Fibromyalgia

What is Fibromyalgia?

Fibromyalgia syndrome is a chronic painful condition that leads to pain at specific tender points or all over the body.

The condition is associated with extreme fatigue and other symptoms such as sleep disturbances, headaches, irritable bowel syndrome, muscle pain and stiffness etc.

Where does the term ‘fibromyalgia’ originate?

The term fibromyalgia is derived from three words – “fibro” is a Latin word meaning fibrous tissues such as tendons and ligaments that connect bones to muscles and bones respectively.

The middle part “my” is derived from the word “myo” meaning muscles.

The word “algia” refers to pain.

The word literally means pain in the fibrous tissues. Fibromyalgia is a syndrome of multiple symptoms rather than just pain.

Who does fibromyalgia affect?

Fibromyalgia has a worldwide presence affecting nearly 1 in 20 people globally. In England and Wales there are nearly 1.76 million adults with the condition.

In the United States nearly 2–10% of the general population of all ages are affected by this condition.

Although men may be affected by this condition, women are seen to be seven times more likely to develop fibromyalgia.

The condition develops commonly between 30 and 60 years of age but may affect children and the elderly.

Causes of fibromyalgia

The exact cause of this condition is not known; however, the pain pathways, hormonal changes and immune system disturbances have all been studied and found in patients with fibromyalgia. This suggests a deeper and multifactorial causation of the condition.

Diagnosis of fibromyalgia

The condition may often be a challenge to diagnose. This is because there are no clear cut sensitive tests that diagnose the condition with conviction.

Much of the diagnosis is based on detailed examination of the patient and presence of symptoms.

Diagnosis is also made by ruling out other conditions that may mimic fibromyalgia.

Treatments

There is no cure for this painful condition and treatment aims at reducing and alleviating the symptoms to as much extent as possible.


The symptoms vary in severity among individuals and sometimes may disrupt the daily functioning of the patient. Overall the treatment involves:-

  • There are several antidepressants and pain relievers that have been tried with success in fibromyalgia.
  • Cognitive behavioral therapy or counselling is part of treating fibromyalgia and may be used with success
  • Meditation, regular exercise and a healthy balanced diet to maintain a healthy body weight is advised as lifestyle changes that benefit fibromyalgia patient. Exercise in particular benefits patients with fibromyalgia to a great extent.

What Causes Fibromyalgia?

The exact cause of fibromyalgia syndrome is unknown, however, several factors have been associated with this condition and this has led to several hypotheses and theories relating to the condition and its cause. Some of the possible causes include:-

  • In a large majority of patients there is no explainable cause of the condition and it develops on its own.
  • Physical trauma for example after road traffic accidents - this may lead to development of long term pain over the muscles and fibrous tissues and development of tender points and other pain conditions associated with fibromyalgia.
  • Repetitive injuries at work and strain of particular groups of muscles, tendons and ligaments are also associated with development of fibromyalgia.
  • Alterations in pain perception pathways – the most likely cause underlying fibromyalgia is alteration of pain perception by the body or increased sensitivity to pain.

Serotonin is a chemical messenger in the brain. It has been suggested that lower levels of this chemical leads to lower generation of the body’s natural pain relievers or endorphins and as a result the pain threshold may be decreased and pain sensitivity may rise.

Lack of serotonin in the brain also predisposes a person to develop depression and depression is commonly seen in patients with fibromyalgia.

  • Alterations in hormone levels – levels of growth hormone is found to be lower among patients with fibromyalgia raising speculation that this may be connected to causation of the condition.

In addition several brain chemical messengers called neurotransmitters may be lower than normal. This includes serotonin, noradrenaline and dopamine. While serotonin is associated with moods and sleep, noradrenaline controls the response to a stressful situation. Dopamine on the other hand deals with moods, behaviour, learning, pleasurable sensations and movements.

  • Inheritance of faulty genes - some genes have been implicated in fibromyalgia and these have been speculated to be the cause of fibromyalgia running in some families.
  • Sleep disturbances are one of the commonest symptoms of fibromyalgia; however, there are studies that show that the causation might be vice versa as well. This means, sleep problems may be the cause of fibromyalgia as well. People with fibromyalgia may have sleep problems that make them feel more pain.
  • Psychological trauma has also been associated with fibromyalgia causation.
  • Some viral infections such as Hepatitis B, Hepatitis C, HIV/AIDS etc. have been associated with fibromyalgia.
  • Depression is a connection with fibromyalgia both as a cause as well as a symptom.
  • An underactive thyroid gland may also precipitate fibromyalgia.
  • Lupus patients are at an increased risk of developing fibromyalgia syndrome. Up to 30% of lupus patients may eventually go on to be diagnosed with fibromyalgia.
  • Certain bone and joint diseases may also predispose a person to develop fibromyalgia. For example, around 10 to 15% of osteoarthritis patients may also develop fibromyalgia. Ankylosing spondylitis and rheumatoid arthritis are other conditions that predispose a person to get fibromyalgia.

