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[[Fibromyalgia]] or '''FM''' or '''fibromyalgia syndrome''' or '''FMS''' is a chronic, debilitating disorder characterized by widespread [[pain]] with additional symptoms such as [[cognitive dysfunction]] or "fibro fog", [[sleep dysfunction|waking unrefreshed]] and [[fatigue]].<ref name="ACR2010" /><ref name="FibroBasics" /> Fibromyalgia is relatively common, affecting between 2-5% of the population.<ref name="ScienceOfFibro" /> Brain imaging and neuroimaging studies have shown fibromyalgia to be a '''pain processing disorder''' involving altered pain processing in the [[central nervous system]].<ref name="ScienceOfFibro" /> The pain and other symptoms of fibromyalgia appear to be caused by neurochemical imbalances in the central nervous system that lead to a '''"central amplification"''' of pain perception (Clauw et al., 2011).<ref name="ScienceOfFibro" /> In fibromyalgia [[pain]] is widespread, on both sides of the body, and above and below the waist.<ref name="ACR2010" /><ref name="excerpt" /> Sufferers are fatigued (excessively tired) even after sleeping for long periods of time, and sleep is often disrupted by pain. Many FM sufferers have [[Sleep dysfunction|sleep disorders]] like [[sleep apnea]] and [[restless legs syndrome]] (RLS).<ref name="webmd-guide" /><ref name="mayo" /><ref name="FibroBasics" /> [[cognitive dysfunction|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]]".<ref name="webmd-guide" /><ref name="mayo" /><ref name="FibroBasics" /> Some people with fibromyalgia experience digestive system problems like [[irritable bowel syndrome]] or gastric-oesophagael reflux disease, [[depression]], [[headache]]s or [[migraine]]s, a painful bladder, or muscle cramps. Other symptoms may include [[Paresthesia|tingling]] or [[numbness]] in hands and feet, pain in jaw and disorders of the jaw such as [[temporomandibular joint disorder]] (TMJ), and [[Menstrual cycle#Health effects in other conditions|menstrual cycle]] cramps.<ref name="ScienceOfFibro" /><ref name="webmd-guide">{{Cite web | url = https://www.webmd.com/fibromyalgia/guide/fibromyalgia-symptoms#1 | title = Fibromyalgia Symptoms|work=WebMD|access-date=2018-08-09|language=en-US}}</ref><ref name="mayo">{{Cite web | url = https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780 | title = Fibromyalgia - Symptoms and causes|work=Mayo Clinic|access-date=2018-08-09|language=en}}</ref><ref name="FibroBasics" /> [[Pain#Pain in Fibromyalgia|Other pain conditions are associated with FM]], such as [[rheumatoid arthritis]] (RA), [[systemic lupus erythematosus]] (Lupus), ankylosing spondylitis, [[interstitial cystitis]], and more.<ref name="mayo" /> In 2017, the [[United Kingdom|United Kingdom]]'s [[National Health Service]] listed fibromyalgia as one of 20 most painful conditions.<ref name="20mostpainful">{{Cite web | access-date=|archive-url=https://web.archive.org/web/20180530191907/https://www.nhs.uk/live-well/healthy-body/20-painful-health-conditions/|archive-date=2018-05-30 | title = 20 Painful Health Conditions|website=[[National Health Service]] | date = 2017-06-23| url = https://www.nhs.uk/live-well/healthy-body/20-painful-health-conditions/|url-status=dead}}</ref><ref name="newsweek">{{Cite web | url = https://www.newsweek.com/20-most-painful-conditions-nhs-1191081 | title = Here are 20 of the most painful health conditions you can get | last = Osborne | first = Hannah | date = 2018-10-29 | website = Newsweek|language=en|access-date=2019-03-26}}</ref> 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 and fluctuate in intensity.<ref name="20mostpainful" /><ref name="FMA-uk">{{Cite web | title = What is Fibromyalgia|website=Fibromyalgia Action UK| url = https://www.fmauk.org/2-uncategorised/52-what-is-fibromyalgia | date = |access-date=2021-11-28}}</ref><ref name="FibroBasics" /> The [[United States|United States]] (US) [[Centers for Disease Control and Prevention]] (CDC) states fibromyalgia is a serious disorder, and "can cause pain, [[Fibromyalgia disability process|disability, and lower quality of life]]."<ref name="FibroBasics" /> The [[American College of Rheumatology]] (ACR) created and updates the diagnostic criteria for fibromyalgia.<ref name="ACR2010">{{Cite journal| url = https://www.rheumatology.org/Portals/0/Files/2010_Preliminary_Diagnostic_Criteria.pdf | title=American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia | last = Wolfe | first = Frederick | date = May 2010|volume =62 | issue = 5 | pages = 600–610| doi = 10.1002/acr.20140|type=PDF|archive-url=|archive-date=|access-date= | authorlink = | last2 = Clauw | first2 = Daniel | authorlink2 = |journal=Arthritis Care & Research | last3 = Fitzcharles | first3 = Mary-Ann | first4 = Don | last5 = Katz | last4 = Goldenberg | first5 = Robert | last6 = Mease | first6 = Philip | last7 = Russel | first7 = Anthony | last8 = Russel | first8 = I. Jon | first9 = John | last9 = Winfield | first10 = Muhammad | last10 = Yunus|quote=The reference list consisted of: [[myalgia|muscle pain]], [[irritable bowel syndrome]], [[fatigue]]/tiredness, [[cognitive dysfunction|thinking or remembering problem]], [[paresis|muscle weakness]], [[headache]], pain/cramps in the abdomen, [[paresthesia|numbness/tingling]], [[dizziness]], [[insomnia]], [[depression]], [[constipation]], pain in the upper abdomen, [[nausea]], nervousness, [[chest pain]], [[blurred vision]], [[fever]], [[diarrhea]], dry mouth, [[skin itch|itching]], wheezing, [[Raynaud's syndrome|Raynaud’s phenomenon]], [[hives|hives/welts]], [[tinnitus|ringing in ears]], [[vomiting]], [[heartburn]], oral ulcers, loss of/change in taste, [[seizure]]s, [[dry eye syndrome|dry eyes]], [[dyspnea|shortness of breath]], [[anorexia (appetite loss)|loss of appetite]], [[skin rash|rash]], [[photophobia|sun sensitivity]], hearing difficulties, easy [[bruising]], [[hair loss]], frequent urination, [[painful bladder syndrome|painful urination]], and bladder spasms.}}</ref><ref name="ACR1990" /><ref name="excerpt2" /><ref name="ACR2010" /><ref name="excerpt">{{Cite web | url = https://www.rheumatology.org/Portals/0/Files/2010%20Fibromyalgia%20Diagnostic%20Criteria_Excerpt.pdf | title=2010 Fibromyalgia Diagnostic Criteria - Excerpt | date = 2010 | last = | first = | authorlink = |website=American College of Rheumatology|archive-url=|archive-date=|access-date=}}</ref> See: [[Fibromyalgia#Diagnosis|Fibromyalgia (Diagnosis)]]. [[File:Fibro_Widespread_Pain.png|400px|thumb|right|<span id="ACR1990-image">2010 ACR Preliminatry Diagnostic Criteria:</span> '''Widespread Pain Index (WPI)''', 19 Tender Point Areas<ref name="ACR2010" /><ref name="excerpt" /><br>Image: [https://commons.wikimedia.org/wiki/Category:Fibromyalgia#/media/File:Widespread_Pain_Index_Areas.svg Wikimedia Commons] by author Jmarchn. License: CC-by-sa-3.0]] ==Prevalence== An estimated 4 million people in the US<ref name="FibroBasics" /> and 2-5% of the world population have fibromyalgia (Clauw et al, 2011). Fibromyalgia is the second most common rheumatic disorder behind [[osteoarthritis]]<ref name="ScienceOfFibro">{{Cite journal | last = Clauw | first = Daniel J. | author-link = Daniel Clauw | last2 = Arnold | first2 = Lesley M. | authorlink2 = | last3 = McCarberg | first3 = Bill H. | date = Sep 2011 | title = The Science of Fibromyalgia| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258006/|journal=Mayo Clinic Proceedings|volume=86|issue=9 | pages = 907–911|doi=10.4065/mcp.2011.0206|issn=0025-6196|pmc=3258006|pmid=21878603|access-date=|quote=|via=}}</ref> and is considered by many pain experts to be a [[central nervous system]] disorder which is most often lifelong<ref name="Clauw2018">{{Cite journal | last = Harte | first = Steven E. | author-link = | last2 = Harris | first2 = Richard E. | authorlink2 = | last3 = Clauw | first3 = Daniel J. | authorlink3 = Daniel Clauw | date = 2018 | title = The neurobiology of central sensitization | url =https://onlinelibrary.wiley.com/doi/abs/10.1111/jabr.12137|journal=Journal of Applied Biobehavioral Research|language=en|volume=23|issue=2| pages = e12137|doi=10.1111/jabr.12137|issn=1751-9861|pmc=|pmid=|access-date=|quote=|via=}}</ref> that is not fatal.<ref name="wm">{{Cite web | url = https://www.womenshealth.gov/a-z-topics/fibromyalgia | title = Fibromyalgia | last = | first = | authorlink = | date = | website = Office on Women's Health|archive-url=|archive-date=|url-status=|access-date=2021-12-06}}</ref> It is occurs in women, men, children, and all ethnic groups. Fibromyalgia is often seen in families and most commonly diagnosed in middle aged people, and prevalence increases with age.<ref name="CDC-complications" /><ref name="ScienceOfFibro" /> FM is a [[female predominant diseases|female predominant disease]], diagnosed with female:male of between 7:1 and 1.5:1, depending on the criteria used.<ref name="ACR1990" /><ref name="excerpt2" /><ref name="ACR2010" /><ref name="excerpt" /><ref name="medscape" /> See: [[Fibromyalgia#American College of Rheumatology (ACR) Criteria|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<ref name="Wolfe2018" /> (this criterion further updated in 2016<ref name="2016revision">{{Cite journal | date = 2016-12-01 | title = 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria| url = https://www.sciencedirect.com/science/article/pii/S0049017216302086|journal=Seminars in Arthritis and Rheumatism|language=en|volume=46|issue=3 | pages = 319–329|doi=10.1016/j.semarthrit.2016.08.012|issn=0049-0172}}</ref>).<blockquote>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.<ref name="Wolfe2018" /></blockquote><blockquote>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.<ref name="Wolfe2018">{{Cite journal | last = Wolfe | first = Frederick | last2 = Walitt | first2 = Brian | last3 = Perrot | first3 = Serge | last4 = Rasker | first4 = Johannes J. | last5 = Häuser | first5 = Winfried | date = 2018-09-13 | title = Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias |url =https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203755|journal=PLOS ONE|language=en|volume=13|issue=9| pages = e0203755|doi=10.1371/journal.pone.0203755|issn=1932-6203|pmc=|pmid=30212526|via=}}</ref></blockquote> ==Fibromyalgia in ME/CFS== The most common overlapping condition with [[ME/CFS]] is fibromyalgia.<ref name="ICC2011primer">{{citation | last = Carruthers | first1 = BM | author-link1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | author-link8 = A C Peter Powles | last8 = Powles | first8 = ACP | last9 = Speight | first9 = N | author-link9 = Nigel Speight | last10 = Vallings | first10 = R | author-link10 = Rosamund Vallings | last11 = Bateman | first11 = L | author-link11 = Lucinda Bateman | last12 = Bell | first12 = DS | author-link12 = David Bell | last13 = Carlo-Stella | first13 = N | author-link13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | author-link14 = John Chia | last15 = Darragh | first15 = A | author-link15 = Austin Darragh | last16 = Gerken | first16 = A | author-link16 = Anne Gerken | last17 = Jo | first17 = D | author-link17 = Daehyun Jo | last18 = Lewis | first18 = DP | author-link18 = Donald Lewis | last19 = Light | first19 = AR | author-link19 = Alan Light | last20 = Light | first20 = KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 = I | authorlink23 = Ismael Mena | last24 = Miwa | first24 = K | authorlink24 = Kunihisa Miwa | last25 = Murovska | first25 = M | authorlink25= Modra Murovska | last26 = Stevens | first26 = SR | authorlink26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf }}</ref><ref name="Jason2001">{{Cite journal | last = Jason | first = Leonard | last2 = Taylor | first2 = R.R. | last3 = Kennedy | first3 = C.L. | last4 = Song | first4 = S | last5 = Johnson | first5 = D | last6 = Torres | first6 = S.R. | date = 2001-01-01 | title = Chronic fatigue syndrome: Comorbidity with fibromyalgia and psychiatric illness |url =https://www.researchgate.net/publication/285787383_Chronic_fatigue_syndrome_Comorbidity_with_fibromyalgia_and_psychiatric_illness|journal=Medicine and Psychiatry|volume=4 | pages = 29–34}}</ref> 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.<ref name="Natelson2019">{{Cite journal | last = Natelson | first = Benjamin H. | date = 2019-02-19 | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Fibromyalgia: Definitions, Similarities, and Differences |url =https://www.clinicaltherapeutics.com/article/S0149-2918(19)30003-7/abstract|journal=Clinical Therapeutics|language=English|volume=41|issue=4 | pages = 612|doi=10.1016/j.clinthera.2018.12.016|issn=0149-2918|pmid=30795933}}</ref> 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 [[Chronic fatigue syndrome|CFS]] do not have widespread pain.<ref>{{Cite web | url = https://www.youtube.com/watch?v=wJB95m4FLa0#t=57m27s | title = Webinar with Jarred Younger, Ph.D. | last = Younger | first = Jarred | date = May 20, 2016 | website = YouTube | at=57:27|via=|archive-url=|archive-date=|access-date=| publisher = SolveCFS|type=Video}}</ref> However, the [[Canadian Consensus Criteria]] (CCC) requires the symptom of pain to diagnose ME/CFS.<ref name="Carruthers, 2003">{{Citation | last = Carruthers | first1 = Bruce M. | author-link1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | authorlink6 = Martin Lerner | last7 = Bested | first7 = Alison C. | author-link8 = Pierre Flor-Henry | last8 = Flor-Henry | first8 = Pierre | last9 = Joshi | first9 = Pradip | author-link9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | author-link10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | author-link11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I. | author-link12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols | journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 | pmid = | doi = 10.1300/J092v11n01_02 | url = http://phoenixrising.me/wp-content/uploads/Canadian-definition.pdf }}</ref> It is the pattern (on both sides of the body, and above and below the waist) of chronic widespread [[Musculoskeletal system|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 dysfunction|cognitive symptoms]] and [[unrefreshing sleep]].