Although an exact cause for fibromyalgia has not been ascertained as of 2010, the consensus of current research points towards a genetic predisposition for certain patterns of disordered neuroendocrine signaling brought on by environmental stressors, according to the National Fibromyalgia Association. Fibromyalgia patients experience a broad range of symptoms that overlap with other conditions, and since there is currently no definitive laboratory or imaging test, the diagnosis is often arrived at by systematically ruling out other possibilities.
The Symptom Picture
The hallmarks of fibromyalgia are longstanding chronic pain, heightened sensitivity to pain, chronic fatigue and sleep disturbance. Pain patterns are widespread throughout the body, structural in nature and occur with or without provocation, such as movement or direct pressure. Symptoms are present in the morning and can progress throughout the day. Additional symptoms include irritable bowel, impaired memory and cognition, numbness and tingling, headaches, anxiety and depression, dizziness and palpitations.
The Pain Response
Increased levels of a pain-modulating neurotransmitter called Substance P are noted in fibromyalgia patients, according to NeurologyChannel.com, possibly as part of the physiologic changes associated with certain stressors, notably a chronic sleep disturbance. Lacking sufficient rest, the body's ability to restore and replenish itself is diminished and this is expressed as a decreased tolerance to further physiologic stresses during waking hours. What might be normal or average levels of stress, such as an infection, a bout of emotional or psychological disturbance or an injury, are triggers to which the fibromyalgia patient reacts with an abnormally increased experience of pain.
Risk Factors
A study by the Department of Epidemiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel showed a strong association of fibromyalgia within families, confirming the genetic component. The same study cited a prevalence rates as high as 12.9 percent in the general population, making this a common condition. The National Fibrmyalgia Association reports that 75 to 90 percent of fibromyalgia patients are women in the age range of 20 to 50 years, with increasing diagnosis along with advancing age.
The Diagnostic Challenge
Fibromyalgia is a challenging condition for the clinician to diagnose because it has similar symptoms to a variety of diseases and conditions. Infections such as Lyme disease, autoimmune conditions such as Lupus, and endocrine imbalance as seen in thyroid disorders all involve many of the same symptoms. Additionally, it is possible to have one of those conditions concurrently with fibromyalgia, further confounding the patient and doctor.
Improvements in Diagnosis
One of the commonly used criteria for diagnosing fibromyalgia is the presence of at least 11 out of 18 mapped tender points on specific places throughout the body. There is controversy over this system as being inadequate to fully assess fibromyalgia, and a system that allows for individual variations is needed. In the Journal of Musculoskeletal Medicine, Atul Khasnis, M.D. and William S. Wilke, M.D., offer an alternative to the conventional tender point method of diagnosing fibromyalgia. They describe a pain diagram that allows the patient to define his areas of pain not limited to a list of predetermined points. Also, a questionnaire is included that allows for the inclusion of symptoms other than pain.
