Fibromyalgia is a debilitating disorder characterized by chronic pain and tenderness in muscles throughout the entire body, headache, fatigue, sleep disturbance, depression, interstitial cystitis, irritable bowel syndrome and skin sensitivity. The majority of the patients are women.
Diagnosis includes the presence of 11/18 tender points in well-defined areas, but many patients with early symptoms might not fit this definition.
Pathogenesis is still unknown, but there has been evidence of increased corticotropin-releasing hormone (CRH) and substance P (SP) in the cerebrospinal fluid and serum of patients with fibromyalgia. There is also increased IL-6 and IL-8 in their serum1.
Increased numbers of activated mast cells were also noted in skin biopsies. The hypothesis is put forward that fibromyalgia is a neuro-immunoendocrine disorder where increased release of CRH and SP from neurons in specific muscle sites triggers local mast cells to release proinflammatory and neurosensitizing molecules.
There is evidence for mechanical, thermal, and electrical hyperalgesia. Peripheral and central abnormalities of nociception have been described and these changes may be relevant for the increased pain experienced by these patients.
These changes may result from the release of pain producing substances after muscle or other soft tissue injury. These pain mediators can sensitize important nociceptor systems. Tissue mediators of inflammation and nerve growth factors can excite these receptors and cause substantial changes in pain sensitivity2.
Fibromyalgia pain is widespread and does not seem to be restricted to tender points (TP). It frequently comprises multiple areas of deep tissue pain (trigger points) with adjacent much larger areas of referred pain. Analgesia of areas of extensive nociceptive input has been found to provide often long lasting local as well as general pain relief.
Thus interventions aimed at reducing local fibromyalgia pain seem to be effective but need to focus less on tender points but more on trigger points and other body areas of heightened pain and inflammation.
There is no curative treatment although medication such as low doses of tricyclic antidepressants, serotonin reuptake inhibitors, dual reuptake inhibitors, antiseizure medications namely Pre-gabalin in high doses can help.
Although exercises have been suggested, fibromyalgia patients are unable to tolerate exercise due to their high levels of pain and fatigue.
Fibromyalgia patients may have structural or mechanical causes like scoliosis, localised joint hypomobility, or generalised or local joint laxity; and metabolic factors like depleted tissue iron stores, hypothyroidism or Vitamin D deficiency. Sometimes, correction of an underlying cause of for the muscle pain is needed to resolve the condition3.
1. Lucas HJ. Brauch CM. Settas L. Theoharides TC. Fibromyalgia–new concepts of pathogenesis and treatment. International Journal of Immunopathology & Pharmacology. 19(1):5-10, 2006 Jan-Mar.
2. Staud R. Are tender point injections beneficial: the role of tonic nociception in fibromyalgia. Current Pharmaceutical Design. 12(1):23-7, 2006.3.
3. Gerwin RD. A review of myofascial pain and fibromyalgia–factors that promote their persistence. Acupuncture in Medicine. 23(3):121-34, 2005 Sep.