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A difficult condition to diagnose, Fibromyalgia is characterised by widespread pain in the body.
DAWN CARNES, CAROL FAWKES & ELENA WARD, NATIONAL COUNCIL FOR OSTEOPATHIC RESEARCH, UK
ibromyalgia, sometimes called fibrositis, is characterised
by widespread pain in the body. Symptoms include
multiple muscular tender points, hyperalgesia, allodynia,
symptoms of fatigue, unrefreshing sleep and cognitive
dysfunction (some patients experience a combination
of these). Other reported symptoms include headaches, irritable
bowel syndrome, urinary urgency, feeling irritable, pins and
needles and/or a feeling of swelling in the hands and feet in the
absence of actual swelling.
WHO GETS IT?
Fibromyalgia affects more women than men and commonly
presents in people aged 30–50, although it can affect people
at any age. The reported prevalence of fibromyalgia varies,
possibly due to the challenges in diagnosing the condition and its
similarities with other conditions. Potentially as many as one in 25
people globally has the condition.
WHAT CAUSES IT
The causes of fibromyalgia are still unknown but an increasing
body of evidence shows an interaction between psychological
and social factors, with pain processing mechanisms playing an
important role in the condition, rather than actual tissue damage
and inflammation. There may also be a genetic factor.
Manifestations of central sensitisation have been identified in
patients with fibromyalgia and other chronic pain conditions such
as chronic fatigue syndrome and chronic whiplash-associated
disorder. Studies have investigated pain processing in patients
with fibromyalgia and have found less-effective pain inhibition
pathways; abnormal signalling in areas of the brain involved in
processing pain and emotions; and differences between inhibitory
and excitatory neurotransmittors in cerebrospinal fluid samples in
patients with fibromyalgia, compared with controls. Whether these
changes are causative is still unknown.
HOW IS FIBROMYALGIA DIAGNOSED?
Diagnosis is mostly based on clinical presentation, as there are no
useful blood tests or imaging methods for making a diagnosis. The
presence of tender points, outlined in the American College of
Rheumatology (ACR) 1990 criteria, are sometimes used, as these
are convenient to assess quickly in clinic. However, they do not
take into account the other associated symptoms of fibromyalgia
and tender points are not exclusively present in patients with
fibromyalgia. Furthermore, it was found that up to 25 per cent of
patients with fibromyalgia do not fit the ACR 1990 criteria. The
ACR criteria have since been updated and no longer include digital
palpation of the tender points. The ACR 2010 criteria comprise two
scales: the Widespread Pain Index and the Symptom Severity Index,
and take into account the duration of the patient’s symptoms.
Fibromyalgia can occur in conjunction with other painful diseases,
such as osteoarthritis, rheumatoid arthritis and systemic lupus
erythematosus. It is, therefore important not to ascribe all of a
patient’s symptoms to fibromyalgia, and to refer patients to their GP
if you suspect that there may be another cause for their symptoms.
There is currently no cure for fibromyalgia, but some treatments
are useful in managing the condition. Evidence supports both
aerobic exercise and strength training for improving
wellbeing, pain and tenderness, with the
strongest evidence being for aerobic
exercise. Moderate evidence exists
for heated pool or spa treatments.
Weak evidence supports the
use of manipulation, massage,
electrotherapy and ultrasound,
but research in these areas
is generally limited by small
by a Cochrane systematic
review of acupuncture
for fibromyalgia showed
some effectiveness of this
treatment for reducing
pain in the short term.
In addition to exercise,
there is also strong
evidence for education
and psychological and
behavioural therapy for
For more fibromyaliga
This article was
“EVIDENCE SUPPORTS BOTH
AEROBIC EXERCISE AND
STRENGTH TRAINING FOR
PAIN AND TENDERNESS.”
25/09/14 1:00 PM
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