Fibromyalgia (FM) is a disorder that includes widespread musculoskeletal pain along with fatigue, sleep disturbance, memory changes, mood changes, and more. Studies show that FM amplifies or increases painful sensations by changing the way the brain processes pain signals. FM is NOT a psychological disorder that only people with a troubled past or present acquire. Nor is it due to being inactive or lazy. If ANY doctor suggests that, PLEASE find a different doctor who understands the pathogenesis of FM. Unfortunately, this can be a challenge!
FM symptoms can begin after a physical trauma, surgery, an infection, and/or after a significant stress experience. It can also just gradually appear over time without an obvious triggering event. Women are more vulnerable to acquire FM than men. Many FM patients have other conditions that may be associated with FM including (but not limited to) headache, TMJ, irritable bowel syndrome, anxiety, depression, thyroid/hormonal imbalances, endometriosis, and more.
Though the cause of FM may not be clearly identified, studies suggest there are a variety of factors that work together resulting in FM. Some of these include genetics, infections, and physical and/or emotional trauma. Because FM tends to run in families, there may be certain genes or genetic mutations (changes that occur to genes) that make one more susceptible to developing FM. Infections appear to be a trigger for developing or aggravating FM. Post-traumatic stress disorder and less obvious physical or psychological trauma has been linked to the development of FM. The amplified or heightened pain response has been termed, “central sensitization,” meaning, increased sensitivity to normal pain stimulation in the central nervous system (brain and spinal cord). Because of this heightened nervous system response, what normally isn’t processed as pain in the non-FM person does reach and exceed the pain threshold in the FM patient (sort of like when amputation of a limb occurs and the brain still “thinks” there is a limb and “phantom pain” is felt). Studies show that repeated pain signals result in an abnormal increase in certain brain chemicals (called neurotransmitters). As a result, the brain’s pain receptors seem to develop a “memory” of the pain and become “sensitized” or they overreact to the pain signal input and pain is felt at an increased intensity. Certain risk factors come into play with developing FM, some of which include: your sex (female), family history (increased risk if other family members have FM), and rheumatic diseases such as rheumatoid arthritis and lupus.
Tests to establish the diagnosis of FM are few. In 1990, the American College of Rheumatology established two criteria for diagnosing FM. The first is widespread pain lasting at least three months, and the second is the presence of at least 11 out of 18 positive tender points. Since then, less emphasis has been placed on the exact number of tender points, while ruling out other possible underlying conditions that might be causing the pain is now utilized. There is no lab test to confirm a diagnosis of FM, but blood tests including a complete blood count, an ESR, and thyroid function tests are commonly done to rule out other conditions that have similar symptoms. Treatment is best approached by a “team effort” combining the skills from multiple disciplines including a primary care doctor who “believes in FM” and is willing to work with chiropractors, and others. Exercising, pacing yourself, accepting your limitations, yoga, psychological counseling, nutritional counseling, and having strong family/friend support are all important in the management of FM.