Fibromyalgia overview: Difference between revisions
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==Historical Perspective== | ==Historical Perspective== | ||
The term fibromyalgia was not used until 1976 when Dr. P.K. Hench used it to describe fibromyalgia symptoms. Many names, including "muscular [[rheumatism]]," "[[fibrositis]]," "psychogenic [[rheumatism]]," and "[[neurasthenia]]" were applied historically to symptoms resembling those of fibromyalgia. The term fibromyalgia was coined by researcher Mohammed Yunus as a synonym for [[fibrositis]] and was first used in a scientific publication in 1981. Fibromyalgia is derived from the Latin fibra (fiber) and the Greek words myo (muscle) and algos (pain). The first clinical, controlled study of the characteristics of fibromyalgia syndrome was published in 1981, providing support for symptom associations. In 1984, a connection between fibromyalgia syndrome and other similar conditions was proposed and in 1986, trials of the first proposed medications for fibromyalgia were published. A 1987 article in the Journal of the American Medical Association used the term "fibromyalgia syndrome" while saying it was a "controversial condition." The American College of Rheumatology (ACR) published its first classification criteria for fibromyalgia in 1990, although these are not strictly diagnostic criteria. | The term fibromyalgia was not used until 1976 when Dr. P.K. Hench used it to describe fibromyalgia symptoms. Many names, including "muscular [[rheumatism]]," "[[fibrositis]]," "psychogenic [[rheumatism]]," and "[[neurasthenia]]" were applied historically to symptoms resembling those of fibromyalgia. The term fibromyalgia was coined by researcher Mohammed Yunus as a synonym for [[fibrositis]] and was first used in a scientific publication in 1981. Fibromyalgia is derived from the Latin fibra (fiber) and the Greek words myo (muscle) and algos (pain). The first clinical, controlled study of the characteristics of fibromyalgia syndrome was published in 1981, providing support for symptom associations. In 1984, a connection between fibromyalgia syndrome and other similar conditions was proposed and in 1986, trials of the first proposed medications for fibromyalgia were published. A 1987 article in the Journal of the American Medical Association used the term "fibromyalgia syndrome" while saying it was a "controversial condition." The American College of Rheumatology (ACR) published its first classification criteria for fibromyalgia in 1990, although these are not strictly diagnostic criteria. | ||
==Classification== | ==Classification== | ||
[[DSM]] 5 divides fibromyalgia into four groups based on the differences in psychological and [[autonomic nervous system]] profiles among affected individuals. These four groups are: extreme sensitivity to [[pain]] with no associated psychiatric conditions, fibromyalgia with [[comorbid]] [[pain]]-related [[depression]], [[depression]] with concomitant fibromyalgia syndrome, and fibromyalgia due to [[somatization]] | [[DSM]] 5 divides fibromyalgia into four groups based on the differences in psychological and [[autonomic nervous system]] profiles among affected individuals. These four groups are: extreme sensitivity to [[pain]] with no associated psychiatric conditions, fibromyalgia with [[comorbid]] [[pain]]-related [[depression]], [[depression]] with concomitant fibromyalgia syndrome, and fibromyalgia due to [[somatization|somatization.]]<ref name="pmid2306288">{{cite journal |vauthors=Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P |title=The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee |journal=Arthritis Rheum. |volume=33 |issue=2 |pages=160–72 |year=1990 |pmid=2306288 |doi= |url=}}</ref> | ||
==Pathophysiology== | ==Pathophysiology== | ||
The exact cause of fibromyalgia is unknown. In fact, it is not due to a singular factor but is caused by multiple factors. Fibromyalgia does not start as a result of [[Physical trauma|trauma]] such as a traffic accident, major surgery, or disease. Some evidence shows that [[Lyme Disease|Lyme disease]] may be a trigger of fibromyalgia symptoms. There are various hypotheses put forth describing the pathogenesis of fibromyalgia suggesting that more than one clinical entity may be involved, ranging from a mild, [[idiopathic]] [[inflammation|inflammatory]] process to [[clinical depression]]. | The exact cause of fibromyalgia is unknown. In fact, it is not due to a singular factor but is caused by multiple factors. Fibromyalgia does not start as a result of [[Physical trauma|trauma]] such as a traffic accident, major surgery, or disease. Some evidence shows that [[Lyme Disease|Lyme disease]] may be a trigger of fibromyalgia symptoms. There are various hypotheses put forth describing the pathogenesis of fibromyalgia suggesting that more than one clinical entity may be involved, ranging from a mild, [[idiopathic]] [[inflammation|inflammatory]] process to [[clinical depression]]. | ||
