Fibromyalgia
Fibromyalgia is an idiopathic, chronic pain syndrome characterised by widespread pain, persistent fatigue, sleep disturbances and cognitive impairment, commonly termed "fibrofog". Fibromyalgia is either a primary or concomitant, i.e. it either occurs in the absence or presence of other disorders like lupus (SLE) and rheumatoid arthritis, but not secondary, i.e. no underlying condition exist for which improvement of the secondary condition also improves fibromyalgia symptoms.
Fibromyalgia is a common disorder, affecting more women than men (ratio of 9:1) and is most commonly diagnosed between the ages of 20 and 50. There is no cure. There are few, if any, effective treatments available. Fibromyalgia is neither life-threatening nor degenerative and symptoms can vary greatly on a day to day basis. It tends to follow an pattern of relapsing and remitting disease. Periodic relapses or flares occur unpredictably with a marked worsening of symptoms and is followed periods of remission, in which the person partially or fully recovers only to relapse again.
Symptoms
The hallmark of fibromyalgia symptoms are the presence of symptoms in the absence of diagnostic testing. Muscular weakness is present but muscular strength tests normal. Joint pain is present in the absence of joint inflammation. Notably, joint swelling is often reported to be erroneously perceived by the patient but not the diagnostician. Whether the error lies with the patient's perception or the diagnostician's diagnostic capacity is unclear. Joint swelling can be subtle and mild swelling difficult to palpate and blood tests show no signs of inflammation at times of extremely mild occurrences. Pain levels are disproportionate possibly due to high levels of Substance P, which increases the level of pain and the intensity. Breathing difficulties and chest pain is present in the absent of any apparent dysfunction and spirometry tests are normal. Fibromyalgia is a puzzling disease, with very real, often severe and debilitating symptoms.
- Widespread pain in all four quadrants of the body (left, right, upper, lower)
- Morning Stiffness
- Chronic fatigue
- Nausea
- Sleep Disorders: insomnia
- Urinary and Pelvic Problems
- Dizziness
- Chronic Headaches
- Malaise: cold and flu-like symptoms
- Temperomandibular Joint Dysfunction Syndrome
- Multiple Chemical Sensitivity Syndrome
- "Fibrofog": Cognitive or Memory Impairment
- Skin Complaints
- Chest Symptoms and breathing difficulties
- Anxiety
- Depression
- Muscle cramps and twitching
ACR Diagnostic Criteria
The ACR Diagnostic Criteria were originally compiled as inclusion criteria for a research study and it was never intended for general diagnosis. It is well known that fibromyalgia can start in one quadrant and progress to others as it develops and the tender points can be less or more tender depending on the level of disease activity. The ACR has adopted these diagnostic criteria and it is commonly used to diagnose fibromyalgia in the United States as well as in the United Kingdom.
- Pain in each of the four quadrants of the body, i.e. pain on the left and right, as well as above and below the waist, lasting for 3 months or more
- Pain and tenderness at 11 or more of the 18 designated points but rarely elsewhere, when about 4kg of pressure is applied by the diagnostician to the exact point.
The location of the 18 tender points are bilateral and symmetrical so that only 9 locations exist. Nine points on the left side plus nine points on the right side equal eighteen points. The nine locations are as follows:
- Occiput: at the suboccipital muscle insertions
- Low cervical: at the anterior aspects of the intertransverse spaces at C5-C7
- Trapezius: at the midpoint of the upper border
- Supraspinatus: at origins, above the scapula spine near the medial border
- Second rib: upper lateral to the second costochondral junction.
- Lateral epicondyle: 2 cm distal to the epicondyles
- Gluteal: in the upper outer quadrants of buttocks in anterior fold of muscle
- Greater trochanter: posterior to the trochanteric prominence.
- Knee: at the medial fat pad proximal to the joint line
Other conditions with similar symptoms
Fibromyalgia is generally a diagnosis of exclusion. A number of other conditions can produce similar, if not the same, symptoms, including
- Vitamin B12 deficiency
- Vitamin D deficiency
- Gluten intolerance / Celiac Disease
- Heavy metal toxicity - mercury or lead poisoning
- Infectious diseases like Lyme Disease and Influenza
- Chronic Fatigue Syndrome (M.E. / C.F.S.)
- Systemic Lupus Erythematosus (SLE or Lupus)
- Ehlers-Danlos Syndrome
- Joint Hypermobility Syndrome
- Myofascial Pain Syndrome
- Hypothyroidism
- Depression
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