Definition and Overview

Fibromyalgia refers to a chronic, widespread deep musculoskeletal pain in various parts of the body. Some health experts call it chronic fatigue syndrome (CFS). Although both are similar in many ways, they are different based on the general feeling of the patient. Fibromyalgia is accompanied by pain and stiffness while CFS is dominated by an extreme feeling of tiredness. Many patients with fibromyalgia have at least 11 tender points or areas in the body that are very soft and painful to touch.

The American College of Rheumatology and US National Institute of Health recognize fibromyalgia as a diagnosable central nervous disorder caused by neurobiological abnormalities that lead to cognitive impairment, as well as physiological pain. However, until now, doctors are yet to establish the real cause of this condition, although there are many theories. This makes diagnosis difficult and time-consuming.

In the United States, more than 3 million people are believed to have fibromyalgia. Around half of them are suffering from severe cases that they can no longer perform their regular activities, and about 40% are forced to change or quit their jobs solely because of the condition.

Causes of Condition

Doctors have yet to figure out the exact cause of fibromyalgia, but there are some theories including one that involves serotonin.

Serotonin is a neurotransmitter that is produced by the intestines and the brain. It plays many important functions in the body such as regulating mood and appetite. People who suffer from depression are also often diagnosed with low levels of this chemical. Various theories suggest that people who suffer from fibromyalgia produce less serotonin.

Other theories include:

  • Imbalances in neurotransmitters, making the nerves more sensitive to pain
  • Stress
  • Injury or trauma to the spinal cord and the brain
  • Hormonal imbalance
  • Emotional distress
  • Changes in the weather
  • Lack or excessive physical activity
  • Sleeping issues and disorders

Fibromyalgia also has numerous risk factors including the following:

  • Gender: Women are more at risk of fibromyalgia than men at a ratio of 7:1. Prevalence also increases among women who are already in menopausal stage.

  • Age: The disease is often diagnosed in men and women who are at least 50 years old, but cases among children are also heard of, in which case the condition is called juvenile primary fibromyalgia.

  • In relation to other diseases: if the patient has been diagnosed with autoimmune disorders such as rheumatoid arthritis or systemic lupus, the risk of fibromyalgia is high.

  • Family history: A person who has a relative or parents who are suffering from fibromyalgia, the risk of developing the disease later in life is significantly higher.

Key Symptoms

  • Chronic pain in various parts of the body
  • Presence of more than ten tender points
  • Fibro fog (problems in memory and cognition)
  • Insomnia and other sleeping disorders
  • Muscle stiffness especially in the morning
  • Menstrual cramps
  • Tingling sensation in the limbs
  • Restless leg syndrome
  • Constipation
  • Irritable bowel
  • Facial tenderness
  • TMJ disorder
  • Sensitivity to noise and light
  • Depression
  • Migraines
  • Headaches
  • Muscle cramps and knots
  • Body weakness
  • Balance disorders
  • Itchiness
  • Fatigue
  • Intolerance to stress
  • Irregular heartbeat

Symptoms of this condition are typically experienced after a physical trauma, significant psychological stress, infection, or surgery. However, there are cases wherein the symptoms gradually accumulate without any triggers.

Who to See and Treatments Available

Because fibromyalgia symptoms are also found in other medical conditions, the disease is difficult to diagnose. Usually, patients are treated for other disorders before doctors are able to figure out the root cause.

One of the often-subscribed methods of diagnosing fibromyalgia is called the tender points test. The doctor applies pressure on 18 specific tender points in the body including those found in the shoulders, neck, nape, back of the knee, elbows, and below the waist.

The procedure takes around 5 minutes, and the doctor asks the patient if the tender points hurt when pressed. A patient who confirms pain (tender points tend to palpitate when touched) in at least 11 of these 18 points is often diagnosed with fibromyalgia. However, even if the patient scored less, his condition may still be considered fibromyalgia if he suffers from the following symptoms:

  • Sleeping problems
  • Stiffness
  • Fatigue
  • Neurological problems
  • Cognitive problems
  • Endocrine issues

An additional criterion is the duration and location of the pain. For a person to be diagnosed with fibromyalgia, he should have widespread body pain for no less than 3 months in all four general areas of the body: left and right side, as well as top and bottom of the waist.

The official diagnosis may also be supported by the results of the following diagnostic tests:

  • Complete blood count (CBC)
  • Erythrocyte sedimentation rate (ESR) to detect inflammation (common among people with autoimmune disorders)
  • Antinuclear body (ANA)
  • X-ray
  • Thyroid panel tests
  • Rheumatoid factor
  • MRI

These examinations are performed to rule out other diseases.

Fibromyalgia patients may see a rheumatoid specialist for a treatment plan to help alleviate the symptoms and reduce flare-ups: Typical treatment plan involves the following:

  • Anti-depressants - medications such as Lyrica, Savella, and Cymbalta have been approved by the Food and Drug Administration for the treatment of fibromyalgia and depression. They increase the levels of serotonin, which can help reduce physical pain and improve a person’s mood. Depending on the patient’s response to the medication, the doctor may recommend more than one type of anti-depressant.

  • Trigger point management – This helps control pain in the trigger points. Some examples are injections, application of creams or patches with lidocaine, and low-dose laser.

  • Alternative therapies – conventional treatments that involve medication may be complemented with alternative therapies such as the following:

  • Massage

  • Acupuncture
  • Chiropractic care
  • Biofeedback

Chiropractic and acupuncture, in particular, may be effective in relieving pain due to fibromyalgia as they deal with the body’s pressure points. Chiropractic may also be used to correct nerves that may have been pinched, thereby improving the flow of signals.

  • Elimination diet – some patients complain of flare-ups after eating certain types of food. The doctor may then recommend an elimination diet to determine what these kinds of food are. The patient may have to avoid them altogether or gradually reintroduce the food to their body.

  • Exercise – exercise is now considered important for fibromyalgia patients since it improves muscle condition, enhances the mood, reduces stress, and helps restore hormone imbalance.


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