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Written by Madeline Leong, Pharmacist

What is Fibromyalgia

Fibromyalgia is a disorder where there is generalized musculoskeletal pain, which is usually accompanied with fatigue. The pain usually attacks muscles and soft tissues, rarely on joints. It might also be accompanied with sleep, memory and mood issues. The global prevalence of Fibromyalgia is 2.7% globally. Women are more likely to have this disorder and it is higher chance with age.

Symptoms

Fibromyalgia has many symptoms that tend to vary from person to person, such as:

 

  • Widespread pain (twitching, burning and tightness)
  • Extreme sensitivity
  • Stiffness
  • Fatigue
  • Poor sleep quality
  • Cognitive problems (‘fibro-fog’) 
  • Headaches
  • Irritable bowel syndrome (IBS)
  • Dizziness and clumsiness
  • Sensitivity to cold, heat, sound or light
  • An overwhelming urge to move your legs (restless legs syndrome) 
  • Tingling, numbness, or burning sensations in your hands and feet 
  • In women, unusually painful periods
  • Anxiety
  • Depression

Possible causes

  1. Genetics might be a factor as most of the patients reported to have family history of same disorder. This might be due to certain genetic mutation.
  2. Some infections may trigger or aggravate the symptoms
  3. Physical and emotional trauma.

Diagnosis

There is no specific lab test or imaging study that can be used to diagnose fibromyalgia. Clinician uses the 2010/2011 American College of Rheumatology (ACR) classification criteria to aid in diagnosis of fibromyalgia. Patient need to be ruled out of having other disorder which present with similar symptoms, for example rheumatoid arthritis/lupus/multiple sclerosis and some other autoimmune diseases. Those suspected to have fibromyalgia will have to answer the questions as shown in Figure 1 and meet criteria as per advised by the ACR. The criteria were as below (last revised in 2016):

  1. Widespread pain index (WPI) ≥7 and Symptom Severity Scale (SSS) score ≥5 OR WPI 4–6 and SSS score ≥9
  2. Generalized pain, defined as pain in at least 4 of 5 regions, is present (Left upper, right upper, left lower, right lower, axial)
  3. Symptoms have been generally present for at least 3 months.

Treatment

Similar to many other diseases, fibromyalgia cannot be cure, it can only be controlled. Treatment can be categorized to pharmacological and non-pharmacological approaches:

Pharmacological

  • Medicines that influence the transmission of sensory signals via central nociceptive pathways
  • Symptomatic management with the use of pain killers
  • Antidepressant
  • Antiepileptic
  • Anxiolytic

Non-pharmacological

  • Patient education is very important. Patients need to be educated on what to expect from this disorder and how they can anticipate to improve and control the symptoms
  • Physical activities and exercise such as yoga and taichi might help to relieve the symptoms
  • Meditation and relaxation
  • Traditional approaches like acupuncture and massage
  • Sleep hygiene – patient need to practice good sleeping routine and set a relaxing environment for rest
  • Cognitive behavioral therapy

Fact or myth?

  1. Fibromyalgia and arthritis are the same condition— MYTH

Fibromyalgia affects mostly muscles and soft tissues where arthritis mostly affects joints. Inflammation usually occurs in arthritis but not fibromyalgia.

  1. Exercise should be avoided in patient with Fibromyalgia — MYTH

According to American College of Rheumatology, exercise is very effective in reducing symptoms of fibromyalgia. Exercises recommended include aerobic exercise like walking, biking and swimming. Stretching and strength training is also recommended.

References:

  1. Mayoclinic (2017) Fibromyalgia. [Online] Available at: https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780 [assessed 05/04/2020]
  2. MIMS Rheumatology. Fibromyalgia. [Online] Available at: (https://specialty.mims.com/fibromyalgia/signs%20and%20symptoms?channel=rheumatology [assessed 05/04/2020]
  3. M.Arnold, K.B.Gebke, E.H.S.Choy. (2016) Fibromyalgia: management strategies for primary care providers. Int J Clin Pract [online] 2016 Feb; 70(2): 99–112. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6093261/ [assessed on 05/04/2020]
  4. Lesley M. Arnold, MD; Daniel J. Clauw, MD; L. Jean Dunegan, MD, JD; and Dennis C. Turk. (2012) Mayo Clin Proc. [Online] 2012;87(5):488-496. Available at: https://www.mayoclinicproceedings.org/article/S0025-6196(12)00299-6/fulltext [assessed 05/04/2020]
  5. Cherney, K. Holland, S.Watson. (2019) Everything You Need to Know about Fibromyalgia .[Online] Healthline. Available at: https://www.healthline.com/health/fibromyalgia#symptoms [assessed 05/04/2020]
  6. (2019) What is Fibromyalgia? [Online] Available at: https://www.webmd.com/fibromyalgia/guide/what-is-fibromyalgia#1 [assessed 05/04/2020]
  7. Wolfe, D.J.Clauw, M.Fitzcharles et al. (2010) The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity. Arthritis Care & Research ;62(5):600-610. Available at: https://www.rheumatology.org/Portals/0/Files/2010_Preliminary_Diagnostic_Criteria.pdf [assessed 05/04/2020]
  8. Practical Pain Management. (2016) Fibromyalgia: What Clinicians Need to Know. [Online] Available at: https://www.practicalpainmanagement.com/pain/myofascial/fibromyalgia/fibromyalgia-what-clinicians-need-know [assessed 05/04/2020]
  9. Wolfe F, Clauw DJ, FitzCharles M, Goldenerberg D, Häuser W, Katz RS, Russell IJ, Mease PJ, Russell A, Walitt B. (2016) Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria [abstract]. Arthritis Rheumatol.2016; 68 (suppl 10). Available at: https://acrabstracts.org/abstract/2016-revisions-to-the-20102011-fibromyalgia-diagnostic-criteria/. [Accessed April 7, 2020]
  10. Philips (2018) 10 Myths and Facts of Fibromyalgia. [online] Everyday Health. Available at: https://www.everydayhealth.com/fibromyalgia/myths-facts-about-fibromyalgia/[assessed 05/04/2020]
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