Dear community members,
My name is Dr. Marc Fouradoulas and I am on the team of the Pain Companion medical advisors. Besides the support that you find from other members in this community, we would like to provide qualified articles about important pain related topics. We hope this will help you to learn more about your condition and ways to deal with it. I would like to start off with an article about fibromyalgia:
Fibromyalgia - An Introduction
Fibromyalgia is the second most common chronic musculoskeletal pain disorder after osteoarthritis. It affects about 2 to 8% of the population, primarily women in their middle age1. In the US about 10 million people are diagnosed with fibromyalgia2. The occurrence is similar in different countries, cultures and ethnic groups but increases if a first-degree family member is diagnosed with it.
What is fibromyalgia and how is it diagnosed?
Fibromyalgia is characterized by widespread pain and accompanied by other symptoms such as fatigue, cognitive problems and sleep disturbances. The pain is diffuse and not localized in specific body parts but in the soft tissue, often referred to as generalized tenderness. The diagnostic criteria proposed by the American College of Rheumatology in 20103 include chronic (>3 months) widespread pain and a score of the four items fatigue, non-restorative sleep, cognitive symptoms (concentration, dizziness, memory problems) and sum of other unspecific symptoms like tingling, irritable bowel or bladder, dry eyes or headache.
Other causes like injury or inflammation must be excluded, although it often (10-30%) occurs in addition to other rheumatic disorders like rheumatoid arthritis, lupus and ankylosing spondylitis. Other frequent concurrent disorders are irritable bowel syndrome, temporomandibular joint disorder painful bladder syndrome and many more so called functional disorders.
The diagnostic criteria changed in 2010, as the only clinical criterion „tender-points“ was abandoned. Tender points referred to the observation that the pain threshold in fibromyalgia is generally lowered, leading to tenderness all over the body, especially around joints, when localized pressure is applied. This doesn't mean that there is damage in the tissue. Rather the processing of pain is amplified by the nervous system: What others experience as touch, fibromyalgia patients experience as pain. For this reason, it is considered a "centralized pain disorder" and not a peripheral one.
So to cut a long story short, fibromyalgia is diagnosed based on an arithmetic score of unspecific symptoms without markers in blood, imaging or physical examination.
The problem with the fibromyalgia diagnosis
The diagnostic criteria were initially supposed to accelerate research and were never meant to define a distinct disorder. Hence the diagnosis sums up symptoms that occur together above-average but may have different underlying causes. Therefore, it's better to use the term Fibromyalgia Syndrome (FMS). FMS is a broad label that gives the health care professional an idea of what symptoms you are talking about and that other causes like inflammation have been ruled out. But the value of the label in the treatment process is limited since the understanding of the cause and development of FMS is still very limited. So it's important not to overemphasize this term. On the other side, the diagnosis can point you in the right direction, prevent further unnecessary diagnostic procedures and help establish support groups. It also stresses that the pain is not due to damage in painful regions and is not progressive.
What are the causes of FMS?
Several biological (genetic, inflammation), psychological and social factors have been identified to contribute to the development of FMS. In recent years FMS has been increasingly considered to be a disorder of the stress processing system. The processing of stress and pain are closely interlinked and affect each other, resulting in disordered pain modulation in the central nervous system. Childhood trauma or neglect, physical trauma and psychological factors like anxiety, depression and action proneness have been associated with the onset of FMS4. In other words, chronic psychological as well as physical stress seem to play a major role. This makes treatment challenging but explains the focus in psychological and psychopharmacological interventions. There is a lot more to say about this condition and treatment options and we will cover it in following articles.
I am eager to hear your thoughts and questions regarding this article. Please let me know what other topics you would like to hear more about.
Dr. Marc Fouradoulas
Clauw, Daniel J. "Fibromyalgia: a clinical review." Jama 311.15 (2014): 1547-1555.
Egle, ULRICH T., and B. Zentgraf. "Psychosomatische Schmerztherapie."Stuttgart: Kohlhammer (2014).