<ref name="webmd-guide" /><ref name="mayo" /> 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.<ref>{{Cite web | url = https://osf.io/qwn5h/|website=Center for Open Science|access-date=2019-12-03 | title = Bragee Bertilson et al. - ME CFS and Intracranial Hypertension | date = Nov 27, 2019 | last = | first = | authorlink = |archive-url=|archive-date=}}</ref> ==Health complications== Fibromyalgia is not considered a progressive disease<ref name="Firdous2012" /> but according to Dr. [[Daniel Clauw|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."<ref>{{Cite news |url =http://nationalpainreport.com/ask-the-dctors-is-fibromyalgia-progressive-8831105.html | title = Ask the Doctors: Is Fibromyalgia Progressive? | date = 2016-08-09|work=National Pain Report|access-date=2018-08-09|language=en-US}}</ref> The [[Centers for Disease Control and Prevention|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 *'''Higher rates of major [[depression]]''' :Adults with fibromyalgia are more than 3 times more likely to have major depression than adults without fibromyalgia, and rates of depression and other [[#Mood_disorder_symptoms|mood disorder symptoms]] are higher than in most other illnesses.<ref name="CDC-complications" /><ref name="Alciati2012" /> *'''Death rates from suicide and injuries are higher in people with FM''' :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]], [[systemic lupus erythematosus|lupus]], and [[ankylosing spondylitis]].<ref name="CDC-complications">{{Cite web | url = https://www.cdc.gov/arthritis/basics/fibromyalgia.htm#diagnosis | title = Fibromyalgia {{!}} Arthritis | date = 2020-01-06 | last = Centers for Disease Control and Prevention|website=[[Centers for Disease Control and Prevention]]|language=en-us|access-date=2021-11-27}}</ref> The American College of Rheumatology states that: *Other conditions often occur in fibromyalgia patients **Depression or [[anxiety]] **[[Migraine]] or [[tension-type headache|tension headaches]]s **Digestive problems, e.g. [[irritable bowel syndrome]] (IBS), [[gastroesophageal reflux disease]] (GERD) **Irritable or [[overactive bladder]] **[[Chronic pelvic pain|Pelvic pain]] **[[Temporomandibular joint disorder]] (TMD)<ref name="PatientInfo">{{Cite web | url =https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Fibromyalgia | title = Fibromyalgia | last = | first = |website=American College of Rheumatology|archive-url=|archive-date=|access-date=2021-11-27}}</ref> ==Risk factors== 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.<ref name="NIAMScauses" /> Rheumatic illnesses are risk factors in developing FM, especially [[systemic lupus erythematosus|lupus]] and [[rheumatoid arthritis]] (RA).<ref name="CDC-complications" /> Events linked to causing fibromyalgia to develop include car accidents, [[post-traumatic stress disorder]] (PTSD), repetitive injuries, and illnessss such as a [[virus]].<ref name="FibroBasics">{{Cite web | url = https://www.cdc.gov/arthritis/basics/fibromyalgia.htm | title = Fibromyalgia {{!}} Arthritis | date = 2020-01-06 | website = [[Centers for Disease Control and Prevention]]|language=en-us|access-date=2018-08-09}}</ref><ref name="NIAMScauses">{{Cite web | url = https://www.niams.nih.gov/health_info/Fibromyalgia/ | title = Fibromyalgia What Causes it? | last = Garrick | first = Nancy| publisher = National Institute of Arthritis and Musculoskeletal and Skin Diseases|access-date=2021-11-27|archive-url=|archive-date=|language=en}}</ref> ==Diagnosis== The American College of Rheumatology publishes the most widely used diagnostic criteria for fibromyalgia.<ref name="ACR2010" /><ref name="FibroBasics" /> Tender points, not [[trigger point]]s, are used to diagnose fibromyalgia.<ref>{{Cite web | url = http://www.healthcentral.com/chronic-pain/c/662034/176031/fibromyalgia-trigger/ | title = The Difference Between Fibromyalgia Tender Points and Myofascial Trigger Points - Chronic Pain {{!}} HealthCentral | last = Cooper | first = Celeste | date = May 8, 2015 | website = healthcentral.com|language=en-US|archive-url=|archive-date=|access-date=2018-08-09}}</ref> In fibromyalgia, painful areas of the body will be both 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 for clinicians to check for other conditions that could be causing pain such as [[hypothyroidism]], rheumatoid arthritis, lupus, osteoarthritis, ankylosing spondylitis, and polymyalgia rheumatica.<ref>{{Cite news |url =https://www.webmd.com/fibromyalgia/guide/fibromyalgia-diagnosis-and-misdiagnosis#1 | title = How Is Fibromyalgia Diagnosed?|work=WebMD|access-date=2018-08-12|language=en-US}}</ref> ===United States=== ==== 2010 American College of Rheumatology (ACR) Criteria ==== The new ACR criteria for fibromyalgia assesses: * [[#WPI|Widespread Pain Index]] (WPI), which replaces the older tender points assessment, and * [[#SS|Symptom Severity Score]] (SS), which assesses somatic symptoms other than pain<ref name="ACR2010" /> =====<span id="WPI">Widespread pain index===== There are 19 areas in the widespread pain index (WPI) in the newer ACR criteria.<ref name="masscfids" /><ref name="ACR2010" /> [[File:Widespread Pain Index Areas with numbers.svg|200px|thumb|right|'''WPI''' 19 areas of pain. Count 1 point for each area of pain present at least once a week.<ref name="Firdous2012" /><ref name="ACR2010" /><ref name="excerpt" /><br> Image source: [https://commons.wikimedia.org/wiki/File:Widespread_Pain_Index_Areas_with_numbers.svg#/media/File:Widespread_Pain_Index_Areas_with_numbers.svg Wikimedia Commons] by author Jmarchn. License: CC-by-sa-3.0.]] 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.<ref name="Firdous2012" /><ref name="ACR2010" /> =====<span id="SS">Symptom severity</span>===== 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: *[[Fatigue]] *[[Unrefreshing sleep|Waking unrefreshed]] *[[Cognitive dysfunction|Cognitive symptoms]] *Somatic (physical) symptoms in general (such as [[headache]], weakness, [[Gastrointestinal system|bowel problems]], [[nausea]], [[dizziness]], [[numbness]]/[[Paresthesia|tingling]], [[hair loss]], [[Dry eye syndrome|dry eyes]], [[Raynaud's syndrome|Raynaud's phenomenon]], painful urination, and more.<ref name="Firdous2012" /><ref name="ACR2010" /> [[File:WPI SS Fibro.JPG|600px|thumb|center|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)<ref name="Firdous2012" /><ref name="ACR2010" /> 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.<ref name="Firdous2012" /><br> Source: Jahan F, Nanji K, Qidwai W, Qasim R. Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management. Oman Med J 2012 May; 27(3):192-195. doi: 10.5001/omj.2012.44 license: CC-BY-NC]] 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<ref name="Firdous2012" /><ref name="ACR-rev" /> The 2010 American College of Rheumatology (ACR) proposed diagnostic criteria for fibromyalgia<ref name="ACR2010" /><ref name="excerpt" /> was modified in 2011,<ref name="2016revision" /> with the modification being validated in 2013 and published in 2014.<ref name="prelim2010">{{Cite journal | last = Bennett | first = Robert M. | last2 = Friend | first2 = Ronald | last3 = Marcus | first3 = Dawn | last4 = Bernstein | first4 = Cheryl | last5 = Han | first5 = Bobby Kwanghoon | last6 = Yachoui | first6 = Ralph | last7 = Deodhar | first7 = Atul | last8 = Kaell | first8 = Alan | last9 = Bonafede | first9 = Peter| date = 2014 | title = Criteria for the diagnosis of fibromyalgia: validation of the modified 2010 preliminary American College of Rheumatology criteria and the development of alternative criteria| url = https://www.ncbi.nlm.nih.gov/pubmed/24497443|journal=Arthritis Care & Research|volume=66|issue=9 | pages = 1364–1373|doi=10.1002/acr.22301|issn=2151-4658|pmid=24497443|via=}}</ref> In September 2016, another revision was been made.<ref name="ACR-rev">{{Cite news |url =http://acrabstracts.org/abstract/2016-revisions-to-the-20102011-fibromyalgia-diagnostic-criteria/ | title = 2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria - ACR Meeting Abstracts | last = | first = | date = Sep 28, 2016|work=ACR Meeting Abstracts|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref> =====Take the online Fibromyalgia test ===== This [https://www.fibromyalgiaforums.org/get-help/online-fibromyalgia-test online test by fibromyalgiaforums.org] uses the ACR 2010 Criterion to help diagnose fibromyalgia. =====Tender point test phased out ===== The older 1990 criteria's tender point examination was replaced because men often do not seem to form the tender points needed for diagnosis.<ref name="men">{{Cite news |url =http://www.webmd.com/fibromyalgia/features/how-fibromyalgia-affects-men#2 | title = How Fibromyalgia Affects Men: Symptoms and Diagnosis|work=WebMD|access-date=2018-08-09|language=en-US}}</ref> The 2010 proposed criteria correctly diagnosed more men, with a female:male ratio of 2:1.<ref name="medscape">{{Cite web | last = Boomershine | first = Chad | date = Nov 4, 2017 | title = Fibromyalgia: Practice Essentials, Background, Pathophysiology| url = http://emedicine.medscape.com/article/329838-overview#a5 | website = Medscape | pages = |via=}}</ref> 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.<ref name="NBK279092" /><ref name="masscfids">{{Cite web | url = https://www.masscfids.org/8-resource-library/diagnosis/266-tender-points-might-no-longer-be-used-for-diagnosis-of-fibromyalgia#2 | title = Tender Points might no longer be used for diagnosis of Fibromyalgia | last = Proskauer | first = Charmian | date = Feb 5, 2011 | website = [[Massachusetts ME/CFS & FM Association]]|language=en-GB|archive-url=|archive-date=|access-date=2018-08-09}}</ref> :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<ref name="masscfids" /> ====1990 ACR criteria==== [[File:Fibro_Tender_Points.png|400px|thumb|right|<span id="ACR1990-image">1990 ACR Diagnostic Criteria: 18 Tender Points</span><ref name="ACR1990">{{Cite journal | last = Wolfe | first = Frederick | author-link = Frederick Wolfe | last2 = Smythe | first2 = Hugh | authorlink2 = | last3 = Yunus | first3 = Muhammad | authorlink3 = Muhammad Yunnus | last4 = Bennett | first4 = Robert | authorlink4 = | last5 = Bombardier | first5 = Claire | authorlink5 = | last6 = Goldenberg | first6 = Don | authorlink6 = | last7 = Tugwell | first7 = Peter | author-link7 = | last8 = Campbell | first8 = Stephen | last9 = Abeles | first9 = Micha | author-link9 = |others=P Clark; A Fam; S Farber; J Fiechtner; CM Franklin; R Gatter; D Hamaty; J Lessard; A Lichtbroun; A Masi; G McCain; WJ Reynolds; T Romano; IJ Russell; R Sheon | date = 1990 | title = The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia| url = https://www.rheumatology.org/Portals/0/Files/1990_Criteria_for_Classification_Fibro.pdf | journal=Arthritis and Rheumatism| publisher = The American College of Rheumatology|volume=33|issue=2 | pages = 160-172|quote=|via=}}</ref><ref name="excerpt2">{{Cite web | url = https://www.rheumatology.org/Portals/0/Files/1990%20Fibromyalgia_Excerpt.pdf | title=1990 Fibromyalgia Excerpt | last = Wolfe | first = Frederick | authorlink = Frederick Wolfe | date = 1990 | website = American College of Rheumatology|archive-url=|archive-date=|access-date=}}</ref><br>Image source: [https://commons.wikimedia.org/wiki/File:Tender_points_fibromyalgia_svg.svg WikiMedia Commons], authors Sav vas and Jmarchn, license: CC0 / public domain.]] *1990, [http://www.rheumatology.org/Portals/0/Files/1990_Criteria_for_Classification_Fibro.pdf The American College Of Rheumatology 1990 Criteria For The Classification Of Fibromyalgia]<ref name="ACR1990" /><ref name="excerpt2" /> "American College of Rheumatology guidelines suggest that people with fibromyalgia have pain in at least 11 of these tender points when a doctor applies a certain amount of pressure."<ref name="NBK279092" /><ref name="masscfids" /> ====US Social Security Administration ==== The United States [[Social Security Administration]] (SSA) accepts a diagnosis of FM with either the 2010 or 1990 ACR criteria.<ref name="ACR1990" /><ref name="excerpt2" /><ref name="ACR2010" /><ref name="excerpt" /><ref name="ssa">{{Cite web | url = https://www.ssa.gov/OP_Home/rulings/di/01/SSR2012-02-di-01.html | title = Social Security Ruling: SSR 12-2p | last = ORDP | last2 = OPPS | first = | date = Jul 25, 2012 | website = ssa.gov|language=en|archive-url=|archive-date=|access-date=2018-08-09}}</ref> {{See also|Fibromyalgia disability process}} ==== Sleep studies==== [[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.<ref name="NBK279092">{{Cite book | last = Kaltsas | first = Gregory | last2 = Tsiveriotis | first2 = Konstantinos | date = 2000|editor-last = Feingold|editor-first = Kenneth R.|editor2-last = Anawalt|editor2-first = Bradley|editor3-last = Boyce|editor3-first = Alison|editor4-last = Chrousos|editor4-first = George|editor5-last = de Herder|editor5-first = Wouter W.|editor6-last = Dhatariya|editor6-first = Ketan|editor7-last = Dungan|editor7-first = Kathleen|editor8-last = Hershman|editor8-first = Jerome M.|editor9-last = Hofland|editor9-first = Johannes | title = Endotext [Internet]|chapter=Fibromyalgia|chapter-url=http://www.ncbi.nlm.nih.gov/books/NBK279092/|location=South Dartmouth (MA)| publisher = MDText.com, Inc.|pmid=25905317}}</ref><ref name="ACR2010" /> A diagnosed sleep disorder is also helpful if one needs to [[Fibromyalgia disability process|file for disability]]. ====Brain scans==== Brain scans are a potential aid to help diagnose fibromyalgia.