All About Fibromyalgia

What is Fibromyalgia ?

Fibromyalgia, like many other common chronic pain syndromes , remains a controversial condition. The role of organic disease has been questioned and is generally considered psychogenic or psychosomatic by some, given that the patients are in good general condition, there are no obvious abnormalities on physical examination other than diffuse soft tissue tenderness, and laboratory and radiological examinations of musculoskeletal structures are normal. However, ongoing research suggests that fibromyalgia usually central suggests a pain regulation disorder classified as a form of sensitization . Fibromyalgia (FM) is the most common cause of chronic widespread musculoskeletal pain, often accompanied by fatigue, cognitive impairment, psychiatric symptoms , and multiple somatic symptoms. The etiology of the syndrome is not known exactly and its pathophysiology is unclear. Despite the symptoms of soft tissue pain affecting the muscles, ligaments and tendons , there is no evidence of inflammation in these tissues .

While fibromyalgia is a common disease that includes widespread pain, tenderness, fatigue, and other symptoms , it is not a form of arthritis (joint inflammation), but, like arthritis , it can impair a person’s ability to perform daily activities. Fibromyalgia is not an inflammatory or autoimmune disease. Brain chemicals such as serotonin and norepinephrine can be unbalanced and alter responses to painful stimuli. Fibromyalgia can cause fatigue, poor sleep, and mood problems such as anxiety or stress. It does not cause any findings in X-ray and blood tests.



Fibromyalgia is an often unrecognized syndrome . It affects 2% of the population, with the highest frequency in middle-aged women. Although its pathogenesis is not fully understood, there are increasing successful applications for mechanism-based management approaches to this syndrome . These are likely to be more effective if applied early, making timely diagnosis even more important in general practice.
It overlaps with other functional somatic syndromes such as fibromyalgia , irritable bowel syndrome , chronic fatigue syndrome, and temporomandibular joint dysfunction . It can commonly occur with mood and anxiety disorders. However, research shows that although functional somatic disorders are associated with and potentially interact with psychological conditions, the picture is independent.
Fibromyalgia is characterized by the hallmarks of widespread somatic pain and deep tissue tenderness, often resulting from sensitization of neural pain pathways. There are also variable associations of fatigue, sleep disturbance, cognitive dysfunction, and psychological distress.

How does fibromyalgia occur?

Fibromyalgia may develop spontaneously, but in genetically predisposed individuals it is likely to represent a stereotypical, maladaptive, biological response of the body to the cumulative effects of physical or psychological stress.
Fibromyalgia is associated with psychiatric and musculoskeletal disorders, which can lead to worse outcomes. However, it can sometimes occur after an infection . It can also occur with increased frequency in people with an existing chronic medical disorder, such as fibromyalgia, rheumatic diseases in general . Most cases of fibromyalgia are caused by persistent regional pain.
Fibromyalgia (FM) is the most common cause of widespread musculoskeletal pain in women ages 20 to 55. It is 6 times more common in women than men and can occur in both children and adults.

Symptoms of fibromyalgia ?

Fibromyalgia is a disease that often causes muscle pain and fatigue. People with fibromyalgia have “tender points” on their body. Tender points are specific locations on the neck, shoulders, back, hips, arms, and legs. These spots are painful when pressure is applied to them.
Fibromyalgia symptoms are different for each patient. The most common symptom is widespread pain that has been present for at least three months and cannot be explained by any other medical condition. Severe fatigue and sleep problems are also common. The patient with fibromyalgia may not feel rested after sleeping all night.



Symptoms of fibromyalgia other than widespread pain include:

• Problems with memory or clear thinking
• depression or anxiety
• Migraine or tension-type headaches
• irritable bowel issues or heartburn
• Irritable or overactive bladder
• groin pain
• jaw pain

● Diffuse musculoskeletal pain
Typically, patients with FM involve at least six areas, which may include the head, each arm, chest, abdomen, each leg, upper back and spine, and lower back and spine ( including the hips).
Sometimes the pain may initially be localized , usually in the neck and shoulders . Patients express “I feel like I’m hurting all over” or “I feel like I have the flu all the time”. Patients typically describe pain predominantly along the muscles, but often report that their joints also ache and sometimes describe joint swelling, but no joint inflammation or synovitis is present on examination.

