Amanda Wray What is Fibromyalgia? Fibromyalgia (fy-bro-my-AL-ja) is a common and complex chronic pain disorder that causes widespread pain and tenderness to touch that may occur body wide or migrate over the body. Along with other symptoms, pain and tenderness wax and wane over time. Fibromyalgia (FM) affects people physically, mentally and socially. Approximately 10 million Americans (2-4%) have FM with a ratio of about 8 to 2, women over men. It occurs in people of all ages, including children. The literal translation of the word fibromyalgia is pain in the muscles, ligaments and tendons. But FM is much more than pain and presents with many other symptoms that vary from person to person. Healthcare providers diagnose FM based on a combination of relevant symptoms, or how the person feels, including fatigue, tenderness, functionality, and overall well-being. Lab tests may be needed to rule out or diagnose co-existing conditions (i.e., lupus, thyroid hormone resistance, rheumatoid arthritis). Symptoms of fibromyalgia can vary in intensity. Fatigue, sleep disturbances (sleep apnea and/or waking up unrefreshed), cognitive difficulties (memory problems or thinking clearly), and stiffness are the most prevalent symptoms reported. Additional common symptoms may include depression or anxiety, migraines, tension headaches, pelvic pain, irritable or overactive bladder, irritable bowel syndrome (IBS), TMJD (including tinnitus), and gastrointestinal reflux disease (GERD). Stress often worsens the related problems and symptoms. In a 2013 survey of people with fibromyalgia by Oregon Health and Sciences University and the National Fibromyalgia & Chronic Pain Association, symptoms were measured as well as the impact of fibromyalgia on daily living. (To read survey results, please click here.) There is no cure for fibromyalgia. Multi-disciplinary approaches for management and relief of symptoms are often recommended. Medications, cognitive behavioral therapies, and gentle exercise are the most common combinations. In partnership with a healthcare provider, development of self-management strategies and long-term health goals may reduce the chronic symptoms and the frequency, duration, and intensity of periodic flares (rapid increase of symptoms). Cultural attitudes and stigmatization of people with chronic pain issues often cause people with fibromyalgia to become withdrawn from family and friends. Isolation and feeling alone to manage fibromyalgia can contribute to depression. Symptoms -> HISTORY FM has existed for centuries, and our great grandmothers who experienced FM symptoms were probably diagnosed with rheumatism. In 1904 Sir William Gowers gave a Lecture on Lumbago: Its Lessons and Analogues, to physicians at the National Hospital for the Paralyzed and Epileptic in London, England. It was during this lecture that Dr. Gowers described "fibrositis" for the first time and the term began to be used as a descriptive word for the symptoms of soft tissue rheumatism. The word fibrositis indicated that inflammation was present which contributed to the patient's pain experience. As science advanced and more was learned about the disorder, it became evident that the kind of inflammation found in arthritic diseases is not present in FM. It took until 1976 for the "itis"to be dropped and fibromyalgia syndrome adopted as the new title for this age old malady. Syndrome was added to fibromyalgia because the term offers a way to compile the different symptoms of fibromyalgia into one disorder, discernible by healthcare professionals. In the late 1990's fibromyalgia syndrome (FMS) transitioned into just fibromyalgia (FM) because research began to uncover more scientific evidence of FM being a distinct entity. Although FM has become a familiar medical term, it continues to baffle the professional community as well as the people it affects. SCIENTIFIC PERSPECTIVE Fibromyalgia is a chronic pain state in which the nerve stimuli causing pain originates mainly in the tissues of the body. Hence the increased pain on movement and the aggravation of fibromyalgia by strenuous exertion. Pain is a universal experience that serves the vital function of triggering avoidance. A few unfortunate individuals have a congenital absence of pain sensation; they do not fare well due to repeated bodily insults that go unnoticed. Physicians see patients with an acquired deficiency in the pain sensation (e.g. diabetic neuropathy or neurosyphilis) who develop a severe destructive arthritis--a result of repeated minor joint injuries that are overlooked. Thus pain sensation is a necessary part of being human. Pain sensation is a fact of life. Even the primitive amoeba takes avoiding action in the face of adverse events. In such primitive life forms, pain avoidance is purely reflex action, as they do not have the complexity of a highly developed brain to feel pain in the sense that humans do: (1)The unconscious reflex avoidance reaction that is so rapid that it occurs before the actual awareness of the pain sensation (as in all life forms), (2) the actual experience of the pain sensation (that can only occur in highly complex organisms). This is an important point, as it implies that different parts of the brain are involved in these two consequences of the pain reaction. Over the last few years a number of important research discoveries have started to clarify the enigma of chronic pain. Many of these new findings have a special relevance to the chronic pain of fibromyalgia. The cardinal symptom of FM is widespread body pain. The cardinal finding is the presence of focal areas of hyperalgesia, the tender points. Tender points imply that the patient has a local area of reduced pain threshold, suggesting a peripheral pathology. In general, tender points occur at muscle tendon junctions, a site where mechanical forces are most likely to cause micro-injuries. Many--but not all--FM patients have tender skin and an overall reduction in pain threshold. These latter observations suggest that some FM patients have a generalized pain amplification state. There has been a recent plethora of experimental studies apposite to the pathophysiological basis of both the peripheral and central aspects of pain. In his article "Fibromyalgia: A Clinical Review" published in the Journal of the American Medical Association (JAMA), April 16, 2014, Dr. Dan Clauw, Director of the University of Michigan’s Chronic Pain and Fatigue Research Center expands on current scientific thought regarding the type of pain experienced by people with fibromyalgia:“Fibromyalgia can be thought of as a centralized pain state. Centralized pain is a lifelong disorder beginning in adolescence or young adulthood manifested by pain experienced in different body regions at different times. Centralized refers to central nervous system origins of/or amplification of pain. This term does not imply that peripheral nociceptive input (i.e. damage or inflammation of body regions) is not contributing to these individuals’ pain but rather that they feel more pain than would normally be expected based on the degree of nociceptive input. Understanding centralized pain is important for surgeons and proceduralists because patients with these disorders may request interventions to eliminate pain (e.g. hysterectomy, back surgery). Not surprisingly, this pain-prone phenotype, best exemplified by a patient with fibromyalgia, predicts failure to respond to opioids or operations performed to reduce pain.” PATIENT PERSPECTIVE Symptom severity of FM ranges from slight to severe. Fibromyalgia is life-altering. If you ask any person with fibromyalgia what fibromyalgia is, their response would be pain; from the top of their head to the end of their toes. Pain that "waxes and wanes" from day to day and persists even with the use of scientifically accepted medical treatments. The pain experience is described as deep muscular aching, shooting, throbbing, stabbing, pounding, along with many other descriptions, and at times it is unbearable. People with FM do not sleep well, waking up feeling like they have been hit by a "Mack truck," with morning stiffness or spasticity that makes it difficult to move. Repetitive movement seems to accentuate the pain and forces many people with FM to severely limit their activities, including exercise routines. This lack of exercise results in people becoming physically unfit, causing their FM symptoms to become more severe. The other major complaint is fatigue so severe that people have a difficult time performing everyday tasks, enjoying hobbies, staying employed or taking part in their children's activities. People may feel as though their arms and legs are weighed down by cement, and their bodies may feel so drained of energy that every task is a major effort. The progression of fibromyalgia research has provided new knowledge about centralized pain that is already helping to open doors to better, more effective treatment for people with fibromyalgia.