Fibromyalgia

2018-07-12T08:40:51Z

Adambeyoncelowe:/* Health complications */ Sentence problems

Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. Pain is widespread, on both sides of the body, and above and below the waist.

Sufferers are fatigued and tired even when sleeping for long periods of time, and sleep is often disrupted by pain. Many FM sufferers have sleep disorders like [https://en.wikipedia.org/wiki/Sleep_apnea sleep apnea] and [[Restless leg syndrome]]. [[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". Some experience [[depression]], [[headache]]s, and lower [[abdominal pain]] or cramping. Other symptoms include tingling or [[numbness]] in hands and feet, pain in jaw and disorders of the jaw such as t[[Temporomandibular joint disorder|emporomandibular joint disorder]] (TMJ), [[Menstrual cycle#Health effects in other conditions|menstrual cycle]] cramps, and digestive problems like i[[Irritable bowel syndrome|rritable bowel syndrome]] (IBS).<ref>[https://www.webmd.com/fibromyalgia/guide/fibromyalgia-symptoms#1 Fibromyalgia Symptoms - Web MD]</ref><ref>[https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780 Fibromyalgia - Mayo Clinic]</ref>

[[File:Fibro_Tender_Points.png|400px|thumb|right|1990 ACR Diagnostic Criteria: 18 Tender Points]]
[[File:Fibro_Widespread_Pain.png|400px|thumb|right|2010 ACR Preliminatry Diagnostic Criteria: Wisedpread Pain Index (WPI), 19 Tender Point Areas]]

==Prevelance==
FM is the second most common [https://en.wikipedia.org/wiki/Rheumatism rheumatic disorder] behind [https://en.wikipedia.org/wiki/Osteoarthritis osteoarthritis] and is "now considered to be a lifelong [[Central nervous system]] disorder."<ref>[https://naidw.org/blog/members-myblogs/fibromyalgia-now-considered-as-a-lifelong-central-nervous-system-disorder Fibromyalgia now considered as a lifelong central nervous system disorder NAIDW.org]</ref> An estimated 10 million people in the US and 3-6% of the world population have fibromyalgia. It is seen in women, men, children, and all ethnic groups. It is often seen in families and diagnosed between the ages of 20 to 50 years; incidence increases with age.<ref>[http://www.fmaware.org/about-fibromyalgia/prevalence/ Prevalance - National Fibromyalgia Association]</ref>

FM has a female:male 7:1 ratio under the ''American College of Rheumatology (ACR) 1990 Diagnostic Criteria'' and 2:1 when the ''ACR 2010 Preliminary Diagnostic Criteria'' is used.<ref>[http://emedicine.medscape.com/article/329838-overview#a5 Fibromyalgia:Epidemiology - Medscape]</ref> ''See'': [[Fibromyalgia#American College of Rheumatology (ACR) Criteria|Fibromyalgia (''American College of Rheumatology (ACR) Criteria'' section)]].

==Fibromyalgia in ME/CFS==
Dr. [[Jarred Younger]] has said that many patients that meet the criteria for FM also meet criteria for [[Chronic Fatigue Syndrome]] (CFS) but the reverse is not necessarily true as a lot of people with [[CFS]] do not have [[chronic pain]].<ref>[https://www.youtube.com/watch?v=wJB95m4FLa0#t=57m27s Webinar with Jarred Younger, Ph.D.]</ref> However, the [[Canadian Consensus Criteria]] (CCC) requires the symptom of pain to diagnose [[ME/CFS]]. It is the pattern and significant degree of [[chronic pain]] in FM that sets it apart from other diseases that have pain.

==Health complications==
FM is not a [https://en.wikipedia.org/wiki/Progressive_disease progressive disease] but according to Dr. Dan Clauw the "slow gradual worsening of chronic pain patients over time is due to downstream consequences of poorly controlled pain and other symptoms, wherein individuals then progressively get less active, sleep worse, are under more stress and unknowingly develop bad habits which worsen pain and other symptoms."<ref>[http://nationalpainreport.com/ask-the-dctors-is-fibromyalgia-progressive-8831105.html Ask the Doctors: Is Fibromyalgia Progressive?]</ref>

'''Fibromyalgia complications'''

: People who have fibromyalgia frequently complain of a variety of symptoms that affect other parts of the body. Many people complain of [[gastrointestinal]] issues and [[restless legs syndrome]] (RLS). Additionally, the chronic pain and discomfort of fibromyalgia may lead to [[depression]].<ref>[https://www.sharecare.com/health/fibromyalgia-effects Fibromyalgia Complications - Share Care]</ref>

'''Can fibromyalgia cause other medical conditions?'''

: Fibromyalgia is not known to cause other medical conditions. However, people who have fibromyalgia seem to be at high risk for developing other painful conditions, including osteoarthritis (the common type of arthritis caused by wear and tear on the joints) as well as other related conditions, such as rheumatoid arthritis, lupus, and ankylosing spondylitis. Also, people with fibromyalgia are frequently diagnosed with chronic fatigue syndrome, irritable bowel syndrome (IBS), and temporomandibular joint (TMJ) disorder.<ref>[https://www.sharecare.com/health/fibromyalgia-effects/can-fibromyalgia-cause-medical-conditions Can fibromyalgia cause other medical conditions? - Honor Society of Nursing (STTI) - Share Care]</ref>

==Risk factors==
[https://en.wikipedia.org/wiki/Systemic_lupus_erythematosus Lupus] and [[Rheumatoid arthritis]] (RA) are risk factors in developing FM. Car accidents, [[Post-traumatic stress disorder]] (PTSD), [https://en.wikipedia.org/wiki/Repetitive_strain_injury repetitive injuries], illness such as a [https://en.wikipedia.org/wiki/Viral_disease viral infection], [https://en.wikipedia.org/wiki/Family_history_(medicine) family history], and [https://en.wikipedia.org/wiki/Obesity obesity] have all been linked to FM.<ref>[https://www.cdc.gov/arthritis/basics/fibromyalgia.htm Fibromyalgia Fact Sheet - CDC]</ref><ref>[https://www.niams.nih.gov/health_info/Fibromyalgia/ Fibromyalgia - Questions and Answers about Fibromyalgia - NIH]</ref><ref>[http://www.prohealth.com/library/showarticle.cfm?libid=22315 When Fibromyalgia Is More than Pain - ProHealth By Celeste Cooper]</ref>

==Diagnosis==
Tender points, not trigger points, are used to diagnose Fibromyalgia.<ref>[http://www.healthcentral.com/chronic-pain/c/662034/176031/fibromyalgia-trigger/ The Difference Between Fibromyalgia Tender Points and Myofascial Trigger Points]</ref> Tender points will be above and below the waist and on both sides of the body. (See: Illustrations of the 1990 and 2010 American College of Rheumatology (ACR) Criteria depicting tender points near the top of this page.)

