Pain is awful. Chronic pain is worse. Toss in fatigue and cognitive challenges and things can be brutal. That’s the way it rolls with fibromyalgia. Like any condition we discuss, dicey information is easy to come by. Here’s what to understand…
Looks like our friend is stressed and struggling. Fact is, she’s in pain, terribly fatigued, and can’t think straight. “This has been going on for months. Could I have fibromyalgia?” I’m thinking she needs to see her doc.
Fibromyalgia (FM) is a complicated disorder. To give it its due, we’re going to handle biz in two parts. This article will address what FM is, as well as its causes. And we’ll come back next week with how to manage it.
Good? Well, let’s get busy…
What is fibromyalgia?
Fibromyalgia is a chronic medical condition for which there is no cure. Some four million American adults have been diagnosed. It’s thought that FM ramps-up sensations of pain by changing the way the brain and spinal cord process painful and nonpainful signals.
Symptoms of FM often commence after an event, such as physical or emotional/mental trauma, surgery, or an infection. But, go figure, symptoms may accumulate and grow stronger over time, having no identifiable trigger.
Here are FMs primary symptoms…
- Multisite pain: Was once referred to as widespread pain. FM pain is often described as a constant dull ache that’s lasted for at least three months. To qualify for multisite, the pain has to occur on both sides of the body and above and below the waist.
- Fatigue: Those with FM often awaken tired, even though they report sleeping for long periods of time. Sleep is often interrupted by pain, and many with FM deal with sleep-occurring disorders like sleep apnea and restless leg syndrome.
- Cognitive challenges: Known as “fibro fog,” this symptom impairs the ability to focus, pay attention, and concentrate on mental tasks. Faulty memory may also become an issue.
As if the primary symptoms aren’t enough, often experienced with FM are depression, anxiety, irritable bowel syndrome (IBS), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), migraine and other headaches, temporomandibular joint disorders (TMD), postural tachycardia syndrome, and interstitial cystitis (painful bladder syndrome).
Now, once upon a time, doctors would check 18 tender points to see how many were painful when pressed firmly. The American College of Rheumatology issued new guidelines that don’t require a tender point exam for diagnosis.
So then, to meet current diagnostic criteria for FM, multisite pain has to have been experienced throughout the body, at a similar intensity, for at least three months. Also, there has to be pain in at least four of these five areas…
- Left upper region: Includes shoulder, arm, or jaw
- Right upper region: Includes shoulder, arm, or jaw
- Left lower region: Includes hip, buttock, or leg
- Right lower region: Includes hip, buttock, or leg
- Axial region: Includes neck, back, chest, or abdomen
Also included in the diagnostic criteria are a pain index and symptom severity scale.
A couple of final tidbits: Though FM is a chronic condition, there may be periods of improved pain and fatigue. There are no specific tests for FM, so anything ordered is to rule-out other disorders.
What causes fibromyalgia?
The best place to start a discussion of FM cause is to consider these risk factors…
- Sex: FM is diagnosed more in females.
- Age: FM is more commonly diagnosed in middle age and risk increases as one gets older. But FM can be diagnosed at any age, including in children.
- Family history: One may be more likely to develop FM if a parent or sibling has it.
- Other disorders: A diagnosis of osteoarthritis, rheumatoid arthritis, or lupus may make a FM diagnosis more likely.
As was mentioned, it’s believed that FM is caused by changes in the brain and spinal cord. These changes in pain processing involve an abnormal increase in levels of specific pain signaling chemicals. In addition, the brain’s pain receptors seem to develop a kind of memory of the pain and become sensitized. That allows them to overreact to painful and nonpainful signals.
Keep in mind, the cause of FM is likely a matter of interacting factors. The workings may be a genetic predisposition brought to life by one or more triggers.
Speaking of which…
- Genetics: FM tends to run in families. That says there may be genetic mutations that may make one more susceptible to developing FM.
- Infections: Some illnesses, past and present, appear to either trigger or aggravate FM. Of note are influenza, pneumonia, GI infections, such as those caused by Salmonella and Shigella bacteria, and the Epstein-Barr virus.
- Trauma: FM may be triggered by, say, a car accident or traumatizing encounter. Prolonged emotional/mental stress may also be a trigger. Makes sense that FM has been linked to posttraumatic stress disorder (PTSD).
It’s interesting that FM symptoms are very similar to those of the autoimmune disorders. It’s been a theory that FM actually is an autoimmune disorder, but it can’t be proved because FM doesn’t cause inflammation. In addition, autoantibodies have yet to be found.
That’s a wrap
Yes, pain is awful. Chronic pain is worse. Adding fatigue and cognitive challenges to the mix can make life brutal. Fibromyalgia can be very difficult to live with. But we’re here to provide accurate information…
So much to learn about the mood and anxiety disorders. Take a look at the Chipur titles. Be sure to check-out the article I posted several months ago about myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).