<ref name="Hackshaw2021">{{Cite journal | last = Hackshaw | first = Kevin V. | author-link = | date = Feb 2021 | title = The Search for Biomarkers in Fibromyalgia| url = https://www.mdpi.com/2075-4418/11/2/156|journal=Diagnostics|language=en|volume=11|issue=2 | pages = 156|doi=10.3390/diagnostics11020156|pmc=PMC7911687|pmid=33494476|access-date=|quote=|via=}}</ref><ref name="HashmiTrial">{{Cite web | last = Hashmi | first = Javeria | date = 2020-03-11|others=Nova Scotia Health Authority | title = Brain Imaging Study on Biomarkers for Fibromyalgia| url = https://clinicaltrials.gov/ct2/show/NCT03910010}}</ref> A small study by López-Solà et al. (2017) using a combination of [[functional magnetic resonance imaging|fMRI]] brain scans and artificial intelligence (machine learning) correctly diagnosed 95% of fibromyalgia patients.<ref name="Lopez2017" /> A number of brain imaging studies have found significant results in patients with fibromyalgia, including a [[Functional magnetic resonance imaging|fMRI]] study that found patients with FM "have measurable pain signals in their brains, from a gentle finger squeeze that barely feels unpleasant to people without the disease"<ref name="Gracely2002" /> and MR/PET imaging by Loggia et al 2015 found [[neuroinflammation]] due to [[Glial cell|glial]] activation.<ref name="Loggia2015" /> {{See also|Fibromyalgia notable studies}} ====Blood tests and biomarkers==== 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.<ref name="controversy2021" /><ref name="fmtest">{{Cite web | url = http://fmtest.com/ | title = Home | last = |website=EpicGenetics' FM/a® Test is FDA-compliant and has successfully diagnosed patients with fibromyalgia since 2012.|language=en-US|access-date=2019-03-25}}</ref><ref name="FMa test" /> 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.<ref name="FMa test" /> The FM/a test continues to be marketed despite the suspension of the linked treatment trial,<ref name="FMa test" /> and the fact that only two studies have been published using the test - the last being published in 2015.<ref name="PMC3534336" /><ref name="PMC4435905" /> 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.<ref name="controversy2021" /> One study did not include any men.<ref name="PMC3534336" /> IsolateFibromyalgia, IQuity's RNA based blood test for fibromyalgia, was first announced in 2018 but no peer-reviewed studies have been published. A '''non-invasive eye test''' has found eye abnormalities in people with fibromyalgia, with Garcia et al 2016 finding reduced retinal nerve fiber layer (RNFL) thickness, raising hopes of a non-invasive eye test may help diagnose FM.<ref name="Garcia2016">{{Cite journal | last = Garcia-Martin | first = Elena | last2 = Garcia-Campayo | first2 = Javier | last3 = Puebla-Guedea | first3 = Marta | last4 = Ascaso | first4 = Francisco J. | last5 = Roca | first5 = Miguel | last6 = Gutierrez-Ruiz | first6 = Fernando | last7 = Vilades | first7 = Elisa | last8 = Polo | first8 = Vicente | last9 = Larrosa | first9 = Jose M. | date = 2016-09-01 | title = Fibromyalgia Is Correlated with Retinal Nerve Fiber Layer Thinning | url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008644/|journal=PLoS ONE|volume=11|issue=9| pages = e0161574|doi=10.1371/journal.pone.0161574|issn=1932-6203|pmc=5008644|pmid=27584145}}</ref> The findings were confirmed by Cordón et al 2021, who found that disease severity and reduced quality of life were associated with reduced RNFL.<ref name="Cordon2021">{{Cite journal | last = Cordón | first = B. | last2 = Orduna | first2 = E. | last3 = Viladés | first3 = E. | last4 = Garcia-Martin | first4 = E. | last5 = Garcia-Campayo | first5 = J. | last6 = Puebla-Guedea | first6 = M. | last7 = Polo | first7 = V. | last8 = Larrosa | first8 = J.M. | last9 = Pablo | first9 = L.E. | date = 2021-07-02 | title = Analysis of Retinal Layers in Fibromyalgia Patients with Premium Protocol in Optical Tomography Coherence and Quality of Life | url =https://doi.org/10.1080/02713683.2021.1951301|journal=Current Eye Research|volume=0|issue=0 | pages = 1–11|doi=10.1080/02713683.2021.1951301|issn=0271-3683|pmid=34213409}}</ref> The test requires optical coherence tomography (OCT), which is fast and non-invasive.<ref name="Cordon2021" /> At present, there is no eye test in clinical use for diagnosing FM. In 2019, Hackshaw and colleagues found a unique metabolic fingerprint using a blood spot test that distinguished between fibromyalgia, rheumatoid arthritis and lupus, which they suggested could act as a diagnostic biomarker for FM.<ref name="Hackshaw2019">{{Cite journal | last = Hackshaw | first = Kevin V. | last2 = Aykas | first2 = Didem P. | last3 = Sigurdson | first3 = Gregory T. | last4 = Plans | first4 = Marcal | last5 = Madiai | first5 = Francesca | last6 = Yu | first6 = Lianbo | last7 = Buffington | first7 = Charles A.T. | last8 = Giusti | first8 = M. Mónica | last9 = Rodriguez-Saona | first9 = Luis | date = 2019-02-15 | title = Metabolic fingerprinting for diagnosis of fibromyalgia and other rheumatologic disorders |url =https://www.jbc.org/article/S0021-9258(20)40006-7/abstract|journal=Journal of Biological Chemistry|language=English|volume=294|issue=7 | pages = 2555–2568|doi=10.1074/jbc.RA118.005816|issn=0021-9258}}</ref> [[Heart rate variability]] (HRV) measured by ECG is a possible fibromyalgia biomarker, since it is reduced in people with FM, but heart rate is affected by many different factors so this may be problematic.<ref name="Hackshaw2021" /> === ICD Diagnostic code=== '''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).<ref name="ICD10">{{Cite web | url = http://apps.who.int/classifications/icd10/browse/2016/en#/M79.7 | title = ICD-10 Version:2016 | last = World Health Organization | first = | author-link = World Health Organization | date = 2016 | website = [[World Health Organization]]|at=M79.7 Fibromyalgia|language=en|archive-url=|archive-date=|access-date=2018-09-15}}</ref> The WHO's ICD-10 does not refer to FM as a syndrome and it is not classified in the category for [[Medically unexplained physical symptoms|medically unexplained symptoms]].<ref name="icd10us" /><ref name="ICD10" /> *'''M79.7 Fibromyalgia''' ::Fibromyositis ::Fibrositis ::Myofibrositis<ref name="ICD10" /> In 2015, the [[United States|US]] finally adopted ICD-10 and FM as a diagnosis.<ref name="icd10us">{{Cite web | url = http://www.icd10data.com/ICD10CM/Codes/M00-M99/M70-M79/M79-/M79.7 | title = 2018 ICD-10-CM Diagnosis Code M79.7: Fibromyalgia | website = icd10data.com|language=en|access-date=2018-08-09 | date = 2018 | last = World Health Organization | first = |archive-url=|archive-date= | authorlink = World Health Organization}}</ref><ref>{{Cite news |url =http://nationalpainreport.com/the-health-care-industry-finally-recognizes-fibromyalgia-8827637.html | title = The Health Care Industry Finally Recognizes Fibromyalgia | last = Liptan | first = Ginevra | date = 2015-09-30|work=National Pain Report|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref> '''ICD-11 (2019)''' The [[ICD-11]] (2019) has diagnostic code ''MG30.1 Chronic widespread pain'', and changed the category from a [[:Category:Musculoskeletal diseases and disorders|Musculoskeletal disease]], to the ''General signs and symptoms category'', sometimes referred to as [[Medically unexplained physical symptoms]].<ref name="ICD11">{{Cite web | url = https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/849253504 | title = ICD-11 - Mortality and Morbidity Statistics|website=[[World Health Organization]]|language=en|access-date=2018-08-09}}</ref> *'''MG30.01 Chronic widespread pain''' '''Parent''' ::MG30.0 Chronic primary pain '''Description''' <blockquote>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.<ref name="ICD11" /></blockquote> '''Inclusions''' :*Fibromyalgia '''Exclusions''' :*Acute pain (MG31)<ref name="ICD11" /> ==Differential diagnosis == 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, [[opioid]]s ([[opioid-induced hyperalgesia]]), some chemotherapy drugs, aromatase inhibitors, and bisphosphonates can cause diffuse pain <ref name="NBK540974">{{Cite book | last = Bhargava | first = Juhi | last2 = Hurley | first2 = John A. | date = 2021 | title=Fibromyalgia| url = http://www.ncbi.nlm.nih.gov/books/NBK540974/|location=Treasure Island (FL)| publisher = StatPearls Publishing|doi=|pmc=|pmid=31082018|quote=|via=}}</ref><ref name="PMC5741304">{{Cite journal | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741304/ | title = Diagnostic confounders of chronic widespread pain: not always fibromyalgia | date = 2017 | journal=Pain Rep.|volume =2|issue = 3 | page = e598 |doi =10.1097/PR9.0000000000000598|pmid = 29392213|pmc=PMC5741304|first =Winfried | last = Häuser | first2 =Serge | last2 =Perrot | first3 = Claudia | last3 = Sommer | first4 = Yoram | last4 = Shir | first5 = Mary-Ann | last5 = Fitzcharles | pages = |quote= | last6 = | first6 = | author-link = Winfred Häuser | authorlink2 = |access-date=|via=}}</ref> The limited laboratory findings along with history and physical examination can help differentiate fibromyalgia from other differentials.<ref name="PMC5741304" /> ==Pathophysiology== Fibromyalgia is a '''pain processing disorder''' involving altered pain processing in the [[central nervous system]] which causes widespread pain and a constellation of additional symptoms.<ref name="ScienceOfFibro" /> Neuroimaging and brain imaging studies have shown that the pain and other symptoms of fibromyalgia appear to be caused by neurochemical imbalances in the [[central nervous system]] that lead to a '''central amplification''' of pain perception (Clauw et al., 2011).<ref name="ScienceOfFibro" /> According to the CDC, there is no evidence that a single event "causes" fibromyalgia, instead it appears to be associated with many physical and/or emotional [[Stress|stressors]] and other [[#risk_factors|risk factors]] that may trigger or aggravate symptoms. These include certain [[Infection|infections]], such as a [[Viral infection|viruses]] or [[Lyme disease]], as well as emotional or physical [[trauma]] (injury)."<ref name="FibroBasics" /><ref name="CDC-complications" /> The widespread pain is severe, debilitating, and abnormal in processing its pain. [[Sleep dysfunction|sleep disturbance]] and [[fatigue]] are common symptoms.<ref name="omf">{{Cite news |url =https://www.omf.ngo/what-is-mecfs-old/fibromyalgia/ | title = What is Fibromyalgia?|work=Open Medicine Foundation|access-date=2018-08-09|language=en-US | last = | first = | date = |quote= | author-link = |archive-url=|archive-date=}}</ref> *May 2012, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/ Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management]<ref name="Firdous2012">{{Cite journal | last = Jahan | first = Firdous | last2 = Nanji | first2 = Kashmira | last3 = Qidwai | first3 = Waris | last4 = Qasim | first4 = Rizwan | date = 2012 | title = Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/|journal=Oman Medical Journal|volume=27|issue=3 | pages = 192–195|doi=10.5001/omj.2012.44|issn=1999-768X|pmid=22811766|via=}}</ref> ''See'' Table 1: "Conditions associated with fibromyalgia." Musculoskeletal, [[:Category:genitourinary signs and symptoms|genitourinary]], [[Gastrointestinal system|gastrointestinal]], and miscellaneous conditions often exist among fibromyalgia patients. <blockquote>Pathophysiology: Although the etiology remains unclear, characteristic alterations in the [[Sleep dysfunction|pattern of sleep]] and changes in neuroendocrine transmitters such as [[serotonin]], substance P, growth hormone and [[cortisol]] suggest that regulation of the [[Autonomic nervous system|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 [[neurotransmitter]]s 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." (Firdous et al, 2012)<ref name="Firdous2012" /></blockquote> <blockquote>The frequent co-morbidity of fibromyalgia with [[Mood swings|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.<ref name="Firdous2012" /></blockquote> *May 2018, [https://www.chiropractic.ca/wp-content/uploads/2018/05/107243-2_Chiro_62_1d_Bourgaize.pdf A comparison of the clinical manifestation and pathophysiology of myofascial pain syndrome and fibromyalgia: implications for differential diagnosis and management] *Jun 2018, [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198625 SNPs in inflammatory genes] [[CCL11]], [[CCL4]] and [[MEFV]] in a fibromyalgia family study.<ref name="Zhang2018" /> <blockquote>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.</blockquote> *Jul 2018, [https://www.jrheum.org/content/early/2018/07/09/jrheum.180083 Primary and Secondary Fibromyalgia Are The Same: The Universality of Polysymptomatic Distress] <blockquote>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.<ref>{{Cite journal | last = Wolfe | first = Frederick | last2 = Walitt | first2 = Brian | last3 = Rasker | first3 = Johannes J. | last4 = Häuser | first4 = Winfried | date = 2018-07-15 | title = Primary and Secondary Fibromyalgia Are The Same: The Universality of Polysymptomatic Distress |url =https://www.jrheum.org/content/early/2018/07/09/jrheum.180083|journal=The Journal of Rheumatology|volume =46|issue=2 | pages = 204-212|language=en|doi=10.3899/jrheum.180083|issn=0315-162X|pmid=30008459}}</ref></blockquote> ===Immune system research=== Dr. [[Jarred Younger]] believes an overactive [[immune system]] is the cause and will be conducting a study to test this hypothesis.