● Fatigue and sleep disturbances – Moderate to severe persistent fatigue and sleep disturbances are key features of FM diagnosis. Seemingly minor activities exacerbate pain and fatigue, but prolonged inactivity also increases symptoms . Patients are stiff in the morning and do not feel rested even if they have slept 8 to 10 hours. Morning stiffness rheumatoid arthritis (RA) or polymyalgia It can be difficult to distinguish from rheumatic diseases such as rheumatica . These patients characteristically sleep “lightly”, wake up frequently in the early hours of the morning, and have difficulty falling back asleep. They often say, “No matter how long I sleep, I feel like a truck passed me in the morning.”

● Cognitive disorders – Cognitive disorders are present in most patients with fibromyalgia . Patients typically have problems with attention and difficulty performing tasks that require rapid thought changes. Neuropsychological tests reveal abnormalities that are slightly different from those found in psychiatric disorders. However, subjective cognitive deficits are much more common.



● Psychiatric symptoms – 30 to 50 percent of patients have depression and/or anxiety at the time of diagnosis . Features such as anxiety disorders, bipolar disorder, post- traumatic stress disorder (PTSD), and catastrophizing and alexithymia are more common in patients with fibromyalgia than in the general population.

● Headache – Headache is present in more than 50 percent of patients with FM and includes the migraine and muscle (tension) types. In fibromyalgia , the frequency of headache, anxiety , sensitivity around the head, poor sleep and physical disability are directly proportional to each other. Fibromyalgia is particularly common in patients with migraine.

● Paresthesias – Patients also frequently report paresthesias , including numbness, tingling, burning, or chafing sensations , particularly in both arms and both legs . However, carpal tunnel syndrome or cervical A thorough neurological evaluation or formal electrophysiological testing is usually not worth considering unless there is a concomitant neurological disorder such as radiculopathy .

● Other symptoms and disorders – Patients may also have a variety of pain symptoms that are not fully understood, including abdominal and chest wall pain; symptoms suggestive of IBS ; and pelvic pain and frequency and urgency bladder symptoms suggestive of interstitial cystitis/painful bladder syndrome.

Irritable bowel syndrome is the most common gastrointestinal disorder associated with fibromyalgia . syndrome , although gastroesophageal reflux disease is more common than the general population
Autonomic nervous system dysfunction , dry eyes and Raynaud’s in fibromyalgia The symptoms of the phenomenon are also common. Orthostatic hypotension and altered heart rate variability are common manifestations of autonomic nervous system dysfunction . Dry eye syndrome is 1.4 times higher in fibromyalgia compared to the general population . Raynaud’s Phenomenon is common in fibromyalgia , but primary Raynaud Thermographic and microvascular abnormalities seen in the phenomenon are not seen in fibromyalgia patients.



Hearing loss has also been reported four to five times more frequently in patients with fibromyalgia than in the general population .

Diagnosis of fibromyalgia

Fibromyalgia (FM) should be suspected in patients with chronic pain lasting at least three months without any other identified cause . The diagnosis of FM is symptom- based . FM can usually be diagnosed based on symptoms of widespread pain at multiple sites, often accompanied by moderate to severe sleep or fatigue problems and lasting at least three months; other symptoms may also be present. Physical examination does not reveal joint swelling or other inflammatory changes , although there is widespread tenderness at multiple sites.

Fibromyalgia is a series of subjective symptoms. It is based on documentation of the symptom and the exclusion of other conditions that may cause these symptoms. There are no confirmatory tests or biomarkers . Therefore, the clinician’s familiarity with the diagnosis and a comprehensive clinical encounter are crucial in making a timely diagnosis.

In fibromyalgia Evaluation includes a thorough history and physical examination, along with limited laboratory tests to rule out other conditions.

• Characteristics of pain – The main symptom of fibromyalgia is chronic widespread pain or multi-site pain that has been present for at least three months. The location, duration, quality, and severity of pain are documented.

• Sleep, fatigue, and other associated symptoms and disorders – Patients are asked detailed questions about sleep, mental and physical energy, cognitive impairments, mood disorders and other psychiatric conditions, and other conditions that overlap with fibromyalgia and may be considered part of it. These include chronic migraine or other headache disorders, IBS, chronic pelvic and/or bladder pain and chronic temporomandibular pain symptoms etc. includes.

