Fibromyalgia: Causes, Symptoms, and Management

Fibromyalgia syndrome (FMS) refers to a chronic condition causing pain, tenderness, and stiffness in the muscles, joints, and tendons. This pain is typically widespread, affecting the neck, buttocks, shoulders, arms, upper back, and chest on both sides of the body. Patients also report having “tender points”, which refer to localized areas of the body that cause widespread pain and muscle spasms when touched.1 FMS is also characterized by restlessness, tiredness, fatigue, anxiety, depression, and impaired bowel function.2 Despite experiencing severe pain, patients do not develop tissue damage or deformities because there is no inflammation associated with FMS, which makes it difficult to elucidate the mechanisms of this condition.3 FMS commonly arises in young and middle-aged females in the form of persistent pain, fatigue, stiffness, cognitive difficulties, anxiety, depression, and functional impairment. Furthermore, the prevalence in the United States is 6% to 15%, with women being five times as likely as men to develop FMS.4

While the mechanistic underpinnings remain unclear, there is a characteristic pathophysiology associated with FMS. Namely, patients commonly experience changes in their sleep patterns and neuroendocrine transmitters – such as serotonin, substance P, growth hormone, and cortisol – which indicates that regulation of the autonomic and neuroendocrine systems serves as the biological basis of the condition.5 Although FMS is not life-threatening, it is characterized by debilitating, chronic pain that may result from a variety of interconnected mechanisms. More specifically, patients with FMS may experience aberrant pain processing due to central sensitization; this refers to the blunting of inhibitory pain pathways and associated changes in neurotransmitter levels. Due to aberrant neurochemical processing of sensory signals, the threshold of pain is significantly lowered in patients with FMS.6 Therefore, many of the symptoms associated with FMS may be explained by alterations in the autonomic, neuroendocrine, and pain processing systems.

Management of FMS is often patient-centered and can involve a variety of therapeutic approaches. Pain medications used to treat FMS include paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen. In addition to analgesics, other drugs such as antidepressants, anticonvulsants, dopamine agonists, and growth hormones, can be useful in the management of FMS.7 A combination of tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) can produce mild to moderate improvement in symptoms of FMS. In addition, duloxetine, a serotonin and norepinephrine reuptake inhibitor, has shown promise in patients with FMS.

Lifestyle modifications are a powerful method to alleviate the symptoms of FMS. For example, patients can practice stress management to avoid increased levels of stress and feelings of depression, anxiety, and frustration. Cognitive behavioral therapy, relaxation training, group therapy, and biofeedback are all effective treatment options that can help patients reduce their stress levels.8 Exercise such as walking, jogging, or sports, is another lifestyle change that can help alleviate symptoms by further reducing stress. Additionally, there are several alternative therapies for FMS, such as Chinese herbal medications, Chinese herbal tea, acupuncture, and Tai-chi.8

In summary, FMS is a common condition characterized by widespread pain and stiffness, sleep disturbances, anxiety, and depression, among other symptoms. Although there are many theories of etiology, the biological underpinnings of FMS are not fully understood. With the proper treatment from a skilled chiropractor who can assist in developing an effective exercise plan and implementing appropriate lifestyle changes, patients with FMS can alleviate pain and improve their quality of life.

References

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  2. Shleyfer E, Jotkowitz A, Karmon A, Nevzorov R, Cohen H, Buskila D. Accuracy of the diagnosis of fibromyalgia by family physicians: is the pendulum shifting? J Rheumatol 2009. Jan;36(1):170-173.
  3. Schmidt-Wilcke T, Clauw DJ. Fibromyalgia: from pathophysiology to therapy. Nat Rev Rheumatol 2011. Sep;7(9):518-527.
  4. Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum 1995. Jan;38(1):19-28.
  5. Arnold LM, Hudson JI, Keck PE, Auchenbach MB, Javaras KN, Hess EV. Comorbidity of fibromyalgia and psychiatric disorders. J Clin Psychiatry 2006. Aug;67(8):1219-1225.
  6. Yunus MB. Role of central sensitization in symptoms beyond muscle pain, and the evaluation of a patient with widespread pain. Best Pract Res Clin Rheumatol 2007. Jun;21(3):481-497.
  7. Katz RS, Wolfe F, Michaud K. Fibromyalgia diagnosis: a comparison of clinical, survey, and American College of Rheumatology criteria. Arthritis Rheum 2006. Jan;54(1):169-176.
  8. Culpepper L. Nonpharmacologic care of patients with fibromyalgia. J Clin Psychiatry 2010. Aug;71(8):e20.