Fibromyalgia

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Fibromyalgia FM or FMS is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. Muscle pain is widespread, on both sides of the body, and above and below the waist.[1][2][3][4]

Sufferers are fatigued and tired even when sleeping for long periods of time, and sleep is often disrupted by pain. Many FM sufferers have sleep disorders like sleep apnea and restless legs syndrome (RLS).[5][6][7] Cognitive impairment, when one cannot focus or pay attention and the patient has difficulty concentrating on mental tasks, is known by FM sufferers as "fibro fog".[5][6][7] Some experience depression, headaches, and lower abdominal pain or muscle cramp. Other symptoms include tingling or numbness in hands and feet, pain in jaw and disorders of the jaw such as temporomandibular joint disorder (TMJ), menstrual cycle cramps, and digestive problems like irritable bowel syndrome (IBS).[5][6][7]

Other pain conditions are associated with FM, such as rheumatoid arthritis (RA), systemic lupus erythematosus (Lupus), ankylosing spondylitis, interstitial cystitis, and more.[6]

The United Kingdom (UK) National Health Service (NHS) lists FM as one of 20 most painful conditions.[8] Fibromyalgia pain may be described as diffuse aching or burning, head to toe, and can be worse at some times than at others. The pain can change location.[9] The United States (US) Centers for Disease Control and Prevention (CDC) states FM "can cause pain, disability, and lower quality of life."[7] The medical guide book Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life describes fibromyalgia as "a sensory disorder caused by a miscommunication between the nerves through your body and your brain."[10]

The American College of Rheumatology (ACR) created and updates the diagnostic criteria for fibromyalgia.[1][3][1][2][3][4] See: Fibromyalgia (Diagnosis).


2010 ACR Preliminatry Diagnostic Criteria: Widespread Pain Index (WPI), 19 Tender Point Areas[3][4]

Prevalence[edit | edit source]

Fibromyalgia is the second most common rheumatic disorder behind osteoarthritis[11] and is considered by many pain experts to be a lifelong central nervous system disorder.[12] An estimated 10 million people in the US and 3-6% of the world population have FM. It is seen in women, men, children, and all ethnic groups. It is often seen in families and most commonly diagnosed in middle aged people, and prevalence increases with age.[13][11]

FM is a female predominant disease, diagnosed with female:male of between 7:1 and 1.5:1, depending on the criteria used.[1][2][3][4][14] See: Fibromyalgia (American College of Rheumatology (ACR) Criteria). A September 2018 study by Wolfe et al. found fewer women and more men are diagnosed under the 2010/11 criteria[15] (this criterion further updated in 2016[16]).

What we did not find in our unbiased CritFM samples was 9:1 female to male fibromyalgia ratios that are widely described by expert sources [11–13]. We believe that such findings only occur in the presence of selection bias or biased ascertainment.[15]

As unbiased epidemiological studies show only a small increase in the female to male sex ratio (~1.5:1) as opposed to the observed ratio in clinical studies of 9:1, we believe that the over-identification of fibromyalgia in women and the consequent under-identification of men is the result of bias.[15]

Fibromyalgia in ME/CFS[edit | edit source]

"The most common overlapping condition with ME/CFS is fibromyalgia."[17][18][19] While some have posited ME/CFS and FM are variants of the same illness, Benjamin Natelson, MD summoned considerable amounts of data that suggest the two illnesses differ with different pathophysiologic processes leading to different treatments.[20]

Dr. Jarred Younger has said that many patients that meet the criteria for FM also meet criteria for chronic fatigue syndrome (CFS) but the reverse is not necessarily true as a lot of people with CFS do not have widespread pain.[21] However, the Canadian Consensus Criteria (CCC) requires the symptom of pain to diagnose ME/CFS.[22] It is the pattern (on both sides of the body, and above and below the waist) of chronic widespread musculoskeletal pain (involving muscle, cartilage, ligaments, and connective tissue) in FM that sets it apart from other diseases that have pain; it also causes cognitive symptoms and unrefreshing sleep.[5][6]

