Getting diagnosed with one of the disorders below may not always rule out fibromyalgia, because several conditions may overlap or coexist with fibromyalgia, and have similar symptoms. Like fibromyalgia, a number of these conditions also cannot easily be diagnosed. It is not clear whether these conditions cause fibromyalgia, are risk factors for the disorder, have causes in common with fibromyalgia, or have no relationship at all with it.
This reduced response might explain why fibromyalgia patients are likely to have depression, and are less responsive to opioid painkillers. People with fibromyalgia have decreased activity in opioid receptors in parts of the brain that affect mood and the emotional aspect of pain.
Abnormal Pain Perception and Substance P. Fibromyalgia may involve too much activity in the parts of the central nervous system that process pain (the nociceptive system). Brain scans of fibromyalgia patients have found abnormalities in pain processing centers. For example, researchers have detected up to three times the normal level of substance P (a chemical messenger associated with increased pain perception) in fibromyalgia patients. Some studies have suggested that people with fibromyalgia may perceive pain differently than healthy people.
Studies have reported higher rates of severe emotional and physical abuse in patients with fibromyalgia compared with the general population. However, women who have been raped may face an increased risk for the disease. Most often, the abusers are family members or partners. A history of sexual abuse does not seem to be a risk factor for fibromyalgia.
If several of the above symptoms are present, and none of the physical symptoms (particularly the tender points) of fibromyalgia exist, the condition is most likely major depression.
Researchers condtinue to investigate the link between fibromyalgia and sleep.
Fibromyalgia is also known as fibrositis or fibromyositis. Fibromyalgia is a condition that causes lasting, and sometimes debilitating muscle pain and fatigue. No one knows exactly what causes it, but it may be triggered by injuries, emotional trauma, or viral infections.
Experts have come up with criteria to help recognize MCS:
It would also include a symptom severity scale (SSS), which rates on a scale of 0 to 3 the severity of three common fibromyalgia symptoms:. New criteria. The ACR's proposed new criteria would replace the tender point examination with a widespread pain index (WPI), which counts the number of areas where the patient has felt pain in the last week.
Physical injuries, emotional trauma, or viral infections may trigger the disorder, but no one trigger has been proven to cause primary fibromyalgia. In the most common type of fibromyalgia, the cause is unknown.
Fibromyalgia has symptoms that resemble those of some rheumatic illnesses, including rheumatoid arthritis and lupus (systemic lupus erythematosus). The pain in fibromyalgia, however, does not appear to be due to autoimmune factors, and there is little evidence to support a role for an inflammatory response in fibromyalgia. These are autoimmune diseases in which a defective immune system mistakenly attacks the body's own healthy tissue, producing inflammation and damage.
During this medical history, patients should l the doctor about any drugs they take, including vitamins and over-the-counter or herbal medications.
Unlike ordinary periods of sadness, an episode of major depression can last for many months. Such emotions are temporary and related to the condition. Depressed feelings in people with fibromyalgia can be normal responses to the pain and fatigue caused by this syndrome. They are not considered to be a depression disorder.
In 1990, the ACR set the following criteria for classifying fibromyalgia:
Tender points are located in the following areas:. When the doctor presses on a tender point, the pain is very localized and intensely painful (not just tender). Pain in at least 11 of 18 specific areas called tender points on the body. B.
The health care provider will also examine the nails, skin, mucus membranes, joints, spine, muscles, and bones to help rule out arthritis, thyroid disease, and other disorders.
An in-depth report on the causes, diagnosis, treatment, and prevention of fibromyalgia.
The 18 fibromyalgia tender points are located throughout the body. According to the American College of Rheumatology, a diagnosis of fibromyalgia requires widespread body pain plus localized pain in 11 of these 18 specific points.
This pain must appear in all of the following locations:. Widespread pain must be present for at least 3 months. A.
Studies report an increased prevalence of fibromyalgia among family members. Children and siblings of people with fibromyalgia are eight times more likely to develop the condition than the general population. Family members are also more sensitive to pain, and more likely to have related conditions such as irritable bowel syndrome, temporomandibular disorder, or headaches.
