Fibromyalgia

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Fibromyalgia is a chronic condition characterised by widespread musculoskeletal pain, accompanied by fatigue, sleep disturbances, and cognitive difficulties. It is a functional disorder, meaning there is no clear structural or pathological abnormality underlying the symptoms.

Aetiology

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

• Genetic predisposition, as fibromyalgia tends to run in families
• Trauma or significant physical or emotional stress, which can trigger or exacerbate symptoms
• Infections, such as viral illnesses, which may trigger or worsen fibromyalgia
• Abnormal pain processing, where the central nervous system amplifies pain signals
• Psychological factors, including anxiety, depression, and stress

Pathophysiology

The pathophysiology of fibromyalgia is not fully understood but is thought to involve:

• Central sensitisation, where the central nervous system becomes overly sensitive to pain signals, leading to amplified pain perception
• Abnormalities in neurotransmitters, such as serotonin, norepinephrine, and dopamine, which are involved in pain regulation, mood, and sleep
• Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which may affect the body's response to stress
• Alterations in the autonomic nervous system, potentially leading to symptoms such as fatigue and sleep disturbances

Risk Factors

• Being female, as fibromyalgia is more common in women
• Middle age, with most cases occurring between the ages of 30 and 50
• Family history of fibromyalgia or related conditions
• Having a history of rheumatic diseases, such as rheumatoid arthritis or lupus
• Experiencing chronic stress, anxiety, or depression

Signs and Symptoms

The signs and symptoms of fibromyalgia include:

• Widespread pain, often described as a constant dull ache, typically affecting both sides of the body and above and below the waist
• Fatigue, often severe enough to interfere with daily activities
• Sleep disturbances, including difficulty falling asleep, staying asleep, or experiencing restorative sleep
• Cognitive difficulties, often referred to as "fibro fog," including problems with memory, attention, and concentration
• Other symptoms may include headaches, irritable bowel syndrome (IBS), depression, and anxiety

Investigations

There is no specific test for fibromyalgia, so diagnosis is typically based on clinical criteria and the exclusion of other conditions. Investigations may include:

• Clinical examination: Assessment of tender points and a thorough review of symptoms.
• Laboratory tests: To rule out other conditions with similar symptoms, such as rheumatoid arthritis, lupus, or thyroid disorders. Common tests include complete blood count (FBC), erythrocyte sedimentation rate (ESR), and thyroid function tests.

Management

Primary Care Management

• Patient education: Providing information about the condition, its chronic nature, and the importance of self-management.
• Pain management: Analgesics such as paracetamol or NSAIDs may be used, although their effectiveness in fibromyalgia is limited. Tricyclic antidepressants (e.g., amitriptyline) or serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine may be prescribed to help with pain and sleep disturbances.
• Sleep hygiene: Encouraging good sleep practices to improve sleep quality.
• Physical activity: Regular, low-impact aerobic exercise, such as walking, swimming, or cycling, can help reduce pain and improve function.
• Psychological support: Cognitive behavioural therapy (CBT) may be beneficial in managing symptoms and improving quality of life.

Specialist Management

• Referral to rheumatology: For patients with complex symptoms or who do not respond to initial management.
• Multidisciplinary approach: Involving physiotherapists, occupational therapists, and psychologists to address the various aspects of the condition.
• Medications: Gabapentinoids (e.g., pregabalin) may be considered for neuropathic pain, although their use should be carefully monitored due to potential side effects.
• Complementary therapies: Some patients may benefit from acupuncture, massage, or other complementary treatments, though evidence for these therapies varies.

References

1. NHS (2024) Fibromyalgia. Available at: https://www.nhs.uk/conditions/fibromyalgia/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Fibromyalgia. Available at: https://cks.nice.org.uk/topics/fibromyalgia/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Fibromyalgia: Clinical Features, Diagnosis, and Management. Available at: https://www.bmj.com/content/350/bmj.h2972 (Accessed: 24 June 2024).
4. American College of Rheumatology (2024) Fibromyalgia. Available at: https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Fibromyalgia (Accessed: 24 June 2024).

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