What are the other Names for this Condition? (Also known as/Synonyms)

• Charcots Hysteria (due to Fibromyalgia)
• Chronic Rheumatism (due to Fibromyalgia)
• Fibromyalgia Syndrome (FMS) 

What is Fibromyalgia? (Definition/Background Information)

• Fibromyalgia may be described as a medical disorder or a syndrome distinguished by chronic, long-term body pain, and tenderness in the joints, muscles, tendons, and soft tissues. According to studies, it is a common condition that may affect between 2-4% of the general population
• Fibromyalgia affects the way the brain processes pain signals and it is often associated with fatigue (tiredness), sleep problems, headaches, numbness of hands and feet, depression, and anxiety
• Presently, there is no cure for Fibromyalgia. However, the condition may be properly controlled through medication, self-care techniques, and non-drug therapies. Even though Fibromyalgia is long-lasting, the prognosis of individuals with the condition is generally favorable

Who gets Fibromyalgia? (Age and Sex Distribution)

• Fibromyalgia is a common condition worldwide with a reported incidence of 1 case per 25-50 individuals
• Men, women, and children, of all ages may be affected by Fibromyalgia
• It is more common in females than males (9:1 female-male ratio). Studies have shown that women between the age group of 20-55 years are most susceptible to this condition
• No racial or ethnic predilection is seen

What are the Risk Factors for Fibromyalgia? (Predisposing Factors)

• Gender: Women (in the 20-55 year age group) are at a higher risk for Fibromyalgia, when compared to men in the same age range
• Hormone level: A low, growth hormone (GH) level makes an individual easily susceptible to Fibromyalgia
• Age: Women in the age group of 20-55 years, and during their child-bearing years are more at risk. Elderly men, women, and children, are also vulnerable to the disorder
• Genetics: A genetic defect passed along during birth, may be a significant risk factor for Fibromyalgia. Hence, it is more common in individuals, who have family members diagnosed with the condition. It is suggested that the affected gene may decrease the pain threshold of an individual 
• Sleep disorders: Individuals with sleep disorders are more likely to develop Fibromyalgia, because sleep disorders are the early symptoms of the disorder
• Individuals with any form of rheumatic disease, such as the following, have a higher risk:
  • Systemic lupus erythematosus (SLE, an autoimmune disorder): An individual diagnosed with SLE is likely to develop Fibromyalgia
  • Osteoarthritis: An individual diagnosed with osteoarthritis (degeneration of the joints), is at a high risk
  • Spondylitis: Any individuals suffering from spondylitis (a type of arthritis causing severe back pain) 
• Emotional or physical trauma: An individual who undergoes physical or emotional trauma is likely to be at risk
• Neck injury: An individual who has had a neck injury is at risk for Fibromyalgia
• Depression: Individuals suffering from depression may develop Fibromyalgia
• Irritable bowel syndrome: An individual who is suffering from an irritable bowel syndrome has an increased risk for developing fibromyalgia.

Individuals diagnosed with chronic fatigue syndrome, rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, vulvodynia, TM joint pain, endometriosis, and inflammatory bowel disease, may have associated Fibromyalgia.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Fibromyalgia? (Etiology)

The exact cause of Fibromyalgia is presently not well understood. The following causative factors have been identified:

• Genetics: When an individual’s close family member is affected by Fibromyalgia, there is an increased likelihood of the other members in the family becoming susceptible to the disorder. Those with Fibromyalgia may have gene(s) that make them react intensely to stimuli
• Infections: Viral infections and other illnesses
• Physical or emotional trauma: Physical or emotional trauma, like serious illnesses or accidents could be cause factors. During such trauma, the body’s response to stress changes and it creates a higher sensitivity of the entire body to pain
• Abnormal pain response: The level of chemical in the cerebrospinal fluid, which transmits pain impulses to the brain, is three times higher in Fibromyalgia-affected individuals. This could be a cause for the increase in pain
• Depression: Chronic pain may cause feelings of anxiety and depression that can worsen Fibromyalgia
• Sleep disorder: It is during the stage-4 sleep that the muscles get refreshed. Individuals suffering from Fibromyalgia sleep long-hours, but they get only a poor-quality sleep. Hence, the muscles are not refreshed. Having a poor sleep may be a factor in the genesis of Fibromyalgia
• Lower level of serotonin: Lower levels of serotonin, a brain neurotransmitter, may result in increased pain-sensitivity
• Stress: Stress and poor physical conditioning can cause Fibromyalgia. Muscle ‘microtrauma’ – a condition where mild damage of muscles occurs, may lead to pain and fatigue
• Biochemical and hormonal changes: Biochemical changes relating to hormones and menopause, could be a cause
• Low level of growth hormone leading to muscle pain
• Increased presence of “substance P”: Substance P is a chemical that amplifies pain signals. An increased level of this substance, could be a possible cause for Fibromyalgia
• Physical and sexual abuse: Children and adults who have been subjected to physical and sexual abuse may suffer from the condition
• Adenosine monophosphate deaminase deficiency type 1 could be a possible cause for Fibromyalgia

Fibromyalgia is not known to be an autoimmune disorder, or an illness associated with inflammation of the muscles and joints.

