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Fibromyalgia

 

Condition
Fibromyalgia
Class
Central Nervous System
Description

Fibromyalgia is a recognised medical condition characterised by widespread pain, a heightened painful response to pressure, stiffness, disturbed sleep, chronic fatigue, and often accompanied by feelings of anxiety and depression.

The condition is not life-threatening, deforming or progressive, but because of its exhausting effects, people with fibromyalgia often limit their social and professional activities.

An estimated 1 in 50 people may be affected by fibromyalgia at some stage during their life. The condition affects people of all ages and all ethnic groups, but is most likely to occur in those between the age of 25 and 55, and is 9 times more likely to occur in women than men.

The presence of symptoms associated with other conditions often means that there is a delay in the diagnosis of fibromyalgia, and patients may be transferred from one specialist to another in failed attempts to reach a firm diagnosis.

Causes

The exact cause of fibromyalgia has not been identified but it is thought to be caused by many interacting biochemical, metabolic and immunological factors, including environmental and genetic influences.

Fibromyalgia was often originally described as fibrositis, the suffix ‘itis’ suggesting an inflammatory disorder. It is now recognised that there is no inflammatory process in the disease. While pain may be experienced in the muscles, tendons and joints, fibromyalgia, unlike osteoarthritis and rheumatoid arthritis, is not associated with inflammation or erosion of the joints.

An increased understanding of the condition has led to recognition that fibromyalgia is due to an abnormal processing of the sensations of pain and pressure, and the condition is now classed as a central sensitivity syndrome. It appears that people with fibromyalgia have a low threshold to pain because of changes in the level of certain chemical transmitters within the body that affect the perception of pain and the emotional reactions to pain.

The most widely recognised change in chemical transmitters is the abnormally low levels of the neurotransmitter serotonin. In some individuals, this may be due to a fault in the gene responsible for serotonin metabolism. Serotonin is involved in pain perception, sleep and mood disorders which would explain many of the symptoms of fibromyalgia.

Another neurotransmitter called Substance P, released when nerves are stimulated, increases the sensitivity of nerves to pain and heightens awareness to pain. Levels of Substance P are up to 3 times higher than normal in people with fibromyalgia. This means that the response even to relatively minor painful events can be magnified to produce feelings of intense pain.

High levels of a transmitter called nerve growth factor have also been found in the blood of patients with fibromyalgia. Nerve growth factor increases the production of Substance P, with its associated effects, and may also be responsible for spreading pain signals so the person experiences pain in widespread areas throughout the body.

Other transmitters and hormones such as dopamine, growth hormone and hydrocortisone have also been shown to be involved. Furthermore, hormonal changes occurring during the menstrual cycle may magnify the responses to the changes in the various transmitters and hormones, possibly explaining why fibromyalgia is more common in women than men.

Changes in the level of neurotransmitters can also affect a person’s mood, causing anxiety and depression, and changes to the way the person thinks about and responds to problems. All of these factors may combine to alter the way that the person copes with pain, contributing to the debilitating effects of the condition.

Sleep deprivation also has a multitude of effects. Long periods of sleeplessness or disturbed sleep are exhausting and sap the person’s ability to cope with everyday activities, and may eventually lead to mood changes. Furthermore, synthesis of many of the body’s neurotransmitters occurs during sleep, particularly during the non-rapid eye movement (non-REM or 4th) phase of sleep. Disruption of non-REM sleep has been linked to falls in serotonin, growth hormone and hydrocortisone. All of which, in their own right, may increase pain sensitivity.

Symptoms

Widespread pain, a heightened painful response to pressure, stiffness, sleep disturbances, chronic fatigue, anxiety and depression are the most commonly reported symptoms of fibromyalgia. Other symptoms such as swallowing difficulties, irritable bowel and restless legs may also occur.

Low pain thresholds, so the person experiences painful sensations to what would normally be regarded as harmless stimuli. Pain is often more intense in the morning and may be described as burning or stabbing. Pain may be localised to the shoulders, neck, back and joints but is more often widespread, affecting all regions of the body.

Appearance of negative symptoms, such as a lack of drive and motivation, anxiety and depression, create negative beliefs and stifle ambition, thereby limiting social and professional activities.

An inability to sleep or frequent wakening during the night creates day time fatigue and saps energy that prevents the person doing her or his best, reinforces painful sensations and contributes to negative mood and motivation that can be incapacitating.

Symptoms are often described as relapsing because the person may experience periods of relief followed by periods of apparently worsening symptoms. Although fibromyalgia is not a progressive disease, the constant interplay between pain, mood and sleep deprivation can all combine to create the feeling that it is getting worse.

Treatment

There is no cure for fibromyalgia but medicines and lifestyle changes(see Living with Fibromyalgia below) can help ease symptoms and help people get the most out of their lives.

Analgesics and anti-inflammatories such as Anadin paracetamol, Panadol extra, Askit Powders, Anadin ibuprofen, Voltarol Pain-Eze containing aspirin, paracetamol, ibuprofen or diclofenac can all be purchased from pharmacies without the need for a prescription. Taken orally, these products are useful for easing widespread pain. Although fibromyalgia is not associated with inflammation, anti-inflammatory agents also have analgesic properties that will help bring relief.

When pain is more localised, for example affecting isolated areas of the body such as the neck, back, arms or legs, topical analgesics such as Voltarol Emulgel, Mentholatum Ibuprofen Gel, Radian-B Ibuprofen Gel may be useful. The act of rubbing these preparations into the affected area will also help ease symptoms.