A Swedish study of 234 ME/CFS patients meeting the Canadian Consensus Criteria found that 96% had trigger point pain consistent with fibromyalgia and 67% met the diagnostic criteria for fibromyalgia.[23]

Health complications[edit | edit source]

Fibromyalgia is not a progressive disease but according to Dr. Dan Clauw the "slow gradual worsening of chronic pain patients over time is due to downstream consequences of poorly controlled pain and other symptoms, wherein individuals then progressively get less active, sleep worse, are under more stress and unknowingly develop bad habits which worsen pain and other symptoms."[24]

The CDC recognizes the following complications:

  • Lower quality of life
Especially for women with fibromyalgia
  • More hospitalizations
In the United States people with fibromyalgia are twice as likely to be hospitalized
Adults with fibromyalgia are more than 3 times more likely to have major depression than adults without fibromyalgia.[citation needed]
  • Death rates from suicide and injuries are higher
Overall life span remains similar to the general population.
  • Higher rates of other rheumatic conditions
Comorbidities include other types of arthritis such as osteoarthritis, rheumatoid arthritis, lupus, and ankylosing spondylitis.[13]

The American College of Rheumatology states that:

Risk factors[edit | edit source]

Fibromyalgia is more likely to occur in middle-aged people but can affect any age group, including children. It is more common in women and girls, in obese people and in people with a family history.[26]

Rheumatic illnesses are risk factors in developing FM, especially lupus and rheumatoid arthritis (RA).[13]

Events linked to causing fibromyalgia to develop include car accidents, post-traumatic stress disorder (PTSD), repetitive injuries, and illnessss such as a virus.[7][26]

Diagnosis[edit | edit source]

Tender points, not [trigger points]], are used to diagnose FM.[27] Tender points will be above and below the waist and on both sides of the body. (See: 1990 ACR and 2010 ACR images above right depicting tender points.) It is important to check for other conditions that could be causing pain such as hypothyroidism, RA or lupus, osteoarthritis, ankylosing spondylitis, and polymyalgia rheumatica.[28]

United States[edit | edit source]

2010 American College of Rheumatology (ACR) Criteria[edit | edit source]

The new ACR criteria for fibromyalgia assesses:

Widespread pain index[edit | edit source]

There are 19 areas in the widespread pain index (WPI) in the newer ACR criteria.[29][3]

WPI 19 areas of pain. Count 1 point for each area of pain present at least once a week.[30][3][4]

This Widespread Pain Index (WPI) is scored out of 19, and is one of the two required scores needed for a doctor to make a diagnosis of fibromyalgia, and is considered in combination with the SS score.[30][3]

Symptom severity[edit | edit source]

The Symptom Severity score ranks each of the following groups of fibromyalgia symptoms on a scale of 0-3, giving a SS score out of 12:

Table 2: SS scale score. Add a 4th column for Somatic (physical) symptoms in general (such as Headache, weakness, bowel problems, nausea, dizziness, numbness/tingling, hair loss, dry eyes, Raynaud's phenomenon, painful urination, and more).[30][3] The patient ranks specific symptoms on a scale of 0-3. The numbers assigned to each column are added up, for a total of 0-12.[30]

A fibromyalgia diagnosis is based on both the WPI score and the SS score either:

  • WPI of at least 7 and SS scale score of at least 5, or
  • WPI of at least 4 and SS scale score of at least 9
  • with symptoms present for at least three months[30][31]

The 2010 American College of Rheumatology (ACR) proposed diagnostic criteria for Fibromyalgia[3][4] was modified in 2011,[32] with the modification being validated in 2013 and published in 2014.[33] In September 2016, another revision was been made.[31]

Take the online Fibromyalgia test[edit | edit source]

This online test by fibromyalgiaforums.org uses the ACR 2010 Criterion to help diagnose fibromyalgia.