• Other disorders and differential diagnosis – Inflammatory disorders that can cause musculoskeletal pain and accompany or mimic fibromyalgia rheumatological disorders, localized pain syndromes and thyroid disease etc. researched

identify diffuse soft tissue tenderness and exclude other diseases with similar symptoms .
● Laboratory tests – There are no laboratory tests or radiographic or pathological findings of diagnostic value for fibromyalgia and testing is kept to a minimum . Often only a complete blood count (CBC) and erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) is sufficient. Generally, if another disease or type of disease is suspected, it is evaluated by the relevant specialty .

Fibromyalgia itself does not cause any abnormalities on laboratory tests or routine imaging, certain tests are done to rule out an associated disease or other disease that may mimic fibromyalgia . For example, serological tests such as antinuclear antibody and rheumatoid factor etc. Thyroid function tests or creatinine in patients with suspected thyroid disease or inflammatory muscle disease, respectively kinase (CK) is required. Viral antibody tests or ordering vitamin D levels are not helpful in diagnosing fibromyalgia . Low vitamin D levels are common in patients with chronic pain, but have not found an association with a diagnosis of fibromyalgia .



Obstructive sleep apnea and symptoms of restless legs or repetitive limb movements are referred for a formal sleep evaluation, which may include an overnight polysomnogram . Apnea is generally more common in men with fibromyalgia .

Patients suspected of having an undiagnosed psychiatric disorder such as depression or anxiety should undergo further evaluation and treatment by an experienced specialist in these circumstances.

Classification and diagnostic criteria of fibromyalgia

Fibromyalgia (FM) classifications are useful mostly for clinical research and epidemiological studies. They are not used to diagnose the disease.

AAPT Diagnostic Criteria for Fibromyalgia
1. Multisite pain is defined as 6 or more areas of pain out of a total of 9 possible areas.
2. Moderate to severe sleep problems OR fatigue
3. Multiple site pain plus fatigue or sleep problems must be present for at least 3 months.

The presence of another pain disorder or associated symptoms does not exclude the diagnosis of fibromyalgia. However, a clinical evaluation is recommended to assess any condition that may fully explain the patient’s symptoms or contribute to the severity of symptoms.

Other disorders as fibromyalgia :

Depending on symptoms, medical history, and physical examination, other tests such as ferritin , iron- binding capacity and percent saturation , and vitamin B12 and vitamin D levels may also be evaluated.



fibromyalgia , which are more common than would be expected alone. Some features of these conditions, such as musculoskeletal pain in patients with chronic forms of arthritis , fibromyalgia may mimic or exacerbate symptoms . Patients with depression, obstructive sleep apnea or restless legs syndrome may have sleep disturbance and fatigue. Recognition and effective treatment of these comorbidities can potentially contribute to symptomatic relief in patients with fibromyalgia .

Treatment of fibromyalgia

What Are Common Treatments?
Exercise, yoga, thai Chi or other low-impact aerobic activity is the most effective treatment. Acupuncture, chiropractic , and massage can help relieve symptoms . Psychotherapy can help patients manage stress and anxiety. A sleep specialist can help patients address sleep disorders. Three drugs are FDA-approved for fibromyalgia : duloxetine ( Cymbalta ) and milnacipran ( Savella ) adjust brain chemicals to relieve widespread pain and pregabalin ( Lyrica ), which blocks overactive nerve cells involved in pain. Older medications such as amitriptyline ( Elavil ), cyclobenzaprine ( Flexeril ), and other antidepressants may also be used. Opioids and sleeping pills like zolpidem ( Ambien ) for fibromyalgia It is not recommended for use in the treatment of symptoms .

Personal care, fibromyalgia It is important to manage their symptoms and have a good quality of life. A healthy lifestyle along with medications can help reduce pain, improve sleep, and relieve fatigue.

Exercise should be done frequently, but it should be started lightly. Walking, swimming, stretching, and yoga are beneficial for people with fibromyalgia . More movement should be added to daily routines, such as taking the stairs instead of the elevator. Rest and relaxation are also beneficial. Every day should be timed to relax. Deep breathing or medications can reduce stress. Regular sleep habits, such as going to bed at the same time each night, should be established.

Treatment of Fibromyalgia  combines multimodal , multidisciplinary , non-pharmacological and pharmacological approaches that need to be individually tailored.