As sleep disturbances can increase the intensity of pain and cause chronic fatigue, OTC preparations that help sleep could be tried. Nytol Caplets and Nytol One-A-Night both contain the antihistamine diphenhydramine which causes drowsiness and helps people fall asleep. For those people who prefer natural remedies, Kalms Herbal Sedative Tablets or Nytol Herbal, containing passion flower, valerian, gentian or hops, provide useful alternatives that exert a calming or relaxing influence.

If these OTC medicines do not provide sufficient relief, doctors may try a number of stronger alternatives. Analgesics such as tramadol may be prescribed if pain is particularly severe. Morphine and derivatives of morphine such as codeine and dihydrocodeine are not recommended because of the risk of dependence during long term use. If insomnia or sleep disturbance are particularly bothersome, non-benzodiazepine hypnotics such as zaleplon, zopiclone and zolpidem may be used for short term relief. Each of these has a short duration of action that is sufficient to induce sleep, but which wears off before the next day so they do not cause drowsiness.

For people aged 55 or over, medicines containing melatonin may be used for the short-term treatment of insomnia characterised by poor quality of sleep. Melatonin is a naturally occurring hormone produced by the pineal gland in the brain. Normally, the hormone is secreted as darkness falls and it helps to induce sleep. As people age, the production of melatonin declines and this may contribute to sleep disturbances. Tablets containing melatonin may help reverse this decline and restore normal sleep patterns.

As fibromyalgia is associated with a decrease in the level of certain neurotransmitters, drugs that increase the level of these neurotransmitters, particularly serotonin levels, may be used. Many antidepressants have such an action, for example, fluoxetine (Prozac), duloxetine (Cymbalta) and amitriptyline. In addition to relieving depression, which in itself will help lift mood and a person’s reaction to fibromyalgia, they also have an analgesic effect and so will help ease pain simultaneously.

Another neurotransmitter is dopamine, one of the body’s natural analgesics. A reduction in the level of dopamine may increase the perception and sensation of pain. A reduction in the level of dopamine has also been associated with restless legs syndrome, a condition frequently experienced by people with fibromyalgia Drugs that increase the level of the neurotransmitter dopamine, for example pramipexole, ropinirole and rotigotine may help to correct the imbalance that is thought responsible for restless leg syndrome and fibromyalgia.

Conversely, drugs that reduce the level of certain transmitters that increase pain sensitivity, for example, gabapentin (Neurontin) and pregabalin (Lyrica) may also be tried.

When to see your pharmacist

Talk to your pharmacist if you are concerned about any of your symptoms. If your symptoms are mild, your pharmacist will be able to recommend a range of OTC medicines and natural remedies that will ease pain, help you relax and gain an improved night’s sleep.

If you notice that your symptoms get worse when taking any prescribed medicines, ask your pharmacist to conduct a review of your medicines. It is possible that some medicines may be affecting the level of your neurotransmitters thereby increasing the underlying central sensitivity syndrome. Your pharmacist will assess each of your medicines and recommend that you ask your doctor to change the dosage or prescribe an alternative product if any of them are suspected of being the cause.

When to see your doctor

If you or someone close to you has any of the symptoms described above and you suspect fibromyalgia, make an appointment to see your doctor. Keep a diary of your symptoms, show it to your doctor and do not be reluctant to suggest what you suspect. Fibromyalgia is a condition that is diagnosed by exclusion. This means that the symptoms can sometimes be so vague that the doctor may suspect many other causes and so may send you for tests or to other specialists before making a diagnosis and starting an appropriate treatment.

Also see your doctor if you have tried various OTC medicines and you find that they are not bringing relief. The fact that fibromyalgia is a widespread condition involving many transmitters means that doctors may try different types or combinations of medicines used for other conditions if symptoms are particularly severe.

Talk too about counselling. There are counsellors who can suggest techniques to help you cope with symptoms and lift mood that will reduce your perceptions of pain and allow you to enjoy your life more fully.

Living with fibromyalgia

Perhaps the first and most important point to emphasise is that fibromyalgia is a recognised medical condition. It is important for you and those close to you to appreciate this fact. If you are experiencing any of the symptoms described above but your condition has not yet been diagnosed, suggest fibromyalgia to your doctor or ask for a second opinion. The symptoms of fibromyalgia are common to many other disorders and it can be difficult for doctors to make a firm diagnosis.

Maintain a positive mood. Although it is easier said than done, try not to let things get you down or get on top of you. The more you learn to cope, the less effect the symptoms will have on you, your life and those close to you.

Take regular outdoor exercise, particularly in daylight hours. Exercise keeps you fit and healthy, gives you an interest and something to look forward doing, lifts mood and eases pain. Exercising in daylight, particularly during the winter months also helps drive away seasonal affective disorder. Take it easy at first and build up gradually. The secret is not overdoing things that could make muscle pain worse.

Swimming is another great form of exercise. The warm temperature of swimming pools in sport and leisure centres helps soothe aching muscles, while the act of swimming gently exercises muscles without the impact stresses that walking and running may cause.

Further information

Facts about fibromyalgia, its causes, treatments, lifestyle advice and patient support groups are all available from:

UK Fibromyalgia
7 Ashbourne Road
Bournemouth
Dorset
BH5 2JS

Tel: 01202 259155
Email: info@ukfibromyalgia.com
Web: www.ukfibromyalgia.com


Fibromyalgia Association UK
Training and Enterprise Centre
Applewood Grove
Cradley Heath
B64 6EW
Helpline: 0844 887 2444
Email: charity@fmauk.org
Web: www.fibromyalgia-associationuk.org


Reviewed on 24 November 2011



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