==Causes== | ==Causes== | ||
The exact cause of fibromyalgia is unknown. Possible causes or triggers of fibromyalgia include [[trauma|physical]] or emotional trauma, abnormal [[pain]] response (areas in the [[brain]] that are responsible for [[pain]] may react differently in fibromyalgia patients), sleep disturbances, and [[infections]], including [[viral infections]]. | The exact cause of fibromyalgia is unknown. Possible causes or triggers of fibromyalgia include [[trauma|physical]] or emotional trauma, abnormal [[pain]] response (areas in the [[brain]] that are responsible for [[pain]] may react differently in fibromyalgia patients), sleep disturbances, and [[infections]], including [[viral infections]]. | ||
==Differentiating Fibromyalgia from other Diseases== | ==Differentiating Fibromyalgia from other Diseases== | ||
Fibromyalgia must be differentiated from other diseases that present with [[pain]], [[fatigue]] and [[sleep disturbance]], and symptoms of cognitive dysfunction and [[psychiatric disease]] which include [[rheumatoid arthritis]], [[SLE]], [[chronic fatigue syndrome]], [[spondyloarthritis]], and [[polymyalgia rheumatica]]. | Fibromyalgia must be differentiated from other diseases that present with [[pain]], [[fatigue]] and [[sleep disturbance]], and symptoms of cognitive dysfunction and [[psychiatric disease]] which include [[rheumatoid arthritis]], [[SLE]], [[chronic fatigue syndrome]], [[spondyloarthritis]], and [[polymyalgia rheumatica]]. | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
The prevalence of fibromyalgia in the United States was reported to range from 500-5000 per 100,000 people. Females are more commonly affected than males with a ratio of 9:1. People between 20 and 50 years old are more commonly affected. Fibromyalgia has no racial predilection. | The prevalence of fibromyalgia in the United States was reported to range from 500-5000 per 100,000 people. Females are more commonly affected than males with a ratio of 9:1. People between 20 and 50 years old are more commonly affected. Fibromyalgia has no racial predilection. | ||
==Risk Factors== | ==Risk Factors== | ||
Common risk factors in the development of fibromyalgia include stressful or traumatic events, such as car accidents, [[post-traumatic stress disorder]] ([[PTSD]]), and [[injury|injuries]] from repetitive stress on a [[joint]], including frequent knee bending, [[illness]] (such as [[viral infections]]), or [[obesity]]. Family history is also a common risk factor. | Common risk factors in the development of fibromyalgia include stressful or traumatic events, such as car accidents, [[post-traumatic stress disorder]] ([[PTSD]]), and [[injury|injuries]] from repetitive stress on a [[joint]], including frequent knee bending, [[illness]] (such as [[viral infections]]), or [[obesity]]. Family history is also a common risk factor. | ||
==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
Fibromyalgia is a long-term disorder. If left untreated, [[chronic pain]] could cause permanent changes in how the body perceives [[pain]]. Complications that can develop as a result of fibromyalgia include marked functional impairment, [[depression]], [[anxiety]], [[insomnia]], [[obesity]], and [[allodynia]]. Factors associated with poor outcomes are female gender, low socioeconomic status, and being unemployed. Even with appropriate treatment, though symptoms of fibromyalgia sometimes improve, the pain may get worse and continue for months or years. | Fibromyalgia is a long-term disorder. If left untreated, [[chronic pain]] could cause permanent changes in how the body perceives [[pain]]. Complications that can develop as a result of fibromyalgia include marked functional impairment, [[depression]], [[anxiety]], [[insomnia]], [[obesity]], and [[allodynia]]. Factors associated with poor outcomes are female gender, low socioeconomic status, and being unemployed. Even with appropriate treatment, though symptoms of fibromyalgia sometimes improve, the pain may get worse and continue for months or years. | ||
==Diagnosis== | ==Diagnosis== | ||
===Diagnostic Criteria=== | ===Diagnostic Criteria=== | ||
The most widely accepted set of diagnostic criteria for fibromyalgia was elaborated in 2010 by the Multicenter Criteria Committee of the the American College of Rheumatology. A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met: | The most widely accepted set of diagnostic criteria for fibromyalgia was elaborated in 2010 by the Multicenter Criteria Committee of the the American College of Rheumatology. A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met: | ||
