Constantly experience muscle pain in various parts of the body. Insomnia, difficulty concentrating and fatigue are things that you go through every day. But even after multiple visits to the doctor, several X-rays and MRIs, he has not been diagnosed with any disease that explains his condition. In fact, he has even been forced to wonder if everything is “only in his head.” After seeking help from several doctors and support groups on the Internet, he has begun to wonder if he could be affected by fibromyalgia . Because the painful parts of the body in fibromyalgia patients do not show any damage or physical injury, until recently it was believed that the condition was a psychological disorder. However, research now indicates that fibromyalgia could have a pathophysiological basis. Fibromyalgia, which affects more than 3-6% of the world’s population, can be difficult to understand and diagnose. In fact, the condition is not diagnosed in 3 out of 4 people.
Causes and Risk Factors:
The exact cause of fibromyalgia is unknown. However, studies have revealed that the condition could be triggered by injuries, emotional trauma, viral infections, hormonal changes or medications. Some of the risk factors for fibromyalgia are as follows:
- Gender: Nine out of ten patients with fibromyalgia are women.
- Age: Fibromyalgia commonly occurs in people between 20 and 60 years of age, peaking around 35 years of age. You can also develop the condition in adolescence, but it is uncommon.
- Family history: If your father, mother or brother suffers from fibromyalgia, you are 8 times more likely to develop the condition.
- Stress level: Having a stress environment at home or at work can increase the risk.
- Trauma: People who have suffered traumatic incidents in their childhood could develop fibromyalgia when they are older.
Criteria for the Diagnosis of Fibromyalgia:
There are no tests that accurately diagnose fibromyalgia. In some cases, the patient continues for years without a diagnosis. Because fibromyalgia patients often suffer from diseases such as depression and arthritis, the precise diagnosis of the condition is complicated and can take more than 5 years. However, the American College of Rheumatology has recently issued a series of criteria that have facilitated the diagnostic process. To be diagnosed with fibromyalgia, your symptoms must be present for a minimum period of 3 months. There are 3 categories in which you are evaluated.
1. Physiological Symptoms (Generalized Pain Index):
Referred to as sensitive points, there must be regions in your body that are marked by localized and extreme pain when touched or pressed. To be diagnosed with fibromyalgia, you must experience muscle pain in more than 5 of these areas.
- Any side of the back of the neck, directly below the hairline.
- Any side of the front of the neck, above the collarbone.
- Either side of the chest, directly below the collarbone.
- Any side of the upper back, around the area where the neck and shoulder meet.
- Any side of the upper back, next to your spine.
- Either side of the lower back, just below the waist.
- Either side of the buttocks under the hip bones.
- The inside of any of the arms around your inner elbow.
- Either of the two kneecaps.
2. Psychological Symptoms (Symptom Severity Scale):
Apart from the sensitive points, you would also have to rate your severity level on a scale of 0-3. To be considered for diagnosis, you must have a score of 7-9 on the severity scale.
- Sleep disturbance
- Difficulty concentrating or remembering details
3. Additional Symptoms:
Together with the score in the previous points, you will be evaluated based on any additional symptoms you may experience. Some of these are as follows.
- Digestive problems such as irritable bowel syndrome
After taking into account all the above points and making sure that the symptoms are not the result of other similar diseases (such as thyroid or liver disease), the doctor will proceed to diagnose a patient with muscle pain. However, this set of criteria is not the ultimate basis of the diagnosis, since the condition could manifest itself differently in several people. Although this is a big leap in our understanding of fibromyalgia, more research is needed to help us identify the condition more accurately.
A New Vision of our Understanding of Fibromyalgia:
A recent study has proposed new perspectives in our understanding of the disease. The study analyzed 37 fibromyalgia patients and 35 healthy individuals. The participants underwent a series of stimuli of three types: visual, auditory and tactile. An MRI recorded the brain responses of the participants to each stimulation. It was observed that different parts of the brains of fibromyalgia patients responded differently to stimulations. The researchers identified a “signature” of brain-based fibromyalgia, which perceived some stimuli as painful muscle pain. This signature was absent in healthy participants. In another study, it was observed that the parts of the body that felt the pain revealed that they contained an excessive amount of blood vessels.
“The greater amount of blood vessels could be responsible for the high sensation of pain”.
The results of this study suggest the possible involvement of the brain and nervous system in fibromyalgia. Although experts believe that the results and the method chosen by the study are too simplistic, they agree with the promises it has. If further research warrants, the results could help in the effective diagnosis and treatment of muscle pain. In fact, a new line of treatment – Emotional Awareness and Expression Therapy – that takes into account the brain pattern of patients has helped several people with fibromyalgia.