Fibromyalgia…..a familiar medical term associated with chronic pain, but what exactly is Fibromyalgia?
Fibromyalgia; the clinical definition:
“a chronic disorder characterized by widespread pain that is often accompanied by fatigue, depression, sleep disturbance, cognitive impairment, and digestive and urinary symptoms.”
It is a poorly understood disorder in which pain signals processed by the brain appear to be exaggerated, amplifying the sensation of pain in muscles and soft tissues. There are no tests to identify it, so fibromyalgia is diagnosed by excluding other possible causes.
Fibromyalgia; the timeline:
Back to the Beginning (1592-1900)
Early on, doctors didn’t have separate definitions for all the pain conditions we recognize today. Descriptions and terminology started out broad and gradually were narrowed down.
In 1592, French physician Guillaume de Baillou introduced the term “rheumatism ” to describe musculoskeletal pain that didn’t originate from injury. This was a broad term that would have included fibromyalgia as well as arthritis and many other illnesses. Eventually, doctors began to use “muscular rheumatism” for painful conditions that, like fibromyalgia, didn’t cause deformity.
Two-hundred years later, definitions still were rather vague. However, in 1815, Scottish surgeon William Balfour noted nodules on connective tissues and theorized that inflammation could be behind both the nodules and pain. He was also the first to describe tender points (which would later be used to diagnose fibromyalgia.)
A few decades later, French doctor, Francios Valleix, used the term “neuralgia” to describe what he believed was referred pain from tender points traveling along the nerves. Other theories of the day included hyperactive nerve endings or problems with the muscles themselves.
In 1880, American neurologist George William Beard coined the terms neurasthenia and myelasthenia to describe widespread pain along with fatigue and psychological disturbance. He believed the condition was caused by stress.
1900–1975
The creation of more specific terminology really exploded in the early 20th century. Different names for fibromyalgia-like illness included:
- Myogeloses
- Muscle hardening
- Fibrositis
Fibrositis, coined in 1904 by British neurologist Sir William Gowers, is the one that stuck. The symptoms Gowers mentioned will look familiar to those with fibromyalgia:
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Spontaneous pain
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Sensitivity to pressure
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Fatigue
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Sleep disturbances
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Sensitivity to cold
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Aggravation of symptoms by muscle over-use
As a treatment, he suggested cocaine injections, as cocaine was then used medicinally as a topical anesthetic.
Medically, “fibro” means connective tissue and “itis” means inflammation. Soon after Gowers put forth the name, another researcher published a study seeming to confirm many of Gowers’ theories about the mechanisms of inflammation in the condition. This helped cement the term fibrositis in the vernacular. Ironically, this other research was later found to be faulty.
In the 1930s, interest heightened in muscle pain referred from tender/trigger points and charts of these patterns began to appear. Local injections of anesthetic continued to be a suggested treatment.
Fibrositis wasn’t a rare diagnosis back then. A 1936 paper stated the fibrositis was the most common form of severe chronic rheumatism. It also said that, in Britain, it accounted for 60 percent of insurance cases for rheumatic disease.
Also in that era, the concept of referred muscle pain was proven via research. A study on pain pathways mentioned deep pain and hyperalgesia(a heightened pain response) and may have been the first to suggest that the central nervous system was involved in the condition.
Additionally, a paper on trigger points and referred pain put forth the term “myofascial pain syndromes” for localized pain. Researchers suggested that the widespread pain of fibrositis may come from one person having multiple cases of myofascial pain syndrome.
World War II brought a renewed focus when doctors realized that soldiers were especially likely to have fibrositis. Because they didn’t show signs of inflammation or physical degeneration, and symptoms appeared linked to stress and depression, researchers labeled it “psychogenic rheumatism.” A 1937 study suggested that fibrositis was a “chronic psychoneurotic state.” Thus, the on-going debate between physical and psychological was born.
Fibrositis continued to gain acceptance, even though doctors couldn’t agree on exactly what it was. In 1949, a chapter on the condition appeared in a well-regarded rheumatology textbook called Arthritis and Allied Conditions. It read, “[T]here can no longer be any doubt concerning the existence of such a condition.” It mentioned several possible causes, including:
- Infection
- Traumatic or occupational
- Weather factors
- Psychological disturbance
Still, descriptions were vague mish-mashes that we now recognize as including several very different types of pain conditions. They generally involved fatigue, headaches, and psychological distress, but poor sleep wasn’t mentioned.
The first description of fibrositis that truly resembles what we recognize today as fibromyalgia came in 1968. Researcher Eugene F. Traut’s paper mentioned:
- Female predominance
- Generalized aching and stiffness
- Fatigue
- Headaches
- Colitis
- Poor sleep
- Being “worry worts”
- Tender points discovered by physical exam
- An important mind-body connection
Along with generalized pain, he recognized certain regional ones that appeared to be common, including what we now know as carpal tunnel syndrome. He mentioned “various levels of the spinal axis,” which you may recognize from modern diagnostic criteria: pain in the axial skeleton (bones of the head, throat, chest, and spine) and in all four quadrants of the body.