===United States===
==== American College of Rheumatology (ACR) Criteria ====

*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] "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>[http://www.health.com/health/gallery/0,,20345635,00.html 18 Points Used to Diagnose Fibromyalgia - Health.com]</ref> <ref>[https://www.masscfids.org/8-resource-library/diagnosis/266-tender-points-might-no-longer-be-used-for-diagnosis-of-fibromyalgia Tender Points might no longer be used for diagnosis of Fibromyalgia - Massachusettes CFIDS/ME FM Association]</ref>

*2010, The [https://www.fibroknowledge.com/site/acr-2010 2010 American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia: Overview] was proposed and modified in 2011<ref>[http://www.celestecooper.com/fibromyalgia.html 2011 Modification of 2010 ACR Fibromyalgia Criteria - CelesteCooper.com]</ref> with the modification being validated in 2013 and published in 2014.<ref>[https://www.ncbi.nlm.nih.gov/pubmed/24497443 Criteria for the diagnosis of fibromyalgia: validation of the modified 2010 preliminary American College of Rheumatology criteria and the development of alternative criteria. - PubMed]</ref> September of 2016, another revision has been made.<ref>[http://acrabstracts.org/abstract/2016-revisions-to-the-20102011-fibromyalgia-diagnostic-criteria/ 2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria]</ref>

:Men do not seem to form the tender points needed for diagnosis under the 1990 criteria,<ref>[http://www.webmd.com/fibromyalgia/features/how-fibromyalgia-affects-men#2 How Fibromyalgia Affects Men - WebMD]</ref> the 2010 proposed criteria diagnoses more men with a F/M ratio of 2:1.<ref>[http://emedicine.medscape.com/article/329838-overview#a5 Fibromyalgia - Epidemiology - Sex-related differences in incidence - Medscape]</ref>
:Tender points were used to diagnose with the 1990 criteria, however "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), yet this technique is not typically taught at most medical schools."<ref>[https://www.masscfids.org/8-resource-library/diagnosis/266-tender-points-might-no-longer-be-used-for-diagnosis-of-fibromyalgia#2 Tender Points might no longer be used for diagnosis of Fibromyalgia - Tender Points might no longer be used for diagnosis of Fibromyalgia - Massachusettes CFIDS/ME FM Association]</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>[https://www.masscfids.org/8-resource-library/diagnosis/266-tender-points-might-no-longer-be-used-for-diagnosis-of-fibromyalgia#3 Tender Points might no longer be used for diagnosis of Fibromyalgia - The new criteria for FM diagnosis - Massachusettes CFIDS/ME FM Association]</ref>
:*There are 19 tender point areas in the widespread pain index (WPI), whereas the 1990 criteria had 18 tender points.<ref>[https://www.masscfids.org/8-resource-library/diagnosis/266-tender-points-might-no-longer-be-used-for-diagnosis-of-fibromyalgia#2 Tender Points might no longer be used for diagnosis of Fibromyalgia - Tender Points might no longer be used for diagnosis of Fibromyalgia - Massachusettes CFIDS/ME FM Association]</ref>

The Social Security Administration for SSD/SSI filings relies on the 1990 or 2010 ACR criteria to diagnose fibromyalgia.<ref>[https://www.ssa.gov/OP_Home/rulings/di/01/SSR2012-02-di-01.html SSR 12-2p: Titles II and XVI: Evaluation of Fibromyalgia]</ref>

==== Sleep study ====
Sleep dysfunction is often involved in fibromyalgia. Treating a sleep disorder can help with fibromyalgia symptoms. A diagnosed sleep disorder is also helpful if one needs to file for disability.

*[http://chronicfatigue.about.com/od/treatingfmscfs/a/sleepstudy.htm Getting a Sleep Study with Fibromyalgia or Chronic Fatigue Syndrome]

*[http://www.sciencedaily.com/releases/2008/09/080903134311.htm What A Sleep Study Can Reveal About Fibromyalgia]

*[http://linkis.com/nationalpainreport.com/lzYea Fibromyalgia Sufferers Have Difficulty Maintaining Continuous Sleep, Study Says]

=== Diagnostic code===
====World Health Organization====
The World Health Organization (WHO) International Classification of Diseases (ICD) lists fibromyalgia as a "disease of the [[musculoskeletal system]] and connective tissue", under the code M79.7 (WHO ICD-10 2016).<ref>World Health Organization, [http://apps.who.int/classifications/icd10/browse/2016/en#/M79.7 International Classification of Diseases - Fibromyalgia M79.7], ICD-10, 2016</ref>

===== Medical coding =====

*2015, Fibromyalgia M79.7<ref>[http://www.icd10data.com/ICD10CM/Codes/M00-M99/M70-M79/M79-/M79.7 2015/16 ICD-10-CM Diagnosis Code M79.7]</ref> <ref>[http://nationalpainreport.com/the-health-care-industry-finally-recognizes-fibromyalgia-8827637.html The Health Care Industry Finally Recognizes Fibromyalgia]</ref>

==Pathophysiology==
"Fibromyalgia (FM) is a chronic pain disorder with unknown etiology and unclear pathophysiology. There is no evidence that a single event “causes” FM. Rather, many physical and/or emotional stressors may trigger or aggravate symptoms. These have included certain infections, such as a viral illness or [[Lyme disease]], as well as emotional or physical trauma."<ref>[https://www.uptodate.com/contents/pathogenesis-of-fibromyalgia#! Pathogenesis of fibromyalgia - UpToDate]</ref> The widespread pain is severe, debilitating, and abnormal in processing its pain. There is also sleep disturbance and fatigue. Cause or causes are unproven.<ref>[https://www.omf.ngo/what-is-mecfs-old/fibromyalgia/ Fibromyalgia - Open Medicine Foundation]</ref>

*2012, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/ Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management] Oman Medical Journal

: Pathophysiology: Although the etiology remains unclear, characteristic alterations in the pattern of sleep and changes in neuroendocrine transmitters such as [[serotonin]], substance P, growth hormone and [[cortisol]] suggest that regulation of the autonomic and neuro-endocrine system appears to be the basis of the syndrome. Fibromyalgia is not a life-threatening, deforming, or [https://en.wikipedia.org/wiki/Progressive_disease progressive disease]. [[Anxiety]] and [[depression]] are the most common association. Aberrant pain processing, which can result in [[chronic pain]], may be the result of several interplaying mechanisms. [[Central sensitization]], blunting of inhibitory pain pathways and alterations in [[neurotransmitters]] lead to aberrant neuro-chemical processing of sensory signals in the CNS, thus lowering the threshold of pain and amplification of normal sensory signals causing constant pain.
: The frequent co-morbidity of fibromyalgia with mood disorders suggests a major role for the stress response and for neuroendocrine abnormalities. The [[hypothalamic pituitary axis]] (HPA) 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.
: 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] PDF Table 1 pg. 28

===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>[http://nationalpainreport.com/new-uab-study-could-radically-change-fibromyalgia-treatment-as-we-know-it-8833437.html New UAB Study Could Radically Change Fibromyalgia Treatment As We Know It - National Pain Report By Donna Gregory Burch]</ref><ref>[https://www.youtube.com/watch?v=8e5xKX036bE Testing the fibromyalgia immune system with lipopolysaccharide (LPS) - YouTube - May 24, 2017]</ref>

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

[[ProHealth]] reports that an old [https://en.wikipedia.org/wiki/Tuberculosis Tuberculosis] vaccine, [https://en.wikipedia.org/wiki/BCG_vaccine Bacille Calmette-Guerin] (BCG), may be researched for treatment of Fibromyalgia spearheaded by [http://www.buzzfile.com/business/Epicgenetics,-Inc.-310-586-2929 EpicGenetics] and [http://www.massgeneral.org/ Massachusetts General Hospital].<ref>[http://www.prohealth.com/library/showArticle.cfm?libid=30644 Century-old vaccine gives new hope to fibromyalgia community - ProHealth]</ref>

