Fibromyalgia is a chronic pain disorder, a condition in which patients have widespread musculoskeletal pain and abnormal pain regulation in the nervous system. It is a condition of which the cause is unknown and there is currently no cure. Typically patients will have multiple painful areas on the body, usually in the muscles and tendons (the tight bands of tissue that connect muscle to bone), and commonly say they “hurt all over.” They also may have a variety of other accompanying symptoms or conditions.
Discovered in the mid-19th century in Europe, fibromyalgia affects anywhere from 2 to 3 percent of the population with a higher incidence in women. It is the most common cause of musculoskeletal pain in women ages 20 to 55. The chances of getting the disease are higher from ages 50 to 60.
Altered pain processing
A radical development in the research of fibromyalgia is the understanding that it is not primarily a musculoskeletal problem, rather, it is a condition of altered pain processing in the brain and spinal cord, or central nervous system (CNS). The CNS of a fibromyalgia patient is in persistent “hyper-reactive” mode, resulting in patients being “hyper-reactive” or “hypersensitive” to pain and touch, as well as other senses in some cases. This phenomenon has been coined “central sensitization” and is key to the understanding of what this disease is. Even a light touch, poke or a small injury that would not bother someone else could be very painful in a fibromyalgia patient because of the altered way in which pain is processed in the brain.
Scientists have noted differences in brain and spinal fluid chemistries in fibromyalgia patients including higher levels of pain mediators. Other conditions may also occur due to central sensitization and this is in part why fibromyalgia is a multi-symptom disorder.
A second development in research is the recognition that other syndromes and symptoms coexist with fibromyalgia. The most common ones are:
• mood disorders (usually depression)
• problems with sleep
• fatigue (tiring easily and/or running out of energy quickly)
• memory problems or trouble thinking clearly
While these symptoms are common, a physician should suspect fibromyalgia when there is no clear reason for why the person is having pain.
While not considered a part of fibromyalgia syndrome, per se, patients also commonly have:
• digestive problems: irritable bowel syndrome (IBS) or gastro-esophageal reflux disease (GERD)
• migraine or tension headaches
• irritable or overactive bladder
• pelvic pain
• temporo-mandibular disorder—(TMD) (a set of symptoms including face or jaw pain, jaw clicking and ringing in the ears)
Fibromyalgia has been a controversial disease within the medical community and some doctors say it does not even exist. Since patients typically look normal, it was common that doctors thought that these patients were just depressed. However, with the new science that finds differences in chemistry in the cerebrospinal fluid and the understanding of altered pain processing, fibromyalgia as a diagnosis is becoming more accepted within the medical community. While this means there is still no cure, it does allow doctors to better work with the patient using pain management techniques from medication to lifestyle adjustments.
Fibromyalgia is a diagnosis of exclusion; meaning doctors should make sure there is nothing else ongoing that could account for the symptoms. Since so many things can mimic fibromyalgia symptoms, it can be a long time before patients get a diagnosis while other diseases are being considered. The good news is that as more scientific knowledge comes out about fibromyalgia, the more easily doctors will be willing to diagnose it. An earlier diagnosis means earlier understanding, acceptance, and treatment.
As if making the diagnosis isn’t a frustrating process in and of itself, the treatment can also be equally if not more frustrating for patients, because there is no cure and no one treatment is perfect. Though there are a few medicines that can help fibromyalgia symptoms, this is one of those medical conditions in which lifestyle, understanding of the disease, and a multidisciplinary approach to treatment plays a large part in outcome.