Tender point test phased out[edit | edit source]

The older 1990 criteria's tender point examination was replaced because men often do not seem to form the tender points needed for diagnosis.[34] The 2010 proposed criteria correctly diagnosed more men, with a female:male ratio of 2:1.[14]

Tender point examination was also problematic because "considerable skill is needed to correctly check for a patient's tender points (i.e., digital palpation that is done with certain amount of applied pressure)", but this technique was not taught at most medical schools.[35][29]

The new standards were designed to:
  • eliminate the use of a tender point examination
  • include a severity scale by which to identify and measure characteristic FM symptoms
  • utilize an index by which to rate pain[29]

1990 ACR criteria[edit | edit source]

1990 ACR Diagnostic Criteria: 18 Tender Points[1][2]

US Social Security Administration[edit | edit source]

The United States Social Security Administration (SSA) accepts a diagnosis of FM with either the 2010 or 1990 ACR criteria.[1][2][3][4][36]

Sleep studies[edit | edit source]

Sleep dysfunction is often involved in FM. Treating a sleep disorder or sleep problems may help with FM symptoms, for example fatigue. Sleep apnea, restless legs syndrome and nocturnal myclonus are often found in fibromyalgia patients, and waking unrefreshed is a diagnostic symptom of fibromyalgia.[35][3] A diagnosed sleep disorder is also helpful if one needs to file for disability.

Blood tests[edit | edit source]

EpicGenetics developed the FM/a test blood test to diagnose FM in 2017 - and announced a linked treatment trial involving the BCG vaccine soon after; the trial has since been suspended indefinitely.[37][38] Dr Denise Faustman at Massachusetts General Hospital, who was due to conduct the trial, stated that the test should never have been marketed as a requirement for the treatment trial, and that no patients were ever recruited to the trial.[39]

The FM/a test continues to be marketed despite the suspension of the linked treatment trial,[39] and the fact that only two studies have been published using the test - the last being published in 2015.[40][41] The evidence base supporting the use of the test has been reported to be weak, and no studies have assessed whether the test can correctly determine which patients have fibromyalgia and have some fibromyalgia symptoms that are explained by another diagnosis.[37] One study did not include any men.[40]

IsolateFibromyalgia, IQuity's RNA based blood test for fibromyalgia, was first announced in 2018 but no peer-reviewed studies have been published.

ICD Diagnostic code[edit | edit source]

ICD-10

The World Health Organization (WHO) International Classification of Diseases (ICD) lists FM as a "disease of the musculoskeletal system and connective tissue", under the code M79.7 (WHO ICD-10 Version: 2016).[42] The WHO's ICD-10 does not refer to FM as a syndrome and it is not classified in the category for medically unexplained symptoms.[43][42]

  • M79.7 Fibromyalgia
Fibromyositis
Fibrositis
Myofibrositis[42]

In 2015, the US finally adopted ICD-10 and FM as a diagnosis.[43][44]

ICD-11 (2019)

The ICD-11 (2019) has diagnostic code MG30.1 Chronic widespread pain, and changed the category from a Musculoskeletal disease, to the General signs and symptoms category, sometimes referred to as Medically unexplained physical symptoms.[45]

  • MG30.01 Chronic widespread pain

Parent

MG30.0 Chronic primary pain

Description

Chronic widespread pain (CWP) is diffuse pain in at least 4 of 5 body regions and is associated with significant emotional distress (anxiety, anger/frustration or depressed mood) or functional disability (interference in daily life activities and reduced participation in social roles). CWP is multifactorial: biological, psychological and social factors contribute to the pain syndrome. The diagnosis is appropriate when the pain is not directly attributable to a nociceptive process in these regions and there are features consistent with nociplastic pain and identified psychological and social contributors.[45]

Inclusions

  • Fibromyalgia

Exclusions

  • Acute pain (MG31)[45]

Differential diagnosis[edit | edit source]

Conditions which have symptoms that are similar to fibromyalgia, particularly involving chronic widespread pain and fatigue should be ruled out, either by the routine tests recommended to aid fibromyalgia diagnosis, or by symptom pattern and history. Differential diagnoses for fibromyalgia include:

  • Inflammatory rheumatic diseases:
rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome, mixed connective tissue disease, scleroderma, or inflammatory spondyloarthritis, inflammatory polyarthritis, polymyalgia rheumatica, inflammatory myopathy or systemic inflammatory arthropathies
  • Musculoskeletal or spinal conditions:
myofascial pain syndrome, hypermobility syndromes including Ehlers-Danlos Syndrome, spinal stenosis, myelopathies, myositis
  • Endocrine and metabolic disorders:
Hashimoto's thyroiditis (hypothyroidism), hyperparathyroidism, acromegaly, and vitamin D deficiency
  • Gastrointestinal diseases:
Celiac disease or other forms of irritable bowel disease, Non-celiac gluten sensitivity
  • Infectious diseases::
Lyme disease, hepatitis C, and HIV, although these are not routinely tested for, Chronic Lyme disease may be secondary to fibromyalgia
  • Cancers at the very early stages:
fever, night sweats, and weight loss are common signs
  • Neurological conditions:
multiple sclerosis, Parkinson's disease and peripheral neuropathies
  • Medication-induced pain conditions:
statins, opioids (opioid-induced hyperalgesia), some chemotherapy drugs, aromatase inhibitors, and bisphosphonates can cause diffuse pain [46][47]

The limited laboratory findings along with history and physical examination can help differentiate fibromyalgia from other differentials.[47]

Pathophysiology[edit | edit source]

"Fibromyalgia (FM) is a chronic pain disorder with unknown etiology and unclear pathophysiology. There is no evidence that a single event “causes” FM. Rather, many physical and/or emotional stressors are risk factors that may trigger or aggravate symptoms. These have included certain infections, such as a viruses or Lyme disease, as well as emotional or physical trauma."[7][13] The widespread pain is severe, debilitating, and abnormal in processing its pain. sleep disturbance and fatigue are common symptoms. Cause or causes are unproven.[48]

Pathophysiology: Although the etiology remains unclear, characteristic alterations in the pattern of sleep and changes in neuroendocrine transmitters such as serotonin, substance P, growth hormone and cortisol suggest that regulation of the autonomic and neuroendocrine system appears to be the basis of the syndrome. Fibromyalgia is not a life-threatening, deforming, or [progressive disease. Anxiety and depression are the most common association. Aberrant pain processing, which can result in chronic pain, may be the result of several interplaying mechanisms. Central sensitization, blunting of inhibitory pain pathways and alterations in neurotransmitters lead to aberrant neurochemical processing of sensory signals in the CNS, thus lowering the threshold of pain and amplification of normal sensory signals causing constant pain.[30]

The frequent co-morbidity of fibromyalgia with mood disorders suggests a major role for the stress response and for neuroendocrine abnormalities. The hypothalamic pituitary axis (HPA axis) is a critical component of the stress-adaptation response. In FMS, stress adaptation response is disturbed leading to stress induce symptoms. Psychiatric co-morbidity has been associated with FMS and needs to be identified during the consultation process, as this requires special consideration during treatment.[30]

SNPs with significant TDTs were found in 36% of the cohort for CCL11 and 12% for MEFV, along with a protein variant in CCL4 (41%) that affects CCR5 down-regulation, supporting an immune involvement for FM.

Fibromyalgia can be considered either primary, or dominant, also known as idiopathic fibromyalgia, or secondary. In the primary form, the causes of the disorder are unknown, but in secondary fibromyalgia, the disorder usually occurs alongside other debilitating medical conditions, such as rheumatoid arthritis (RA), lupus, and multiple sclerosis.[50]

Immune system research[edit | edit source]

Dr. Jarred Younger believes an overactive immune system is the cause and will be conducting a study to test this hypothesis.[51][52] An overactive immune system can cause inflammation and chronic pain.[53][54]

Dr. William Pridgen's research of HSV-1 (cold sore virus) as being involved in FM has conducted a successful Phase III clinical trial, which had been fast-tracked by the Food and Drug Administration (FDA), of a combination drug that suppresses this virus and also helps with pain.