Symptoms of major depression include the following:
Lyme disease is a bacterial disease transmitted by ticks. If fibromyalgia patients are incorrectly diagnosed and treated for Lyme disease with long courses of antibiotics, the drugs may have serious side effects. Some experts believe that 15 - 50% of patients referred to clinics for Lyme disease actually have fibromyalgia. Lyme Disease. But if this disorder isn't diagnosed right away or it comes back, it may be mistaken for fibromyalgia. Health care providers can usually (but not always) diagnose Lyme disease correctly using blood tests that identify antibodies directed at the bacteria that cause it.
A doctor should always take a careful personal and family medical history, which includes a psychological profile and history of any factors that might indicate other conditions, such as:
Symptoms of a migraine attack may include heightened sensitivity to light and sound, nausea, vision problems (auras), speech difficulty, and intense pain that is mainly on one side of the head.
However, only 18 to 36% of fibromyalgia patients have major depression. Studies report that 50 to 70% of fibromyalgia patients have a lifetime history of depression. The link between psychological disorders and fibromyalgia is very strong. Major Depression.
Chronic migraine sufferers who do not benefit from usual therapies may also have fibromyalgia. Chronic Headache. Chronic primary headaches, such as migraines, are common in fibromyalgia patients. Some experts believe that migraine headaches and fibromyalgia both involve defects in the systems that regulate certain chemical messengers in the brain, including serotonin and epinephrine (adrenaline). Low levels of magnesium have also been noted in patients with both fibromyalgia and migraines.
The disorder usually occurs in people ages 20 - 60, though it can start at any time. In one study, cases of fibromyalgia increased with age and reached a frequency of more than 7% among people in their 60s and 70s. Others note that fibromyalgia is most common in middle-aged women. Some studies have noted peaks at around age 35.
An estimated 30 - 40% of patients have had to quit work or change jobs. About half of all patients have difficulty with routine daily activities, or are unable to perform them. Patients with either CFS or fibromyalgia are more likely to lose their jobs, possessions, and support from friends and family than are people suffering from other conditions that cause fatigue.
The tender points may change in location and sensitivity over time. A doctor may recheck tender points that do not respond the first time in patients who have other fibromyalgia symptoms.
Restless Legs Syndrome. RLS is an unsettling and poorly understood movement disorder that is sometimes described as a sense of unease and weariness in the lower leg that is aggravated by rest and relieved by movement. About 15% of people with fibromyalgia have restless legs syndrome (RLS).
These risk factors include:. Some evidence suggests that several factors may make people more susceptible to fibromyalgia.
Current research is examining variations in certain genes in people with fibromyalgia. Genetic, environmental, and psychological factors may all be involved in fibromyalgia. These changes involve the stress response and may affect the way a person processes pain.
Because no laboratory test can confirm fibromyalgia, doctors will usually first test for similar conditions. Between 10% and 30% of all doctor's office visits are due to symptoms that resemble those of fibromyalgia, including fatigue, malaise, and widespread muscle pain.
Areas in the brain that are responsible for the sensation of pain react differently in fibromyalgia patients than the same areas in healthy people. Many experts believe that fibromyalgia is not a disease, but is rather a chronic pain condition brought on by several abnormal body responses to stress.
Fibromyalgia can be mild or disabling, and the emotional toll can be substantial. People with fibromyalgia experience greater psychological distress and a greater impact on quality of life than those with other conditions, such as chronic low back pain.
This type of fibromyalgia appears in adolescents, more commonly in girls. Juvenile primary fibromyalgia is uncommon, but studies indicate that its incidence may be increasing. It typically starts after age 13 and peaks at age 14. Symptoms are similar to those of adult fibromyalgia, but outcomes may be better in young people. Juvenile Primary Fibromyalgia.
These spots must be painful when pressed, not simply tender. The physical exam may not reveal much, other than the tender spots that are included in the diagnostic criteria. For fibromyalgia to be diagnosed, these tender sites should not show signs of inflammation (redness, swelling, or heat in the joints and soft tissue).
In general, children with fibromyalgia most often have sleep disorders and widespread pain. Symptoms in Children. They may also experience fatigue, stress, depression, and headaches.