EpicGenetics has a blood test that is identifying the presence of specific white blood cell abnormalities of patients diagnosed with FM and has partnered with two universities to offer [https://en.wikipedia.org/wiki/Disease_gene_identification#Whole_exome_sequencing whole exome sequencing] free of charge to those who test positive with their [http://fmtest.com/ FM/a® test].<ref>[http://www.businesswire.com/news/home/20170419005324/en/EpicGenetics-Assistance-Leading-Medical-Centers-Expands-Clinical EpicGenetics, with the Assistance of Leading Medical Centers, Expands Clinical Study of FM/a® Test to Diagnose Fibromyalgia, Identify Genetic Markers Unique to the Disorder and Explore Direct Treatment Approaches - Business Wire]</ref> Concerns have been raised in regards to the FM/a EpicGenetics Blood Test, however.<ref>[http://www.fmperplex.com/2013/02/25/junk-science-junk-ethics/ Junk Ethics - The Fibromyalgia Perplex by Fred Wolfe]</ref>

== Comorbidities ==

*[[Allodynia]]
**[https://en.wikipedia.org/wiki/Allodynia Allodynia] "Allodynia is pain, generally on the skin, caused by something that wouldn't normally cause pain." <ref>[http://chronicfatigue.about.com/od/glossary/g/allodynia.htm Allodynia - about.com definition article]</ref>
**[http://chronicfatigue.about.com/b/2009/03/07/painful-to-touch-fibromyalgia-tactile-allodynia.htm Painful to Touch: Fibromyalgia & Tactile Allodynia - Does Your Skin Hurt? Here's Why!] "It's another one of those fibromyalgia symptoms that just doesn't make sense -- pain, sometimes severe pain, from a simple touch. The closest thing it compares to is having a sunburn all the time. A lot of people don't understand this symptom, including those who have it, because while it's common in fibromyalgia, it's rare in the general population."<ref>[http://chronicfatigue.about.com/b/2009/03/07/painful-to-touch-fibromyalgia-tactile-allodynia.htm Painful to Touch: Fibromyalgia & Tactile Allodynia - Does Your Skin Hurt? Here's Why!]</ref>

*[[Body temperature]]
**[https://www.verywell.com/temperature-sensitivity-in-fibromyalgia-and-mecfs-716025 Temperature Sensitivity in Fibromyalgia & Chronic Fatigue Syndrome] "When you're exposed to heat, does it feel like you're burning up? Does it seem impossible for you to cool off? Or maybe it's cold that bothers you, chilling you to the bone, leaving you unable to warm up.
**Or are you one of those people with fibromyalgia (FMS) and chronic fatigue syndrome (ME/CFS) who is cold all the time, or hot all the time, or alternately hot or cold while out of sync with the environment?"<ref>[https://www.verywell.com/temperature-sensitivity-in-fibromyalgia-and-mecfs-716025 Temperature Sensitivity in Fibromyalgia & Chronic Fatigue Syndrome - Very Well By Adrienne Dellwo]</ref>

*[[Brain fog]]
**[http://www.news-medical.net/health/What-is-Fibro-Fog-Fibromyalgia-and-Cognitive-Dysfunction.aspx What is Fibro Fog? - Fibromyalgia and Cognitive Dysfunction] "Mental confusion along with difficulty in concentration and loss of memory is often termed “fibro fog”".<ref>[http://www.news-medical.net/health/What-is-Fibro-Fog-Fibromyalgia-and-Cognitive-Dysfunction.aspx What is Fibro Fog - Fibromyalgia and Cognitive Dysfunction - Medical.net]</ref>

*Costochondritus
**[https://en.wikipedia.org/wiki/Costochondritis Costochondritis] is chest and ribcage pain. [https://www.verywell.com/costochondritis-in-fibromyalgia-716178 Costochondritis in Fibromyalgia]
**[[Gastrointestinal system]]
***[[Irritable bowel syndrome]]: [http://chronicfatigue.about.com/od/whyfmscfsarelinked/a/IBS.htm Irritable Bowel Syndrome in Fibromyalgia & Chronic Fatigue Syndrome - Why Do They Go Together?] "Fibromyalgia, chronic fatigue syndrome and irritable bowel syndrome (IBS) frequently go together. No one really knows why, but we do know that all three conditions can include imbalances of serotonin -- although in fibromyalgia (FMS) and Chronic Fatigue Syndrome (CFS or ME/CFS) it's an imbalance in the brain, while with IBS it's in the gut."<ref>[http://chronicfatigue.about.com/od/whyfmscfsarelinked/a/IBS.htm Irritable Bowel Syndrome in Fibromyalgia & Chronic Fatigue Syndrome - Why Do They Go Together?]</ref>

*Language Impairment
**[http://chronicfatigue.about.com/b/2009/02/03/impaired-language-in-fibromyalgia-chronic-fatigue-syndrome.htm Impaired Language in Fibromyalgia & Chronic Fatigue Syndrome - Talking, Reading & Writing] "How often do you find yourself searching your brain for a simple word that you just can't remember?"<ref>[http://chronicfatigue.about.com/b/2009/02/03/impaired-language-in-fibromyalgia-chronic-fatigue-syndrome.htm Impaired Language in Fibromyalgia & Chronic Fatigue Syndrome - Talking, Reading & Writing]</ref> "The diagnosis of [[Aphasia]] is a condition that robs you of the ability to communicate. It can affect your ability to speak, write and understand language, both verbal and written"<ref>[http://www.mayoclinic.org/diseases-conditions/aphasia/basics/definition/con-20027061 Aphasia - Mayo Clinic]</ref> but with dysphasia you will have those symptoms and trouble listening and doing numeral calculations."<ref>[http://www.ayushveda.com/healthcare/dysphasia.htm What is Dysphasia?-Ayushveda]</ref> [[Word-finding problems]] is also a symptom of ME/CFS.

*OBGYN
**[https://www.verywellhealth.com/menstrual-periods-and-fibromyalgia-715596 Menstrual Periods with Fibromyalgia: Personal Stories]
**[http://chronicfatigue.about.com/od/Research/fl/Fibromyalgia-Tied-to-Hysterectomy-Gynecologic-Disease.htm Fibromyalgia is tied to Hysterectomy and Gynecological Disease and Endocrine and Autoimmune Disorders]. "Did you have a gynecologic surgery, such as a hysterectomy, in the few years before you developed fibromyalgia?"<ref>[http://chronicfatigue.about.com/od/Research/fl/Fibromyalgia-Tied-to-Hysterectomy-Gynecologic-Disease.htm Fibromyalgia Tied to Hysterectomy, Gynecologic Disease]</ref>

*[[Orthostatic intolerance]]
**[https://www.verywell.com/orthostatic-intolerance-715915 Orthostatic Intolerance - Very Well By: Adrienne Dellwo]
**[http://drlapp.com/wp-content/uploads/TTT_symptoms.pdf Symptoms Predict the Outcome of Tilt Table Testing in CFS/ME/FM] Symptoms can include low blood pressure and/or sudden high blood pressure, dizziness, fainting.
**[https://www.healthrising.org/blog/2017/09/21/fibromyalgia-problems-standing-orthostatic-intolerance/ An Overlooked Issue in Fibromyalgia? Study Highlights Problems Standing (Orthostatic Intolerance)]