On September 5th, 2018, EpicGenetics announced that Massachusetts General Hospital received approval from the FDA to test the BCG vaccine (an old Tuberculosis vaccine) on patients that tested positive with its FM/a® test.[55][56]

Recognizing FM may involve activation of the immune system researchers performed exome sequencing on chemokine genes in a region of chromosome 17 identified in a genome-wide family association study. Their conclusion: "SNPs with significant TDTs were found in 36% of the cohort for CCL11 and 12% for MEFV, along with a protein variant in CCL4 (41%) that affects CCR5 down-regulation, supporting an immune involvement for FM."[49]

Dr David Andersson from the Institute of Psychiatry, Psychology and Neuroscience at King's College London, led a new study into Fibromyalgia being an immune system disorder.[57]

Andersson and his colleagues harvested blood from 44 people with fibromyalgia and injected purified antibodies from each of them into different mice. The mice rapidly became more sensitive to pressure and cold, and displayed reduced grip strength in their paws. Animals injected with antibodies from healthy people were unaffected.[58]

Prof Camilla Svensson from the Karolinska Institute in Sweden, who was also involved in the study, said: “Antibodies from people with fibromyalgia living in two different countries, the UK and Sweden, gave similar results, which adds enormous strength to our findings.”[58]

Brain and spinal cord research[edit | edit source]

A 2004 study by Heffez et al. studied 270 patients with FM and found that 46% had cervical spinal stenosis and 20% chiari malformation.[59] In 2007, Heffez et al. saw significant improvement in physical and mental well-being was found in patients with cervical stenosis who received surgery.[60] A second study in 2007 by Andrew Holman found that 71% had cervical spinal cord compression.[61] It is important to note that in the past many patients were misdiagnosed with FM when further testing would have revealed the true source of their pain; the 2010 (updated in 2016) ACR criteria has helped curb misdiagnoses.[62][63][15]

Various types of brain imaging are being used to research FM.

In 2002, an fMRI study conducted by Richard Gracely and Daniel Claw found people with FM "have measurable pain signals in their brains, from a gentle finger squeeze that barely feels unpleasant to people without the disease."[64] A 2007 study by Borsook et al., Neuroimaging revolutionizes therapeutic approaches to chronic pain found decreased gray matter density relative to controls in cingulate cortex (CC), medial prefrontal cortex (Med. PFC), parahippocampal gyrus (PHG) and insula.[65] In 2015, Loggia et al. imaged neuroinflammation due to glial activation using MR/PET imaging.[66][67] In 2017, López-Solà et al. identified three brain patterns based on fMRI responses to pressure pain and non-painful multisensory stimulation. "These patterns, taken together, discriminate FM from matched healthy controls with 92% sensitivity and 94% specificity."[68] In 2018, Albrecht et al used PET scans to document glial activation.[69] Also in 2018, Martucci et al. found unbalanced activity between the ventral and dorsal cervical spinal cord. Ventral neural processes were increased and dorsal neural processes were decreased which may reflect the presence of central sensitization contributing to fatigue and other bodily symptoms in FM.[70]

Fibromyalgia is not the same as depression[edit | edit source]

Depression doesn't cause the pain of fibromyalgia, a new study shows.[71]

"People still doubt fibromyalgia is a disease," Giesecke tells WebMD. "Previously, we found that fibromyalgia patients really do have increased central pain processing. Now we can show this is not affected by depression. Something is wrong here, and it is not at all connected with depression."[71]

"Giesecke's group looked at brain responses to painful stimuli, and then checked to see if there was any difference between depressed and nondepressed fibromyalgia patients. They showed the activation of areas of the brain related to pain were not different in patients with and without depression." But there is a difference between people with and without fibromyalgia, he says.[71]

The researchers use an imaging device called functional magnetic resonance imaging, or fMRI, to look at how the brain responds to pain. Study participants get a mildly painful pressure on their thumb, which makes the brain's pain centers "light up" on the image. Thumb pressure -- at a level healthy people hardly feel -- sets off a firestorm in the pain centers of fibromyalgia patients' brains.[71]

  • 2013, Small fibre pathology in patients with fibromyalgia syndrome[72]
A study involving skin biopsies funds that fibromyalgia is neuropathic - and not a form of depression or a Psychosomatic Disorder

