, at first there wasn’t much
agreement on what to call the illness. Before
the term fibromyalgia syndrome was coined,
the syndrome was given a variety of names,
such as psychogenic rheumatism, fibrositis,
and myelasthenia, although fibromyalgia was
also used.
Finally, in 1990, the American College of
Rheumatology, an organization of doctors
and scientists who work in the field of rheumatic diseases, developed diagnostic criteria
(rules for diagnosis) and the term fibromyalgia
syndrome became the official name.
What causes fibromyalgia?
There is a short answer and a long answer to
the question “what causes fibromyalgia?” The
short answer is: Researchers don’t know. The
longer answer is a bit more complicated.
Because one of the main complaints with
fibromyalgia is generalized and chronic pain,
it was originally thought that it was a muscle
disease and that is likely why “myalgia” is
part of the name. However, over the years, the
medical community has learned that there is
Although it hasn’t been proven yet, there are
some strong theories about fibromyalgia and
what brings it on.
Physical trauma or injury: While not all
people with fibromyalgia have been injured,
a large number have. They may have been in
a car accident or some other type of accident
that, in particular, causes injury and pain to
the spine. It’s thought that this type of injury
affects the central nervous system of some
people and then progresses to fibromyalgia.
Infection: Although it’s not been proven, there
are theories that an infection, either bacterial or
viral, may be responsible for fibromyalgia.
Genetics: It’s believed that some people have
a genetic predisposition to fibromyalgia, which
means it runs in families. These are the people
who may have the illness triggered by an
accident or infection.
One thing that researchers have found in
patients with fibromyalgia is that they have a
lower level of cortisol, a stress-fighting and
anti-inflammatory hormone, than people who
don’t have fibromyalgia. The researchers
believe that this lower level of cortisol may
affect how people feel and interpret pain and
other sensations.
Another difference that’s been found is in
something called serotonin, which is also
lower in patients with fibromyalgia. Serotonin
acts as a chemical messenger that transmits
nerve signals between nerve cells. Finally, a
protein called substance P is found in higher
levels in people with fibromyalgia. Substance
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Spine University's Guide to Fibromyalgia
P is involved in how a person processes by
stimulating nerve endings at the site of injury.
• Feeling exceptionally sensitive to heat and
cold
Who gets fibromyalgia?
• Headaches
Anyone can get fibromyalgia, including
children. When a child, usually a teenager,
develops it, it’s called juvenile fibromyalgia
syndrome. However, it’s mostly adults that
develop fibromyalgia and the majority of them
are women. In fact, among those over 50 years
old, women outnumber men with fibromyalgia
by up to seven to one.
• Irritable bowel (diarrhea and/or constipation)
It doesn’t seem that any part of the world is
more affected by fibromyalgia than another.
Estimates in the United States, Canada, Spain,
France, and the United Kingdom are that
about two to five percent of the population is
affected. Researchers also say that there will
be more diagnoses around the world as doctors
become more aware of the diagnostic criteria
and recognize patients who have the syndrome.
What are the symptoms of fibromyalgia?
There are several different signs and symptoms
associated with fibromyalgia and each one,
taken alone, likely doesn’t seem to mean very
much. But, by combining the symptoms, they
can cause severe disability. The most common
and the hallmark symptom is widespread,
chronic pain. This pain can – and most often is
– severe and debilitating. There are also tender
points, spots or points on the body that are
particularly painful if any pressure is applied.
Other signs and symptoms include:
• Changes in vision
• Depression and/or anxiety
• Difficulty concentrating and remembering
things (often called fibro fog)
• Difficulty sleeping and not feeling
refreshed or rested after sleeping
• Difficulty with balance, dizziness
• Fatigue, often to the point of exhaustion
• Need to urinate urgently and/or frequently
• Numbness and tingling throughout the
body
• Sensitivity to chemicals
• Stiffness and joint pain upon waking
Some of these problems are more common
than others. For example, researchers have
found that 40 percent of people who have
fibromyalgia also have depression, compared
with 10 percent of the general public. Up to
45 percent of people with fibromyalgia have
anxiety and up to 51 percent have anxiety if
they have fibromyalgia and another illness
as well. Irritable bowel syndrome seems to
affect up to 70 percent, compared with only 20
percent of the general public.
How these symptoms affect different people
also varies quite a bit. For example, sensitivity can be very severe – some people may
not tolerate contact with their clothing, for
example.
How is fibromyalgia diagnosed?
There is no test that can tell a doctor if a
patient has fibromyalgia. Because many of
the symptoms can be caused by other diseases
or syndromes, doctors must rule out the other
illnesses before they can diagnose fibromyalgia. This is called a diagnosis of exclusion.