Who Gets Fibromyalgia?

At present there are 1 in 20 people worldwide that are affected with the chronic pain syndrome of fibromyalgia.

Along with pain these patients manifest a range of or other symptoms of varying severity including headaches, irritable bowel syndrome, depression and anxiety, cognitive difficulties, fatigue and menstrual irregularities.

The condition can affect anyone of any age and sex, however, some people are more prone to this condition. These high risk vulnerable groups are based on:-

Gender

Women are at least seven times more likely than men to get fibromyalgia. In fact, between 80% and 90% of those affected by the syndrome are female.

Although hormonal hypotheses have been put forward as the cause of this condition, and to explain the female preponderance in prevalence, the exact cause for this gender prevalence is unknown.

Age

The condition is commonly seen between the ages of 20 and 55 years among women. This is their reproductive period and diagnosis is typically made during this time.

The condition may also affect the elderly as well as children. Children may also develop fibromyalgia but may have a slower development and manifestation of symptoms.

Serotonin levels in brain

Some theories suggest that lower levels of serotonin – a chemical messenger in the brain - leads to an increase in pain sensitivity and a lower pain threshold.

Women have around seven times less serotonin in the brain. Lack of serotonin in brain also predisposes a person to develop depression and depression is commonly seen in patients with fibromyalgia.

Growth hormone deficiencies have also been speculated as a condition found among fibromyalgia patients.

Genes

Some genes that run in families seem to predispose an individual to get fibromyalgia.

Patients with sleep disorders

Patients with sleep disorders and sleep apnea or snoring are more likely to get fibromyalgia.

Lupus patients

Lupus patients are at an increased risk of developing fibromyalgia syndrome. Up to 30% of lupus patients may eventually go on to be diagnosed with fibromyalgia.

Bone and joint diseases

Certain bone and joint diseases may also predispose a person to develop fibromyalgia. For example, around 10 to 15% of osteoarthritis patients may also develop fibromyalgia. Ankylosing spondylitis is another condition that predisposes a person to get fibromyalgia.

Physical trauma

Fibromyalgia may also occur after a physical trauma e.g. in a road traffic accident etc. The pain due to the accident may go on to become chronic and there is development of typical tender points that characterize fibromyalgia.

Fibromyalgia in Children

Fibromyalgia affects over 5 million Americans and it is recorded that one sufferer out of every six, is a child.

Fibromyalgia symptoms in children

In children with this condition the symptoms include:-

  • Long term widespread pain and increased pain sensitivity
  • Morning stiffness
  • Fatigue
  • Lack of restorative sleep
  • There are five tender points in children rather than the 18 as seen in adults. These tender points in a child are located at the neck, chest, hips, thighs, and buttocks.
  • Gastrointestinal or digestive problems similar to irritable bowel syndrome
  • Migraine headaches
  • Inability to concentrate on school or academic work or remember things
  • The symptoms generally start during adolescence between ages of 13 and 15 years. Girls are more likely to get fibromyalgia than boys.

Diagnosing fibromyalgia in children

Diagnosis at present cannot be made on the basis of any imaging study like X rays or CT scans. These scans and blood tests just help to rule out other conditions that may mimic fibromyalgia that include multiple sclerosis or lupus etc.

Who is more likely to get fibromyalgia?

Children who have a parent with the condition are more likely to develop fibromyalgia suggesting a genetic connection. Children with conditions like Irritable Bowel Syndrome, Premenstral Syndrome, or Sleep disorders are more likely to develop fibromyalgia.

Fibromyalgia treatment for children

In a child treatment involves:-

  • Physical therapy and exercise
  • Medications – pain relievers and drugs that help in sleep are rarely used in children unless absolutely necessary.
  • Treatment and diagnosis also aims to look for and treat depression that may commonly be found in persons with fibromyalgia. Antidepressants and counselling including cognitive behavior therapy can be useful in these patients.
  • The child requires adequate support from parents and family members. It should be emphasized to the caregivers and family members not to pass judgements about the child faking the condition or “just being lazy”. This would raise feelings of guilt or shame in a child and may lead to depression. Counselling should involve the whole family and caregivers. Parents are encouraged to educate their child’s teachers, friends and peers about their condition and limitations.
  • A healthy lifestyle with a healthy balanced diet, stress free environment and meditation also helps in maintaining a near normal life.

