Fibromyalgia is a rheumatic condition characterized by muscular and/or musculoskeletal pain, tenderness, and stiffness at specific points of the body, especially the tendons, bones, ligaments, and muscles. Fibromyalgia’s symptoms can be confused with arthritis, but fibromyalgia is thought to arise as a result of a dysregulated nervous system, with the spine and brain not being able to process pain signals from other parts of the body properly.
Around 10 million people in the United States are affected by fibromyalgia, which is about 3% of the population. It’s believed that fibromyalgia is caused by both environmental and genetic factors.
Fibromyalgia causes
Fibromyalgia is an extremely difficult condition to treat, partially because so little is known about its causes. There are several conditions linked to fibromyalgia, including depression, post-traumatic stress disorder (PTSD), anxiety, insomnia, and chronic pain. Fibromyalgia tends to run in families, so it is thought to be genetic. However, which genes are responsible for fibromyalgia is unknown.
Similar to myalgic encephalomyelitis, some researchers believe that fibromyalgia is developed as a response to a previous viral or bacterial infection that has caused long-term inflammatory responses.
Fibromyalgia symptoms & health effects
Symptoms of fibromyalgia include:
- Increased sensitivity to pain
- Increased sensitivity to light, temperature, and pressure
- Joint and muscle pain
- Body-wide pain
- Headache/migraine
- Muscle stiffness
- Insomnia
- Fatigue
- Difficulty concentrating or remembering things
- Clouding of consciousness, aka “brain fog”
- Restless leg syndrome (RLS)
- Irritable bowel syndrome (IBS)
- Bladder problems
- Gluten intolerance
Fibromyalgia diagnosis
There are no lab or imaging tests for fibromyalgia specifically, as little is known about the condition. Instead, the widespread pain index (WPI) is used. A WPI is a simple diagnostic test where three main metrics are looked at:
- The location of the pain on the body, using a list of 19 body areas. This includes the neck, shoulders, hips, chest, legs, and arms.
- The intensity of fatigue, waking unrefreshed, and cognitive symptoms..
- The other symptoms the patient suffers from and their intensity,
The scores from these three metrics are added up and then given a total WPI score. Part 1, the location metric, can be scored to a maximum of 19. Part 2, symptom intensity, gives a maximum score of 9. Part 3, where other symptoms and their severity are listed, gives a maximum score of 3.
A WPI score of 7 or more, the symptom severity (SS) scale score is greater than or equal to 5 and the WPI equals 3 to 6, or the SS scale score is greater than or equal to 9. Testing a patient’s range of mobility and their sensitivity to touch are also common diagnostic tests.
Fibromyalgia prognosis
Fibromyalgia is neither a progressive disease nor is it usually life-threatening in and of itself. However, fibromyalgia can have a significant impact on quality of life (QoL), increasing the likelihood of anxiety, depression, and insomnia.
Fibromyalgia treatments
Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine and milnacipran and the CNS depressant pregabalin (Lyrica) are most commonly prescribed for those suffering from fibromyalgia. Other than these medications, treatment programs often include plenty of rest, exercise, and diet changes, as so little is understood in how to treat fibromyalgia effectively.
Sometimes, opioids are prescribed for those in extreme pain. However, they have little efficacy when it comes to fibromyalgia, and could end up adding to the pain rather than getting rid of it, in the form of addiction.
First-line treatments
The most common first-line treatments for fibromyalgia are cognitive behavioral therapy (CBT) and antidepressants. Analgesics like acetaminophen (paracetamol) are also commonly used.
Other treatments
If a patient is in extreme pain and other treatments are not effective, then anticonvulsant or anti-seizure medications (e.g. pregabalin, gabapentin) may be prescribed. In rare circumstances, opioids may be prescribed.
Adjunctive therapy & alternative treatments
Although there is little evidence for their efficacy, acupuncture, massage, meditation, yoga, Tai Chi, stress management, and biofeedback techniques may be utilized to manage pain. Dietary changes (e.g. eliminating processed foods, gluten, and/or dairy), capsaicin, melatonin supplements, and exercise can help reduce chronic pain, fatigue, anxiety, and insomnia.
Cannabis for fibromyalgia
Cannabis could be helpful for some of the symptoms of fibromyalgia, especially chronic pain and insomnia. However, the quality of evidence is low, with most randomized clinical trials (RCTs) showing little difference in pain scores between fibromyalgia patients that use cannabis and patients that do not.
Yet, when looking at the sorts of symptoms associated with fibromyalgia (e.g. IBS, migraines, restless legs), there seems to be at least average-if-not-strong evidence that cannabis could help with them. This suggests that fibromyalgia may be associated with a disrupted endocannabinoid system in some, but have other factors in its development in others.
There are also few medications available for the treatment of fibromyalgia. Second-line treatments such as enti-epileptic medications and opioids are not ideal as they have several negative side effects, including dizziness, sleepiness, blurred vision, dry mouth, fatigue, and addiction. Medical cannabis represents an alternative to such medications.
Most studies on the use of medical cannabis for fibromyalgia pain and other symptoms show positive results. To quote one study:
“The mean amount per month of cannabis consumed was 31.4±16.3g, and 80% of cannabis consumers (CC) smoked pure cannabis or cannabis mixed with tobacco. Pain relief was reported by 94% of CC, while 93% reported improved sleep quality, 87% reported improvement in depression, and 62% reported improvement in anxiety.”
Additional information for patients
There are three main associations in the US that provide support for those with fibromyalgia. They are:
- The National Fibromyalgia Association (NFA)
- The Fibromyalgia Care Society of America (FCSA)
- American Fibromyalgia Syndrome Association (AFSA)
Fibromyalgia FAQs
What causes fibromyalgia?
Little is known about what causes fibromyalgia, but both genetic and environmental factors are thought to play a part. Fibromyalgia seems to arise from an inability for the central nervous system (CNS) to properly process pain signals. Fibromyalgia could be a response to a previous viral or bacterial infection.
Does fibromyalgia get worse as you age?
Fibromyalgia is not a progressive disease, so it does not necessarily get worse with age, although flare-ups may increase (or decrease) with age. In fact, with appropriate treatment, exercise, regulating stress & mood, and appropriate rest, it is possible to keep fibromyalgia under control.
Is fibromyalgia life long?
Fibromyalgia is a chronic condition, so it does not “go away,” although it is possible to keep it under control by following a healthy lifestyle.
Which conditions can fibromyalgia be mistaken for?
Fibromyalgia may be mistaken for sero-negative rheumatoid arthritis, ankylosing spondylitis, Lyme disease, polymyalgia rheumatica, and lupus.
Resources
- Chronic widespread pain and fibromyalgia: could there be some relationships with infections and vaccinations?: https://pubmed.ncbi.nlm.nih.gov/22243559/
- Fibromyalgia: Diagnosis, Treatment, and Steps to Take: https://www.niams.nih.gov/health-topics/fibromyalgia/diagnosis-treatment-and-steps-to-take
- Antiepileptic drugs for neuropathic pain and fibromyalgia ‐ an overview of Cochrane reviews: https://pmc.ncbi.nlm.nih.gov/articles/PMC6469538/
- The Consumption of Cannabis by Fibromyalgia Patients in Israel: https://onlinelibrary.wiley.com/doi/10.1155/2018/7829427
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