#Widespread pain index (WPI) > 7 and symptom severity (SS) scale score >5 or WPI 3–6 and SS scale score >9. | #Widespread pain index (WPI) > 7 and symptom severity (SS) scale score >5 or WPI 3–6 and SS scale score >9. | ||
#Symptoms have been present at a similar level for at least 3 months. | #Symptoms have been present at a similar level for at least 3 months. | ||
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===Medical Therapy=== | ===Medical Therapy=== | ||
Medical therapy includes [[analgesics]], [[antidepressants]], skeletal [[muscle relaxants]], [[anticonvulsants]], and anti-anxiety medications | Medical therapy includes [[analgesics]], [[antidepressants]], skeletal [[muscle relaxants]], [[anticonvulsants]], and anti-anxiety medications. | ||
===Psychotherapy=== | ===Psychotherapy=== | ||
Although there is no universally accepted cure, some doctors have claimed to have successfully treated fibromyalgia stemming from a psychological cause. As the nature of fibromyalgia is not well understood, some physicians believe that it may be [[Psychosomatic illness|psychosomatic]] or [[Psychogenic disease|psychogenic]]. [[Cognitive behavioral therapy]] has been shown to improve the quality of life and coping in fibromyalgia patients and other sufferers of [[chronic pain]]. | Although there is no universally accepted cure, some doctors have claimed to have successfully treated fibromyalgia stemming from a psychological cause. As the nature of fibromyalgia is not well understood, some physicians believe that it may be [[Psychosomatic illness|psychosomatic]] or [[Psychogenic disease|psychogenic]]. [[Cognitive behavioral therapy]] has been shown to improve the quality of life and coping in fibromyalgia patients and other sufferers of [[chronic pain]]. | ||
===Surgery=== | ===Surgery=== | ||
Surgical intervention is not recommended for the management of fibromyalgia. | Surgical intervention is not recommended for the management of fibromyalgia. | ||
===Primary | ===Primary Prevention=== | ||
There is no established method of prevention of fibromyalgia. | There is no established method of prevention of fibromyalgia. | ||
===Secondary | ===Secondary Prevention=== | ||
There are no specific secondary preventive measures available for fibromyalgia. However, proper treatment and lifestyle changes can help reduce the frequency and severity of symptoms. Secondary preventive measures for fibromyalgia include adequate [[sleep]], reducing emotional and mental [[Stress (medicine)|stress]], regular [[exercise]], following a [[balanced diet]] and monitoring one's own symptoms. | There are no specific secondary preventive measures available for fibromyalgia. However, proper treatment and lifestyle changes can help reduce the frequency and severity of symptoms. Secondary preventive measures for fibromyalgia include adequate [[sleep]], reducing emotional and mental [[Stress (medicine)|stress]], regular [[exercise]], following a [[balanced diet]] and monitoring one's own symptoms. | ||
=== '''Future or Investigational Therapies''' === | |||
Several drugs, including [[milnacipran]], [[guaifenesin]], and [[dextromethorphan]] are being investigated as potential therapies for fibromyalgia. [[Milnacipran]] is a [[serotonin-norepinephrine reuptake inhibitor]] (SNRI), and a Phase III study demonstrated statistically significant therapeutic effects of the drug as a treatment for fibromyalgia syndrome. [[Guaifenesin]] is a more controversial potential therapy, and a study by researchers at Oregon Health Science University in Portland failed to demonstrate any benefits from this treatment, though results of the study have since been contested. [[Dextromethorphan]] is an over-the-counter cough medicine that has been used in research settings to investigate the nature of fibromyalgia [[pain]], but there are no controlled trials of its safety or efficacy in clinical use. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 21:09, 28 July 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Fibromyalgia (FM) is a disorder characterized by the presence of chronic widespread pain and tactile allodynia. The criteria for such an entity have not yet been thoroughly developed. The recognition that fibromyalgia involves more than just pain has led to the frequent use of the term "fibromyalgia syndrome." It is not contagious, and recent studies suggest that some people with fibromyalgia may be genetically predisposed. The disorder is not directly life-threatening. The degree of symptoms may vary greatly from day to day with periods of flares (severe worsening of symptoms) or remission; however, the disorder is generally thought to be non-progressive.