The study authors stated, "This strengthens the notion that fibromyalgia syndrome is not a variant of depression, but rather represents an independent entity that may be associated with depressive symptoms". The findings also point "towards a neuropathic nature of pain in fibromyalgia syndrome... with regard to the persistent somatoform pain disorder that is sometimes assumed to be underlying in patients with fibromyalgia syndrome, our study shows a clear distinction to fibromyalgia syndrome: persistent somatoform pain disorder (ICD-10 F45.40) may be present in patients with fibromyalgia syndrome, however, in the majority of cases the definition of pain starting in connection with an emotional conflict situation or psycho-social stress strong enough to be taken as a crucial aetiological influence and pain in the course of a primary depressive disorder or schizophrenia in addition to chronic widespread pain lasting longer than 6 months is not fulfilled."[72]

Comorbidities, overlapping conditions, and common symptoms[edit | edit source]

Comorbid conditions of fibromyalgia (FM) are ME/CFS which is the most common comorbidity,[17][19] autoimmune diseases; migraines; multiple chemical sensitivities (MCS); and orthostatic intolerance (OI) / postural orthostatic tachycardia syndrome (POTS).[17][30][73] Overlapping conditions are depression and anxiety; digestive conditions, menstrual problems; Gulf War Illness (GWI); nervous system disorders; low blood pressure (Low BP); other pain conditions; and sleep dysfunction/disturbance[17][30][6]

Allodynia[edit | edit source]

Types of Allodynia: Tactile; Mechanical; and Thermal.[citation needed] Allodynia of pain, generally on the skin, that's caused by something that wouldn't normally cause pain.[74]

Anxiety[edit | edit source]

[25]

Body temperature[edit | edit source]

for temperature sensitivity; burning, tingling, and prickling due to paresthesia; numbness; dry eyes and dry mouth; and more.)[citation needed][75]

Costochondritis[edit | edit source]

Costochondritis is inflammation of the costal cartilages (shown in red) causing chest and ribcage pain. From BodyParts3D/Anatomography (Life Science db.jp), license CC BY-SA 2.1 JP.

Costochondritis is a condition that causes pain in the cartilage that connect your ribs to your sternum (breastbone). Cartilage is the tough, bendable tissue that protects your bones where they rub against each other.[76]

Costochondritis causes pain in the area where your sternum joins with your ribs. The pain may come and go, and may get worse over time. The pain may be sharp, or dull and aching. It may be painful to touch your chest. The pain may spread to your back, abdomen, or down your arm. It may get worse when you move, breathe deeply, or push or lift an object. The pain may make it hard for you to sleep or do your usual activities.[76]

People tend to describe the pain as stabbing, burning, aching, confined to one spot, usually in the very center of the chest, but it may radiate outward.[77]

Depression and anxiety[edit | edit source]

Fibromyalgia sufferers are "up to three times more likely to have depression at the time of their diagnosis than someone without fibromyalgia."[78] Anxiety is also more common.[25][79]

Differences between depression and fibromyalgia[edit | edit source]

  • Depression and anxiety are common in fibromyalgia but are not core diagnostic symptoms, so they are not required for a diagnosis of Fibromyalgia, and a significant number of people with fibromyalgia have never had depression.[80][1][3]
  • Fibromyalgia is a diagnosis of chronic widespread pain, but pain is not needed for a diagnosis of depression.
  • 2007, The classification of fibromyalgia syndrome[81] (Abstract)
  • 2008, The relationship between fibromyalgia and major depressive disorder: a comprehensive review[82] (Abstract)
  • 2010, Anxiety and depressive symptoms in fibromyalgia are related to poor perception of health but not to pain sensitivity or cerebral processing of pain[83] (Abstract)
  • 2012, Fibromyalgia a discrete entity?[84] (Full text)
  • 2012 Fibromyalgia isn't depression - WebMD[71]

Dry eye syndrome[edit | edit source]

[citation needed]

Fatigue[edit | edit source]

Most people with fibromyalgia experience fatigue.[25]

Fibro fog and Cognitive dysfunction[edit | edit source]

  • 'Mental confusion along with difficulty in concentration and loss of memory is often termed “fibro fog"'.[85]