*[[Sleep dysfunction]]
**[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4648619/ Sleep is associated with task-negative brain activity in fibromyalgia participants with comorbid chronic insomnia]. "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>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4648619/ Sleep is associated with task-negative brain activity in fibromyalgia participants with comorbid chronic insomnia]</ref>
**[http://www.prohealth.com/library/showarticle.cfm?libid=22344 Fibromyalgia and Sleep] "Most people with fibromyalgia have an associated sleep disorder that makes it difficult for them to get the deep, restorative sleep they need."<ref>[http://www.prohealth.com/library/showarticle.cfm?libid=22344 Fibromyalgia and Sleep - ProHealth - By: Cort Johnson]</ref>

*[[Thyroid disease]]
**[http://thyroid.about.com/cs/fibromyalgiacfs/a/cfsfibrothyroid.htm Chronic Fatigue Syndrome, Fibromyalgia, and Autoimmune Thyroid Disease] "CFS, FMS and HAIT patients often visit their doctors complaining of a host of symptoms. (See sidebar.) Since symptoms are similar, there is a risk of misdiagnosis. Some doctors still fail to even acknowledge the existence of CFS and FMS."<ref>[http://thyroid.about.com/cs/fibromyalgiacfs/a/cfsfibrothyroid.htm Chronic Fatigue Syndrome, Fibromyalgia, and Autoimmune Thyroid Disease]</ref>
**[http://chronicfatigue.about.com/b/2011/09/21/thyroid-disease-in-fibromyalgia-chronic-fatigue-syndrome.htm Thyroid Disease in Fibromyalgia & Chronic Fatigue Syndrome] "Fibromyalgia and chronic fatigue syndrome are multi-system illnesses. They hit you hard in multiple ways, and confuse doctors of all specialties because not everything can be explained by the one system they focus on."<ref>[http://chronicfatigue.about.com/b/2011/09/21/thyroid-disease-in-fibromyalgia-chronic-fatigue-syndrome.htm Thyroid Disease in Fibromyalgia & Chronic Fatigue Syndrome]</ref>

*Other symptoms and comorbidities
**[http://chronicfatigue.about.com/od/whatisfibromyalgia/a/fibrosymptoms.htm Fibromyalgia Symptoms - The Monster List!] " ...the list of possible symptoms is far-reaching and body-wide."<ref>[http://chronicfatigue.about.com/od/whatisfibromyalgia/a/fibrosymptoms.htm Fibromyalgia Symptoms - The Monster List!]</ref>

==Treatment==

===United States===
'''Rheumatology and primary care providers: Diagnosing and treatment'''

*2012, [https://en.wikipedia.org/wiki/Mayo_Clinic Mayo Clinic] published [http://www.mayoclinicproceedings.org/article/S0025-6196%2812%2900299-6/fulltext A Framework for Fibromyalgia Management for Primary Care Providers]. Rheumatologists stopped treating fibromyalgia patients and primary care providers began treating although rheumatologists are most often the specialist to diagnose. (Please see [http://me-pedia.org/wiki/Fibromyalgia#Disability disability] heading about ''primary provider'' and ''specialists'' for disability cases.)

=== Drugs ===
There are approved and off-label drugs for treating FM. ''Please Note: The information under "Drugs" is not meant to promote any Rx drug for Fibromyalgia but to inform you of these drugs both approved and off-label. Always consult your doctor for guidance on Rx drug use for any illness or disease.''

====United States====
===== FDA approved=====

*[http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm107802.htm Living with Fibromyalgia, Drugs Approved to Manage Pain] ([https://en.wikipedia.org/wiki/FDA_Consumer FDA For Consumers])

*[https://en.wikipedia.org/w/index.php?title=Cymbalta&redirect=no Cymbalta] ([https://en.wikipedia.org/wiki/Duloxetine Duloxetine is Generic])

*[https://en.wikipedia.org/w/index.php?title=Lyrica&redirect=no Lyrica]

*[https://en.wikipedia.org/w/index.php?title=Savella&redirect=no Savella]

===== Side effects for FDA approved =====
''Not all side effects are listed, review each medication's possible side effects with your doctor.''

*Cymbalta (Duloxetine is generic) is facing lawsuits due to severe withdrawal symptoms.<ref>[http://www.drugwatch.com/cymbalta/lawsuits/ Cymbalta Lawsuits - Drug Watch]</ref> There is a Facebook group dedicated to questions about the drug and tapering off of it; [https://www.facebook.com/groups/Cymbaltahurtsworse/?multi_permalinks=572848582870894&notif_t=group_highlights Cymbalta Hurts Worse]. Eli Lilly has settled hundreds of personal injury lawsuits with patients experiencing severe withdrawal symptoms.<ref>[http://nationalpainreport.com/eli-lilly-settles-cymbalta-withdrawal-lawsuits-8831647.html Eli Lilly Settles Cymbalta Withdrawal Lawsuits - Donna Gregory Burch - National Pain Report - October 6, 2016]</ref>

*Lyrica (Pregabalin is generic) is causing weight gain.<ref>[http://www.drugsdb.com/rx/lyrica/lyrica-and-weight-gain/ Lyrica and Weight Gain - Drugsdb.com]</ref>

*Savella (Milnacipran is generic) has a list of side effects.<ref>[http://www.drugs.com/sfx/savella-side-effects.html Savella Side Effects - Drugs.com]</ref>

=====Off label=====

*[[Low dose naltrexone]]: Taken at bedtime for sleep. Helps pain due to better sleep.

*[[Gabapentin]]: [http://www.mayoclinic.org/diseases-conditions/fibromyalgia/expert-answers/fibromyalgia-treatment/FAQ-20058273 Is gabapentin (Neurontin, others) an effective fibromyalgia treatment?] Used for pain, sleep.

*Low dose [https://www.drugs.com/search.php?searchterm=Quetiapine Quetiapine](Brand name Seroquel): [http://www.cortjohnson.org/blog/2014/02/27/tackling-pain-depression-fibromyalgia-quetiapine-scores-benefits-clinical-trial/ Tackling Pain and Depression in Fibromyalgia: Quetiapine Scores Some Benefits in Clinical Trial] Taken at bedtime for sleep.

*[[Tramadol]]: For chronic ongoing pain.

*[http://www.fibromyalgia-reviews.com/Drg_Zanaflex.cfm Zanaflex for Fibromyalgia] (Generic name Tizanidine): Muscle relaxer for pain, sleep.

===== Side effects for Off label =====
''Not all side effects are listed, review each medication's possible side effects with your doctor.''