Historical Perspective
The term fibromyalgia was not used until 1976 when Dr. P.K. Hench used it to describe fibromyalgia symptoms. Many names, including "muscular rheumatism," "fibrositis," "psychogenic rheumatism," and "neurasthenia" were applied historically to symptoms resembling those of fibromyalgia. The term fibromyalgia was coined by researcher Mohammed Yunus as a synonym for fibrositis and was first used in a scientific publication in 1981. Fibromyalgia is derived from the Latin fibra (fiber) and the Greek words myo (muscle) and algos (pain). The first clinical, controlled study of the characteristics of fibromyalgia syndrome was published in 1981, providing support for symptom associations. In 1984, a connection between fibromyalgia syndrome and other similar conditions was proposed and in 1986, trials of the first proposed medications for fibromyalgia were published. A 1987 article in the Journal of the American Medical Association used the term "fibromyalgia syndrome" while saying it was a "controversial condition." The American College of Rheumatology (ACR) published its first classification criteria for fibromyalgia in 1990, although these are not strictly diagnostic criteria.
Classification
DSM 5 divides fibromyalgia into four groups based on the differences in psychological and autonomic nervous system profiles among affected individuals. These four groups are: extreme sensitivity to pain with no associated psychiatric conditions, fibromyalgia with comorbid pain-related depression, depression with concomitant fibromyalgia syndrome, and fibromyalgia due to somatization.[1]
Pathophysiology
The exact cause of fibromyalgia is unknown. In fact, it is not due to a singular factor but is caused by multiple factors. Fibromyalgia does not start as a result of trauma such as a traffic accident, major surgery, or disease. Some evidence shows that Lyme disease may be a trigger of fibromyalgia symptoms. There are various hypotheses put forth describing the pathogenesis of fibromyalgia suggesting that more than one clinical entity may be involved, ranging from a mild, idiopathic inflammatory process to clinical depression.
Causes
The exact cause of fibromyalgia is unknown. Possible causes or triggers of fibromyalgia include physical or emotional trauma, abnormal pain response (areas in the brain that are responsible for pain may react differently in fibromyalgia patients), sleep disturbances, and infections, including viral infections.
Differentiating Fibromyalgia from other Diseases
Fibromyalgia must be differentiated from other diseases that present with pain, fatigue and sleep disturbance, and symptoms of cognitive dysfunction and psychiatric disease which include rheumatoid arthritis, SLE, chronic fatigue syndrome, spondyloarthritis, and polymyalgia rheumatica.
Epidemiology and Demographics
The prevalence of fibromyalgia in the United States was reported to range from 500-5000 per 100,000 people. Females are more commonly affected than males with a ratio of 9:1. People between 20 and 50 years old are more commonly affected. Fibromyalgia has no racial predilection.
Risk Factors
Common risk factors in the development of fibromyalgia include stressful or traumatic events, such as car accidents, post-traumatic stress disorder (PTSD), and injuries from repetitive stress on a joint, including frequent knee bending, illness (such as viral infections), or obesity. Family history is also a common risk factor.
