A clear understanding of fibromyalgia

Fibromyalgia syndrome is a condition characterised by chronic widespread musculoskeletal pain, fatigue, sleep disturbances and cognitive disorders, associated with varied additional symptoms such as irritable bowel syndrome, dry mouth , dry eyes, temporomandibular dysfunction and many others. Despite being a common ailment, it often goes misunderstood and undiagnosed due to its complex nature.

In his latest online article, consultant in anaesthetics and pain management Dr Rajesh Menon aims to provide a clear understanding of fibromyalgia, its symptoms, causes, and management strategies to help those affected navigate their condition more effectively.

Symptoms of fibromyalgia

Fibromyalgia manifests through a variety of symptoms, making it challenging to identify. The primary symptom is widespread pain, often described as a constant, dull ache lasting for at least three months. This pain occurs on both sides of the body and above and below the waist.

In addition to pain, many individuals experience fatigue, even after sleeping for long periods. This fatigue can disrupt normal daily activities and is often accompanied by sleep disturbances. Patients may also report cognitive difficulties, commonly referred to as "fibro fog," which includes problems with concentration, memory, and mental clarity.

Prevalence - 2-4% worldwide, female to male ratio - 9:1

Other common symptoms include:

• Irritable bowel syndrome (IBS): A gastrointestinal disorder causing abdominal pain, bloating, and irregular bowel movements.
• Headaches and migraines: Frequent, severe headaches or migraines.
• Heightened sensitivity: Increased sensitivity to pain, temperature, light, and sound.
• Mood disorders: Anxiety and depression are prevalent among those with fibromyalgia.

Causes and risk factors

The precise cause of fibromyalgia is still unknown, but it is thought to result from a combination of genetic, environmental, and psychological factors. Abnormal levels of certain chemicals in the brain and changes in the way the central nervous system processes pain signals might contribute to the development of the condition.

Risk factors for fibromyalgia include:

• Genetics: A family history of fibromyalgia may increase susceptibility.
• Infections: Certain illnesses or infections may trigger or exacerbate symptoms.
• Trauma: Physical or emotional trauma has been linked to the onset of fibromyalgia.
• Gender: Women have a higher likelihood of developing fibromyalgia compared to men. Ratio 9:1

Diagnosis and treatment

Diagnosing fibromyalgia can be difficult because there are no specific laboratory tests available for confirmation. Physicians typically rely on patient history, physical examination, and ruling out other conditions with similar symptoms. The American College of Rheumatology’s criteria include widespread pain lasting at least three months and the presence of additional symptoms such as fatigue, waking unrefreshed, and cognitive issues.

In the NHS, fibromyalgia patients are primarily treated by general practitioners (GPs), with no referral to secondary care. This limitation often affects the variety and depth of available treatment options. Most medications used to manage fibromyalgia symptoms are unlicensed for this specific condition, meaning they are not officially approved but can still be prescribed off-label by doctors.

Treatment for fibromyalgia is multifaceted and focuses on managing symptoms rather than curing the condition. Common approaches include:

• Medications: Pain relievers, antidepressants, and anti-seizure drugs can help reduce pain and improve sleep. However, the effectiveness of these medications may vary, and options are limited within the NHS framework. Non-licences drugs like Cannabis, low-dose Naltrexone, melatonin and low-dose intravenous immunoglobin are tried with variable benefits.
• Therapy: Cognitive behavioural therapy (CBT) can assist in coping with pain and addressing any mental health concerns.
• Exercise: Regular physical activity, particularly low-impact exercises like swimming and walking, can alleviate symptoms and improve overall wellbeing.
• Lifestyle changes: Stress management techniques, adequate sleep, weight loss and a balanced diet are crucial in managing fibromyalgia.

Dr Rajesh Menon is an esteemed pain management specialist. You can schedule an appointment with Dr Menon on his Top Doctors profile.