Fibromyalgia and Parenting

Fibromyalgia is a chronic pain condition with widespread pain, impairment of daily living functions, sleep disturbance and lack of sleep, presence of typical tender points over the body etc. There are other symptoms such as non-restorative sleep and fatigue.

About 10 million people are currently diagnosed with this disorder. Although 9 out of 10 people diagnosed are women, men also get this disorder.

Because of the high prevalence among women and the widespread and multitude of symptoms, being a parent with fibromyalgia is tough.

Some of the key points in handling parenthood when suffering from fibromyalgia include the following:-

  • Fibromyalgia involves feeling physical pain and fatigue among other symptoms but this does not mean a mother with the condition cannot sit and read a book or watch a movie with her children. Finding alternative ways to spend quality time with the children, helping them with their school work etc. can also lay foundations of good parenting.
  • It is of prime importance to explain the condition to the children. When the children know about the possible symptoms, triggers and seriousness of the condition, they can make allowances and adjustments. This helps in maintaining optimum health and energy as well as in bonding with the child.
  • Regular exercise programmes, yoga, Tai chi, aerobics, a healthy diet and a healthy lifestyle contributes to minimal symptoms and allows for better parenting. Parents with fibromyalgia are expected to take care of themselves to have energy for spending time with the children.
  • Depression and anxiety disorders are common among women with fibromyalgia. These women are also more prone to stress that aggravates their symptoms of fibromyalgia. Getting diagnosed and treated for these conditions is important to prevent ill effects of these mental disorders on the family especially the children.
  • Associated conditions like irritable bowel syndrome, migraine, sleep disorders are symptoms that need to be addressed and controlled as much as possible for a better quality of life.

Fibromyalgia and Support From Partner

Any physical illness may bring in stress into a relationship. The stress becomes particularly burdensome when the condition is chronic and debilitating because of the extra need for care, changes in lifestyle and adjustments. One such condition is fibromyalgia.

Fibromyalgia syndrome is a chronic and long term condition that is incurable and associated with symptoms including widespread pain, fatigue, headaches, irritable bowel syndrome, inability to get refreshing sleep, waking up tired and stiff and developing cognitive disturbances including lack of concentration and clumsiness, dizziness etc.

There is in addition extreme sensitivity to pain. Patients tend to be sensitive to changes in the weather, to bright lights, noise etc. These symptoms have varying course of severity and come and go over time. Fibromyalgia is not life-threatening and does not reduce life expectancy.

About 10 million people are currently diagnosed with this disorder. Although 9 out of 10 people diagnosed are women, men also get this disorder. The chronic and incurable nature of the condition makes the disease particularly stressful and the condition seriously affects relationships with the partner or spouse.

Fibromyalgia and sex life

Several studies have shown a negative effect of fibromyalgia on the sex lives of women. One of the hypotheses connecting sexual dysfunction and fibromyalgia in women is that the disease process affects the psychological but not the physiological aspect of the sexual response cycle.

This means that the woman may be physiologically normal in terms of sexual response but her psyche and psychological response to sexual activity may be altered.

Further depression and anxiety that go hand in hand with the diagnosis of fibromyalgia may affect sexual relationships significantly.

Understanding what is wrong

One of the major problems of fibromyalgia is the difficulty in pinpointing the exact cause and pathophysiology of the condition. Symptoms are varied, manifestations are different between individuals and there is a large controversy regarding this condition.

Several factions believe fibromyalgia to be more psychological that physical. Underestimating the chronic and severity of this condition may make a spouse unable to empathize or respond to the needs of the sufferer. This affects the relationship between partners severely.

Support

Furthermore, due to the inability to participate in all activities due to the physical needs of the debilitating condition, partners may often perceive the patient as a burden. This is a significant factor because even in its absence, the patient may himself/herself feel a sense of being a burden to his/her partner.

Partner reaction to the disease need not always be indifferent. Some may be overprotective or discouraging of activity that also works negatively in the relationship. This may create a feedback loop and change the perception and behaviour of the patient affecting the patient’s functioning.

Supportive behaviour from the partner improves functioning, provides patient physical adjustment, reduces stress and enhances marital or relationship satisfaction.