Gastrointestinal problems[edit | edit source]

[citation needed]

Gulf War Illness[edit | edit source]

GWI increases risk of developing fibromyalgia.[86]

Interstitial cystitis[edit | edit source]

Interstitial cystitis causes a painful bladder.[citation needed]

  • [Interstitial cystitis]]/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome.[87]

Language Impairment or word problems[edit | edit source]

  • [citation needed]
  • "The diagnosis of aphasia is a condition that robs you of the ability to communicate. It can affect your ability to speak, write and understand language, both verbal and written"[88] but with dysphasia you will have those symptoms and trouble listening and doing numerical calculations.[20]

Migraine and headaches[edit | edit source]

Both tension-type headaches and migraines can be complications of fibromyalgia.[25]

Both fibromyalgia and migraine may reflect problems in the brain’s pain processing center. It is believed that both conditions are caused by excitation of the nervous system or an over-response to stimuli. Stress is usually cited as a trigger for both migraine and fibromyalgia attacks.[89]

Multiple Chemical Sensitivity (MCS)[edit | edit source]

It is thought that both Fibromyalgia and MCS are central sensitization syndromes.[citation needed]

OBGYN[edit | edit source]

  • Menstrual Periods with Fibromyalgia: Personal Stories

You may have heard about a possible link between gynecologic surgery (such as a hysterectomy) and the development of fibromyalgia, and doctors have long suspected that fibromyalgia has strong -hormonal ties and triggers. This does not seem surprising as we've long suspected a link between endocrine disorders, gynecological conditions, and autoimmune conditions.[citation needed]

Orthostatic intolerance (OI)[edit | edit source]

Postural orthostatic tachycardia syndrome (POTS) and other forms of orthostatic intolerance often occur in people with fibromyalgia.[73] Symptoms can include low blood pressure and/or sudden high blood pressure, dizziness, fainting.

Raynaud's syndrome[edit | edit source]

In Raynaud's syndrome, the blood vessels constrict more than they should, which allows less blood to get through. That not only makes your extremities cold, it makes them extremely difficult to warm up. The most commonly affected body parts are the fingers and toes, but your lips, nose, ear lobes, knees, and nipples may also be involved.

[citation needed]

Rheumatic conditions - other rheumatic conditions[edit | edit source]

Osteoarthritis, rheumatoid arthritis, lupus, and ankylosing spondylitis are more common in people with fibromyalgia.[13]

Sleep dysfunction[edit | edit source]

Sleep problems occur in most people with FM.[25] Waking unrefreshed is a diagnostic symptom, and the sleep disorders sleep apnea, restless legs syndrome and nocturnal myclonus are common in people with fibromyalgia.[3][35]

Vatthauer et al. (2015) found that sleep was associated with task-negative brain activity in fibromyalgia participants with comorbid chronic insomnia.[92]

The present results of this study suggest that long-term, comorbid pain and sleep disturbance may be associated with increased activation in core default mode brain areas that is above and beyond long-term pain disturbance alone.[92]

Stress and Post-traumatic stress disorder[edit | edit source]

PTSD, which is a mental illness that results from traumatic events, is a risk factor for fibromyalgia.[25][26]

Temporomandibular joint disorder (TMJ/TMD)[edit | edit source]

The temporomandibular joint is the joint between the mandible (light blue) and the temporal bone (orange) of the skull

Other than headaches, the symptoms of TMJ include:

  • Jaw pain
  • Discomfort or difficulty chewing
  • Painful clicking in the jaw
  • Difficulty opening or closing the mouth
  • Locking jaw
  • Ringing in the ears[citation needed]

Thyroid disease[edit | edit source]

People with Hashimoto's autoimmune thyroid disease often experience significant fatigue and body aches. While these symptoms are common in Hashimoto's, they can also be markers of other diseases, like chronic fatigue syndrome or fibromyalgia.[citation needed]

Other symptoms[edit | edit source]

Treatment[edit | edit source]

United States[edit | edit source]

Rheumatology and primary care providers: Diagnosing and treatment:

Drugs[edit | edit source]

Therapies[edit | edit source]

Exercise[edit | edit source]

Please Note: These treatments are for fibromyalgia patients and not ME/CFS sufferers due to it's hallmark symptom of post-exertional malaise.

