Fibromyalgia
Fibromyalgia is a medical syndrome which causes chronic widespread pain, accompanied by fatigue, waking unrefreshed, and cognitive symptoms. Other symptoms can include headaches, lower abdominal pain or cramps, and depression.[9] People with fibromyalgia can also experience insomnia[10] and a general hypersensitivity.[11][12] The cause of fibromyalgia is unknown, but is believed to involve a combination of genetic and environmental factors.[4] Environmental factors may include psychological stress, trauma, and certain infections.[4] Since the pain appears to result from processes in the central nervous system, the condition is referred to as a "central sensitization syndrome".[4][13]
Not to be confused with Myalgic encephalomyelitis/chronic fatigue syndrome nor with Myelofibrosis.
Fibromyalgia was first defined in 1990, with updated criteria in 2011,[4] 2016,[9] 2019.[12] The term "fibromyalgia" is from Neo-Latin fibro-, meaning "fibrous tissues", Greek μυο- myo-, "muscle", and Greek άλγος algos, "pain"; thus, the term literally means "muscle and fibrous connective tissue pain".[14] Fibromyalgia is estimated to affect 2–4% of the population.[15] Women are affected about twice as often as men.[4][15] Rates appear similar in different areas of the world and among different cultures.[4]
The treatment of fibromyalgia is symptomatic[16] and multidisciplinary.[17] The European Alliance of Associations for Rheumatology strongly recommends aerobic and strengthening exercise.[17] Weak recommendations are given to mindfulness, psychotherapy, acupuncture, hydrotherapy, and meditative exercise such as qigong, yoga, and tai chi.[17] The use of medication in the treatment of fibromyalgia is debated[17][18] although antidepressants can improve quality of life.[19] Common helpful medications include other serotonin–norepinephrine reuptake inhibitors, nonsteroidal anti-inflammatory drugs, and muscle relaxants.[20] Q10 coenzyme and vitamin D supplements may reduce pain and improve quality of life.[21] While fibromyalgia is persistent in nearly all patients, it does not result in death or tissue damage.[18]
History[edit]
Chronic widespread pain had already been described in the literature in the 19th century but the term fibromyalgia was not used until 1976 when Dr P.K. Hench used it to describe these symptoms.[22] Many names, including muscular rheumatism, "fibrositis", "psychogenic rheumatism", and "neurasthenia" were applied historically to symptoms resembling those of fibromyalgia.[23] The term fibromyalgia was coined by researcher Mohammed Yunus as a synonym for fibrositis and was first used in a scientific publication in 1981.[24] Fibromyalgia is from the Latin fibra (fiber)[25] and the Greek words myo (muscle)[26] and algos (pain).[27]
Historical perspectives on the development of the fibromyalgia concept note the "central importance" of a 1977 paper by Smythe and Moldofsky on fibrositis.[28][29] The first clinical, controlled study of the characteristics of fibromyalgia syndrome was published in 1981,[30] providing support for symptom associations. In 1984, an interconnection between fibromyalgia syndrome and other similar conditions was proposed,[31] and in 1986, trials of the first proposed medications for fibromyalgia were published.[31]
A 1987 article in the Journal of the American Medical Association used the term "fibromyalgia syndrome" while saying it was a "controversial condition".[32] The American College of Rheumatology (ACR) published its first classification criteria for fibromyalgia in 1990.[33] Later revisions were made in 2010,[34] 2016,[9] and 2019.[12]
Classification[edit]
Fibromyalgia is classed as a disorder of pain processing due to abnormalities in how pain signals are processed in the central nervous system.[35] The International Classification of Diseases (ICD-11) includes fibromyalgia in the category of "Chronic widespread pain," code MG30.01.[36] People with fibromyalgia differ in several dimensions: severity, adjustment, symptom profile, psychological profile and response to treatment.[37]
Comorbidity[edit]
Fibromyalgia as a stand-alone diagnosis is uncommon, as most fibromyalgia patients often have other chronic overlapping pain problems or mental disorders.[11] Fibromyalgia is associated with mental health issues like anxiety,[50] posttraumatic stress disorder,[4][50] bipolar disorder,[50] alexithymia,[51] and depression.[50][52][53] Patients with fibromyalgia are five times more likely to have major depression than the general population.[54] Experiencing pain and limited activity from having fibromyalgia leads to less activity, leading to social isolation and increased stress levels, which tends to cause anxiety and depression.[55]
Fibromyalgia and numerous chronic pain conditions frequently coexist.[52] These include chronic tension headaches,[50] myofascial pain syndrome,[50] and temporomandibular disorders.[50] Multiple sclerosis, post-polio syndrome, neuropathic pain, and Parkinson's disease are four neurological disorders that have been linked to pain or fibromyalgia.[52]
Fibromyalgia largely overlaps with several syndromes that may share the same pathogenetic mechanisms.[56][57] These include myalgic encephalomyelitis/chronic fatigue syndrome[58][56] and irritable bowel syndrome.[57]
Comorbid fibromyalgia has been reported to occur in 20–30% of individuals with rheumatic diseases.[52] It has been reported in people with noninflammatory musculoskeletal diseases.[52]
The prevalence of fibromyalgia in gastrointestinal disease has been described mostly for celiac disease[52] and irritable bowel syndrome (IBS).[52][50] IBS and fibromyalgia share similar pathogenic mechanisms, involving immune system mast cells, inflammatory biomarkers, hormones, and neurotransmitters such as serotonin. Changes in the gut biome alter serotonin levels, leading to autonomic nervous system hyperstimulation.[59]
Fibromyalgia has also been linked with obesity.[60] Other conditions that are associated with fibromyalgia include connective tissue disorders,[61] cardiovascular autonomic abnormalities,[62] obstructive sleep apnea-hypopnea syndrome,[63] restless leg syndrome[64] and an overactive bladder.[65]
Society and culture[edit]
Economics[edit]
People with fibromyalgia generally have higher healthcare costs and utilization rates. A review of 36 studies found that fibromyalgia causes a significant economic burden on health care systems.[239] Annual costs per patient were estimated to be up to $35,920 in the US and $8,504 in Europe.[239]
Controversies[edit]
Fibromyalgia was defined relatively recently. In the past, it was a disputed diagnosis. Rheumatologist, Frederick Wolfe, lead author of the 1990 paper that first defined the diagnostic guidelines for fibromyalgia, stated in 2008 that he believed it "clearly" not to be a disease but instead a physical response to depression and stress.[240] In 2013, Wolfe added that its causes "are controversial in a sense" and "there are many factors that produce these symptoms – some are psychological and some are physical and it does exist on a continuum".[241] Some members of the medical community do not consider fibromyalgia a disease because of a lack of abnormalities on physical examination and the absence of objective diagnostic tests.[28][242]
In the past, some psychiatrists have viewed fibromyalgia as a type of affective disorder, or a somatic symptom disorder. These controversies do not engage healthcare specialists alone; some patients object to fibromyalgia being described in purely somatic terms.[243]
As of 2022, neurologists and pain specialists tend to view fibromyalgia as a pathology due to dysfunction of muscles and connective tissue as well as functional abnormalities in the central nervous system. Rheumatologists define the syndrome in the context of "central sensitization" – heightened brain response to normal stimuli in the absence of disorders of the muscles, joints, or connective tissues. Because of this symptomatic overlap, some researchers have proposed that fibromyalgia and other analogous syndromes be classified together as central sensitivity syndromes.[244][13]