Factors that exacerbate pain in fibromyalgia
• Persistent peripheral pain causes ( spinal and/or peripheral arthritis , tendinopathies , and myofascial trigger points)
• Sleep disorders ( obstructive sleep apnea , restless legs, and periodic limb movement disorder)
• Obesity (with consequent pain-sensitizing effects of meta- inflammation )
• To smoke
• Opioid- induced hyperalgesia
• Myopathies
• Depression
•Disruptive cognitive states
• Psychosocial stressors

Non-pharmacological approaches

Fibromyalgia is greater than that of other rheumatic conditions and most chronic diseases. Because medical treatment of fibromyalgia is often only partially successful, patients need ongoing support. This is the most important of all interventions. However, cognitive dysfunction due to fibromyalgia , which is often not noticed by treating professionals, can complicate this process.
Overall, exercise and psychotherapy approaches have the greatest evidence of efficacy among non-pharmacological treatments, but they need to be tailored to the individual. Pre-exercise biomechanical assessment followed by exercise monitoring by a knowledgeable physical therapist is recommended. The promotion of daily physical activity can be supplemented by using an actimeter . Referral to a psychologist should be considered in all patients, especially those who are more psychologically distressed.
Complementary approaches to fibromyalgia treatment may include:
 Nutrition (for example, special diets, dietary supplements, herbs, probiotics and microbial based therapies).
 Psychological support ( eg meditation , hypnosis, music therapies , relaxation therapies).
 Physical modalities ( e.g. acupuncture, massage, spinal manipulation ).
 Psychological and physical (for example, yoga, tai chi , dance therapies , some types of art therapy) or combinations of psychological and nutritional (for example, mindful eating).
fibromyalgia , the following summarizes assessments of the efficacy and safety of specific approaches.
 Acupuncture: Limited evidence suggests that fibromyalgia patients who receive acupuncture have improvement in symptoms such as pain and stiffness compared to those who do not receive acupuncture (for example, people on the waiting list). However, acupuncture for fibromyalgia It has not been shown to be more effective than simulated acupuncture in relieving symptoms . Electroacupuncture may give better results than manual acupuncture.
 Biofeedback techniques : Measures body functions and gives information about them so that the patient can learn to control them. A small number of short-term biofeedback studies , particularly electromyographic (EMG) biofeedback , in which people learn to control and reduce muscle tension , show that it can reduce fibromyalgia pain. However, the overall evidence on biofeedback is so limited that fibromyalgia No definite conclusions have been reached as to whether it is beneficial for the symptoms .
 Guided imagery is a technique in which people are taught to focus on pleasant images to change negative or stressful emotions. Guided imagery can be self-directed or moderated by a practitioner or a recording. Fibromyalgia Studies of directed imagery for symptoms have had inconsistent results. While some studies showed a reduction in symptoms such as pain and fatigue in patients who were taught guided imagery, some studies had no effect. Guided imagery is one of a group of approaches called relaxation techniques. Relaxation techniques are generally considered safe for healthy people. However, sometimes people report experiencing unpleasant experiences, such as increased anxiety.
 Magnetic Therapies: Static (permanent) magnets are found in magnetic mattress pads , shoe inserts, bracelets, and other products. There is not enough evidence about its benefits. Electromagnets are used in a type of therapy called transcranial magnetic stimulation (TMS) that affects brain activity. Magnets and magnetic devices may not be safe for people with metal implants or medical devices such as pacemakers. Headaches have been reported as a side effect in several studies for fibromyalgia .
 Massage therapy : Although it is stated that massage can provide short-term relief in some fibromyalgia symptoms, the evidence is limited. Experts recommend that massage therapy for fibromyalgia should not cause pain. It may be necessary to start with a very gentle massage and gradually increase its intensity over time. Massage therapy appears to carry little risk when performed by a trained practitioner.
 Mindfulness meditation: Mindfulness meditation is a type of meditation that involves focusing entirely on moment-to-moment experiences . In some studies, mindfulness meditation training has led to short-term improvements in pain and quality of life in people with fibromyalgia . However, conclusive conclusions could not be drawn due to the small number of studies and the relatively low quality of evidence . Frequent practice of mindfulness techniques can be important for good results.
 Mindfulness and other forms of meditation are generally considered safe for healthy people. However, for people with certain health conditions, they may need to be changed from time to time to be safe and comfortable.
 Meditative Movement Practices ( Thai Chi , Qigong , and Yoga): Thai originated in China Chi and Qigong and yoga of Indian origin involve a combination of physical postures or movements, a focus on breathing, and meditation or relaxation. Because these three practices have so much in common, they are sometimes grouped together as meditative movement practices. Exercise is beneficial for people with fibromyalgia , so meditative movement practices can be helpful because of the physical activity they involve. Fibromyalgia tai for symptoms Some individual studies of chi , qigong , or yoga have reported promising results. However, there is not enough high-quality evidence for these approaches to allow firm conclusions about their effectiveness. Meditative movement practices usually have good safety records when performed under the guidance of a qualified instructor. yoga, thai Very few side effects have been reported in chi or qigong studies. However, these practices may need to be modified to make them suitable for people with fibromyalgia .
 So little research has been done on chiropractic care and hypnosis that no conclusions can be drawn about these practices.
 An approach called amygdala retraining has been proposed as a treatment for fibromyalgia . Since almost no research has been done on this approach, its efficacy and safety cannot be evaluated .
 Nutritional Approaches: Vitamin D deficiencies of fibromyalgia It has been suggested that it may worsen symptoms . In a study of women with fibromyalgia who had low vitamin D levels , 20 weeks of vitamin D supplementation resulted in pain relief. Also, low magnesium It is not clear whether fibromyalgia levels contribute to fibromyalgia and whether magnesium supplements can help reduce symptoms . Nutritional supplements such as soy, S- adenosyl – L- methionine ( SAMe ) , and creatine There is insufficient evidence to determine whether it is beneficial.
 Balneotherapy : Balneotherapy is the technique of bathing in tap or mineral water for health purposes; it also includes related applications such as sludge packs. While there has been some research on balneotherapy for fibromyalgia , there is not enough evidence to draw firm conclusions that it relieves symptoms.
 Homeopathy : Homeopathy is a medical system based on the unusual idea that a disease can be cured with highly diluted solutions of a substance that causes similar symptoms in healthy people. However, homeopathy studies have not been shown to be beneficial for fibromyalgia . While highly diluted homeopathic remedies are generally safe, not all products labeled as homeopathic are highly diluted; some may contain significant amounts of different additives and therefore cause side effects.
 Reiki : Reiki is a complementary health approach in which practitioners place their hands on or just above the person to facilitate their own healing response. Studies have shown that Reiki has no effect on pain or other symptoms .
 Topical Herbal Products : Topical products containing Capsaicin recommended for fibromyalgia have been studied for fibromyalgia and there was insufficient evidence to determine whether these products are helpful.

