Fibromyalgia

Fibromyalgia is a condition characterised by wide spread pain. The pain is described in the muscles, tendons, ligaments, even skin and it is all over the body and the four limbs. Other synonyms such as fibrositis or muscular rheumatism may indicate the same illness. This condition is not inflammatory or degenerative therefore it does not cause any damage to the joints and patients may look well despite experiencing severe pain and other symptoms. 

 

Fibromyalgia is estimated to affect 2-4% of the population and female to male ratio is approximately 9:1. The term derived from Latin, fibro meaning fibrous tissue, in Greek myo means muscle and Greek algos means pain, so it literally means muscle and connective tissue pain. 

 

Tiredness and sleep disturbance are the main additional symptoms; many patients report irritability, feeling down, forgetfulness or poor concentration, unstable bladder and irritable bowel syndrome. Fibromyalgia can co-exist with other morbid conditions such as hypermobility, depression, anxiety, post-traumatic stress disorder and other chronic rheumatological or neurological diseases. There is no single test to diagnose fibromyalgia and often physical examination, blood tests and imaging are normal. Furthermore the symptoms of fibromyalgia may mimic other conditions such as rheumatic disorders, osteoporosis and underactive thyroid. The American College of Rheumatology (ACR) has suggested criteria that are known as the ACR 1990 Criteria which define fibromyalgia on the basis of history and the presence of tender points. Patients usually have tender points at certain sites.

 

The cause is not clear but research suggests an abnormality in pain processing pathways. This means hyperexcitability of pain processing pathways and underactivity of inhibitory pain pathways. A simple example would be that a minor knock for most people could be extremely painful for someone with fibromyalgia. The pain is often affected by our emotion, moods, depression, anxiety and these factors may well make the pain seem worse. Sleep and particularly deep sleep is very relevant and it was noted that people who are deprived of deep sleep (stage 4) experience pain symptoms similar to fibromyalgia. 

 

The role of the GP is very important in excluding other illnesses and referral to a secondary care physician may be necessary.  Treatment is usually undertaken by a multidisciplinary team since it includes physiotherapy, graded exercise programme, cognitive behavioural therapy and finally medications. In the UK we have limited organisations to support fibromyalgia and more needs to be done in this difficult area. 

 

 

Fibromyalgia Action UK

Studio 3007
Mile End Mill
12 Seedhill Road

Paisley

PA11JS

Clinical Sciences Centre

University Hospital Aintree

Lower Lane

Liverpool L9 7AL