Fibromyalgia

Understanding the condition

From: MedlinePlus, National Library of Medicine

Fibromyalgia is chronic (long-lasting) condition that causes pain all over the body, fatigue, and other symptoms. There is no cure, but treatments can help with the symptoms.

What causes fibromyalgia?

From: MedlinePlus, National Library of Medicine

The exact cause of fibromyalgia is unknown. Studies of the brains of people with fibromyalgia found that they seem to process pain differently than people who don't have it. They may feel pain when others do not, and they may also have a more severe reaction to pain.

Fibromyalgia can run in families, so genetics may also play a role. Other factors may also be involved, such as having certain diseases that cause pain.

Who is at risk for fibromyalgia?

From: MedlinePlus, National Library of Medicine

Anyone can get fibromyalgia, but it is more common in:

• Women; they are twice as likely to have fibromyalgia
• Middle-aged people; your chance of having it increases as you get older
• People with certain diseases, such as lupus, rheumatoid arthritis, osteoarthritis or ankylosing spondylitis
• People who have a family member with fibromyalgia

What are the symptoms of fibromyalgia?

From: MedlinePlus, National Library of Medicine

The main symptoms of fibromyalgia are:

Other symptoms may include:

People who have fibromyalgia are also more likely to have certain diseases, including:

• Chronic (long-lasting) pain and stiffness all over the body. People often describe it as aching, burning, or throbbing.
• Fatigue and tiredness.
• Trouble sleeping.
• Problems with thinking, memory, and concentration (sometimes called "fibro fog")
• Muscle and joint stiffness
• Numbness or tingling in the arms and legs
• Sensitivity to light, noise, odors, and temperature
• Anxiety
• Depression
• Headaches, including migraines
• Irritable bowel syndrome
• Pain in the face or jaw, including disorders of the jaw know as temporomandibular joint syndrome (TMJ)

How is fibromyalgia diagnosed?

From: MedlinePlus, National Library of Medicine

Fibromyalgia can be hard to diagnose. It sometimes takes visits to several different health care providers to get a diagnosis. One problem is that there isn't a specific test for it. And the main symptoms, pain and fatigue, are common in many other conditions. Providers have to rule out other causes of the symptoms before making a diagnosis of fibromyalgia. This is called making a differential diagnosis.

To find out if you have fibromyalgia, your provider:

• Will take your medical history, including asking detailed questions about your symptoms
• Will do a physical exam
• May order x-rays and blood tests to rule out other conditions

What are the treatments for fibromyalgia?

From: MedlinePlus, National Library of Medicine

Not all providers are familiar with fibromyalgia and its treatment. You should see a provider or team of providers who specialize in the treatment of fibromyalgia.

There is no cure for fibromyalgia, so treatment focuses on relieving the symptoms. Providers usually use a combination of treatments, including medicines, lifestyle changes, talk therapy, and complementary therapies:

• Medicines
• Certain antidepressants and anti-seizure medicines, which may help with pain or sleep problems. Pain relievers.
• Lifestyle changes
• Getting enough sleep. Getting regular physical activity. If you have not already been active, start slowly and gradually increase how much activity you get. You may want to see a physical therapist, who can help you create a plan that is right for you. Learning how to manage stress. Learning to pace yourself. If you do too much, it can make your symptoms worse. So you need to learn to balance being active with your need for rest.
• Talk therapy, such as cognitive behavioral therapy (CBT), can help you learn strategies to deal with pain, stress, and negative thoughts. If you also have depression along with your fibromyalgia, talk therapy can help with that too.
• Complementary therapies have helped some people with the symptoms of fibromyalgia. But researchers need to do more studies to show which ones are effective. You could consider trying them, but you should check with your provider first. These therapies include:
• Mindfulness meditation. Biofeedback, which uses electronic devices to measure body functions such as breathing and heart rate. This teaches you to be more aware of your body functions so you can learn to control them. Movement therapies such as yoga and tai chi. Massage therapy. Acupuncture.

Genetic causes described in the linked summary

From: MedlinePlus Genetics

Fibromyalgia is known to run in families, suggesting that genetic factors contribute to the risk of developing this disease. However, little is known for certain about the genetic basis of fibromyalgia. It is likely that variations in many genes, each with a small effect, combine to increase the risk of developing this condition.