Disorders Affected by the Sympathetic (also called Autonomic) Nervous System. Other conditions that commonly occur with fibromyalgia include:.
Disturbances in memory and concentration are also very common. These conditions often go undiagnosed. Up to a third of fibromyalgia patients have depression. Depression and Mood.
Studies suggest that changes in growth hormone likely stem from the hypothalamus in the brain. Low levels of growth hormone may lead to impaired thinking, lack of energy, muscle weakness, and intolerance to cold. Some studies have reported low levels of insulin-like growth factor-1 (IGF-1) in about a third of fibromyalgia patients. IGF-1 is a hormone that promotes bone and muscle growth. Although researchers have not found a link between IGF-1 levels and fibromyalgia, growth hormone levels in the blood may be a marker of the disorder. Low IGF-1 Levels.
Morning stiffness is common, and patients may also experience fever, weight loss, and fatigue. It is important to diagnose polymyalgia rheumatica early with an erythrocyte sedimentation rate (ESR) test, because some PMR patients have a related condition (giant cell arteritis) that may lead to blindness if not treated. Polymyalgia rheumatica is a condition that causes pain and stiffness. Tender points are also present with this disorder, although they almost always occur in the hip and shoulder area. Polymyalgia rheumatica usually responds to low doses of a steroid medication such as prednisone. It generally occurs in older women. Polymyalgia Rheumatica.
It can take an average of 5 years to finally get a diagnosis. It is important to diagnose fibromyalgia as soon as possible, so treatment can be started. But because there is no clear method (such as laboratory or imaging tests) to diagnose the condition, as many as three out of every four people with fibromyalgia remain undiagnosed.
Another three points can be added for these additional symptoms:
Chronic Fatigue Syndrome. The main differences are:. They are also treated almost identically. The two disorders share most of the same symptoms. A doctor can diagnose either disorder based only on symptoms reported by the patient. There is a significant overlap between fibromyalgia and chronic fatigue syndrome (CFS). As with fibromyalgia, the cause of CFS is unknown.
Drugs and Alcohol. Fatigue is a side effect of many prescription and over-the-counter medications, such as antihistamines. Health care providers should consider medications as a possible cause of fatigue if a person has recently started, stopped, or changed medications. Constant fatigue is also a symptom of drug and alcohol dependency or abuse. Withdrawal from caffeine can also produce depression, fatigue, and headache.
Tests that are done to diagnose diseases with similar symptoms may include:
Lower levels of stress hormones lead to impaired responses to psychological or physical stresses. Researchers have also found abnormalities in the hormone system known as the hypothalamus-pituitary-adrenal gland (HPA) axis. (Examples of physical stress include infection or exercise.). The HPA axis controls important functions, including sleep, the stress response, and depression. Stress Hormones. Changes in the HPA axis appear to produce lower levels of the stress hormones norepinephrine and cortisol.
Psychological and social factors are not primary causes of fibromyalgia, but they may contribute to the condition in three ways:
The main symptom of fibromyalgia is pain. The exact locations of the pain are called tender points. The pain can be in one place or all over the body. Pain. Fibromyalgia pain is often described as:.
To meet the criteria for a fibromyalgia diagnosis, a patient would need to have seven or more pain areas and a symptom severity score of five or more; or three to six pain areas and a symptom severity score of nine or more. The symptoms must have been present for at least 3 months. The WPI and SS scores are totaled to create a final score of between 0 and 12.
Multiple chemical sensitivity (MCS) is a term for conditions in which certain chemicals cause symptoms that are similar to CFS or fibromyalgia. Multiple Chemical Sensitivity. Because everyone is exposed to many chemicals on a daily basis, it is very difficult to determine whether chemicals are responsible for specific symptoms. As with CFS and fibromyalgia, MCS may be a medical or psychological problem.
Women may be especially likely to develop fibromyalgia during menopause. Nine out of 10 fibromyalgia patients are women.
