Fibromyalgia, the chronic pain diagnosis of exclusion
Fibromyalgia (pronounced fie-bro-my-AL-juh) is one of the most common chronic widespread pain conditions. The condition affects millions of people in the U.S.
The causes of fibromyalgia are still not fully known, but recent data suggest that changes in the central nervous system may contribute to the chronic pain of this condition.
Studies have shown that fibromyalgia patients have a heightened sensitivity to pain. Fibromyalgia may not be easy to diagnose. There is no blood test or X-ray to identify it, and some fibromyalgia symptoms are similar to other conditions. Thatís why patients may end up seeing more than one doctor before being diagnosed.
Both fibromyalgia and arthritis can cause severe pain and fatigue. However, people with arthritis suffer from inflammation, while fibromyalgia sufferers experience flu-like aching and muscle tenderness.
For people who are susceptible to the condition, fibromyalgia has been thought to be triggered by stressful or traumatic events, such as car accidents, as well as repetitive injuries, illness, and certain diseases.
Fibromyalgia symptoms can be unpredictable. Pain and fatigue may increase or decrease without notice, so it may be hard to plan your daily activities.
For some people with fibromyalgia, doing too much on good days can bring on more bad days. If this has happened to you before, be sure to pace yourself and take breaksóeven on the good days.
Possible Causes of Fibromyalgia
When you have a lifelong condition like fibromyalgia, it makes sense that you may want to know what causes it. Experts have a number of theories about what causes fibromyalgia, but they do not yet know its exact cause. Itís likely that a number of factors may trigger and contribute to fibromyalgia.
Where Fibromyalgia May Start
Heredity. Like many diseases, fibromyalgia may run in families. So it is likely that some people are born with genes that increase their risk of getting it. It can start at any time, but there may be some events that trigger fibromyalgia in those who are more likely to get it.
What Causes the Pain of Fibromyalgia?
With fibromyalgia, changes may occur in the nerve and brain cells. Due to these changes, people with fibromyalgia may become very sensitive to touch and feel pain more strongly. In scientific studies, it was shown that people with fibromyalgia report more intense feelings of pain. Itís as though the "volume control" for pain is turned up. In several studies it was shown that people with fibromyalgia react more strongly to pain signals than people without the condition.
History of Fibromyalgia
Fibromyalgia is not a new illness. Fibromyalgia was once thought to be a mental disorder and was first described by doctors in the early 1800s. At that time, they wrote about a health condition called "muscular rheumatism." The symptoms were stiffness, aches, pains, tiredness, and difficulty sleeping.
The tender points that are common with fibromyalgia were first described by a doctor in Scotland in the early 1820s. Eighty years later, the term "fibrositis" was first used to describe the chronic and crippling pain of fibromyalgia. The ending "itis" was used as a part of its name because swelling was thought to be a cause of the pain. It took until 1976 for the name of the condition to be changed to "fibromyalgia." It was changed because swelling in the body was no longer thought to be the cause of pain. The term fibromyalgia is taken from three Latin and Greek words: fibra, which means fibrous tissue and has to do with painful tendons and ligaments; myos, which means muscles; and algos, which means pain.
Symptoms of Fibromyalgia
The symptoms of fibromyalgia can vary from mild to severe and may go on for a long time and should be discussed with your health care professional. Fibromyalgia is not considered to be life-threatening, and its symptoms may not necessarily get worse with time. Although fibromyalgia cannot be cured, many people with fibromyalgia are able to manage their symptoms with proper treatment.
Pain is the main symptom
The main symptom of fibromyalgia is pain all over the body for more than three months. It is common for people to experience achy muscles that feel tender to the touch and morning stiffness. The pain of fibromyalgia is a "deep" muscle pain and may be felt as:
The pain may not always be the same. For some people with fibromyalgia, the pain and stiffness are worst when they wake up, improve during the day, and increase again at night. But others have all-day, non-stop pain. For many, the pain gets worse with physical activity, stress, or anxiety. Fibromyalgia patients may be more sensitive to light and temperature.
Along with overall pain, people with fibromyalgia have many specific parts of the body that are tender to the touch, also known as tender points. These include:
- The front and back of the neck
- Mid to upper back of the shoulders
- Upper chest
- Upper buttocks
Studies Prove Fibromyalgia is Real
In 1981, the first study confirmed that symptoms and the tender points areas on the body could be used to properly diagnose fibromyalgia.
Nine years later, in 1990, the American College of Rheumatology wrote the first set of guidelines to help diagnose the condition. While these guidelines have done a lot to help people get an accurate diagnosis of fibromyalgia, there is still much to be learned about its cause. One of the first theories to come out about fibromyalgia was that it was caused by a brain disorder. While there is still no clear-cut answer, there are theories that in some people with fibromyalgia, changes occur in the nerves and brain cells. Due to these changes, people with fibromyalgia become very sensitive to touch and feel pain more intensely.
Researchers have conducted studies to assess pain reactions in people with fibromyalgia while looking at images of their brain. In these studies, more activity in certain parts of the brain of people with fibromyalgia are activated under painful conditions. In addition, studies confirm that people with fibromyalgia feel pain more intensely at lower levels than people without the condition.
Other Fibromyalgia Symptoms
- Disturbed sleep: People with fibromyalgia often sleep lightly and wake up during the night. They also often wake up feeling tired and unrefreshed
- Fatigue: People with fibromyalgia may often feel tired throughout the day
- Mood changes: Some people with fibromyalgia report that they feel "blue" or "down." Others report feeling anxious
- Problems with thinking: Some people with fibromyalgia say that they often feel confused, canít concentrate, and have memory lapses. These problems have been referred to as "fibro fog"
Key point to keep in mind: Fibromyalgia differs from person to person. The most common complaint is chronic widespread pain. Beyond that, no two people with fibromyalgia have exactly the same signs and symptoms.
For many people with fibromyalgia, getting a diagnosis isn't easy. For some, it may take years of going from doctor to doctor. In fact, it can take an average of a year and a half and three doctors for people with fibromyalgia to get an accurate diagnosis. The process can be frustrating. However, research has shown that getting a diagnosis of fibromyalgia, along with education about it, is an essential first step in better managing the symptoms of fibromyalgia.
Why is Making the Diagnosis so Difficult?
Making the diagnosis of fibromyalgia can be hard because there is no specific test for it. Your doctor can't see it on an x-ray or do a blood test. Instead, he or she relies on your symptoms.
Fibromyalgia symptoms can vary a great deal from one person to the next. And they can be similar to those of many other conditions. For example, some of the symptoms of fibromyalgia can look like those of rheumatoid arthritis, osteoarthritis, hyperthyroidism, and lupus, so doctor's typically do tests to see if these other conditions are causing your symptoms.
Using Criteria to Make the Diagnosis
The American College of Rheumatology has developed criteria for the diagnosis of fibromyalgia. Your doctor may use these to help in your diagnosis. These include:
- Pain all over the body (that is, on both the right and left sides of the body and above and below the waist) for at least 3 months
- Pain in at least 11 of the 18 tender-point areas of the body when pressed mildly but firmly on these areas
- Other signs or symptoms of fibromyalgia, such as fatigue, disturbed sleep, and morning stiffness
These guidelines are helpful, but there is still a lot of opportunity to better understand the condition. Some doctors believe that you can have fibromyalgia even if you don't have pain in 11 tender points. Others say that as long as you have widespread pain, you don't need to have tender points.
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