Pharmacological approaches

Some patients do not tolerate or benefit from medications. In fibromyalgia, drug therapy only has a supportive role in symptom management. All drugs should be started at low doses and increased with caution. They should be chosen to manage the individual’s predominant symptoms , such as pain, sleep disturbance, and psychological distress that are most amenable to drug therapy . If there is no benefit, the drug should be stopped.
• Antidepressants : Low-dose amitriptyline has traditionally been the first-line medication to treat pain and sleep disturbance in fibromyalgia . However, the evidence supporting its use and benefits is weak. Duloxetine is not approved for the treatment of fibromyalgia in some countries . SSRI drugs for fibromyalgia It has been shown to be moderately effective in reducing symptoms . It is considered that drugs containing milnacipran may have a special role in the treatment of obese patients , since they cause mild weight loss .
• Antiepileptics : Pain-relieving neurotransmitters in the central nervous system concentrations of glutamate and substance P increased in fibromyalgia . They are targets of the drugs pregabalin and gabapentin , which have potential pain modulator, physiological sleep-promoting, and anxiolytic effects . Pregabalin also has little benefit for sleep, but its weight gain often limits its use.
• Other drugs: tramadol , There is preliminary evidence from randomized controlled efficacy studies in subgroups treated with pramipexole and memantine . Pure opioid receptor agonists such as codeine, fentanyl and oxycodone are contraindicated due to poor clinical response and increased risk of opioid- induced hyperalgesia . Only
• Analgesics: The effectiveness of paracetamol used alone has not been proven. non Steroid anti- inflammatory drugs are more effective.
Multidisciplinary management is required for the treatment of fibromyalgia . Non-pharmacological treatments also have an important place. Medications can contribute to active rehabilitation . There is some evidence for amitriptyline , duloxetine , milnacipran , and pregabalin , but not all patients will benefit.