Fibromyalgia (FM) formerly known as Fibrositis, is a chronic disorder characterized by widespread pain that is accompanied by other symptoms such as fatigue, sleep disturbances, headaches, and cognitive dysfunction. FM is caused by a dysfunction in the central nervous systems detection of and response to pain. As a result, the patient experiences an amplification of pain. Sleep disturbance in FM is a consequence of HPA axis dysfunction. The peripheral nervous system also appears to play a role in this condition. Global prevalence of FM is estimated to be about 2.7% of the population. FM is more common in women with a female to male ratio of 3:1. While FM can develop at any age, in women it is most commonly diagnosed in middle age. According to CDC, the annual cost of healthcare for FM patients is $9573 per patient. FM is the second most common rheumatic disorder after osteoarthritis. FM can have detrimental effects on patient’s lives and interfere with their work and personal relationships. According to a study, 35% of FM patients report difficulties in performing daily activities. Fibromyalgia is a common and complex condition characterized by widespread musculoskeletal pain, accompanied by mood, memory, sleep, and fatigue issues. Studies show that fibromyalgia intensifies pain sensations by altering the way your brain processes pain signals.

The exact cause of FM is unclear but both genetics and environment appear to play a role in the development of this condition. Genetic Support of genetic association comes from several studies that show first degree relatives of FM patients are 9 times more likely to get the disorder as compared to general population. In addition, genetic studies reveal an association with dysfunction in the serotonergic, dopaminergic, and catecholaminergic pathways involved in pain transmission and modulation. Catecholaminergic pathways include neurotransmitters dopamine, epinephrine and norepinephrine. Dopamine and serotonin are neurotransmitters that affect the way the body interprets pain. Gene association studies found single nucleotide polymorphism in three genes: gamma-aminobutyric acid receptor subunit- β 3 (GABRB3), trace amine receptors (TAAR1) and guanylate binding protein 1 (GBP1) that differed in FM patients and healthy controls. Environmental factors and infection These factors may include stress, trauma, and certain infections like Epstein Barr virus and Lyme disease. Studies have also implicated early sexual abuse in development of FM. Evidence suggests the role of cytokines, which are linked to the immune inflammatory process, in the pathogenesis of FM. Pro-inflammatory cytokine such as IL-1RA, IL-6, and IL-8 have been found to be increased in FM patients.

Diagnosis of fibromyalgia can be a challenging task since its symptoms can mimic or be associated with many other health conditions. Nevertheless, fibromyalgia diagnosis is carried out purely on clinical grounds, depending on the patient’s physical examination and doctor’s history. To be diagnosed with fibromyalgia, you must have had at least three months of persistent pain as well as pain and tenderness in at least 11 out of 18 tender points. These tender points may include:    Thighs    Shoulders    Ribcage    Neck    Lower back    Knees    Chest    Buttocks    Elbows(arms) Also, before you are diagnosed with this syndrome, the tender points must be analyzed through a digital palpation with about 4 kg of pressure. During this analysis, the pain points are pressed and the patient has to state whether the sensation is “painful” or “irritating.” If the patient feels an unbearable pain rather than a mere irritation in most tender points, then he/she may be suffering from fibromyalgia disorder. Your doctor may also inquire about your stress levels, sleep disturbances and fatigue. No definite x-rays or blood tests are used during the diagnosis of fibromyalgia.  Other tests such as thyroid functionality, rheumatoid factor, cyclic citrullinated peptide test, erythrocyte sedimentation rate and a complete blood count may be conducted to rule out other possible medical conditions.

There is no cure for Fibromyalgia. Treatment options are primarily aimed at relieving your pain, increasing restorative sleep, and improving the physical functioning of your body. There exists a number of treatment options including medication, therapy, and alternatives (such as acupuncture). Treatment Through Medication There exist a variety of medications that can be taken to relieve pain, and improve sleep, for those patients suffering from fibromyalgia, including: Anti-seizure drugs: These type of medications are usually used to treat epilepsy, but tend to be helpful in reducing a handful of pain conditions. For instance, Lyrica (pregabalin) has long been used to treat fibromyalgia, while Neurontin (gabapentin) has the potential to reduce fibromyalgia symptoms. Antidepressants: Your doctor may prescribe muscle relaxants such as cyclobenzaprine, which may help you get to sleep. Other medications such as Savella (milnacipran), and Cymbalta (Duloxetine) may help ease the fatigue and pain usually associated with fibromyalgia. Neuromodulating antiepileptics and antidepressants have also been known to substantially reduce the symptoms of fibromyalgia. For instance, antidepressants such as norepinephrine and serotonin provide tolerability and efficacy to deal with fibromyalgia, as they re-uptake body inhibitors and relieve pain by increasing the activity of noradrenergic antinociceptive pathways. Pain relievers: Pain relievers such as Ultram (tramadol), naproxen, ibuprofen, and acetaminophen are recommended to help ease the pain.

Owing to its complexity, FM remains a difficult condition to treat despite an increase in our understanding of FM over the years. Patients are rarely cured despite multidisciplinary treatment approaches. A greater understanding of pathogenesis of FM is needed to develop new therapeutics for enhancing current treatment strategies. Research is also needed to assess whether combination therapies provide better outcomes than monotherapy. Analysis of multicomponent treatment strategy for FM may work short time in improving symptoms but there is no evidence of its efficacy in the long term.