<ref>{{Cite news |url =http://nationalpainreport.com/new-uab-study-could-radically-change-fibromyalgia-treatment-as-we-know-it-8833437.html | title = New UAB Study Could Radically Change Fibromyalgia Treatment As We Know It | last = Gregory Burch | first = Donna | date = 2017-04-24|work=National Pain Report|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref><ref>{{Cite web | url = https://www.youtube.com/watch?v=8e5xKX036bE | title = Testing the fibromyalgia immune system with lipopolysaccharide (LPS) | last = Younger | first = Jarred | authorlink = Jarred Younger | date = May 24, 2017 | website = YouTube | archive-url=|archive-date=|access-date=|via=Younger Lab}}</ref> An overactive immune system can cause [[inflammation]] and [[chronic pain]].<ref>{{Cite news |url =https://www.epainassist.com/autoimmune/what-is-overactive-immune-system | title = What is Overactive Immune System {{!}} Causes {{!}} Symptoms {{!}} Treatment | last = Kerkar | first = Pramod | date = 2016-09-29|work=ePainAssist|access-date=2018-10-04|archive-url=|archive-date=|language=en-gb}}</ref><ref>{{Cite news |url =https://www.webmd.com/a-to-z-guides/autoimmune-diseases | title = Autoimmune Diseases|work=WebMD|access-date=2018-10-04|language=en-US}}</ref> Dr. William Pridgen's research of [[Herpes simplex virus#HSV-1|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. {{See also|Fibromyalgia drugs|Fibromyalgia drugs (see drug trials section for IMC-1)}} Recognizing FM may involve activation of the [[immune system]] researchers performed [[Whole exome sequencing|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."<ref name="Zhang2018">{{Cite journal | last = Zhang | first = Zhifang | last2 = Feng | first2 = Jinong | last3 = Mao | first3 = Allen | last4 = Le | first4 = Keith | last5 = Placa | first5 = Deirdre La | last6 = Wu | first6 = Xiwei | last7 = Longmate | first7 = Jeffrey | last8 = Marek | first8 = Claudia | last9 = Amand | first9 = R. Paul St | date = 2018-06-21 | title = SNPs in inflammatory genes CCL11, CCL4 and MEFV in a fibromyalgia family study| url = http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198625|journal=PLOS ONE|language=en|volume=13|issue=6| pages = e0198625|doi=10.1371/journal.pone.0198625|issn=1932-6203|pmid=29927949|via=}}</ref> 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.<ref name="Goebel2021">{{Cite journal | last = Goebel | first = Andreas | last2 = Krock | first2 = Emerson | last3 = Gentry | first3 = Clive | last4 = Israel | first4 = Mathilde R. | last5 = Jurczak | first5 = Alexandra | last6 = Urbina | first6 = Carlos Morado | last7 = Sandor | first7 = Katalin | last8 = Vastani | first8 = Nisha | last9 = Maurer | first9 = Margot | date = 2021-07-07 | title = Passive transfer of fibromyalgia symptoms from patients to mice | url =https://www.jci.org/articles/view/144201?key=51bf6d85e305f6b62f87#SEC4|journal=The Journal of Clinical Investigation|language=en|volume=131|issue=13|doi=10.1172/JCI144201|issn=0021-9738}}</ref><blockquote>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.<ref name="Guardian2021">{{Cite web | url = http://www.theguardian.com/society/2021/jul/01/fibromyalgia-may-be-a-condition-of-the-immune-system-not-the-brain-study | title = Fibromyalgia may be a condition of the immune system not the brain – study | date = 2021-07-01 | website = The Guardian|language=en|access-date=2021-07-08}}</ref></blockquote><blockquote>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.”<ref name="Guardian2021" /></blockquote> === Brain and spinal cord research === A 2004 study by Heffez et al. studied 270 patients with FM and found that 46% had [[cervical spinal stenosis]] and 20% [[chiari malformation]].<ref name="Heffez2004">{{Cite journal | last = Heffez | first = Dan S. | last2 = Ross | first2 = Ruth E. | last3 = Shade-Zeldow | first3 = Yvonne | last4 = Kostas | first4 = Konstantinos | last5 = Shah | first5 = Sagar | last6 = Gottschalk | first6 = Robert | last7 = Elias | first7 = Dean A. | last8 = Shepard | first8 = Alan | last9 = Leurgans | first9 = Sue E. | date = 2004-04-09 | title = Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis in a non-randomized group of patients with the diagnosis of fibromyalgia| url = https://link.springer.com/article/10.1007/s00586-004-0672-x|journal=European Spine Journal|language=en|volume=13|issue=6 | pages = 516–523|doi=10.1007/s00586-004-0672-x|issn=0940-6719|pmc=|pmid=15083352|via=}}</ref> In 2007, Heffez et al. saw significant improvement in physical and mental well-being was found in patients with cervical stenosis who received surgery.<ref name="Heffez2007">{{Cite journal | last = Heffez | first = Dan S. | last2 = Ross | first2 = Ruth E. | last3 = Shade-Zeldow | first3 = Yvonne | last4 = Kostas | first4 = Konstantinos | last5 = Morrissey | first5 = Mary | last6 = Elias | first6 = Dean A. | last7 = Shepard | first7 = Alan | date = 2007 | title=Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications |url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2200733/|journal=European Spine Journal|volume=16|issue=9 | pages = 1423–1433|doi=10.1007/s00586-007-0366-2|issn=0940-6719|pmc=2200733|pmid=17426987|quote=|via=}}</ref> A second study in 2007 by Andrew Holman found that 71% had cervical [[spinal cord]] compression.<ref name="Holman2008">{{Cite journal | date = 2008-07-01 | title = Positional Cervical Spinal Cord Compression and Fibromyalgia: A Novel Comorbidity With Important Diagnostic and Treatment Implications |url =https://www.sciencedirect.com/science/article/pii/S1526590008004379|journal=The Journal of Pain|language=en|volume=9|issue=7 | pages = 613–622|doi=10.1016/j.jpain.2008.01.339|issn=1526-5900 | last = Holman | first = Andrew|quote=|via=|pmc=|pmid=}}</ref> In the past many patients were misdiagnosed with FM when further testing would have revealed the correct diagnosis for the cause of their pain; the 2010 (updated in 2016) ACR criteria has helped curb misdiagnoses.<ref name="misdiagnosis">{{Cite news | title = Common Misdiagnoses of Fibromyalgia| url = https://www.webmd.com/fibromyalgia/guide/common-misdiagnoses-of-fibromyalgia#|work=WebMD|access-date=2018-11-26|language=en-US | last = | first = | date = |archive-url=|archive-date=}}</ref><ref name="Wolfe2018" /> Various types of brain imaging are being used to research FM. {{See also|Fibromyalgia notable studies}} In 2002, an [[Functional magnetic resonance imaging|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."<ref name="anapsid2002">{{Cite web | url = http://www.anapsid.org/cnd/diagnosis/brainpain.html | title = Fibromyalgia Pain Isn't All In Patient's Heads, New Brain Study Finds|website= Melissa Kaplan's Chronic Neuroimmune Diseases| date = 2014 |access-date=2021-11-28}}</ref> A 2007 study by Borsook et al. found decreased gray matter density relative to controls in cingulate cortex (CC), medial prefrontal cortex (Med. PFC), parahippocampal gyrus (PHG) and insula.<ref name="Borsook2007">{{Cite journal | last = Borsook | first = David | last2 = Moulton | first2 = Eric A | last3 = Schmidt | first3 = Karl F | last4 = Becerra | first4 = Lino R | date = 2007-09-11 | title = Neuroimaging Revolutionizes Therapeutic Approaches to Chronic Pain | url =https://link.springer.com/article/10.1186/1744-8069-3-25|journal=Molecular Pain|language=en|volume=3|issue=1 | pages = 1744–8069-3-25|doi=10.1186/1744-8069-3-25|issn=1744-8069|pmid=17848191|via=}}</ref> In 2015, Loggia et al. imaged [[neuroinflammation]] due to [[Glial cell|glial]] activation using MR/PET imaging.<ref name="Loggia2015">{{Cite journal | last = Loggia | first = Marco L. | last2 = Chonde | first2 = Daniel B. | last3 = Akeju | first3 = Oluwaseun | last4 = Arabasz | first4 = Grae | last5 = Catana | first5 = Ciprian | last6 = Edwards | first6 = Robert R. | last7 = Hill | first7 = Elena | last8 = Hsu | first8 = Shirley | last9 = Izquierdo-Garcia | first9 = David | date = 2015-01-08 | title = Evidence for brain glial activation in chronic pain patients |url =https://academic.oup.com/brain/article/138/3/604/333527?searchresult=1|journal=Brain|language=en|volume=138|issue=3 | pages = 604–615|doi=10.1093/brain/awu377|issn=1460-2156}}</ref> In 2017, López-Solà et al. identified three [[brain]] patterns based on [[Functional magnetic resonance imaging|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."<ref name="Lopez2017">{{Cite journal | last = López-Solà | first = Marina | last2 = Woo | first2 = Choong-Wan | last3 = Pujol | first3 = Jesus | last4 = Deus | first4 = Joan | last5 = Harrison | first5 = Ben J. | last6 = Monfort | first6 = Jordi | last7 = Wager | first7 = Tor D. | date = 2017 | title=Towards a neurophysiological signature for fibromyalgia| url = https://www.ncbi.nlm.nih.gov/pubmed/27583567|journal=Pain|volume=158|issue=1 | pages = 34–47|doi=10.1097/j.pain.0000000000000707|issn=1872-6623|pmid=27583567|via=}}</ref> In 2018, Albrecht et al used [[Positron emission tomography|PET]] scans to document [[Glial cell|glial]] activation.<ref name="Albrecht2018">{{Cite journal | last = Albrecht | first = Daniel S. | last2 = Forsberg | first2 = Anton | last3 = Sandstrom | first3 = Angelica | last4 = Bergan | first4 = Courtney | last5 = Kadetoff | first5 = Diana | last6 = Protsenko | first6 = Ekaterina | last7 = Lampa | first7 = Jon | last8 = Lee | first8 = Yvonne C. | last9 = Höglundi | first9 = Caroline Olgart | date = 2018-09-14|others=Catana, Ciprian; Cervenka, Simon; Akeju, Oluwaseun; Lekander, Mats; Cohen, George; Halldin, Christer; Taylor, Norman; Kim, Minhae; Hooker, Jacob M.; Loggia, Marco L. | title = Brain glial activation in fibromyalgia – A multi-site positron emission tomography investigation | url =https://www.sciencedirect.com/science/article/pii/S0889159118302423|journal=Brain, Behavior, and Immunity|language=en|volume= | pages = |doi=10.1016/j.bbi.2018.09.018|issn=0889-1591|via=}}</ref> 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.<ref name="Martucci2018">{{Cite journal | last = Martucci | first = Katherine T | last2 = Weber | first2 = Kenneth A | last3 = Mackey | first3 = Sean C | date = 2018-10-03 | title = Altered Cervical Spinal Cord Resting State Activity in Fibromyalgia| url = https://onlinelibrary.wiley.com/doi/abs/10.1002/art.40746|journal=Arthritis & Rheumatology|language=en|doi=10.1002/art.40746|issn=2326-5191}}</ref> === Fibromyalgia is not the same as depression === * Oct 24, 2003, [https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression#1 Fibromyalgia Isn't Depression]<ref name="webmd-notdepress" /> <blockquote>[[Depression]] doesn't cause the pain of fibromyalgia, a new study shows.<ref name="webmd-notdepress" /></blockquote> <blockquote>"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."<ref name="webmd-notdepress" /></blockquote> <blockquote>"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.<ref name="webmd-notdepress" /> </blockquote><blockquote>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.<ref name="webmd-notdepress" /></blockquote> * 2013, Small fibre pathology in patients with fibromyalgia syndrome<ref name="brain-1857" /> :A study involving skin biopsies funds that fibromyalgia is neuropathic - and not a form of [[depression]] or a [[Psychosomatic illness|Psychosomatic Disorder]] <blockquote>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."<ref name="brain-1857">{{Cite journal | last = Üçeyler | first = Nurcan | last2 = Zeller | first2 = Daniel | last3 = Kahn | first3 = Ann-Kathrin | last4 = Kewenig | first4 = Susanne | last5 = Kittel-Schneider | first5 = Sarah | last6 = Schmid | first6 = Annina | last7 = Casanova-Molla | first7 = Jordi | last8 = Reiners | first8 = Karlheinz | last9 = Sommer | first9 = Claudia | date = 2013-03-09 | title = Small fibre pathology in patients with fibromyalgia syndrome | url =https://doi.org/10.1093/brain/awt053|journal=Brain|volume=136|issue=6 | pages = 1857–1867|doi=10.1093/brain/awt053|issn=1460-2156}}</ref></blockquote> ===Insulin resistance === In 2019 a small observation study by Pappolla et al. was published that found insulin resistance was associated with fibromyalgia, however the study was quickly retracted due to both criticisms of the methodology and issues with ethics approval requirements. Some of the same authors, including Pappolla, published a second observational study in 2021, again showing a likely association between having insulin resistance and fibromyalgia.<ref name="Fang2021">{{Cite journal | title = Insulin Resistance is Associated with Central Pain in Patients with Fibromyalgia | date = Mar 2021| url = https://www.painphysicianjournal.com/linkout?issn&vol=24&page=175|journal=Pain Physician|volume=24|issue=2 | pages = 175–184 | last = Pappolla | first = Miguel A. | author-link = | last2 = Manchikanti | first2 = Laxmaiah | authorlink2 = | last3 = Candido | first3 = Kenneth D. | authorlink3 = | last4 = Grieg | first4 = Nigel | authorlink4 = | last5 = Seffinger | first5 = Michael | authorlink5 = | last6 = Ahmed | first6 = Fauwad | authorlink6 = | last7 = Fang | first7 = Xiang | last8 = Andersen | first8 = Clark | last9 = Trescot | first9 = Andrea M.|doi=|pmc=|pmid=33740353|access-date=|issn=2150-1149|quote=|via=}}</ref> == Comorbidities, overlapping conditions, and common symptoms == [[File:Fibromyalgia and comorbid conditions.JPG|700px|thumb|center|The most common comorbid conditions in fibromyalgia are [[ME/CFS]], which is the most common comorbidity,<ref name="Jason2001" /> [[irritable bowel syndrome]] (IBS), [[tension-type headache]]s, [[migraine]], [[temporomandibular joint disorder]], [[chronic pelvic pain]], vulvodynia in women, [[interstitial cystitis]], painful bladder syndrome, and in men chronic prostatitis, and prostadynia.<ref name="ScienceOfFibro" /> Also common are [[autoimmune disease|autoimmune disease]]s, [[migraine]]s, [[Multiple chemical sensitivity|multiple chemical sensitivity]] (MCS), and [[orthostatic intolerance]] (OI) / [[postural orthostatic tachycardia syndrome]] (POTS).