*Low dose naltrexone: Insomnia, the drug must be stepped up slowly.
*Gabapentin (Brand name Neurontin): [https://www.drugs.com/sfx/gabapentin-side-effects.html Gabapentin side effects]
*Low dose quetiapine (Brand name Seroquel): Weight gain, [https://en.wikipedia.org/wiki/Suicidal_ideation suicidal ideation]
*Tramadol: [http://fibromapp.com/fibromyalgia-cfsme-seizuresblackouts-the-tramadol-connection/ Having Seizures or Blackouts? The Tramadol Connection]
*Zanaflex (Generic name Tizanidine): [https://www.drugs.com/sfx/zanaflex-side-effects.html Zanaflex Side Effects]

===Articles and blogs on drugs===

*[http://fibromapp.com/fibromyalgia-cfsme-seizuresblackouts-the-tramadol-connection/ Having Seizures or Blackouts? The Tramadol Connection]

*[http://curetogether.com/blog/2011/08/10/patients-say-fibromyalgia-drugs-make-things-worse-rest-is-best/ Patients Say Fibromyalgia Drugs Make Things Worse, Rest is Best] - Graph of Patient-Rated Drugs - ''Cure Together Blog''

===Sleep medications===
Disordered sleep is a prominent symptom in FM. There are four
types of sleep medications used in FM; antihistamines, benzodiazepines, nonbenzodiazepines, sedating antidepressants.<ref>[http://www.fibrodaze.com/sleep-medications/ Sleep Medications For Fibromyalgia Fibrodaze.com]</ref>

Low dose naltrexone and low dose seroquel (see under the heading: [http://me-pedia.org/wiki/Fibromyalgia#Drugs Drugs]) can also help with sleep when taken at bedtime.

*[http://fedupwithfatigue.com/why-your-fibro-meds-arent-working/ Why Your Fibro Meds Aren't Working]

=== Drug trials ===

*ASP8062
**2017, [https://clinicaltrials.gov/ct2/show/NCT03092726?term=ASP8062&cond=Fibromyalgia&rank=1 ClinicalTrials.gov A Phase 2a, Randomized, Double-Blind Placebo-controlled, Parallel-group Study to Assess the Analgesic Efficacy and Safety of ASP8062 in Subjects With Fibromyalgia]
**Cannabinoid-based therapy
**2017, [https://fibromyalgianewstoday.com/2017/03/27/fibromyalgia-targeted-ap-cbd-thc-therapy-undergoing-phase-1-clinical-trial/ Intec Pharma Launches Phase 1 Trial of Cannabinoid-based Therapy for Fibromyalgia, Lower Back Pain.]

*IMC-1

:2016, [http://simmaronresearch.com/2016/10/pridgen-antiviral-treatment-fibromyaligia/ The Pridgen Revolution? Dr. Pridgen on Bringing His Antiviral Approach to Fibromyalgia To Market] "Almost three years ago, Dr. Pridgen threatened to turn the world of fibromyalgia treatment on its head. Few had connected fibromyalgia with viruses or even immune problems when Pridgen announced that a) FM is caused herpes simplex virus reactivation and b) that it could be treated with antivirals."<ref>[http://simmaronresearch.com/2016/10/pridgen-antiviral-treatment-fibromyaligia/ The Pridgen Revolution? Dr. Pridgen on Bringing His Antiviral Approach to Fibromyalgia To Market]</ref>
:2016, [https://fibromyalgianewstoday.com/2016/02/02/combo-tx-fast-tracked-for-fibromyalgia/ Novel Fibromyalgia Treatment Granted FDA Fast Track Designation] "In the successful Phase II trial in fibromyalgia, IMC-1 was studied to confirm the hypothesis that chronic tissue-resident herpes simplex virus type 1 ([[HSV-1]]) may be one of the underlying causes of fibromyalgia and causally related to fibromyalgia symptoms or recurrence. IMC-1 is a novel fixed-dose oral combination antiviral medication designed to suppress this suspected virus and thus alleviate fibromyalgia symptoms."<ref>[http://fibromyalgianewstoday.com/2016/02/02/combo-tx-fast-tracked-for-fibromyalgia/ Novel Fibromyalgia Treatment Granted FDA Fast Track Designation - Fibromyalgia News Today By Charles Moore]</ref>
:2017, [http://simmaronresearch.com/2017/03/valley-death-fibromyalgia-pridgen/ Through the “Valley of Death”: Dr. Pridgen, Fibromyalgia and the Looming Trials] "First there were the anecdotal reports – FM patients were not just getting better but some, and not just a few, were getting well using something entirely new – an antiviral protocol, of all things, created not by a pain specialist or rheumatologist but by a surgeon."<ref>[http://simmaronresearch.com/2017/03/valley-death-fibromyalgia-pridgen/ Through the “Valley of Death”: Dr. Pridgen, Fibromyalgia and the Looming Trials - Simmaron Research By Cort Johnson]</ref>
:2017, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328426/? A famciclovir + celecoxib combination treatment is safe and efficacious in the treatment of fibromyalgia] "IMC-1 was efficacious and safe in treating symptoms of fibromyalgia, supporting the hypothesis that herpes virus infections may contribute to this syndrome. Improved retention rates, decreased adverse event rates, and evidence of efficacy on a broad spectrum of outcome measures are suggestive that IMC-1 may represent an effective, novel treatment for fibromyalgia."<ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328426/? A famciclovir + celecoxib combination treatment is safe and efficacious in the treatment of fibromyalgia - NCBI, Dovepress Journal of Pain - J Pain Res. 2017; 10: 451–460.
Published online 2017 Feb 22. doi: 10.2147/JPR.S127288]</ref>
:Bacille Calmette-Guerin (BCG) vaccine
:2017, [http://www.prohealth.com/library/showArticle.cfm?libid=30644 Century-old vaccine gives new hope to fibromyalgia community]

===Drug trials failed===

*TNX-102

:2016, The drug failed in its primary goal in providing pain relief and ''Tonix Pharmaceuticals'' will not be moving forward in developing a Ffbromyalgia drug.<ref>[http://nationalpainreport.com/potential-fibromyalgia-treatment-is-put-on-hold-8831410.html Potential Fibromyalgia Treatment is Put on Hold - National Pain Report - September 2016]</ref>
:DS-5565
:2016, [http://nationalpainreport.com/three-new-fibromyalgia-drugs-could-be-on-the-way-8830514.html Three New Fibromyalgia Drugs Could Be On The Way] "Japanese drugmaker Daiichi Sankyo is now testing what could be Lyrica 2.0."<ref>[http://nationalpainreport.com/three-new-fibromyalgia-drugs-could-be-on-the-way-8830514.html Three New Fibromyalgia Drugs Could Be On The Way By Donna Gregory Burch]</ref>

:'''Phase III clinical trial of DS-5565 found ineffective'''
:2017, [https://www.healthrising.org/blog/2017/07/08/mirogabalin-fibromyalgia-drug-fails/ The Big Hurt: Second Major Fibromyalgia Drug in a Year Fails] "In the three 13-week, double-blind, global, phase 3 ALDAY clinical trials evaluating Mirogabalin for the treatment of pain associated with fibromyalgia, Mirogabalin did not meet the primary efficacy endpoint to demonstrate a statistically significant reduction in the weekly average of worst daily pain score from baseline to Week 13."<ref>[https://www.healthrising.org/blog/2017/07/08/mirogabalin-fibromyalgia-drug-fails/ The Big Hurt: Second Major Fibromyalgia Drug in a Year Fails - Health Rising]</ref>

=== Therapies ===

==== Exercise ====
''Please Note'': These recommendations are for fibromyalgia patients and '''not''' [[ME/CFS]] sufferers.