The signs and symptoms of fibromyalgia are related to the way the brain recognizes and interprets pain signals. People with fibromyalgia have an increased sensitivity to pain; they feel pain more acutely than others would in response to a given stimulus. Researchers describe this phenomenon as the "volume" of pain sensations being turned up too high (pain amplification). Studies of the genetics of fibromyalgia have focused on genes with roles in the way the brain processes pain. For example, several genes that may influence the condition are involved in the production and breakdown of certain chemical messengers called neurotransmitters. These chemicals relay signals between nerve cells that can increase or decrease the sensation of pain, a process known as pain modulation.

Nongenetic (environmental) factors also play critical roles in a person's risk of developing fibromyalgia. The disorder can be triggered by infection or illness that would not otherwise cause chronic pain, injury, and other physical stress. Psychological and social factors such as a history of childhood abuse or neglect, exposure to war or other catastrophic events, and low job or life satisfaction have also been associated with an increased risk of fibromyalgia. Additionally, physical inactivity, obesity, and sleep disturbances seem to increase risk. However, many people who develop this condition do not have any recognized triggers or risk factors. It is likely that environmental conditions interact with genetic factors to determine the overall risk of developing this disorder.

Inheritance described in the linked summary

From: MedlinePlus Genetics

Fibromyalgia does not have a clear pattern of inheritance in families. Overall, the risk of developing this condition is about eight times higher for first-degree relatives of affected individuals (such as siblings or children) as compared to the general public. Many people with fibromyalgia also have relatives with headaches, irritable bowel syndrome, temporomandibular joint dysfunction, and other conditions that cause chronic pain. These disorders may cluster in families in part because they share some genetic risk factors with fibromyalgia.

Which doctor should you see?

The suggested department for discussing Fibromyalgia is Rheumatology, with a rheumatologist as the relevant type of clinician. General physician / Family Medicine; paediatrician for children. Referral depends on symptoms.

Additional services that may be relevant, depending on the findings, include: Clinical Genetics.

This is an editorial referral starting point. The appropriate clinic depends on the person’s age, symptoms, previous diagnosis and local services. The first clinician can decide whether another specialty or a team is needed; a department label does not confirm the diagnosis.

How to prepare for an assessment

Bring a short timeline of the main symptoms: when they first appeared, whether they are constant or episodic, what seems to change them, and how they affect daily activities. Include previous reports, discharge summaries, current medicines and supplements, allergies, and any relevant family history. A dated record is more useful than trying to match every feature in an online article.

Ask the clinician what is already established and what remains uncertain. If a test is suggested, ask what question it answers, what its limitations are and how the result would change the next step. The information here is not an instruction to arrange every possible test. In children, bring growth, developmental and school information if it is relevant to the concern.

• Are the findings inflammatory, structural or due to another mechanism?
• Is there evidence that other organs need assessment?
• How will function and any treatment-related risks be monitored?

Treatment discussions and follow-up

Where the source describes treatments, these are an overview of possible care, not a prescription for an individual. Ask which option applies to the confirmed diagnosis, what benefit is expected, what adverse effects to watch for and how progress will be assessed. Availability, approvals and local practice can differ from the country described in the source.

Before leaving the appointment, clarify the next review date, who will communicate results, and whom to contact if the situation changes. Discuss difficulties with sleep, work, school, mobility, eating or emotional wellbeing when these are relevant. Practical support may require coordination between the treating clinician and other services.

The collected references do not establish a complete prevention or long-term outlook section for this entry. Missing information should not be interpreted as proof that prevention is impossible or that a particular outcome is inevitable. Ask what is known for the exact subtype, stage and personal circumstances, and which uncertainties remain.

When to seek emergency help

Severe breathing difficulty, collapse, new stroke-like symptoms, a seizure that is prolonged or repeated without recovery, uncontrolled major bleeding, or an immediate risk of self-harm require emergency help. In India, call 112 or reach the nearest emergency department. This is a general, non-exhaustive warning list; it is not a condition-specific triage tool.