<ref name="Firdous2012" /><ref name="Yun2013" /><ref name="Comorbid2020">{{Cite journal | last = Sleurs | first = David | authorlink = | last2 = Tebeka | first2 = Sarah | authorlink2 = | last3 = Scognamiglio | first3 = Claire | authorlink3 = | last4 = Dubertret | first4 = Caroline | authorlink4 = | last5 = Le Strat | first5 = Yann | authorlink5 = | date = 2020 | title=Comorbidities of self-reported fibromyalgia in United States adults: A cross-sectional study from The National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III)| url = https://onlinelibrary.wiley.com/doi/abs/10.1002/ejp.1585|journal=European Journal of Pain|language=en|volume=24|issue=8 | pages = 1471–1483|doi=10.1002/ejp.1585|issn=1532-2149|pmc=|pmid=|access-date=|quote=|via=}}</ref> Overlapping conditions are [[ME/CFS]], [[IBS]], [[Temporomandibular joint disorder]] (TMD), [[interstitial cystitis]], [[multiple chemical sensitivity]], chronic [[tension-type headache]], and chronic low back pain.<ref name="Firdous2012" /><ref name="mayo" /><ref name="Yunus2008" />]] ====Overlapping conditions ==== The most common overlapping medical conditions in people with fibromyalgia are [[ME/CFS]], [[IBS]], [[Temporomandibular joint disorder]] (TMD), [[interstitial cystitis]], [[multiple chemical sensitivity]], chronic [[tension-type headache]], and chronic low back pain<ref name="Yunus2008">{{Cite journal | last = Yunus | first = Muhammad B. | author-link = Muhammad Yunus | date = 2007-06-01 | title = Fibromyalgia and Overlapping Disorders: The Unifying Concept of Central Sensitivity Syndromes |url =https://www.sciencedirect.com/science/article/pii/S0049017207000066|journal=Seminars in Arthritis and Rheumatism|language=en|volume=36|issue=6 | pages = 339–356|doi=10.1016/j.semarthrit.2006.12.009|issn=0049-0172|pmc=|pmid=|access-date=|quote=|via=}}</ref> ===[[Allodynia]]=== Allodynia is when ordinary sensations cause pain, and is common in people with fibromyalgia.<ref name="Coster2008">{{Cite journal | last = Cöster | first = Lars | last2 = Kendall | first2 = Sally | last3 = Gerdle | first3 = Björn | last4 = Henriksson | first4 = Chris | last5 = Henriksson | first5 = Karl G. | last6 = Bengtsson | first6 = Ann | date = 2008 | title = Chronic widespread musculoskeletal pain – A comparison of those who meet criteria for fibromyalgia and those who do not| url = https://onlinelibrary.wiley.com/doi/abs/10.1016/j.ejpain.2007.10.001|journal=European Journal of Pain|language=en|volume=12|issue=5 | pages = 600–610|doi=10.1016/j.ejpain.2007.10.001|issn=1532-2149}}</ref><ref name="Baron2010">{{Cite journal | last = Baron | first = Ralf | author-link = | last2 = Tölle | first2 = Thomas R. | authorlink2 = | last3 = Freynhagen | first3 = Rainer | authorlink3 = | last4 = Brosz | first4 = Mathias | authorlink4 = | last5 = Gockel | first5 = Ulrich | authorlink5 = | last6 = Koroschetz | first6 = Jana | authorlink6 = | last7 = Rehm | first7 = Stefanie E. | author-link8 = | date = Jun 1, 2010 | title = A cross-sectional survey of 3035 patients with fibromyalgia: subgroups of patients with typical comorbidities and sensory symptom profiles |url =https://academic.oup.com/rheumatology/article/49/6/1146/1790415|journal=Rheumatology|language=en|volume=49|issue=6 | pages = 1146–1152|doi=10.1093/rheumatology/keq066|issn=1462-0324|quote=|via=|pmc=|pmid=|access-date=}}</ref> The main types of [[allodynia]] are: * '''Mechanical / Tactile''' Caused by movement across the skin such as a cotton bud, or brushing a painter's brush against the skin; or by light pressure or touch, e.g. clothing or bedsheets touching the skin. * '''Thermal / Temperature''' Caused by heat or cold that is not extreme enough to cause damage to skin tissues.<ref name="Jensen2014">{{Cite journal | last = Jensen | first = Troels S | last2 = Finnerup | first2 = Nanna B | date = 2014-09-01 | title = Allodynia and hyperalgesia in neuropathic pain: clinical manifestations and mechanisms |url =https://www.sciencedirect.com/science/article/pii/S1474442214701024|journal=The Lancet Neurology|language=en|volume=13|issue=9 | pages = 924–935|doi=10.1016/S1474-4422(14)70102-4|issn=1474-4422}}</ref> {{See also|Allodynia}} ===Anxiety=== Anxiety is more common in people with fibromyalgia than in healthy people.<ref name="PatientInfo" /><ref name="Jensen2010" /> {{See also|Anxiety}} ===[[Body temperature]]=== Hypersensitivity to cold or heat is common in fibromyalgia, especially in people with [[allodynia]].<ref name="Baron2010" /><br> [[Small fiber peripheral neuropathy]] occurs in some people with fibromyalgia, causing a combination of [[temperature sensitivity]], burning, tingling, and prickling due to [[paresthesia]], [[numbness]], [[dry eye syndrome|dry eyes]] and [[dry mouth]].<ref name="ACR2010" /><ref name="PN-webmd">{{Cite web | url = https://www.webmd.com/brain/understanding-peripheral-neuropathy-basics#3 | title = Peripheral Neuropathy -- Symptoms, Types, and Causes of Peripheral Neuropathy | date = |website=WebMD|access-date=2018-10-04|archive-url=|archive-date=| page=3|language=en-US}}</ref> {{See also|Temperature sensitivity}} ===[[Chest pain]]=== Chest pain has been reported in many people with fibromyalgia. A study of over 2,000 FM patients prescribed the popular pain drugs [[Lyrica]] or [[Cymbalta]] found that approximately 23% had chest pain.<ref name="Gore2012">{{Cite journal | last = Gore | first = Mugdha | last2 = Tai | first2 = Kei-Sing | last3 = Chandran | first3 = Arthi | last4 = Zlateva | first4 = Gergana | last5 = Leslie | first5 = Douglas| date = 2011-10-20 | title = Clinical comorbidities, treatment patterns, and healthcare costs among patients with fibromyalgia newly prescribed pregabalin or duloxetine in usual care | url =https://www.tandfonline.com/doi/pdf/10.3111/13696998.2011.629262|journal=Journal of Medical Economics|volume=15|issue=1 | pages = 19–31|doi=10.3111/13696998.2011.629262|issn=1369-6998}}</ref> ===[[Cognitive dysfunction]] and [[Fibro fog]]=== The cognitive problems or "fibro fog" in fibromyalgia are part of the diagnostic criteria, although [[cognitive dysfunction|brain fog]] in general occurs in a number of different health conditions.<ref name="ACR2010" /> Cognitive dysfunction in fibromyalgia includes problems with thinking and memory.<ref name="Park2001" /> Fibromyalgia is known to cause multiple types of cognitive impairment.<ref name="Wu2018">{{Cite journal| url = https://journals.lww.com/psychosomaticmedicine/Fulltext/2018/06000/Cognitive_Impairment_in_Fibromyalgia__A.5.aspx | title = Cognitive Impairment in Fibromyalgia: A Meta-Analysis of Case-Control Studies | last = Wu | first = Yu-Lin | last2 = Huang | first2 = Chun-Jen | date = 2018|journal=Psychosomatic medicine|volume = 80|issue =5 | pages =432-438|pmid=29528888 | last3 = Fang | first3 = Su-Chen | last4 = Ko | first4 = Ling-Hsin | last5 = Tsai | first5 = Pei-Shan}}</ref> ====Fibro fog ==== The "Fibro fog" or brain fog in fibromyalgia is a highly disabling symptom that includes memory problems, problems managing activities/schedule, difficulty with verbal expression, focus/concentration, and generally experiencing "life in a haze".<ref name="Kratz2015" /> Fibro fog has been found to linked to the degree of pain and was found to be unrelated to any depression or anxiety that some people with fibromyalgia also have.<ref name="Park2001" /> The term '''dyscognition''' is sometimes used to refer to signs of cognitive problems, including diminished performance on tests of memory tests, verbal fluency, attention and concentration problems, reduced executive functioning.The Multiple Ability Self-Report Questionnaire (MASQ) is often used to assess cognitive dysfunction in fibromyalgia research, including "fibro fog".<ref name="Kratz2015">{{Cite journal | last = Kratz | first = Anna L. | author-link = | last2 = Schilling | first2 = Stephen | authorlink2 = | last3 = Goesling | first3 = Jenna | authorlink3 = | last4 = Williams | first4 = David A. | authorlink4 = | date = Jun 2015 | title = Development and Initial Validation of a Brief Self-Report Measure of Cognitive Dysfunction in Fibromyalgia| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456217/|journal=The journal of pain : official journal of the American Pain Society|volume=16|issue=6 | pages = 527–536|doi=10.1016/j.jpain.2015.02.008|issn=1526-5900|pmc=4456217|pmid=25746197|access-date=|quote=|via=}}</ref> Improving pain and sleep may reduce cognitive impairment. Treatment for cognitive dysfunction in FM including "fibro fog" include [[transcranial direct current stimulation]], [[exercise|physical activity]], and CBT for sleep although studies are limited.<ref name="Bell2019">{{Cite journal | last = Bell | first = Tyler Reed | authorlink = | last2 = Trost | first2 = Zina | authorlink2 = | last3 = Buelow | first3 = Melissa T. | authorlink3 = | last4 = Clay | first4 = Olivio | authorlink4 = | last5 = Younger | first5 = Jarred | authorlink5 = | last6 = Moore | first6 = David | authorlink6 = | last7 = Crowe | first7 = Michael | date = Sep 2018 | title = Meta-analysis of cognitive performance in fibromyalgia| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6151134/|journal=Journal of clinical and experimental neuropsychology|volume=40|issue=7 | pages = 698–714|doi=10.1080/13803395.2017.1422699|issn=1380-3395|pmc=6151134|pmid=29388512|access-date=|quote=|via=}}</ref> One randomized controlled trial found CBT for sleep difficulties in FM improved executive functions and alertness but [[sleep hygiene]] did not.<ref name="Bell2019" /> {{See also|Cognitive dysfunction}} ===[[Depression]] and [[anxiety]]=== {{See also|Depression|Depression|Anxiety|Anxiety}} Fibromyalgia sufferers are "up to three times more likely to have depression at the time of their diagnosis than someone without fibromyalgia."<ref name="webmd-depress">{{Cite news |url =https://www.webmd.com/fibromyalgia/fibromyalgia-and-depression#1 | title = Fibromyalgia and Depression|work=WebMD|access-date=2018-08-19|language=en-US}}</ref> [[Anxiety]] is also more common.<ref name="PatientInfo" /> {{See also|Depression}}{{See also|Mental health}} ====<span id="depression">Differences between depression and fibromyalgia==== * Depression and anxiety are common in fibromyalgia but are not core diagnostic symptoms, so they are not required for a diagnosis of fibromyalgia in the ACR criteria<ref name="ACR1990" /><ref name="ACR2010" /> * A study of over 3,000 patients by Koroschetz et al. (2011) found that a significant number of people with fibromyalgia have never had depression.<ref name="Koroschetz2011-symptoms">{{Cite journal | last = Koroschetz | first = Jana | last2 = Rehm | first2 = Stefanie E. | last3 = Gockel | first3 = Ulrich | last4 = Brosz | first4 = Mathias | last5 = Freynhagen | first5 = Rainer | last6 = Tölle | first6 = Thomas R. | last7 = Baron | first7 = Ralf | date = 2011-05-25 | title = Fibromyalgia and neuropathic pain - differences and similarities. A comparison of 3057 patients with diabetic painful neuropathy and fibromyalgia| url = https://doi.org/10.1186/1471-2377-11-55|journal=BMC Neurology|volume=11|issue=1 | pages = 55|doi=10.1186/1471-2377-11-55|issn=1471-2377|pmc=3125308|pmid=21612589}}</ref> * Fibromyalgia is a diagnosis of '''chronic widespread pain''', but pain is part of the diagnostic criteria for depression.<ref name="Muller2007">{{Cite journal | last = Müller | first = W. | last2 = Schneider | first2 = E.M. | last3 = Stratz | first3 = T. | date = 2007-09-01 | title = The classification of fibromyalgia syndrome | url =https://doi.org/10.1007/s00296-007-0403-9|journal=Rheumatology International|language=en|volume=27|issue=11 | pages = 1005–1010|doi=10.1007/s00296-007-0403-9|issn=1437-160X}}</ref><ref name="webmd-notdepress">{{Cite web | url = https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression | title = Fibromyalgia Isn't Depression | last = DeNoon | first = Daniel J.|website=WebMD|language=en|access-date=2021-03-27}}</ref> * Jensen et al. (2010) found that [[anxiety]] and [[depression]] are not linked to increased pain sensitivity or alertered pain processing, which are key mechanisms in fibromyalgia.<ref name="Jensen2010" /> ===[[Sjögren's syndrome|Dry eye syndrome]]=== [[Sjögren's syndrome]], also known as Sicca or dry eye syndrome causes dry eyes and a dry mouth; it is a less common comorbidity in people with fibromyalgia.<ref name="Firdous2012" /><ref name="sjogrens">{{Cite web | url = https://www.mayoclinic.org/diseases-conditions/sjogrens-syndrome/symptoms-causes/syc-20353216 | title = Sjogren's syndrome - Symptoms and causes|website=Mayo Clinic|language=en|access-date=2021-11-29}}</ref> {{See also|Sjögren's syndrome}} ===[[Fatigue]]=== Most people with fibromyalgia experience fatigue, and it is a recognized diagnostic symptom. Some people with fibromyalgia also met the full diagnostic criteria for [[myalgic encephalomyelitis]] or [[chronic fatigue syndrome]].<ref name="PatientInfo" /><ref name="ACR2010" /> {{See also|Chronic fatigue}} ===Fibro fog=== See [[#Cognitive_dysfunction_and_Fibro_fog|cognitive dysfunction and Fibro fog]]. ===[[Digestive problems|Gastrointestinal problems]]=== [[Irritable bowel syndrome|IBS]] often occurs in people with fibromyalgia.<ref name="ScienceOfFibro" /> {{See also|Irritable bowel syndrome}} ===[[Gulf War Illness]]=== GWI increases risk of developing fibromyalgia.<ref name="VA">{{Cite web | url = https://www.publichealth.va.gov/exposures/gulfwar/fibromyalgia.asp | title = Fibromyalgia in Gulf War Veterans - Public Health | last = US Department of Veterans Affairs|language=en|access-date=2018-08-19}}</ref> {{See also|Gulf War Illness}} ===[[Hyperalgesia]]=== Fibromyalgia involves an increased sensitivity to painful stimuli, known as [[hyperalgesia]]. Hyperalgesia has been described as a lowered pain threshold, and can be thought of as "increasing the volume" of pain.<ref name="ScienceOfFibro" /> {{See also|Hyperalgesia}} ===[[Interstitial cystitis]]=== Interstitial cystitis is a common comorbidity in people with fibromyalgia, and causes a painful bladder.