What are the Signs and Symptoms of Fibromyalgia?

The common signs and symptoms of Fibromyalgia are widespread pain all over the body, and pain at certain tender points that include:

• Back of the head, front side of the neck
• Inner knees
• Between shoulder blades, top of the shoulder, outer elbows
• Sides of hips, upper hips
• Upper chest

The pain and tenderness may appear and disappear; the pain may also affect different regions over time (move about the body).

Other signs and symptoms include:

• Anxiety (causing palpitations), depression, and fatigue
• Sleep disturbances, morning stiffness, concentration and memory problems (memory loss, often called fibro fog)
• Chronic headaches, nausea, dizziness, and fainting
• Irritable bowel syndrome
• Painful menstrual cramps, abdominal pain during menstruation (may be due to associated endometriosis), and pelvic pain
• Numbness, tingling in the hands, arms, feet, and legs
• Urinary problems, including pain while urinating and frequent urination
• Muscle aches on both sides of the body, above and below the waist
• Temporomandibular (TM) joint dysfunction syndrome, causing pain in jaw while chewing food
• Skin complaints
• Night sweats
• Heat or cold intolerance (abnormal temperature sensitivity)
• Heartburn with difficulty swallowing (due to esophageal dysmotility)

In Fibromyalgia, there is no inflammation and damage to the muscles and joints, even though there is joint pain.

How is Fibromyalgia Diagnosed?

No specific lab tests or imaging studies are available for diagnosing Fibromyalgia. Hence, in most cases the condition may be misdiagnosed. A diagnosis of Fibromyalgia is usually based on the diagnostic criteria issued by the American College of Rheumatology.

It is termed as "2010 Preliminary Diagnostic Criteria”, according to which, a patient satisfies the diagnostic criteria for Fibromyalgia, if the following 3 conditions are met:

• Widespread pain index (WPI) ≥7 and symptom severity (SS) scale score ≥5, or WPI = 3-6 and SS scale score ≥9
• Symptoms have been present at a similar level, for at least 3 months
• The patient does not have a disorder that would otherwise explain the pain and other symptoms

The SS scale score is the sum of the severity of the 3 symptoms (fatigue, waking unrefreshed, cognitive symptoms), plus the extent/severity of somatic symptoms in general, like muscle pain/weakness, irritable bowel syndrome, fatigue/tiredness, thinking or memory problems, headache, pain/cramps in the abdomen, etc. The final score may lie between 0 and 12.

• Physicians follow the differential diagnosis method wherein they consider all possible diseases that could have affected the patient, based on their symptoms, gender, age, geographic location, medical history, etc.
• Blood tests are performed to rule out conditions that may have similar symptoms. They are also used to eliminate, systemic rheumatic conditions associated with Fibromyalgia. The blood tests include:
  • Complete blood count (CBC)
  • Erythrocyte sedimentation rate test (ESR)
  • Serum protein electrophoresis (SPEP)
  • Antinuclear antibody (ANA)
  • Rheumatoid factor (RF factor)
  • Liver tests to rule out Hepatitis
• Thyroid function tests (TSH, T3 level, T4 level) and calcium blood levels are obtained to exclude hypercalcemia, hyperparathyroidism, hypothyroidism
• Alkaline phosphatase and CPK blood levels are obtained, to exclude Paget’s disease and polymyositis
• A blood vitamin D level can help detect vitamin D deficiency

A differential diagnosis may be undertaken to exclude the following conditions:

• Hypothyroidism
• Polymyalgia rheumatica

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Fibromyalgia?

Following are the medical complications that may arise out of Fibromyalgia:

• Fibromyalgia may interfere with the daily routine of the individual and their ability to either work at home or work place
• Causes frustration leading to depression and other health-related anxieties
• Severe, chronic, and widespread pain throughout the body
• Sleep disturbances
• Memory or cognitive problems called fibro fog
• Restless leg syndrome
• Tension headaches and migraine (headache that affects only one side of the head)
• Sensitivity to light
• Gastrointestinal symptoms, such as nausea, stomach cramping, and gastroesophageal reflux disease (GERD)
• In women: Painful menstrual periods and painful abdominal cramping

How is Fibromyalgia Treated?