Four years later, though, researcher Hugh A. Smythe penned a textbook chapter on fibrositis that had a far-reaching influence on future studies and led to his being called the “grandfather of modern fibromyalgia.” He’s believed to be the first to describe it exclusively as a widespread condition, thus distinguishing it from myfascial pain syndrome.
Smythe not only included poor sleep in the description but described what sleep was like for patients and also provided unpublished electroencephalogram (sleep study) findings that showed dysfunction in stage-3 and stage-4 sleep. Further, he stated that non-restorative sleep, trauma, and emotional distress all could lead to heightened symptoms.
Subsequent research confirmed sleep abnormalities as well as showing that sleep deprivation can lead to fibromyalgia-like symptoms in healthy people.
Smythe then was involved in a study that better defined tender points and suggested their use in diagnosis. It also listed chronic pain, disturbed sleep, morning stiffness, and fatigue as symptoms that could help diagnose the condition.
1976 – Present
While researchers had made some good progress, they still hadn’t uncovered evidence of inflammation, the “itis” in fibrositis. The name was then changed to fibromyalgia: “fibro” meaning connective tissues, “my” meaning muscle, and “algia” meaning pain.
Still, a lot of questions remained. The primary symptoms were vague and common in the population. Doctors still didn’t have a handle on what fibromyalgia was.
Then, a seminal study lead by Muhammed Yunus came out in 1981. It confirmed that pain, fatigue, and poor sleep were significantly more common in people with fibromyalgia than in healthy control subjects; that the number of tender points was significantly greater; and that multiple other symptoms were significantly more common as well. These additional symptoms included:
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Subjective swelling
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Paresthesia (abnormal nerve sensations)
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Overlapping conditions such as irritable bowel syndrome (IBS), tension headaches, and migraines
This paper established enough of a consistent symptom cluster to officially denote fibromyalgia a syndrome as well as the first criteria proven to differentiate those with fibromyalgia from others.
A wealth of research has since confirmed that these symptoms and overlapping conditions are in fact associated with fibromyalgia.
Yunus then led research cementing the idea of several overlapping conditions, including primary dysmenorrhea (painful period) along with IBS, tension headache, and migraine. He then believed the unifying feature was muscle spasms, but that suggestion would later give way to the theory of central sensitization.
Since this point, we’ve had a tremendous amount of research published and progress made. We still don’t have all the answers, but we’ve gained a much better understanding of what may be going on in our bodies.
Important advances include:
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1984: First study published linking higher fibromyalgia prevalence in those with rheumatoid arthritis
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1985: First controlled study of juvenile fibromyalgia was published
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1986: Drugs influencing serotonin and norepinephrine were first shown to be effective
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1990: American College of Rheumatology establishes official diagnostic criteria of widespread pain and tenderness in at least 11 of 18 specific tender points, thus standardizing research inclusion criteria around the world
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1991: Fibromyalgia Impact Questionnaire developed for doctors to evaluate the function
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1992: Discovery of low growth-hormone levels
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1993: Studies demonstrate central sensitization and HPA axis (stress regulation) abnormalities
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1994: Confirmation of elevated substance P (pain messenger) in cerebrospinal fluid
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1995: First U.S. prevalence study shows fibromyalgia in two percent of the population
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1995: First SPECT (brain imaging) showing abnormal blood-flow patterns in the brain
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1999: First study demonstrating a genetic component to explain why it runs in families
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2000: Review of evidence coins the term central sensitization syndromes
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2005: American Pain Society releases first guidelines for treating fibromyalgia pain
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2007: Lyrica (pregabalin) becomes first FDA-approved treatment in the U.S. (Cymbalta (duloxetine) and Savella (milnacipran) followed, in 2008 and 2009, respectively
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2010: American College of Rheumatology releases alternate diagnostic criteria using questionnaires instead of tender points
Research has continued to shore up these findings as well as suggest new possible causal factors and mechanisms. Some ongoing lines of inquiry include:
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Inflammation of the Fascia: some research has suggested that the widespread pain of fibromyalgia may indeed be inflammatory, but in the extremely thin body-wide web of connective tissue called fascia
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Extra Nerves on Blood Vessels: a much-publicized study shows extra temperature and pain-sensing nerves in the circulatory system
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Small-fiber neuropathy: emerging research is showing that certain specialized nerves may be damaged
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Immune System Abnormalities: some lines of research are showing abnormal activity in the immune system that may suggest chronic immune-system activation or autoimmunity, or a possible autoimmune reaction to serotonin
Several researchers also are working to establish subgroups of fibromyalgia, believing that it’s the key to nailing down the underlying mechanisms and best treatments. More treatments are always under investigation, and a major goal has long been identifying and establishing objective diagnostic tools such as a blood test or scan.