<ref name="ScienceOfFibro" /><ref name="Nickel2010">{{Cite journal | last = Nickel | first = J. Curtis | last2 = Tripp | first2 = Dean A. | last3 = Pontari | first3 = Michel | last4 = Moldwin | first4 = Robert | last5 = Mayer | first5 = Robert | last6 = Carr | first6 = Lesley K. | last7 = Doggweiler | first7 = Ragi | last8 = Yang | first8 = Claire C. | last9 = Mishra | first9 = Nagendra | date = 2010 | title=Interstitial cystitis/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome | url =https://www.ncbi.nlm.nih.gov/pubmed/20719340|journal=The Journal of Urology|volume=184|issue=4 | pages = 1358–1363|doi=10.1016/j.juro.2010.06.005|issn=1527-3792|pmid=20719340|via=}}</ref> {{See also|Interstitial cystitis}} ===[[Irritable bowel syndrome]] === IBS is a particularly common comorbidity in people with fibromyalgia. Other [[:Category:Digestive signs and symptoms|digestive system problems]] may also occur.<ref name="ScienceOfFibro" /> {{See also|Irritable bowel syndrome}} ===Language impairment and [[word-finding problems]]=== The [[cognitive dysfunction|"fibro fog"]] or brain fog that is a well recognized symptom of FM typically causes problems with words and language.<ref name="ACR2010" /> Cognitive impairment in fibromyalgia includes: *[[Word-finding problems]]<ref name="Park2001">{{Cite journal | last = Park | first = Denise C. | last2 = Glass | first2 = Jennifer M. | last3 = Minear | first3 = Meredith | last4 = Crofford | first4 = Leslie J.| date = 2001 | title = Cognitive function in fibromyalgia patients | url = https://onlinelibrary.wiley.com/doi/abs/10.1002/1529-0131%28200109%2944%3A9%3C2125%3A%3AAID-ART365%3E3.0.CO%3B2-1 | journal = Arthritis & Rheumatism |language=en|volume=44|issue=9 | pages = 2125–2133|doi=10.1002/1529-0131(200109)44:9<2125::AID-ART365>3.0.CO;2-1|issn=1529-0131}}</ref><ref name="Natelson2019" /> * [[Memory problems|short-term memory problems]] * vulnerability to distraction by irrelevant stimuli (known as "selective attention") *[[Slowed thought|mental slowing]] *[[information overload]], and *[[multi-tasking problems]] *[[attention deficit|attention]] and [[concentration problems|concentration problems]]<ref name="Bell2019" /><ref name="Kratz2015" /><ref name="Teodoro2018">{{Cite journal | last = Teodoro | first = Tiago | author-link = | last2 = Edwards | first2 = Mark J. | authorlink2 = | last3 = Isaacs | first3 = Jeremy D. | authorlink3 = | date = 2018-12-01 | title = A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review | url =https://jnnp.bmj.com/content/jnnp/89/12/1308.full.pdf | journal=Journal of Neurology, Neurosurgery & Psychiatry|language=en|volume=89|issue=12 | pages = 1308–1319|doi=10.1136/jnnp-2017-317823|issn=0022-3050|pmc=|pmid=29735513|access-date=|quote=|via=}}</ref> {{See also|Cognitive dysfunction}} ===[[Lower back pain]]=== Mechanical [[lower back pain]] is more common in patients with FM.<ref name="PMC5741304" /> A study of over 2,000 FM patients prescribed the popular pain drugs [[Lyrica]] or [[Cymbalta]] found that over 60% had some form of lower back pain.<ref name="Gore2012" /> ===[[Mast cell activation syndrome|Mast Cell Activation Syndrome]]=== Migratory bone pain, [[arthralgia|joint pain]] or [[myalgia|muscle pain]] and fibromyalgia are common in people with [[mast cell activation syndrome]] (MCAS). MCAS is far less common than fibromyalgia and it is unclear how many fibromyalgia patients also have MCAS.<ref name="Afrin2020">{{Cite journal | title = Diagnosis of mast cell activation syndrome: a global “consensus-2” | date = 2021-05-01| url = https://www.degruyter.com/document/doi/10.1515/dx-2020-0005/html?lang=en|journal=Diagnosis|volume=8|issue=2 | pages = 137–152 | last = Afrin | first = Lawrence B. | author-link = Lawrence Afrin | last2 = Ackerley | first2 = Mary B. | authorlink2 = | last3 = Bluestein | first3 = Linda S. | authorlink3 = | last4 = Brewer | first4 = Joseph H. | authorlink4 = Joseph Brewer | last5 = Brook | first5 = Jill B. | authorlink5 = | last6 = Buchanan | first6 = Ariana D. | authorlink6 = | last7 = Cuni | first7 = Jill R. | last8 = Davey | first8 = William P. | last9 = Dempsey | first9 = Tania T. | last10 = Dorff | first10 = Shanda R. | last11 = Dubravec | first11 = Martin S.|language=en|doi=10.1515/dx-2020-0005|pmc=|pmid=|access-date=|issn=2194-802X|quote=|via=}}</ref><ref name="Valent2019">{{Cite journal | title = Doctor, I Think I Am Suffering from MCAS: Differential Diagnosis and Separating Facts from Fiction | date = 2019-04-01| url = https://www.jaci-inpractice.org/article/S2213-2198(18)30819-5/abstract|journal=The Journal of Allergy and Clinical Immunology: In Practice|volume=7|issue=4 | pages = 1109–1114 | last = Valent | first = Peter | last2 = Akin | first2 = Cem|language=English|doi=10.1016/j.jaip.2018.11.045|pmid=30961836|issn=2213-2198}}</ref> The MCAS consensus criteria (2020) states that it is unclear how many people with fibromyalgia may have MCAS ''associated with'' their fibromyalgia, or as a cause of their fibromyalgia.<ref name="Afrin2020" /> {{See also|Mast cell activation syndrome}} === Menstrual cycle effects === Schertzinger et al. (2017) found that levels of the sex hormones [[progesterone]] and [[testosterone]] were linked to pain severity in fibromyalgia.<ref name="Schertzinger2017">{{Cite journal | title = Daily Fluctuations of Progesterone and Testosterone Are Associated With Fibromyalgia Pain Severity | date = 2018-04-01| url = https://www.jpain.org/article/S1526-5900(17)30804-0/abstract|journal=The Journal of Pain|volume=19|issue=4 | pages = 410–417 | last = Schertzinger | first = Meredith | last2 = Wesson-Sides | first2 = Kate | last3 = Parkitny | first3 = Luke | last4 = Younger | first4 = Jarred|language=English|doi=10.1016/j.jpain.2017.11.013|pmid=29248511|issn=1526-5900}}</ref> ===[[Migraine]] and [[headache]]s=== Both [[tension-type headache]]s and [[migraine]]s are commonly in patients with fibromyalgia.<ref name="ScienceOfFibro" /><ref name="PatientInfo" /> <blockquote>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.<ref name="migrainecenters">{{Cite news |url =https://migrainecenters.com/blog/migraines-and-fibromyalgia/ | title = Migraines and Fibromyalgia - Migraine Centers | date = 2016-05-06|work=Migraine Centers|access-date=2018-08-19|language=en-US}}</ref></blockquote> {{See also|Tension-type headache|Tension-type headache|Migraine|Migraine}} ===Mood disorder symptoms=== While [[depression]] and depressive symptoms are common in FB, bipolar disorder symptoms are also much more common than in the general population. Alciati et al 2012 reports on this.<ref name="Alciati2012">{{Cite journal | last = Alciati | first = A. | last2 = Sgiarovello | first2 = P. | last3 = Atzeni | first3 = F. | last4 = Sarzi-Puttini | first4 = P. | date = 2012-09-28 | title = Psychiatric problems in fibromyalgia: clinical and neurobiological links between mood disorders and fibromyalgia| url = https://air.unimi.it/retrieve/handle/2434/667633/1304487/document.pdf | journal=Reumatismo|volume=64|issue=4 | pages = 268–274|doi=10.4081/reumatismo.2012.268|issn=0048-7449|pmid=23024971}}</ref> {{See also|Mental health}} ===[[Multiple chemical sensitivity|Multiple Chemical Sensitivity]]=== [[Multiple chemical sensitivity]] (MCS) has been found in approximately 50% of fibromyalgia patients, although this is based on a very small number of studies using the 1990 ACR criteria for fibromyalgia.<ref name="MCS1">{{Cite journal | last = Slotkoff | first = A.T. | last2 = Radulovic | first2 = D.A. | last3 = Clauw | first3 = D.J. | date = 1997-01-01 | title = The Relationship between Fibromyalgia and the Multiple Chemical Sensitivity Syndrome | url =https://doi.org/10.3109/03009749709065700|journal=Scandinavian Journal of Rheumatology|volume=26|issue=5 | pages = 364–367|doi=10.3109/03009749709065700|issn=0300-9742|pmid=9385348}}</ref><ref name="MCS2">{{Cite journal | last = Hudson | first = J.I. | last2 = Goldenberg | first2 = D.L. | last3 = Pope | first3 = H.G. | last4 = Keck | first4 = P.E. | last5 = Schlesinger | first5 = L. | date = Apr 1992 | title = Comorbidity of fibromyalgia with medical and psychiatric disorders |url =https://pubmed.ncbi.nlm.nih.gov/1558082/|journal=The American Journal of Medicine|volume=92|issue=4 | pages = 363–367|doi=10.1016/0002-9343(92)90265-d|issn=0002-9343|pmid=1558082}}</ref><ref name="Slotkoff1997">{{Cite journal | last = Slotkoff | first = A.T. | last2 = Radulovic | first2 = D.A. | last3 = Clauw | first3 = D.J. | date = 1997-01-01 | title = The Relationship between Fibromyalgia and the Multiple Chemical Sensitivity Syndrome | url =https://doi.org/10.3109/03009749709065700|journal=Scandinavian Journal of Rheumatology|volume=26|issue=5 | pages = 364–367|doi=10.3109/03009749709065700|issn=0300-9742|pmid=9385348}}</ref> MCS has been referred to as a partially overlapping condition, with [[fatigue]] and [[headache]]s occurring in both FM and MCS, and muscle or joint pain being reported in some people with MCS.<ref name="Yunus2008" /><ref name="J092v05n03_06">{{Cite journal | last = Donnay | first = Albert | last2 = Ziem | first2 = Grace | date = 1999-01-01 | title = Prevalence and Overlap of Chronic Fatigue Syndrome and Fibromyalgia Syndrome Among 100 New Patients with Multiple Chemical Sensitivity Syndrome | url =https://doi.org/10.1300/J092v05n03_06|journal=Journal of Chronic Fatigue Syndrome|volume=5|issue=3-4 | pages = 71–80|doi=10.1300/J092v05n03_06|issn=1057-3321}}</ref> {{See also|Multiple chemical sensitivity}} ===Obesity=== Obesity is commonly found in patients with fibromyalgia, and increased [[body mass index]] been linked to increased pain severity and increases in other fibromyalgia symptoms, however the effects of [[weight loss]] on fibromyalgia symptoms is not clear.<ref name="DOnghia2020">{{Cite journal | last = D'Onghia | first = Martina | last2 = Ciaffi | first2 = Jacopo | last3 = Lisi | first3 = Lucia | last4 = Mancarella | first4 = Luana | last5 = Ricci | first5 = Susanna | last6 = Stefanelli | first6 = Nicola | last7 = Meliconi | first7 = Riccardo | last8 = Ursini | first8 = Francesco | date = 2021-04-01 | title = Fibromyalgia and obesity: A comprehensive systematic review and meta-analysis |url =https://www.sciencedirect.com/science/article/pii/S0049017221000275|journal=Seminars in Arthritis and Rheumatism|language=en|volume=51|issue=2 | pages = 409–424|doi=10.1016/j.semarthrit.2021.02.007|issn=0049-0172}}</ref><ref name="Gore2012" /> A few studies have reported positive effects from weight loss in FM, either by [[bariatric surgery]], a combination of [[:Category:Diets|diet]] and [[exercise]] combination or behavioral weight loss.<ref name="DOnghia2020" /> ===Obstetrics and gynaecology=== [[Chronic pelvic pain]] and [[vulvodynia]], which is chronic pain around the opening of the vagina, are particularly common in women with FM.<ref name="ScienceOfFibro" /><ref name="PMC5741304" /><ref name="vulvodynia">{{Cite web | url = https://www.mayoclinic.org/diseases-conditions/vulvodynia/symptoms-causes/syc-20353423 | title = Vulvodynia - Symptoms and causes|website=Mayo Clinic|language=en|access-date=2021-11-28}}</ref> [[Early menopause]] and [[hysterectomy]] are linked to increased risk of fibromyalgia.<ref name="Pamuk2009">{{Cite journal | title = Increased frequencies of hysterectomy and early menopause in fibromyalgia patients: a comparative study | date = 2009-05-01| url = https://doi.org/10.1007/s10067-009-1087-1|journal=Clinical Rheumatology|volume=28|issue=5 | pages = 561–564 | last = Pamuk | first = Ömer Nuri | last2 = Dönmez | first2 = Salim | last3 = Çakir | first3 = Necati|language=en|doi=10.1007/s10067-009-1087-1|issn=1434-9949}}</ref> A number of studies have found that women with fibromyalgia were more likely to have had a hysterectomy than the general population, and they were more likely to have poorer health and higher health costs than women with fibromyalgia who had not had a hysterectomy.<ref name="Santoro2012">{{Cite journal | title = Fibromyalgia and hysterectomy: the impact on health status and health care costs | date = Nov 2012| url = https://pubmed.ncbi.nlm.nih.gov/22875702/|journal=Clinical Rheumatology|volume=31|issue=11 | pages = 1585–1589 | last = Santoro | first = Maya S. | author-link = | last2 = Cronan | first2 = Terry A. | authorlink2 = | last3 = Adams | first3 = Rebecca N. | authorlink3 = | last4 = Kothari | first4 = Dhwani J. | authorlink4 = |doi=10.1007/s10067-012-2051-z|pmc=|pmid=22875702|access-date=|issn=1434-9949|quote=|via=}}</ref> Fibromyalgia patients were more likely to have had a gynaecological surgery compared to other chronic pain patients, with rates of fibromyalgia being higher in patients who had hysterectomy, oophorectomy (ovary removal) and cystectomy (bladder or cyst removal) than only hysterectomy.<ref name="Brooks2015">{{Cite journal | title = Assessing the prevalence of autoimmune, endocrine, gynecologic, and psychiatric comorbidities in an ethnically diverse cohort of female fibromyalgia patients: does the time from hysterectomy provide a clue? | date = 2015-08-20| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548754/|journal=Journal of Pain Research|volume=8 | pages = 561–569 | last = Brooks | first = Larry | last2 = Hadi | first2 = Joseph | last3 = Amber | first3 = Kyle T | last4 = Weiner | first4 = Michelle | last5 = La Riche | first5 = Christopher L | last6 = Ference | first6 = Tamar|doi=10.2147/JPR.S86573|pmc=4548754|pmid=26316807|issn=1178-7090}}</ref> [[#Pregnancy complications|Pregnancy complications]] have been found to be more common in women with fibromyalgia,<ref name="Magtanong2019">{{Cite journal | title = Maternal and neonatal outcomes among pregnant women with fibromyalgia: a population-based study of 12 million births | date = 2019-02-01| url = https://doi.org/10.1080/14767058.2017.1381684|journal=The Journal of Maternal-Fetal & Neonatal Medicine|volume=32|issue=3 | pages = 404–410 | last = Magtanong | first = Glenda Gatan | last2 = Spence | first2 = Andrea R. | last3 = Czuzoj-Shulman | first3 = Nicholas | last4 = Abenhaim | first4 = Haim Arie|doi=10.1080/14767058.2017.1381684|pmid=28954564|issn=1476-7058}}</ref> and the menstrual cycle has been found to be related to pain fluctuations in fibromyalgia.