The onset of symptoms can be very gradual
or they can come on suddenly. A thorough
medical history may reveal if there has
been a physical or psychological stress that
occurred just before the onset of symptoms.
For example, statistics have shown that about
22 percent of patients with fibromyalgia
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Spine University's Guide to Fibromyalgia
symptoms had experienced whiplash not long
before, but researchers aren’t convinced that
this plays a role. Interestingly, many patients
with fibromyalgia, as with other chronic pain
syndromes, also have a childhood history of
physical or sexual abuse.
According to specialists, to be diagnosed with
the syndrome, you must have spontaneous
chronic widespread pain (pain that appears
out of nowhere, not caused by an accident or
injury) that involves both arms and legs, and
the trunk of your body.
The pain may be different from person to
person. One may complain of a deep aching
pain, while another may complain of a
stabbing pain. The pain may come and go,
although most people describe it as constant
pain that can get worse from time to time. This
pain may be severe enough to limit every day
activities.
When looking for fibromyalgia, doctors also
look for tender points. These, as described
earlier, cause deep pain when they are pressed.
Of course, the doctors also look at the signs
and symptoms and then put the pieces of the
puzzle together.
How is fibromyalgia treated?
Unfortunately, there isn’t any particular onesize-fits all treatment for fibromyalgia yet. In
fact there is no treatment for fibromyalgia at
all. There are some treatments that are helping
some patients with some symptoms, but for
others, they may not do anything. And, even
with treatment, it’s rare that all the symptoms
will go away.
In 2007, a group called the European League
Against Rheumatism (EULAR) published
treatment recommendations for fibromyalgia,
which they say that they will update every
five years. The guidelines currently stress
the importance of a complete and comprehensive evaluation of the patient, including
pain, function and any psychosocial issues
involving the patient. They then recommend
using a team approach to treatment, rather than
just one. This means using medications along
with heated pool exercises and/or swimming,
individually tailored exercise programs with
strength training, and cognitive behavior
therapy for psychological support.
Medications that are used aren’t specifically
for fibromyalgia, but they have been found to
be helpful for some people with the syndrome.
These include antidepressants, which have
been found effective in treating chronic pain,
analgesics (pain killers), and even medications
used to prevent seizures.
Antidepressants: The older antidepressants, tricyclics such as amitriptyline, have
been found to reduce pain and improve every
day function, but some of the newer antidepressants, the serotonin reuptake inhibitors
(SSRIs), such as fluoxetine, the serotonin
norepinephrine reuptake inhibitors (SNRIs),
such as venlafaxine or duloxetine, and 5-HT3
receptor antagonists, such as tropisetron, have
also been found to be effective.
Analgesics: Generally, many patients manage
with the use of over-the-counter medications
like acetaminophen, or weaker prescription
medications. However, tramadol, a controlled
drug, is often recommended for flare-ups of
fibromyalgia pain. Some patients wonder why
they aren’t given stronger pain medications.
Along with corticosteroids, stronger pain
medications like Demerol or morphine are not
recommended.
Antiseizure medications: Pregbalin (Lyrica)
has recently been approved by the United
States FDA for the treatment of fibromyalgia.
Researchers found that pregbalin helped
moderate the pain process and reduce the
painful sensations.
What happens after you’ve had fibromyalgia for a while?
Fibromyalgia isn’t a fatal disease nor is it a
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Spine University's Guide to Fibromyalgia
progressive disease, which means it usually
doesn’t progress from mild to moderate to
severe. Fibromyalgia also doesn’t progress
into any other disease.
That being said, the pain and fatigue from
fibromyalgia can cause a person to become
depressed or anxious and this can become a
vicious cycle. Also, the difficulty in managing
with fibromyalgia may result in isolation as
it becomes too difficult to work, to get out of
the house, or to see friends. Making meals can
become too difficult, resulting in malnutrition.
Poor sleep contributes to fatigue, and that also
becomes a vicious cycle.
Early treatment may help reduce the symptoms
and prevent these other issues from popping
up.
What is being done for fibromyalgia?
Researchers are continuing to try to identify
the causes of the syndrome. Treatment can’t
be targeted until they know why fibromyalgia occurs. Experts will continue revising
the diagnostic criteria in order to fine tune
the diagnosis. But importantly, raising public
awareness is a major issue. It’s only with
public education that people will realize that
fibromyalgia is a true medical illness, with
diagnosis and management, and not a figment
of someone’s imagination or a ploy to get
attention.
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Spine University's Guide to Fibromyalgia
Notes
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