(source; verywellhealth)
Fibromyalgia…..”clear as mud”
Ok; let’s try to simplify Fibromyalgia pain from other pain.
The mimicry of widespread pain and fatigue syndromes…..
The presence of widespread pain and fatigue opens the door for a plethora of medical conditions, stemming from a variety of root causes and making it critical for the practitioner to conduct a systematic evaluation before landing on the diagnosis of fibromyalgia. There are 3 broad categories of conditions – other than classic fibromyalgia – that are most often the cause of widespread pain and fatigue:
(1) Medical problems are caused by the presence of any medical condition or disease such as thyroid disease, diabetes, Lyme disease, cancer, and others.
(2) Musculoskeletal problems cause pain that is actually arising from a specific muscle or joint and includes myofascial pain syndrome, trigger points or “muscle knots”, and spinal joint problems such disc degeneration and pinched nerves.
(3) Metabolic/Functional problems represent sub-clinical conditions involving dysfunction of internal organs and individual metabolism, rather than true pathology or disease. These include subtle functional hypothyroidism, inefficiency of energy production in the cells due to mitochondrial dysfunction, nutritional deficiencies, chemical and food sensitivities, reactions to medications, and other problems with body metabolism and biochemistry.
Unfortunately, the standard treatment approach for classic fibromyalgia will not help patients whose pain and fatigue is rooted in any of these 3 categories.
The root of classic fibromyalgia
So what sets fibromyalgia apart from its camouflaging conditions?
The simple answer is the central nervous system. Classic fibromyalgia involves a hyper-responsive nervous system that accentuates pain in response to normal stimuli.
Studies are showing strong correlations between physical and/or emotional trauma, particularly during early life (childhood), and the development of fibromyalgia.
Some people develop fibromyalgia after a severe car accident, work related injury, serious surgical procedures, physical or emotional abuse, or after witnessing a horrific event.
These traumatic events derail the central nervous system and may lead to a heightened and prolonged pain response to normal stimuli such as bright lights, sounds, changes in temperature, moderate pressure on the skin or muscles, household chemicals, etc.
Many fibromyalgia patients have extraordinary amounts of stress in their life or have experienced intensely emotional events in the past. The stress and emotional trauma disrupts the brain’s ability to process pain appropriately.
Therefore, widespread pain and fatigue in the presence of stress and trauma, but in the absence of a metabolic, functional, or musculoskeletal problem, often points to classic fibromyalgia.
(source; fibrofix)
Fibromyalgia; what are the signs & symptoms?
Fibromyalgia is a syndrome because there are multiple symptoms associated with it. If you have only one or two of the symptoms, you are less likely to be diagnosed with that specific disease, or less likely to develop that disease. Here are the symptoms you can expect to exhibit together if you have fibromyalgia:
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Anxiety or depression
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Decreased pain threshold or tender points
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Incapacitating fatigue
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Widespread pain
Most of the people who suffer from this painful condition are women between ages 25 and 60. Women are 10 times more likely to get this disease than men.
The biggest characteristic of fibromyalgia is widespread pain, and not just in one place. It’s severe pain throughout the person’s whole boyd.
Pain is the main reason people go to the doctor in the first place and end up getting diagnosed with the disease.
The types of pain can include:
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Deep pain
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Sharp pain
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Throbbing
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Aching
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Soreness
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Burning
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Gnawing
The pain can usually comes and goes without much warning.
It’s still not clear what actually causes this common and painful condition. In fact, researchers have concluded that fibromyalgia is caused by a combination of several factors, not one single thing.
Some researchers have said that lower levels of serotonin – a brain neurotransmitter that regulates pain sensitivity – is to blame for fibromyalgia, while others theorize that significant hormonal changes, like menopause, cause the onset of the disease.
That could explain why so many more women are diagnosed with fibromyalgia every year.
It’s important to note that there are many theories about the causes of fibromyalgia, and all of them are exactly that: theories. There has been no clear consensus on a singular cause.
What are the symptoms of fibromyalgia?
Some of the symptoms of fibromyalgia — also known as fibromyalgia syndrome or FMS — can include the following:
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Pain
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Anxiety
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Concentration and memory problems — known as “fibro fog”
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Depression
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Fatigue
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Headaches
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Irritable bowel syndrome
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Morning stiffness
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Painful menstrual cramps
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Sleep problems
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Numbness, and tingling in hands, arms, feet, and legs
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Tender points
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Urinary symptoms, such as pain or frequency
(source; louisianapain)
Diagnosing Fibromyalgia is challenging to say the least….for today
In the not-so-distant-future; a groundbreaking 100 % accurate/reliable blood test will detect fibromyalgia.