*Warm water exercise is best.<ref>[http://chronicfatigue.about.com/od/treatingfmscfs/a/warmwaterFMS.htm Warm-Water Exercise for Fibromyalgia - About.com Health FMS/ME/CFS]</ref><ref>[https://www.ncbi.nlm.nih.gov/pubmed/18173915 Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia. - PubMED]</ref>

*Moderate aerobic exercise and weights with as fewer reps possible with a day or two of rest in between. Do not start a program if you are in a flare.<ref>[http://www.arthritis.org/living-with-arthritis/tools-resources/expert-q-a/fibromyalgia-questions/fibromyalgia-exercise.php Exercising With Fibromyalgia - By Ronenn Roubenoff, MD]</ref>

*[https://www.youtube.com/watch?v=BauJYuJwFsI Easy fibromyalgia exercises and motivation to keep you healthy!] Videos on YouTube from Eric Suarez, CPT.

*[http://chronicfatigue.about.com/od/whatisfibromyalgia/a/Fibromyalgia-Myth-Vs-Fact.htm Fibromyalgia Myth vs. Fact] Heading: ''Myth #3: People With Fibromyalgia Need More Exercise''. Appropriate exercise, which each patient needs to gauge for themselves.

==== 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]

*2016, [http://chronicfatigue.about.com/od/alternativetreatments/a/bodywork.htm Massage, Rolfing & Other Bodywork - Are They Effective Fibromyalgia & Chronic Fatigue Syndrome Treatments?]

==== Acupuncture ====

*2004, [[U.S. Department of Health and Human Services]] (HHS) and [https://en.wikipedia.org/wiki/Centers_for_Medicare_and_Medicaid_Services Centers for Medicare and Medicaid Services] (CMS) ruled April 16, 2004, a noncoverage determination for acupuncture.<ref>[https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R11NCD.pdf CMS.gov Regulations and Guidance]</ref>

*2005, [http://acupunctureschoolonline.com/acupuncture-good-for-fibromyalgia.html Acupuncture Good for Fibromyalgia?] "acupuncture gave no significant pain relief to fibromyalgia patients."<ref>[http://acupunctureschoolonline.com/acupuncture-good-for-fibromyalgia.html Acupuncture Good for Fibromyalgia? Acupuncture School Online]</ref>

*2016, [http://www.sciencedirect.com/science/article/pii/S2095496416602352 Short-term complementary and alternative medicine on quality of life in women with fibromyalgia] "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>[http://www.sciencedirect.com/science/article/pii/S2095496416602352 Short-term complementary and alternative medicine on quality of life in women with fibromyalgia - JIM, Elsevier, Science Direct]</ref>

*2016, [https://fibromyalgianewstoday.com/2016/02/01/acupuncture-does-not-reduce-pain-for-women-with-fibromyalgia/ Acupuncture Does Not Appear to Relieve Pain in Fibromyalgia Patients]

== Disability ==
===United States===
''Please Note'': The following is NOT legal advice and it should not be relied upon in taking steps for a disability case. Only ''[https://www.ssa.gov/ Social Security]'' and a Disability Lawyer practicing ''[https://en.wikipedia.org/wiki/Category:Disability_law_in_the_United_States Disability Law]'' can provide the most up to date and the correct legal avenue for bringing a disability case.

In the[[ United States]], [https://www.ssa.gov/ssi/ Social Security Insurance] and [https://www.ssa.gov/disability/ Social Security Disability] (SSI) and (SSD) benefits are available for Fibromyalgia. Generally for SSI/SSD, notes and tests from a ''Primary Provider'' '''may''' be allowed for submission but ''Specialists'' such as a rheumatologist, neurologist, rpychiatrist, etc. are required for diagnosis, ongoing treatment and completing SSI/SSD paperwork.

The Social Security Administration for SSD/SSI filings relies on the 1990 or 2010 ACR criteria to diagnose Fibromyalgia. (See: "Policy Interpretation" for the POLICY INTERPRETATION RULING.)<ref>[https://www.ssa.gov/OP_Home/rulings/di/01/SSR2012-02-di-01.html SSR 12-2p: Titles II and XVI: Evaluation of Fibromyalgia]</ref>

*[http://fibromyalgia.newlifeoutlook.com/fibromyalgia-disability-benefits/?utm_source=Twitter&utm_medium=Social Applying for Disability With Fibromyalgia] One patient's success of applying, denial, successful appeal, and a breakdown of what SSI/SSD requires for the medical determination of a favorable decision of disability.

*[https://www.socialsecurity.gov/OP_Home/rulings/di/01/SSR2012-02-di-01.html Fibromyalgia: Policy Interpretation Ruling - Social Security]

*[http://www.disabilitysecrets.com/social_security_disability_fibromyalgia.html Social Security Disability (SSDI & SSI) for Fibromyalgia - Disability Secrets By NOLO]

*[http://www.mdjunction.com/fibromyalgia/fibromyalgia-disability Fibromyalgia Disability Patient Support Forums] at [[MDJunction]]

==== Examinations and Tests ====
For documentation of symptoms and providing proof of a fibromyalgia (FM) diagnosis, you and your doctor should consider the following examinations and tests:

:'''Fibromyaglia Diagnostic Examination'''
:[http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Health-Care-Team/What-is-a-Rheumatologist Rheumatologist] examination and diagnosis of FM. (Consider having a rheumatologist order tests and coordinate and order other specialists' tests and complete the paperwork for Social Security. A primary doctor cannot complete disability paperwork but ''may'' be able to forward test results.)
:'''Arthritis'''
:[https://en.wikipedia.org/wiki/Nuclear_medicine#Diagnostic Whole body bone scan] to rule out treatable arthritis.
:'''Blood Tests'''
:Routine blood tests for [[diabetes]] (fasting sugar, A1C) and a full [[Thyroid disease]] panel ([https://en.wikipedia.org/wiki/Thyroid_function_tests#Thyroid-stimulating_hormone TSH, T3, Free T3, T4 and Free T4]).
:Rule out [[Rheumatoid arthritis]], lupus, [[Lyme disease]] and other diseases that can share some of the same symptoms of fibromyalgia and may be treatable.
:Vitamin and mineral deficiencies such as [[B12]] and [[Vitamin D]] which are treatable with over the counter supplements and prescription treatments improving fatigue and pain.
:[[Irritable bowel syndrome]] diagnosis which may require blood, [http://www.mayoclinic.org/tests-procedures/endoscopy/basics/definition/PRC-20020363 upper endoscopy] to rule out [https://en.wikipedia.org/wiki/Coeliac_disease celiac disease] and [https://en.wikipedia.org/wiki/Stool_test fecal tests] to check for bacteria ([[SIBO]]) and [http://www.umm.edu/health/medical/altmed/condition/intestinal-parasites intestinal parasites].
:'''Mental Health and Cognition'''
:* Psychiatric evaluation as depression and anxiety can be treated.
:* [[Cognitive dysfunction]] tests. '''Sleep dysfunction'''
:* Sleep study for [[Restless legs syndrome]], [[Sleep disturbance]] and rule out [[Narcolepsy]].
:* [[Tilt table test]] for [[Orthostatic intolerance]]. '''Other examinations and tests'''
:An ear, nose, and throat specialist (ENT) ([http://www.mayoclinic.org/departments-centers/otorhinolaryngology-ent/overview Otorhinolaryngology]) examination and imaging may be ordered for [[Temporomandibular joint disorder]] (TMJ). (Ear, sinus, throat/lymph infections, and [[tinnitus]] can also be documented.)

