Chronic widespread pain: what causes it and how is it diagnosed?

Chronic widespread pain (CWP) and fibromyalgia affect 2-4% of people, women more often than men.

 

We recently spoke with leading consultant pain management specialist , Dr Salmin Aseri, to find out about chronic widespread pain, its causes, symptoms and how it's diagnosed.
 

What is chronic widespread pain (CWP)?

It's estimated that somewhere between 1.8 million and 2.9 million people in the UK have fibromyalgia. The condition commonly develops between the ages of 25 and 55, however, children can also get it. Studies show that more women are diagnosed with fibromyalgia than men.

CWP/FMS is, in essence, the presence of chronic widespread pain. It is often with other chronic painful bodily symptoms and runs a fluctuating, relapsing and remitting course. It has an overall good prognosis.
 

What causes chronic widespread pain (CWP)?

We don't know the exact reason why people get fibromyalgia. However, there does seem to be a common link with things such as a traumatic event, arthritis, mental health and well-being.

Fibromyalgia isn't caused by injury or damage to the body. However, it does increase the sensitivity of your nerve endings, which means you could feel pain from a small amount of minor knocks or pressure.

There is one theory that the condition is caused by problems with a person's central nervous system – this controls all the sensations and movements the body makes.

Studies show that parts of the brain that register pain react differently if you have fibromyalgia. It means you feel pain when other people feel stiff or uncomfortable.

Lack of good quality sleep can worsen pain and might even cause pain.

Unhappiness, pain, depression and stress can all reduce the quality of your sleep.

Symptoms often start after an accident, illness or a time of emotional stress and anxiety.

When you're depressed or low, pain from fibromyalgia can also feel worse. Your pain can also make you feel more stressed. Unlike conditions, such as arthritis, the pain you feel with fibromyalgia isn't caused by visible damage to your body or inflammation.

This doesn't mean the symptoms of fibromyalgia are "imagined" or unreal but anxiety, physical or mental trauma, and sleep disturbance are factors that are thought to affect the condition.
 

What are the symptoms?

Symptoms:

• pain – it may feel as though you've got pain that spreads throughout your entire body and some parts – such as your neck and back – feeling particularly painful.

• fatigue, tiredness and generally feeling like you have no energy.

• sleeping badly – waking up feeling unrested

• stiffness and aching – often feels worse during or after exercise.

It's common for your condition to flare-up, this can make your symptoms suddenly worse.
 

Fibromyalgia can also cause:

• Poor concentration and forgetfulness

• worry, stress or low mood

• numbness, tingling or swelling of your feet and hands

• headaches

• restless legs syndrome – an uncomfortable, tingling feeling in your legs, especially at night.

• feeling low, weepy or irritable

• feeling like you need to wee urgently, especially at night

• menstrual periods that are painful

• stomach pain, diarrhoea and constipation – sometimes diagnosed as irritable bowel syndrome (IBS)

• increased sensitivity to things like sound, cold, knocks and bumps

• tender or overly sensitive joints and muscles
 

How is chronic widespread pain diagnosed?

A physical exam can be helpful to detect tenderness and can help exclude other causes of muscle pain. There are no diagnostic tests (such as blood tests or X-rays) for this issue. You may need tests to rule out other health problem that might be confused with fibromyalgia.

You will be asked to describe your widespread body pain as this is a feature of fibromyalgia, health care providers will ask you to describe your pain. This may help tell the difference between fibromyalgia and other diseases that have similar symptoms. Other conditions such as polymyalgia rheumatica and hypothyroidism (underactive thyroid gland) and can sometimes mimic fibromyalgia. Blood tests can tell if you have either of these problems. Fibromyalgia is sometimes confused with lupus or rheumatoid arthritis. There is a difference in the symptoms, blood tests and physical findings that will help your health care provider detect these health issues. Unlike fibromyalgia, these rheumatic diseases cause inflammation in the tissues and joints.

ACR 2010 Criteria required for a Fibromyalgia Diagnosis

1. Pain and symptoms over the last week, based on the total of a number of painful areas out of 19 parts of the body plus the level of severity of these symptoms:

a. Fatigue

b. Waking unrefreshed

c. Cognitive (thought or memory) problems.

Also, a number of other general physical symptoms.

2. Symptoms that last at least three months at a similar level.

3. No other health problems would explain the pain and other symptoms
 

If you currently suffer from chronic pain, we recommend booking an appointment with a leading consultant pain management specialist such as Dr Salmin Aseri. Visit his Top Doctors profile today for more information.