New research finds an accurate way of diagnosing fibromyalgia and differentiating it from other related conditions. Using blood samples and innovative techniques, scientists have detected a “molecular fingerprint” that is unique to the condition.
Being developed by researchers at Ohio State University, it’s expected to be ready to be put-into-play within 5 years.
Click on the following link to learn more:
Fibromyalgia Blood Test
The Ohio State University Fibromyalgia Blood Test is not the first Fibromyalgia blood test to be developed. Two other diagnostic tests are currently available:
- In 2012, EpicGenetics introduced the FM/a® Test, an FDA-compliant blood test based on identifying the unique immunologic patterns in fibromyalgia. It is 95% accurate and is covered by Medicare and most insurance plans.
- In 2018, IQuity introduced the IsolateFibromyalgia® test, which relies on RNA gene expression to identify fibromyalgia. It is 94% accurate but is not yet covered my most insurance plans.
Even though there are already two blood tests for Fibromyalgia on the market, some doctors remain skeptical of their accuracy (source; prohealth).
Today, Fibromyalgia can’t be easily confirmed or ruled out through a simple laboratory test. Your doctor can’t detect it in your blood or see it on an X-ray. Instead, fibromyalgia appears to be linked to changes in how the brain and spinal cord process pain signals.
Because there is no definitive 100% accurate test for diagnosing fibromyalgia, your doctor must rely solely on your group of symptoms to make a diagnosis.
In the American College of Rheumatology guidelines for diagnosing fibromyalgia, one of the criteria is widespread pain throughout your body for at least three months. “Widespread” is defined as pain on both sides of your body, as well as above and below your waist.
Old guidelines required tender points……
Fibromyalgia is also often characterized by additional pain when firm pressure is applied to specific areas of your body, called tender points. In the past, at least 11 of these 18 spots had to test positive for tenderness to diagnose fibromyalgia.
But fibromyalgia symptoms can come and go, so a person might have 11 tender spots one day but only eight tender spots on another day. And many family doctors were uncertain about how much pressure to apply during a tender point exam. While specialists or researchers may still use tender points, an alternative set of guidelines has been developed for doctors to use in general practice.
These newer diagnostic criteria include:
- Widespread pain lasting at least three months
- Presence of other symptoms such as fatigue, waking up tired and trouble thinking
- No other underlying condition that might be causing the symptoms
Excluding other possible causes…..
It’s important to determine whether your symptoms are caused by some other underlying problem. Common culprits include:
- Rheumatic diseases. Certain conditions — such as rheumatoid arthritis, Sjogren’s syndrome and lupus — can begin with generalized aches and pain.
- Mental health problems. Disorders such as depression and anxiety often feature generalized aches and pain.
- Neurological disorders. In some people, fibromyalgia causes numbness and tingling, symptoms that mimic those of disorders such as multiple sclerosis and myasthenia gravis.
- MS. Fibromyalgia symptoms can be similar to MS symptoms. Click on the following link to learn about differences between Fibromyalgia & MS.
Tests that may be needed….
While there is no 100% accurate lab test to confirm a diagnosis of fibromyalgia, your doctor may want to rule out other conditions that may have similar symptoms. Blood tests may include:
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Complete blood count
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Erythrocyte sedimentation rate
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Thyroid function tests
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Vitamin D levels
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Extremely low testosterone level
Your doctor may also perform a careful physical exam of your muscles and joints, as well as a neurological exam to look for other causes of your symptoms. If there’s a chance that you may be suffering from sleep apnea, your doctor may recommend a sleep study.
More clues for fibromyalgia diagnosis….
People who have fibromyalgia also often wake up tired, even after they’ve slept continuously for more than eight hours. Brief periods of physical or mental exertion may leave them exhausted. They may also have problems with short-term memory and the ability to concentrate. If you have these problems, your doctor may ask you to rank how severely they affect your day-to-day activities.
Fibromyalgia often coexists with other health problems, so your doctor may also ask if you experience:
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Irritable bowel syndrome
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Headaches
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Jaw pain
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Anxiety or depression
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Frequent or painful urination
Possible fibromyalgia triggers…….
In some cases, fibromyalgia symptoms begin shortly after a person has experienced a mentally or physically traumatic event, such as a car wreck. People who have post-traumatic stress disorder appear to be more likely to develop fibromyalgia, so your doctor may ask if you’ve experienced any traumatic events recently.
Because a genetic factor appears to be involved in fibromyalgia, your doctor may also want to know if any other members of your immediate family have experienced similar symptoms.
All this information taken together will give your doctor a much better idea of what may be causing your symptoms. And that determination is crucial to developing an effective treatment plan.
(source; mayoclinic)
As you can see Fibromyalgia is complicated and, in of itself, an added strand within one’s painweb that causes significantly more pain and frustration.