Changes appear to occur in several brain chemicals, although no regular pattern has emerged that fits most patients. Fibromyalgia may be a result of the effects of pain and stress on the central nervous system that lead to changes in the brain, rather than a brain disorder itself. Many hormonal, metabolic, and brain chemical abnormalities have been described in studies of fibromyalgia patients.
About 5 million Americans, or 2% to 5% of adults have fibromyalgia. The condition affects women more often than men.
Post-traumatic stress disorder (PTSD) or chronic stress may play a strong role in the development of fibromyalgia in some patients. PTSD, an anxiety disorder, is a reaction to a specific traumatic event. Some evidence indicates that PTSD actually causes changes in the brain, possibly from long-term overexposure to stress hormones.
Some report that their fatigue is more distressing than their pain, because it interferes with their ability to enjoy life. Many patients complain that they can't get to sleep or stay asleep, and they feel tired when they wake up. Some experts believe that if a person does not have sleep problems, the condition may not be fibromyalgia.
Fatigue and sleep disturbances are almost universal in patients with fibromyalgia. It is not clear whether fibromyalgia leads to poor sleeping patterns or if the sleep disturbances come first. Restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) are also common. Fatigue and Sleep Disturbances.
No blood, urine, or other laboratory tests can definitively diagnose fibromyalgia. If these tests show abnormal results, the doctor should look for other disorders.
The following symptoms may also occur with fibromyalgia:. Other Symptoms.
Some experts believe these disorders interact so often that they may all be part of one general condition. Examples are:. Certain stress-related disorders are also common with fibromyalgia, and have overlapping symptoms.
Because many patients do not meet the current fibromyalgia criteria, the American College of Rheumatology (ACR) has proposed introducing a new set of diagnostic criteria that take into consideration symptoms such as fatigue, sleep disturbances, and cognitive problems, in addition to pain.
Certain factors may inappropriay trigger a person's stress response and contribute to the development of fibromyalgia, including:
Fibromyositis; Fibrositis; Myofascial pain syndrome Diagnosis Treatment.
Some research has found muscle abnormalities in fibromyalgia patients, including:
Myofascial pain syndrome can be confused with fibromyalgia and may also occur with it. Unlike tender points, trigger points are often small lumps, about the size of a pencil eraser. Unlike fibromyalgia, myofascial pain tends to occur in trigger points, as opposed to tender points, and typically there is no widespread, generalized pain. Trigger-point pain occurs in tight muscles, and when the doctor presses on these points, the patient may experience a muscle twitch. Myofascial Pain Syndrome.
Serotonin. Lower serotonin levels have been noted in some patients with fibromyalgia. Of particular interest to researchers is serotonin, an important nervous system chemical messenger found in the brain, gut, and other areas of the body. Serotonin helps create feelings of well-being, adjusts pain levels, and promotes deep sleep.
The doctor may suggest follow-up psychological profile testing if laboratory results do not indicate a specific disease.
Some doctors believe that fibromyalgia is simply an extreme type of chronic fatigue syndrome. However, evidence indicates that the two disorders are distinct, and each has its own treatments.
The hypothalamus is a highly complex structure in the brain that regulates many important brain chemicals.
To date, none of these abnormalities has a clearly defined relationship with fibromyalgia.
Fibromyalgia should be suspected in any person who has muscle and joint pain with no identifiable cause. Fibromyalgia criteria can be helpful, particularly if the patient does not have another disorder, such as depression or arthritis, which could complicate the diagnosis. Failure to meet the criteria, however, does not rule out fibromyalgia.
Some studies have found that people who have both psychological disorders and fibromyalgia are more likely to seek medical help, compared with patients who simply have symptoms of fibromyalgia. If this is the case, study results may be biased, finding a higher-than-actual association between depression and fibromyalgia.
This mismatch in sensory signals might enhance the perception of pain. This increase in awareness is called generalized hypervigilance. Some fibromyalgia patients may be oversensitive to external stimulation, and overly anxious about the sensation of pain. Fibromyalgia patients have been found to have greater awareness of, or less tolerance for, movement problems (such as tremor) that don't match their expected sensory feedback. Fibromyalgia patients also seem to be more sensitive to sounds.
Fibromyalgia side effects