Of course, one can have arthritis, sleep apnea, [[Chronic lyme disease|chronic Lyme disease]] or other diseases and still have FM, but there may be a treatable condition where a patient's overall health, including their FM, improves.<ref>[http://www.webmd.com/fibromyalgia/guide/common-misdiagnoses-of-fibromyalgia#1 Common Misdiagnoses of Fibromyalgia - WebMD]</ref><ref>[http://www.cfidsselfhelp.org/library/overlapping-and-related-conditions Overlapping and Related Conditions - CFIDS & Fibromyalgia]</ref><ref>[http://www.prohealth.com/library/showarticle.cfm?libid=22315 When Fibromyalgia Is More than Pain - ProHealth By Celeste Cooper]</ref>

There have been cases of [[Vitamin D]] deficiency being misdiagnosed as fibromyalgia as a D deficiency can cause pain. Supplementation or prescribed D treatments may alleviate this pain. However, it is possible to have both a D deficiency and fibromyalgia and correcting the deficiency will only resolve the pain stemming from it.<ref>[http://www.medscape.com/viewarticle/737800_4 What Is Fibromyalgia? Medscape Readers Weigh In - Medscape By Bret Stetka, MD]</ref><ref>[http://www.webmd.com/pain-management/features/vitamin-d-deficiency-and-chronic-pain-link#1 Chronic Pain: Does Vitamin D Help? - WebMD By Gina Shaw]</ref>

==== Blogs about navigating SSD process ====

*Resources for getting approved for disability include this [http://www.meaction.net/2017/04/17/the-sleepy-girl-guide-to-social-security-disability-u-s/ Guide to Social Security Disability for People with Myalgic Encephalomyelitis and Chronic Fatigue Syndrome], available on the #[[MEAction]] website.

*[https://howtogeton.wordpress.com/2017/03/20/how-pattys-lawyer-never-told-her-the-most-important-thing-she-needed-to-know/ How Patty’s Lawyer Never Told Her What She Needed to Know]

*[https://howtogeton.wordpress.com/2017/05/01/sample-doctor-letters-for-disability/ Sample Doctor Letters for Disability]

== Notable studies ==

*2002, [http://www.anapsid.org/cnd/diagnosis/brainpain.html Fibromyalgia Pain Isn't All In Patient's Heads, New Brain Study Finds]

*2004, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1754959/ A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing]

*2012, [https://www.researchgate.net/publication/230626400_Dysfunctional_endogenous_analgesia_during_exercise_in_patients_with_chronic_pain_To_exercise_or_not_to_exercise Dysfunctional endogenous analgesia during exercise in patients with chronic pain: To exercise or not to exercise?]

*2015, [http://onlinelibrary.wiley.com/doi/10.1111/1756-185X.12550/abstract Some oxidative and antioxidative parameters and their relationship with clinical symptoms in women with fibromyalgia syndrome]

*2015, [http://onlinelibrary.wiley.com/doi/10.1002/acr.22626/full Understanding the Association of Fatigue With Other Symptoms of Fibromyalgia: Development of a Cluster Model]

*2015, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4648619/ Sleep is associated with task-negative brain activity in fibromyalgia participants with comorbid chronic insomnia]

*2015, [https://biblio.ugent.be/publication/6993821 Cognitive performance is related to central sensitization in patients with chronic whiplash-associated disorders and fibromyalgia: a case-control study]

*2015, [http://eujournal.org/index.php/esj/article/viewFile/6167/5952 Fibromyalgia: A search for markers and their evaluation throughout a treatment]

*2015, [http://www.sciencedirect.com/science/article/pii/S2213158215001394 Normalization of aberrant resting state functional connectivity in fibromyalgia patients following a three-month physical exercise therapy]

*2015, [https://www.sciencedaily.com/releases/2015/08/150819172431.htm Researchers identify potential sleep-related treatment targets for fibromyalgia]

*2015, [https://www.sciencedaily.com/releases/2015/05/150517071813.htm Fibromyalgia has central nervous system origins]

*2015, [http://synapse.koreamed.org/search.php?where=aview&id=10.3344/kjp.2015.28.3.169&code=0047KJP&vmode=FULL The Iceberg Nature of Fibromyalgia Burden: The Clinical and Economic Aspects]

*2015, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499983/ The effects of aquatic, isometric strength-stretching and aerobic exercise on physical and psychological parameters of female patients with fibromyalgia syndrome]

*2016, [https://www.ncbi.nlm.nih.gov/pubmed/27713820 Fibromyalgia syndrome: metabolic and autophagic processes in intermittent cold stress mice.]

*2016, [http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161574 Fibromyalgia Is Correlated with Retinal Nerve Fiber Layer Thinning]

*2016, [https://www.ncbi.nlm.nih.gov/pubmed/26272057 The prevalence of severe fatigue in rheumatic diseases: an international study.]

*2016, [http://journals.lww.com/clinicalpain/Abstract/2016/04000/Characteristics_of_Disturbed_Sleep_in_Patients.4.aspx Characteristics of Disturbed Sleep in Patients With Fibromyalgia Compared With Insomnia or With Pain-Free Volunteers]

*2016, [https://www.ncbi.nlm.nih.gov/pubmed/26218005 Is Efficacy of Milnacipran in Fibromyalgia Predictable? A Data Mining Analysis of Baseline and Outcome Variables.]

*2017, [https://www.ncbi.nlm.nih.gov/pubmed/28614420# The degree of cardiac baroreflex involvement during active standing is associated with the quality of life in fibromyalgia patients.] (Orthostatic Intollerance)

*2017, [https://www.dovepress.com/evidence-of-both-systemic-inflammation-and-neuroinflammation-in-fibrom-peer-reviewed-fulltext-article-JPR Evidence of both systemic inflammation and neuroinflammation in fibromyalgia patients, as assessed by a multiplex protein panel applied to the cerebrospinal fluid and to plasma]

*2017, [https://www.ncbi.nlm.nih.gov/pubmed/27583567 Towards a neurophysiological signature for fibromyalgia.]

===Awards and current research===

*2016, [http://www.uofmhealth.org/news/archive/201610/chronic-pain-researchers-expand-work-75m-award-nih Chronic pain researchers to expand work with $7.5M award from NIH]

=== Psychiatric paradigm ===

*2015, [https://www.ncbi.nlm.nih.gov/pubmed/26190965 Brain "fog," inflammation and obesity: key aspects of neuropsychiatric disorders improved by luteolin.]

*2016, [http://bjp.sagepub.com/content/10/3/156.full.pdf+html Explaining unexplained pain to fibromyalgia patients: finding a narrative that is acceptable to patients and provides a rationale for evidence-based interventions]

*2016, [http://headache.imedpub.com/fibromyalgia-a-short-commentary.pdf Fibromyalgia: A Short Commentary iMedPub Journals - Journal of Headache & Pain Management - Frederick Wolfe and Brian Walitt]

===Hyperbaric oxygen therapy===

*2015, [http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127012 Hyperbaric Oxygen Therapy Can Diminish Fibromyalgia Syndrome]

:[http://www.news-medical.net/news/20150603/Women-who-suffer-from-fibromyalgia-benefit-from-hyperbaric-oxygen-therapy.aspx Noted in this News Medical article about the research all the women had concussions.]