Natural History, Complications and Prognosis
Fibromyalgia is a long-term disorder. If left untreated, chronic pain could cause permanent changes in how the body perceives pain. Complications that can develop as a result of fibromyalgia include marked functional impairment, depression, anxiety, insomnia, obesity, and allodynia. Factors associated with poor outcomes are female gender, low socioeconomic status, and being unemployed. Even with appropriate treatment, though symptoms of fibromyalgia sometimes improve, the pain may get worse and continue for months or years.
Diagnosis
Diagnostic Criteria
The most widely accepted set of diagnostic criteria for fibromyalgia was elaborated in 2010 by the Multicenter Criteria Committee of the the American College of Rheumatology. A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met:
- Widespread pain index (WPI) > 7 and symptom severity (SS) scale score >5 or WPI 3–6 and SS scale score >9.
- Symptoms have been present at a similar level for at least 3 months.
- The patient does not have a disorder that would otherwise explain the pain.
History and Symptoms
The defining symptoms of fibromyalgia are chronic, widespread pain and tenderness to light touch.
Physical Examination
A physical examination helps not only to confirm the diagnosis of fibromyalgia but also to rule out other systemic diseases. A careful physical examination also helps in identifying associated conditions. The tender-point examination is the most important aspect of the physical examination; other aspects of the examination are typically normal in fibromyalgia patients.
Laboratory Findings
Blood and urine tests are usually normal. However, tests may be done to rule out other conditions that may have similar symptoms.
Fibromyalgia X-ray findings
There are no X-ray findings associated with fibromyalgia.
CT
There are no CT findings associated with fibromyalgia.
MRI
There are no MRI findings associated with fibromyalgia.
Ultrasound
There are no ultrasound findings associated with fibromyalgia.
Other Imaging Findings
There are no other imaging findings associated with fibromyalgia.
Other Diagnostic Studies
There are no other specific diagnostic findings associated with fibromyalgia.
Treatment
There is no universally accepted treatment or cure for fibromyalgia, and treatment typically consists of symptom management. Treatment options include medications, patient education, aerobic exercise, and cognitive behavioral therapy, which have been shown to be effective in alleviating pain and other fibromyalgia-related symptoms.
Medical Therapy
Medical therapy includes analgesics, antidepressants, skeletal muscle relaxants, anticonvulsants, and anti-anxiety medications.
Psychotherapy
Although there is no universally accepted cure, some doctors have claimed to have successfully treated fibromyalgia stemming from a psychological cause. As the nature of fibromyalgia is not well understood, some physicians believe that it may be psychosomatic or psychogenic. Cognitive behavioral therapy has been shown to improve the quality of life and coping in fibromyalgia patients and other sufferers of chronic pain.
Surgery
Surgical intervention is not recommended for the management of fibromyalgia.
Primary Prevention
There is no established method of prevention of fibromyalgia.
Secondary Prevention
There are no specific secondary preventive measures available for fibromyalgia. However, proper treatment and lifestyle changes can help reduce the frequency and severity of symptoms. Secondary preventive measures for fibromyalgia include adequate sleep, reducing emotional and mental stress, regular exercise, following a balanced diet and monitoring one's own symptoms.
Future or Investigational Therapies
Several drugs, including milnacipran, guaifenesin, and dextromethorphan are being investigated as potential therapies for fibromyalgia. Milnacipran is a serotonin-norepinephrine reuptake inhibitor (SNRI), and a Phase III study demonstrated statistically significant therapeutic effects of the drug as a treatment for fibromyalgia syndrome. Guaifenesin is a more controversial potential therapy, and a study by researchers at Oregon Health Science University in Portland failed to demonstrate any benefits from this treatment, though results of the study have since been contested. Dextromethorphan is an over-the-counter cough medicine that has been used in research settings to investigate the nature of fibromyalgia pain, but there are no controlled trials of its safety or efficacy in clinical use.
References
- ↑ Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P (1990). "The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee". Arthritis Rheum. 33 (2): 160–72. PMID 2306288.