Warm water exercise can be helpful for fibromyalgia. Start slow and don't push through the pain.[95][96] Image source: Wikimedia Commons. Author: Peter van der Sluijs

Several studies have found that warm-water pool exercise is a beneficial treatment for fibromyalgia. A very large survey of patients found that 26% have used pool therapy, rating it as very effective.[97] The same survey found 74% of patients found heat helpful - either warm water or heat packs.[97] Warm water especially important in FMS because the vasodilatory effect of the heating may improve blood flow to muscles, helping to reduce pain, and many people with FM are also intolerant of cold. A warm-water pool is one that's kept around 89.6 to 93 degrees Fahrenheit (32 to 34 Celsius), which is several degrees warmer than most heated pools.[98]

Dr Roubenoff Ronenn recommends moderate aerobic exercise and weights with six to eight reps, and then a day or two of rest in between. He cautions people not to start a program if they are in a flare.[95]

Massage[edit | edit source]

Acupuncture[edit | edit source]

Manual acupuncture (skin penetration without stimulation) is the most common form of acupuncture but gives no clinically significant pain relief to fibromyalgia patients, but a Cochrane review found electro-acupuncture, which involves an electrical current, significantly reduced pain, stiffness, and fatigue and improve sleep quality and global well-being in people with fibromyalgia for a one-month period, but not long term.[35][100]

2016 reviewed acupuncture (AC), electroacupuncture (EAC) and moxibustion, but found none improved quality of life in women with fibromyalgia.[101] "There was no significant improvement in pain or reduction of tender points in any of the groups studied, at the end of the 8th session."[101]

In 2004, U.S. Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) ruled a noncoverage determination for acupuncture.[102]

Controversies[edit | edit source]

Dr. Frederick Wolfe[edit | edit source]

Dr. Frederick Wolfe, the director of the National Databank for Rheumatic Diseases and the lead author of the 1990 paper that first defined the diagnostic guidelines for fibromyalgia, says he has become cynical and discouraged about the diagnosis. He now considers the condition a physical response to stress, depression, and economic and social anxiety.[103][104]

Fibromyalgia and Chiari malformation[edit | edit source]

Some individuals diagnosed with FMS were undergoing surgery for chiari malformation (CM). These are two separate conditions; FMS cannot be resolved by undergoing a risky CM surgery.[105][106]

Most patients with FM do not have CIM pathology. Future studies should focus on dynamic neuroimaging of craniocervical neuroanatomy in patients with FM.[105]

Blood test [edit | edit source]

EpicGenetics developed a blood test to identifying the presence of specific white blood cell abnormalities of patients diagnosed with FM - FM/a® test - and announces a linked treatment trial that never started.[107][citation needed][38] Most insurance companies will cover the test.[108][109] EpicGenetics offers help to determine if your insurance will cover their test.[38]

The FM/a test continues to be marketed despite the suspension of the linked treatment trial,[39] and the fact that only two studies have been published using the test - one comparing fibromyalgia patients with healthy controls, and another with lupus and rheumatoid arthritis patients.[40][41] In the 6 years since the last study was published, no further research has appeared on the FM/a test, leaving many to conclude that the evidence base is weak.[37]

IsolateFibromyalgia, IQuity's RNA based blood test for fibromyalgia, was first announced in 2018 but has insufficient data supporting its use: no peer-reviewed studies had been published by 2021.

Disability: SSI/SSD and LT[edit | edit source]

Notable studies[edit | edit source]

News articles and features[edit | edit source]

In a sea of skeptics, this physician was one of fibromyalgia patients’ few true allies. Or was he?] - STAT news reports on the marketing of the FM/a test, and the linked treatment that never started.

See also[edit | edit source]

Learn more[edit | edit source]

Diagnosing and categorizing fibromyalgia[edit | edit source]

Blood tests[edit | edit source]

Brain scans[edit | edit source]

References[edit | edit source]

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