<ref name="Schertzinger2017" /> {{See also|Menopause}} ===[[Orthostatic intolerance]] (OI) === [[Postural orthostatic tachycardia syndrome]] (POTS) and other forms of orthostatic intolerance often occur in people with fibromyalgia.<ref name="Yun2013">{{Cite journal | last = Yun | first = Dong Joo | last2 = Choi | first2 = Han Na | last3 = Oh | first3 = Gun-Sei | date = 2013 | title = A Case of Postural Orthostatic Tachycardia Syndrome Associated with Migraine and Fibromyalgia| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710947/|journal=The Korean Journal of Pain|volume=26|issue=3 | pages = 303–306|doi=10.3344/kjp.2013.26.3.303|issn=2005-9159|pmid=23862007|via=}}</ref> Symptoms can include [[Orthostatic hypotension|low blood pressure on standing]] and/or sudden high blood pressure, [[dizziness]], [[syncope|fainting]]. Dr Charles Lapp found that fibromyalgia symptoms and ME/CFS symptoms predicted the outcome of [[tilt table test]]ing for [[orthostatic intolerance]].<ref>{{Cite web | url = http://drlapp.com/wp-content/uploads/TTT_symptoms.pdf | title=Symptoms Predict the Outcome of Tilt Table Testing in CFS/ME/FM | last = Lapp | first = Charles W. | last2 = Black | first2 = Laura | date = |website=drlapp.com|archive-url=|archive-date=|access-date= | last3 = Smith | first3 = Rebekah S.}}</ref> Orthostatic intolerance may often be l overlooked in fibromyalgia patients.<ref name="Zumuner2017">{{Cite journal | title = The degree of cardiac baroreflex involvement during active standing is associated with the quality of life in fibromyalgia patients | date = 2017-06-14| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470709/|journal=PLoS ONE|volume=12|issue=6| pages = e0179500 | last = Zamunér | first = Antonio Roberto | last2 = Porta | first2 = Alberto | last3 = Andrade | first3 = Carolina Pieroni | last4 = Forti | first4 = Meire | last5 = Marchi | first5 = Andrea | last6 = Furlan | first6 = Raffaello | last7 = Barbic | first7 = Franca | last8 = Catai | first8 = Aparecida Maria | last9 = Silva | first9 = Ester|doi=10.1371/journal.pone.0179500|pmc=5470709|pmid=28614420|issn=1932-6203}}</ref> {{See also|Orthostatic intolerance}} ===[[Painful bladder syndrome]] and [[chronic pelvic pain]]=== [[Painful bladder syndrome]] and [[chronic pelvic pain]] are common comorbidities in people with fibromyalgia.<ref name="ScienceOfFibro" /> === Pregnancy complications === A study of 12 million live births found that fibromyalgia was a "high risk" condition in pregnancy, associated with higher rates of gestational diabetes, venous thromboembolism, delivery by cesarean, and intrauterine growth restriction in the babies.<ref name="Magtanong2019" /> ===Prostrate symptoms === Men with fibromyalgia commonly experience inflammation of the prostate, known as chronic prostatitis, and prostadynia, which is a chronic nonbacterial and painful inflammation of the prostate. These cause [[chronic pelvic pain]].<ref name="ScienceOfFibro" /><ref name="prostratepain">{{Cite book | title = Understanding Pain: What You Need to Know to Take Control | pages = 149|isbn=978-0-313-39604-5|edition=|language=en| title-link = |chapter-url=https://books.google.com/books?id=bAha4v18oTMC&lpg=PA149&dq=prostadynia&pg=PA149#v=onepage&q&f=true|access-date=| date = 2011-10-10 | publisher = ABC-CLIO |editor-last = Kaye|editor-first = Alan D. |editor-last2 = Urman|editor-first2 = Richard D. |veditors=|others=|doi=|oclc=|quote=|archive-url=|archive-date=|location=|chapter=Gynecological, Pelvic, and Urological Pain | first = Rinoo V. | last = Shah | first2 = Alan D. | last2 = Kaye}}</ref> Frequent and urgent urination are common.<ref name="prostratepain" /> ===[[Raynaud's syndrome]]=== In Raynaud's syndrome or Raynaud's phenomenon, the blood vessels narrow more than they should, which means less blood to get through, making your extremities cold, and making them extremely difficult to warm up. Reynauld's causes fingers, toes, lips, nose, and other parts of you go cold and numb. Fingers and toes change color to white, then blue. As you warm up, skin turns red and they feel tingle, throb or swell up. Reynauld's attacks are caused by cold or emotional [[stress]].<ref name="reynaulds">{{Cite news |url =https://www.mayoclinic.org/diseases-conditions/raynauds-disease/symptoms-causes/syc-20363571 | title = Reynauld's disease - Symptoms and causes|work=Mayo Clinic|access-date=2021-11-28|language=en}}</ref> Raynaud's symptoms have been commonly reported in people with fibromyalgia.<ref name="Firdous2012" /><ref name="ACR2010" /><ref name="Pauling2019">{{Cite journal | last = Pauling | first = John D. | last2 = Hughes | first2 = Michael | last3 = Pope | first3 = Janet E. | date = 2019-12-01 | title = Raynaud’s phenomenon—an update on diagnosis, classification and management| url = https://doi.org/10.1007/s10067-019-04745-5|journal=Clinical Rheumatology|language=en|volume=38|issue=12 | pages = 3317–3330|doi=10.1007/s10067-019-04745-5|issn=1434-9949}}</ref> {{See also|Raynaud's syndrome}} ===Rheumatic conditions - other rheumatic conditions=== [[Osteoarthritis]], [[rheumatoid arthritis]], [[systemic lupus erythematosus|lupus]], and [[ankylosing spondylitis]] are more common in people with fibromyalgia.<ref name="CDC-complications" /> ===[[Sleep dysfunction]]=== Sleep problems occur in most people with FM.<ref name="PatientInfo" /> Waking unrefreshed is a diagnostic symptom, and the sleep disorders [[sleep apnea]], [[restless legs syndrome]] and [[nocturnal myclonus]] are common in people with fibromyalgia.<ref name="ACR2010" /><ref name="NBK279092" /> Vatthauer et al. (2015) found that sleep was associated with task-negative [[brain]] activity in fibromyalgia participants with comorbid chronic [[insomnia]].<ref name="Vatthauer2015">{{Cite journal | last = Vatthauer | first = Karlyn E | last2 = Craggs | first2 = Jason G | last3 = Robinson | first3 = Michael E | last4 = Staud | first4 = Roland | last5 = Berry | first5 = Richard B | last6 = Perlstein | first6 = William M | last7 = McCrae | first7 = Christina S | date = 2015-11-12 | title = Sleep is associated with task-negative brain activity in fibromyalgia participants with comorbid chronic insomnia| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4648619/|journal=Journal of Pain Research|volume=8 | pages = 819–827|doi=10.2147/JPR.S87501|issn=1178-7090|pmc=|pmid=26648751|issue=|via=|quote= | authorlink3 = | authorlink4 = Roland Staud | authorlink5 = }}</ref> <blockquote>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.<ref name="Vatthauer2015" /></blockquote> {{See also|Sleep dysfunction}} ===[[Stress]] and [[Post-traumatic stress disorder]]=== PTSD, which is a mental illness that results from traumatic events, is a risk factor for fibromyalgia.<ref name="PatientInfo" /><ref name="NIAMScauses" /> {{See also|Stress}}{{See also|Post-traumatic stress disorder}} ===[[Temporomandibular joint disorder|Temporomandibular disorder or temporomandibular joint disorder]] (TMD/TMJ) === [[File:Skull_diagram.png|350px|thumb|right|The temporomandibular joint is the joint between the mandible (light blue) and the temporal bone (orange) of the skull.<br>Source: [https://commons.wikimedia.org/wiki/User:LadyofHats LadyofHats on Wikimedia Commons], public domain image.]] TMD, previously known as TMJ, is common in people with fibromyalgia.<ref name="ScienceOfFibro" /> TMD symptoms other than [[headache]]s include: *Jaw pain *Discomfort or difficulty chewing *Painful clicking in the jaw *Difficulty opening or closing the mouth *Locking jaw *Ringing in the ears<ref name="tmh">{{Cite web | website =John Hopkins Medicine|access-date=2021-11-28 | title = Temporomandibular disorder |url =https://www.hopkinsmedicine.org/health/conditions-and-diseases/temporomandibular-disorder-tmd}}</ref> A review by Soares et al (2015) found fibromyalgia has "characteristics that constitute predisposing and triggering factors for TMD".<ref name="Soares2015">{{Cite journal | last = Soares Gui | first = Maisa | last2 = Pimentel | first2 = Marcele Jardim | last3 = Rizzatti-Barbosa | first3 = C'elia Marisa | date = 2015-03-01 | title = Temporomandibular disorders in fibromyalgia syndrome: a short-communication | url =https://www.sciencedirect.com/science/article/pii/S2255502114001758|journal=Revista Brasileira de Reumatologia (English Edition)|language=en|volume=55|issue=2 | pages = 189–194|doi=10.1016/j.rbre.2014.07.004|issn=2255-5021|via=ScienceDirect}}</ref> {{See also|Temporomandibular joint disorder}} ===[[Thyroid disease]]=== People with [[Hashimoto's thyroiditis (hypothyroidism)|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.<ref name="NBK540974" /><ref name="amthyass">{{Cite web | url = https://www.thyroid.org/hashimotos-thyroiditis/ | title = Hashimoto’s Thyroiditis|website=American Thyroid Association|language=en-US|access-date=2020-08-26}}</ref> {{See also|Hashimoto's thyroiditis (hypothyroidism)}} ===Other symptoms=== *Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/ Conditions associated with fibromyalgia. (Table 1)] *[http://www.ncbi.nlm.nih.gov/books/NBK540974/ Fibromyalgia] - StatPearls ==Treatment== Main treatment approaches for fibromyalgia include patient education, exercise including stretching, message, [[Fibromyalgia drugs|medication]], alternative treatments for [[pain management]], and stress management or mental health treatments for any related depression or anxiety.{{citation needed | date = 2021}}<ref name="FibroBasics" /><ref name="ScienceOfFibro" /> {{See also|Fibromyalgia drugs}} ===United States=== Rheumatology and primary care providers: Diagnosing and treatment: *2012, [https://www.mayoclinicproceedings.org/article/S0025-6196(12)00299-6/abstract A Framework for Fibromyalgia Management for Primary Care Providers]<ref>{{Cite journal | last = Arnold | first = Lesley M. | last2 = Clauw | first2 = Daniel J. | last3 = Dunegan | first3 = L. Jean | last4 = Turk | first4 = Dennis C.| date = 2012 | title = A Framework for Fibromyalgia Management for Primary Care Providers |url =https://www.mayoclinicproceedings.org/article/S0025-6196(12)00299-6/abstract|journal=Mayo Clinic Proceedings|language=English|volume=87|issue=5 | pages = 488–496|doi=10.1016/j.mayocp.2012.02.010|issn=0025-6196|via=}}</ref> Rheumatologists stopped treating fibromyalgia patients and primary care providers began treatment managment although rheumatologists are most often the specialist to diagnose. {{See also|Fibromyalgia disability process}} ===Drugs=== {{Main article| page_name = Fibromyalgia drugs}} === Therapies === ==== Exercise ==== ''Please Note'': The research supporting these treatments are for fibromyalgia patients '''without''' [[ME/CFS]] sufferers due to it's hallmark symptom of [[post-exertional malaise]]. [[File:Warm water exercise.JPG|200px|thumb|left|Warm water exercise can be helpful for fibromyalgia. Start slow and don't push through the pain.<ref name="Ronenn" /><ref>{{Cite journal | last = Bidonde | first = Julia | last2 = Busch | first2 = Angela J. | last3 = Webber | first3 = Sandra C. | last4 = Schachter | first4 = Candice L. | last5 = Danyliw | first5 = Adrienne | last6 = Overend | first6 = Tom J. | last7 = Richards | first7 = Rachel S. | last8 = Rader | first8 = Tamara | date = 2014-10-28 | title = Aquatic exercise training for fibromyalgia| url = https://www.ncbi.nlm.nih.gov/pubmed/25350761|journal=The Cochrane Database of Systematic Reviews|issue=10 | pages = CD011336|doi=10.1002/14651858.CD011336|issn=1469-493X|pmid=25350761}}</ref> Image source: [https://commons.wikimedia.org/wiki/File:Water_aerobics_in_a_swimmingpool_Gambia.jpg Wikimedia Commons]. Author: Peter van der Sluijs, cropped, license: CC-BY-SA-2.5.]] <blockquote>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.<ref name="Bennett2007">{{Cite journal | last = Bennett | first = Robert M. | author-link = | last2 = Jones | first2 = Jessie | authorlink2 = | last3 = Turk | first3 = Dennis C. | authorlink3 = | last4 = Russell | first4 = I. Jon | authorlink4 = | last5 = Matallana | first5 = Lynne | authorlink5 = | date = Mar 9, 2007 | title = An internet survey of 2,596 people with fibromyalgia| url = https://doi.org/10.1186/1471-2474-8-27|journal=BMC Musculoskeletal Disorders|volume=8|issue=1 | pages = 27|doi=10.1186/1471-2474-8-27|issn=1471-2474|pmc=1829161|pmid=17349056|quote=|via=}}</ref> The same survey found 74% of patients found heat helpful - either warm water or heat packs.<ref name="Bennett2007" /> 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.<ref name="Munguia2007">{{Cite journal | last = Munguía-Izquierdo | first = D. | last2 = Legaz-Arrese | first2 = A. | date = 2007 | title=Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia| url = https://www.ncbi.nlm.nih.gov/pubmed/18173915|journal=Clinical and Experimental Rheumatology|volume=25|issue=6 | pages = 823–830|issn=0392-856X|pmid=18173915|via=}}</ref></blockquote> 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.<ref name="Ronenn">{{Cite web | url = http://www.arthritis.org/living-with-arthritis/tools-resources/expert-q-a/fibromyalgia-questions/fibromyalgia-exercise.php | title = Fibromyalgia Exercise {{!