Understanding fibromyalgia: symptoms, causes, diagnosis and treatment

Fibromyalgia, also known as fibromyalgia syndrome, refers to a collection of symptoms, including body pain, tenderness and aches, fatigue and often brain fog. It affects around 2.5 million people in the UK and is a chronic (long-term) condition. 

Fibromyalgia can reduce your quality of life and ability to carry out your usual daily activities. Consequently, it is often accompanied by mental health issues, such as depression and anxiety.

Treating fibromyalgia needs a holistic approach that addresses the multifaceted nature of pain ie its biological, psychological and social factors. 

Signs and symptoms of fibromyalgia

Fibromyalgia reduces your threshold to pain perception. This leads to tender points ie areas that cause pain when pressed. There are 18 common tender points located across the body in those with fibromyalgia, usually near joints, though they are not joints themselves. 

Fibromyalgia pain is widespread, which means it occurs across the whole body but is usually centred on joints, both big and small. It can feel achy, burning or tingling (ie similar to pins and needles). 

Other symptoms of fibromyalgia include easily becoming fatigued, difficulty thinking clearly or remembering things, waking up tired, abdominal pain or cramps, headaches, irritable bowel syndrome, depression and anxiety

These symptoms are persistent and can’t be attributed to anything else. 

Causes of fibromyalgia

The exact cause of fibromyalgia isn’t clear but multiple factors are thought to play a role.

It is triggered in individuals with an underlying and currently unexplained hypersensitivity. Physical triggers include an injury, operation, viral infection or giving birth. Psychological triggers include traumatic life events, such as being in an abusive relationship, a relationship breakdown or the death of a loved one.

Who is at risk of fibromyalgia?

While fibromyalgia can affect anyone, including children (juvenile fibromyalgia), those at greatest risk are middle-aged women. Your risk increases with age. 

Fibromyalgia is also more common in those with hypermobility disorders (eg Ehlers-Danlos syndrome), rheumatologic diseases (eg rheumatoid arthritis, lupus), severe viral infections and mental health conditions (eg depression, anxiety, psychological trauma). 

Diagnosing fibromyalgia

As the symptoms of fibromyalgia are broad and non-specific, you may need blood tests and other investigations to rule out other conditions first. If no other explanations for your symptoms can be found, fibromyalgia is diagnosed based on criteria set out in 2010 by the American College of Rheumatology. 

This includes asking patients to assess the presence or absence of pain at 19 different points along the body using the Widespread Pain Index (WPI), and also determining the presence and assessing the severity of symptoms associated with fibromyalgia using the Symptom Severity (SS) scale. 

Treating fibromyalgia

Fibromyalgia is treated with a holistic approach that takes into account the biological, psychological and social factors that contribute to pain. It focuses on how to improve your quality of life through self-management techniques that help you carry out your usual daily tasks. 

Developing a mindset that helps you regain your confidence in performing the tasks and activities you did before the onset of your fibromyalgia is also important. Support to achieve this is usually delivered as part of a pain management programme, which includes pain psychology and pain physiotherapy.

Depending on your symptoms, your doctor may also prescribe a variety of medications, including anticonvulsants, antidepressants, muscle relaxants, painkillers and sleeping tablets. 

Author biography

Dr Mahmoud Alkholany is a Consultant in Pain Medicine and Anaesthesia at Spire Manchester Hospital, Spire Murrayfield Hospital Wirral and in the NHS at Liverpool University Hospitals. He specialises in pain medicine and has an interest in back pain and sciatica, joint pain, neuropathic pain, facial pain and headache, and fibromyalgia. Dr Alkholany adopts a holistic approach that addresses the multidimensional nature of pain being a bio-psycho-social disorder by offering a wide range of interventional procedures and pharmacological management, along with physical rehabilitation and addressing any psychological stressors.

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