*2016, [https://t.co/BqnFto5mTe Hyperbaric Oxygen Therapy for treating Fibromyalgia: An update] An unsuccessful therapy experience by Donna who writes the blog ''February Stars''.

== Controversies ==

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>[http://www.nytimes.com/2008/01/14/health/14pain.html?_r=0 Drug Approved. Is Disease Real? - New York Times]</ref>

== Learn more ==

*[[Verywell FMS/CFS]]

=== Ongoing process of diagnosing and categorizing ===

*2012, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447191/ Personality and Fibromyalgia Syndrome] Conclusion: "No specific fibromyalgia personality is defined but it is proposed that personality is an important filter that modulates a person’s response to psychological stressors. Certain personalities may facilitate translation of these stressors to physiological responses driving the fibromyalgia mechanism."<ref>[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447191/ Personality and Fibromyalgia Syndrome]</ref>

*2014, [http://www.medpagetoday.com/Rheumatology/Fibromyalgia/49114 Lyme Disease, Fibromyalgia Link Evaporates] (See also: [[Chronic lyme disease]])

*2015, [http://www.news-medical.net/news/20150518/Fibromyalgia-now-considered-as-a-lifelong-central-nervous-system-disorder.aspx Fibromyalgia now considered as a lifelong central nervous system disorder]

*2015, [http://nationalpainreport.com/foundation-of-fibromyalgia-is-altered-central-nervous-system-new-study-validates-8827896.html Foundation of Fibromyalgia Is Altered Central Nervous System, New Study Validates]

*2015, [http://www.jneuro.com/neurology-neuroscience/evaluation-of-antiviral-antibodies-against-epsteinbarr-virus-and-neurotransmitters-in-patients-with-fibromyalgia.pdf Evaluation of Antiviral Antibodies against Epstein-Barr Virus and Neurotransmitters in Patients with Fibromyalgia]

*2015, Question: [http://fmcfstriggerpoints.blogspot.com/2015/09/is-fibromyalgia-psychosomatic-illness.html 'Is Fibromyalgia a Psychosomatic Illness?'] Answer: "Fibromyalgia is NOT a psychosomatic illness."<ref>[http://fmcfstriggerpoints.blogspot.com/2015/09/is-fibromyalgia-psychosomatic-illness.html Is Fibromyalgia a Psychosomatic Illness? Med Student Asks Celeste Cooper]</ref>

*2015, [http://onlinelibrary.wiley.com/doi/10.1002/acr.22626/full Understanding the Association of Fatigue With Other Symptoms of Fibromyalgia: Development of a Cluster Model]

*2016, [http://fibromyalgianewstoday.com/2016/09/09/fibromyalgia-diagnosis-using-noninvasive-eye-examination Diagnosing Fibromyalgia May Be Possible Using Noninvasive Eye Examination]

*2016, [http://bjpo.rcpsych.org/content/2/4/275 The association between borderline personality disorder, fibromyalgia and chronic fatigue syndrome: systematic review] ''BJ Psych Open'' states under heading ''[[Borderline Personality Disorder]] in patients with fibromyalgia'': " ...there does not appear to be firm and consistent evidence to support the hypothesis that the prevalence of BPD (Borderline Personality Disorder) would be higher in individuals with fibromyalgia compared with the general population."<ref>[http://bjpo.rcpsych.org/content/2/4/275 British Journal of Psychiatry Open Sep 2016, 2 (4) 275-279; DOI: 10.1192/bjpo.bp.115.002808 - Sarah Penfold, Emily St. Denis, Mir Nadeem Mazhar]</ref>

*2016, [http://chronicfatigue.about.com/od/glossary/fl/Microglia-in-Fibromyalgia-amp-Chronic-Fatigue-Syndrome.htm Microglia in Fibromyalgia & Chronic Fatigue Syndrome]

*2016, [http://simmaronresearch.com/2016/03/are-chronic-fatigue-syndrome-mecfs-and-fibromyalgia-immune-exhaustion-disorders/ Are Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia Immune Exhaustion Disorders?]

*2016, [https://consultqd.clevelandclinic.org/2016/03/why-fibromyalgia-is-neuropathic/?utm_campaign=qd+tweets&utm_medium=social&utm_source=twitter&utm_content=160308+fibromyalgia+neuropathic&dynid=twitter-_-qd+tweets-_-social-_-social-_-160308+fibromyalgia+neuropathic Why Fibromyalgia Is Neuropathic]

*2016, [https://www.ncbi.nlm.nih.gov/pubmed/27583567 Towards a neurophysiological signature for fibromyalgia]. This study has "discovered a brain signature that identifies fibromyalgia sufferers with 93 percent accuracy". (MRI images.)<ref>[http://www.colorado.edu/today/2016/10/17/neural-signature-fibromyalgia-may-aid-diagnosis-treatment?platform=hootsuite Neural signature for fibromyalgia may aid diagnosis, treatment]</ref>

*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]

=== Blood tests ===

*2013, [http://nationalpainreport.com/new-fibromyalgia-blood-test-is-99-accurate-8821072.html New Fibromyalgia Blood Test is 99% Accurate]

*2014, [http://www.prohealth.com/library/showarticle.cfm?libid=18837 Pridgen Reports Fibromyalgia Antiviral Trial Results “Very Positive”: Predicts New Approach Will Be “Game-Changer”]

*2015, [http://www.ncbi.nlm.nih.gov/pubmed/25377646 Cytokine and chemokine profiles in fibromyalgia, rheumatoid arthritis, and systemic lupus erythematosus: a potentially useful tool in differential diagnosis.]

*2016, [https://fmcfstriggerpoints.blogspot.com/2016/05/blood-test-for-fibromyalgia-fma-test-is.html Blood Test for Fibromyalgia: FM/a Test Ⓡ is now available, Q&A]

*2016, [http://www.liveinsurancenews.com/fibromyalgia-blood-testing-covered-rising-number-insurance-companies/ Fibromyalgia blood testing covered by rising number of insurance companies]

*2017, [http://www.businesswire.com/news/home/20170419005324/en/EpicGenetics-Assistance-Leading-Medical-Centers-Expands-Clinical EpicGenetics, with the Assistance of Leading Medical Centers, Expands Clinical Study of FM/a® Test to Diagnose Fibromyalgia, Identify Genetic Markers Unique to the Disorder and Explore Direct Treatment Approaches]

=== Brain scans ===

*2002, [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]

*2015, [https://www.verywell.com/unique-brain-connectivity-in-fibromyalgia-715630 Unique Brain Connectivity in Fibromyalgia - Increased Importance Assigned to Pain]

*2015, [http://onlinelibrary.wiley.com/doi/10.1002/art.39043/abstract The Somatosensory Link in Fibromyalgia: Functional Connectivity of the Primary Somatosensory Cortex Is Altered by Sustained Pain and Is Associated With Clinical/Autonomic Dysfunction] (Study with brain images and tables.)

==See also==

==References==
<references />

[[Category:Diagnoses]]
[[Category:Comorbidities]]

MEpedia - User contributions [en]

Fibromyalgia

Talk:Erythrocyte sedimentation rate