}} Exercising with Fibromyalgia | last = Ronenn | first = Roubenoff | date = | website = arthritis.org|archive-url=|archive-date=|access-date=2018-08-09}}</ref> {{See also|Exercise}} ==== Massage ==== *2014, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/ Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials]<ref name="Yan2014">{{Cite journal | last = Li | first = Yan-hui | last2 = Wang | first2 = Feng-yun | last3 = Feng | first3 = Chun-qing | last4 = Yang | first4 = Xia-feng | last5 = Sun | first5 = Yi-hua | date = 2014-02-20 | title = Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/|journal=PLoS ONE|volume=9|issue=2|doi=10.1371/journal.pone.0089304|issn=1932-6203|pmc=|pmid=24586677 | pages = |via=}}</ref> ==== Acupuncture ==== 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.<ref name="NBK279092" /><ref name="Cochrane-acupuncture">{{Cite journal | last = Deare | first = JC | last2 = Zheng | first2 = Z | last3 = Xue | first3 = CCL | first4 = Jian Ping | last4 = Liu | first5 = Jingsheng | last5 = Shang | first6 = Sean W | last6 = Scott | first7 = Geoff | last7 = Littlejohn | url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4105202 | title = Acupuncture for treating fibromyalgia]|journal=Cochrane Database Syst Rev. | date = May 31, 2013|issue=5 | pages = CD007070 |volume=2013|doi=10.1002/14651858.CD007070.pub2|pmc=PMC4105202|pmid= 23728665}}</ref> 2016 reviewed acupuncture (AC), electroacupuncture (EAC) and moxibustion, but found none improved quality of life in women with fibromyalgia.<ref name="CAM">{{Cite journal| first = Paulo Araujo | last = Diasa | first2 =André Brito Bastos | last2 = Guimarães | first3 = Andrea | last3 = de Oliveir Albuquerque | first4 = Karoline Lucas | last4 = de Oliveir | first5 = Maria Luzete Costa | last5 = Cavalcante | first6 = Sergio Botelho | last6 = Guimarães | date = 2016-01-01 | title = Short-term complementary and alternative medicine on quality of life in women with fibromyalgia| url = https://www.sciencedirect.com/science/article/pii/S2095496416602352|journal=Journal of Integrative Medicine|language=en|volume=14|issue=1 | pages = 29–35|doi=10.1016/S2095-4964(16)60235-2|issn=2095-4964}}</ref> "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."<ref name="CAM" /> 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.<ref>{{Cite web | url = https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R11NCD.pdf | title=CMS Manual System Pub. 100-03 Medicare National Coverage Determinations | last = | first = | date = Apr 16, 2004 | website = CMS.gov|format = PDF | archive-url=|archive-date=|access-date=}}</ref> == Controversies == === Dr. Frederick Wolfe === 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.<ref name="Wolfe2016">{{Cite journal | last = Wolfe | first = Frederick | last2 = Walitt | first2 = Brian | date = 2016 | title=Fibromyalgia: A Short Commentary| url = http://headache.imedpub.com/fibromyalgia-a-short-commentary.pdf | journal=Journal of Headache & Pain Management|volume=1|issue= 3 | pages = 27|via=iMedPubJournals}}</ref><ref>{{Cite news |url =https://www.news-medical.net/news/20130322/Fibromyalgia-an-interview-with-Dr-Frederick-Wolfe-University-of-Kansas-School-of-Medicine.aspx | title = Fibromyalgia: an interview with Dr Frederick Wolfe, University of Kansas School of Medicine | last = Cashin-Garbutt | first = April | date = 2013-03-22|work=News-Medical.net|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref> === Fibromyalgia and Chiari malformation === 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.<ref name="Chiari">{{Cite journal | last = Watson | first = Nathaniel F. | last2 = Buchwald | first2 = Dedra | last3 = Goldberg | first3 = Jack | last4 = Maravilla | first4 = Kenneth R. | last5 = Noonan | first5 = Carolyn | last6 = Guan | first6 = Qingyan | last7 = Ellenbogen | first7 = Richard G. | date = 2011 | title = Is Chiari I malformation associated with fibromyalgia?| url = https://www.ncbi.nlm.nih.gov/pubmed/21135714|journal=Neurosurgery|volume=68|issue=2 | pages = 443–448; discussion 448–449|doi=10.1227/NEU.0b013e3182039a31|issn=1524-4040|pmid=21135714|via=}}</ref><ref>{{Cite web | url = https://www.massmecfs.org/resource-library/9-treatment/172-cfidsfm-and-chiari-malformation-surgery | title = CFS/FM and Chiari Malformation Surgery | last = Casanova | first = Ken | date = Nov 15, 2015 | website = massmecfs.org|language=en-GB|archive-url=|archive-date=|access-date=2018-08-09}}</ref> ::Most patients with FM do not have [[Chiari malformation|CIM]] pathology. Future studies should focus on dynamic neuroimaging of [[craniocervical instability|craniocervical neuroanatomy]] in patients with FM.<ref name="Chiari" /> ===<span id="bloodtest">Blood test </span>=== EpicGenetics developed a blood test to identifying the presence of specific [[Leucocyte|white blood cell]] abnormalities of patients diagnosed with FM - '''FM/a® test''' - and announces a linked treatment trial although the trial never started and is now suspended.<ref name="FMa test" /> EpicGenetics offers help to determine if your insurance will cover their test.<ref name="fmtest" /> The FM/a test continues to be marketed despite the suspension of the linked treatment trial,<ref name="FMa test">{{Cite web | last = Faustman | first = Denise Louise | authorlink = | date = 2021-05-27|others=Massachusetts General Hospital | title = Phase II Clinical Trial: Multi-dosing the BCG Vaccine for Fibromyalgia| url = https://clinicaltrials.gov/ct2/show/NCT03582085|pmc=|pmid=|access-date=2021-11-27|quote=|via=}}</ref> 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.<ref name="PMC3534336">{{Cite journal | last = Behm | first = Frederick G | last2 = Gavin | first2 = Igor M | last3 = Karpenko | first3 = Oleksiy | last4 = Lindgren | first4 = Valerie | last5 = Gaitonde | first5 = Sujata | last6 = Gashkoff | first6 = Peter A | last7 = Gillis | first7 = Bruce S | date = 2012-12-17 | title = Unique immunologic patterns in fibromyalgia| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3534336/|journal=BMC Clinical Pathology|volume=12 | pages = 25|doi=10.1186/1472-6890-12-25|issn=1472-6890|pmc=3534336|pmid=23245186}}</ref><ref name="PMC4435905">{{Cite journal | last = Wallace | first = Daniel J. | last2 = Gavin | first2 = Igor M. | last3 = Karpenko | first3 = Oleksly | last4 = Barkhordar | first4 = Farnaz | last5 = Gillis | first5 = Bruce S. | date = 2015 | title=Cytokine and chemokine profiles in fibromyalgia, rheumatoid arthritis and systemic lupus erythematosus: a potentially useful tool in differential diagnosis |url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435905/|journal=Rheumatology International|volume=35|issue=6 | pages = 991–996|doi=10.1007/s00296-014-3172-2|issn=0172-8172|pmc=4435905|pmid=25377646}}</ref> 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.<ref name="controversy2021">{{Cite web | last = Boodman | first = Eric | date = Oct 20, 2021 | url =https://www.statnews.com/2021/10/20/selling-certainty-epicgenetics-physician-was-one-of-fibromyalgia-patients-few-true-allies-or-was-he/| title = In a sea of skeptics, this physician was one of fibromyalgia patients’ few true allies. Or was he?| publisher = STAT News}}</ref> 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== {{Main article | page_name = Fibromyalgia disability process}} ==Famous people == Celebrities and famous people with fibromyalgia include: *[[Frida Kahlo]], famous Mexican painter *[[Florence Nightingale]], founder of modern nursing *[[Lady Gaga]] (Stefani Germanotta), American singer/artist *Morgan Freeman, American actor *Jo Guest, British model *[[Janeane Garofalo]], actor and comedienne<ref name="cnn-fibromyalgia">{{Cite web | url = https://www.cnn.com/2017/08/01/health/gallery/famous-people-with-fibromyalgia/index.html | title = Celebrities face fibromyalgia|website=CNN | date = August 1, 2017|access-date=2021-11-20}}</ref><ref name="celebrities-fm">{{Cite web | url = https://www.womansday.com/health-fitness/wellness/g3329/celebrities-with-fibromyalgia/| title = 7 Celebrities You Didn't Know Have Fibromyalgia|website =Woman's Day | last = Murtaugh | first = Taysha | date = 2018-01-18}}</ref> {{See also|Florence Nightingale}} {{See also|Frida Kahlo}} ==Notable studies == {{Main article | page_name = Fibromyalgia notable studies}} ==News articles and features == *2021, [https://www.statnews.com/2021/10/20/selling-certainty-epicgenetics-physician-was-one-of-fibromyalgia-patients-few-true-allies-or-was-he/ 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. *2021, [http://www.theguardian.com/society/2021/jul/01/fibromyalgia-may-be-a-condition-of-the-immune-system-not-the-brain-study Fibromyalgia may be a condition of the immune system not the brain – study] - The Guardian *2017, [https://www.the-rheumatologist.org/article/fmri-can-help-diagnose-fibromyalgia/ fMRI Can Help Diagnose Fibromyalgia] - The Rheumatologist, 2017 ==See also== * [[Fibromyalgia disability process]] * [[Fibromyalgia drugs]] * [[Fibromyalgia notable studies]] * [[Influenza vaccine]] * [[List of famous people with ME, CFS, and/or FMS]] * [[Lady Gaga]] * [[Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life]] - book (2019) == Learn more == *[https://www.cdc.gov/arthritis/basics/fibromyalgia.htm Fibromyalgia] - CDC *[https://dx.doi.org/10.4065%2Fmcp.2011.0206 The Science of Fibromyalgia] - Daniel Clauw, Lesley Arnold, and Bill McCarber for the FibroCollaborative *[https://www.aarp.org/health/conditions-treatments/info-11-2013/fibromyalgia-what-you-need-to-know.html 8 Things to Know About Fibromyalgia] - AARP *[https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression Fibromyalgia isn't depression] - WebMD *2012, [https://web.archive.org/web/20180530191907/https://www.nhs.uk/live-well/healthy-body/20-painful-health-conditions/|archive-date=2018-05-30 | title = 20 Painful Health Conditions 20 Painful Health Conditions] - NHS (archived copy) *2017, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741304/ Diagnostic confounders of chronic widespread pain: not always fibromyalgia] *[https://www.s4me.info/forums/fibromyalgia-and-connective-tissue-disorders.35/ Forum: Fibromyalgia and Connective Tissue Disorders] at [[Science for ME]] *[https://www.verywellhealth.com/chronic-fatigue-syndrome-vs-fibromyalgia-5213420 2022, What’s the Difference Between Chronic Fatigue Syndrome and Fibromyalgia?] - Verywell Health === Diagnosing and categorizing fibromyalgia=== *2017, [http://nationalpainreport.com/study-reveals-new-treatment-target-for-fibromyalgia-inflammation-in-the-brain-8833354.html Study Reveals New Treatment Target for Fibromyalgia: Inflammation in the Brain] *2017, [https://qz.com/1349854/ai-can-spot-the-pain-from-a-disease-some-doctors-still-think-is-fake/? AI can spot the pain from a disease some doctors still think is fake] :Refers to [https://www.ncbi.nlm.nih.gov/pubmed/27583567 Towards a neurophysiological signature for fibromyalgia (2017)] *2018, [https://www.prohealth.com/fibromyalgia/library/fibromyalgia-central-sensitization-syndrome-87957? Fibromyalgia: Central Sensitization Syndrome - Characterizing classes of fibromyalgia within the continuum of central sensitization syndrome] - ProHealth === Blood tests === *2021, [https://www.statnews.com/2021/10/20/selling-certainty-epicgenetics-physician-was-one-of-fibromyalgia-patients-few-true-allies-or-was-he/ In a sea of skeptics, this physician was one of fibromyalgia patients' few true allies. Or was he?] - STAT News on the FM/a test *2014, [http://www.prohealth.com/library/showarticle.cfm?libid=18837 ICM-1: Fibromyalgia Antiviral Trial Results “Very Positive”: Predicts New Approach Will Be “Game-Changer”] === Brain scans === *2002, Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia<ref name="Gracely2002">{{Cite journal | last = Gracely | first = Richard H. | author-link = | last2 = Petzke | first2 = Frank | authorlink2 = | last3 = Wolf | first3 = Julie M. | authorlink3 = | last4 = Clauw | first4 = Daniel J. | authorlink4 = Daniel Clauw | date = 2002 | title = Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia| url = https://onlinelibrary.wiley.com/doi/abs/10.1002/art.10225|journal=Arthritis & Rheumatism|language=en|volume=46|issue=5 | pages = 1333–1343|doi=10.1002/art.10225|issn=1529-0131|pmc=|pmid=|access-date=|quote=|via=}}</ref> ::[http://www.anapsid.org/cnd/diagnosis/brainpain.html Fibromyalgia Pain Isn't All In Patient's Heads, New Brain Study Finds] *2012, [https://www.sciencedaily.com/releases/2012/11/121111153426.htm Fibromyalgia and the brain: New clues reveal how pain and therapies are processed]{{citation needed | date = 2021}} *2018, Brain glial activation in fibromyalgia – A multi-site positron emission tomography investigation<ref name="Albrecth2019">{{Cite journal | last = Albrecht | first = Daniel S. | author-link = | last2 = Forsberg | first2 = Anton | authorlink2 = | last3 = Sandström | first3 = Angelica | authorlink3 = | last4 = Bergan | first4 = Courtney | authorlink4 = | last5 = Kadetoff | first5 = Diana | authorlink5 = | last6 = Protsenko | first6 = Ekaterina | authorlink6 = | last7 = Lampa | first7 = Jon | last8 = Lee | first8 = Yvonne C. | last9 = Höglund | first9 = Caroline Olgart | date = 2019-01-01 | title = Brain glial activation in fibromyalgia – A multi-site positron emission tomography investigation | url =https://www.sciencedirect.com/science/article/pii/S0889159118302423|journal=Brain, Behavior, and Immunity|language=en|volume=75|issue= | pages = 72–83|doi=10.1016/j.bbi.2018.09.018|issn=0889-1591|pmc=|pmid=|access-date=|quote=|via=}}</ref> ::[https://ki.se/en/news/people-with-fibromyalgia-have-inflammation-of-the-brain People with fibromyalgia have inflammation of the brain] ==References== {{reflist}} [[Category:Diagnoses]] [[Category:Potential comorbidities]] [[Category:Musculoskeletal diseases and disorders]] [[Category:Neurological diseases and disorders]]
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