Fibromyalgia is difficult to treat. Healthcare providers, who are adept and comfortable in managing the condition, may be more helpful. The treatment involves a combination of medication, self-care techniques, and non-drug therapies. The main focus is on minimizing symptoms and improving general health.

Medications may include tricyclic antidepressants to:

• To reduce muscle pain 
• To reduce anxiety and depression
• To promote restful sleep

Other medications are meant to calm excited nerves, block nerve pains, or increase the amount of two brain nerve transmitters (serotonin and norepinephrine).

Other treatments include:

• Local injections, analgesics, or cortisone medication administered to the tender points may be recommended
• Use of pain-relievers, muscle relaxants, and non-steroidal anti-inflammatory drugs (NSAIDs)
• Bio feedback and electro-acupuncture are used for relief of symptoms

Home care techniques:

• Physical activities and exercises: Regularly perform some low impact exercises, such as walking, swimming, water aerobics, or biking, to relax the muscles and help with tenderness
• Heat may be applied to sore muscles to relieve the pain
• Stretching exercises may help to a large extent in relaxing the muscles
• Massaging the painful areas helps in reducing the pain
• Use of medications, analgesics (such as acetaminophen, aspirin, ibuprofen, and naproxen), anti-seizure drugs may be recommended, as painkillers and pain-relievers
• Strong pain killers like Codeine or Tramadol could be used when the pain is severe and unbearable

Therapies include:

• Cognitive behavioral therapy (CBT): Talking with a healthcare counselor may help deal with stressful situations
• Antipsychotic medicines, such as neuroleptics, to treat chronic pain resulting from Fibromyalgia
• Psychotherapy to understand and deal with thoughts and feelings
• Relaxation techniques, like listening to music, use of dimly lit spaces, and maintaining the room temperature to the optimum required 
• Physiotherapy exercises, like massaging will improve muscle stiffness/weakness
• Acupuncture: A thin needle is inserted into certain points in the body to relieve pain

How can Fibromyalgia be Prevented?

Currently, no preventive methods are available for Fibromyalgia. Treatment can only reduce the symptoms and duration of the disease. However, the following self-care techniques may help reduce one’s risk for Fibromyalgia:

• Adopt a healthy lifestyle, maintain a healthy diet (a proper, nutritious diet gives you more energy and makes you feel better)
• Get enough sleep and have a regular sleep pattern
• Maintain a positive attitude and outlook
• Aerobic fitness exercises, activities like swimming, cycling, walking, other physical therapies, are beneficial. These have to be performed regularly
• Individuals have to be educated and made aware of the disorder
• Make changes at your work place; adjust the workspace and cut down any wasteful working hours
• Undertake body cleansing; this normally includes a cleansing of the bowels, teeth, kidneys, and liver
• Alternative treatment techniques which include natural and traditional therapies

Stress reduction may be obtained through relaxation techniques such as the following:

• Muscle relaxation
• Yoga 
• Meditation 
• Acupuncture 
• Biofeedback (a technique to control the body)
• Stress-reducing exercises
• Use of relaxation tapes
• Psychological counseling

What is the Prognosis of Fibromyalgia? (Outcomes/Resolutions)

• Fibromyalgia is a long-lasting disorder with no cure available presently. However,  it is not a progressive condition, and therefore does not cause any long-term organ damage. It also does not place one at a higher risk for cardiovascular disease, stroke, or any form of physical deformities
• Individuals with Fibromyalgia may have improved outcomes through proper self-care, healthy lifestyle, and medications

Additional and Relevant Useful Information for Fibromyalgia:

Following are helpful facts that help understand the differences between Chronic Fatigue Syndrome (CFS) and Fibromyalgia:

• Fibromyalgia and chronic fatigue syndrome can have similar symptoms
• Both may co-exist, which makes the diagnosis of either Fibromyalgia, or CFS very challenging, in such individuals
• Generally, in Fibromyalgia the primary symptom is generalized pain, whereas CFS main symptom is chronic fatigue, which does not get better even with rest
• It is estimated that 3 in 4 individuals with Fibromyalgia may have chronic fatigue syndrome and vice versa
• In Fibromyalgia, a chemical in the brain, called substance P is increased in levels. But in CFS, there is no increase in the substance. Substance P is responsible for pain perception
• A protein called RNasel is increased in cells with CFS, but such increase is not seen in Fibromyalgia
• Generally, Fibromyalgia symptoms are initiated by physical stresses to the body (such as a major surgery, or an injury to the body due to an accident). On the other hand, chronic fatigue syndrome often starts after an individual has suffered a flu-like illness

The National Institute of Arthritis & Musculoskeletal and Skin Disease (NIAMS) recommend certain “Tips for a Good Sleep”. This could be additionally helpful for individuals suffering from Fibromyalgia.