Fibromyalgia syndrome

Overview

Fibromyalgia Syndrome (FMS) is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties. It affects how the brain and spinal cord process pain signals, amplifying painful sensations. Fibromyalgia is more common in women and can occur at any age, though it is most often diagnosed in middle adulthood. It is a non-degenerative condition, meaning it does not cause damage to joints or tissues, but it can significantly impact quality of life.

Causes

The exact cause of fibromyalgia is unknown, but it is believed to result from a combination of genetic, neurological, and environmental factors. Potential contributing factors include:

• Genetic predisposition: Family history increases the likelihood of developing fibromyalgia.

• Central sensitization: Abnormal pain processing in the brain and spinal cord leads to heightened sensitivity to pain.

• Physical or emotional trauma: Events such as surgery, injury, or significant psychological stress may trigger the condition.

• Infections: Some viral or bacterial infections may precede the onset of symptoms.

• Autoimmune disorders: Conditions like lupus or rheumatoid arthritis may coexist with or contribute to fibromyalgia.

Symptoms

Fibromyalgia symptoms can vary in intensity and may fluctuate over time. Common features include:

Musculoskeletal Symptoms

• Widespread pain affecting both sides of the body and above and below the waist

• Muscle stiffness, particularly in the morning

• Tender points or areas that are painful to touch

Systemic and Neurological Symptoms

• Chronic fatigue, even after adequate rest

• Sleep disturbances, including insomnia or non-restorative sleep

• “Fibro fog”: Cognitive difficulties such as poor concentration, memory problems, and mental fatigue

• Headaches or migraines

• Numbness or tingling sensations

• Irritable bowel syndrome (IBS)

• Depression and anxiety

Diagnosis

Fibromyalgia is diagnosed based on clinical evaluation, as there are no specific laboratory tests to confirm the condition. The diagnostic process typically includes:

• Medical history and symptom assessment: Documenting chronic widespread pain lasting more than 3 months and associated symptoms.

• Physical examination: Evaluating pain at specific tender points is no longer required for diagnosis but may still be part of assessment.

• Exclusion of other conditions: Blood tests and imaging may be used to rule out conditions with similar symptoms, such as hypothyroidism, lupus, or rheumatoid arthritis.

• ACR criteria: Many physicians use guidelines from the American College of Rheumatology, which consider the widespread pain index and symptom severity scale.

Treatment

Treatment for fibromyalgia focuses on symptom management and improving quality of life. A combination of medication, lifestyle changes, and therapeutic approaches is typically recommended:

Medications

• Analgesics (e.g., acetaminophen or NSAIDs)

• Antidepressants (e.g., amitriptyline or duloxetine) to reduce pain and improve sleep

• Anticonvulsants (e.g., pregabalin or gabapentin) to calm nerve overactivity

Non-Pharmacological Treatments

• Exercise: Low-impact aerobic activities, strength training, and stretching can help reduce pain and fatigue

• Cognitive-behavioral therapy (CBT): For managing pain perception, stress, and emotional health

• Physical therapy: To improve mobility and manage pain

• Sleep hygiene: Establishing regular sleep routines and avoiding stimulants before bedtime

• Mind-body practices: Yoga, tai chi, meditation, and relaxation techniques

Prognosis

Fibromyalgia is a chronic condition, but it is not progressive or life-threatening. While there is currently no cure, many individuals can manage their symptoms effectively with a tailored treatment plan and supportive care. The course of the condition varies—some may experience improvement over time, while others may have persistent symptoms. Long-term outcomes are generally better in individuals who stay physically active, manage stress well, and have access to comprehensive care and support.