There are established protocols to treat pain — locating the relevant muscle or joint, looking at the type of ache, identifying its cause and, finally, mitigation.
But what if the pain is all over the place and pinpointing it or its causes is impossible? Well, such a perplexing condition exists — fibromyalgia. And it is a challenge to diagnose it, forget treatment.
What is fibromyalgia?
Fibromyalgia is a central sensitivity syndrome where the neural circuit of perception, transmission and processing of afferent stimuli is affected. An individual with this syndrome becomes hypersensitive to pain. In other words, the pain processing system of the brain goes haywire.
“Fibromyalgia is a condition in which a person experiences long-term pain that is spread throughout the body,” says Dr PR Krishnan, senior consultant neurologist, Fortis Hospitals, Bannerghatta Road, Bengaluru. “Tenderness can be observed in the joints, muscles, tendons and other soft tissues.”
Causes and symptoms of fibromyalgia
Fibromyalgia can be genetic, but it can also be triggered by events that have occurred in a person’s life and have led to physical or emotional stress.
“Major operations or surgery, emotional trauma, physical stress, serious injury or certain infections trigger fibromyalgia,” says Dr Krishnan. “Sometimes, fibromyalgia can also develop in the absence of any obvious trigger.”
An individual with this syndrome could have symptoms like pain, muscle and joint stiffness, fatigue, insomnia, depression and anxiety, mood disorders and cognitive dysfunction.
“Problems with thinking, memory and concentration, headaches and migraines, tingling or numbness in hands and feet, [and] digestive problems [are also observed],” adds Dr Krishnan.
What is fibro fog?
Individuals with fibromyalgia feel intense or amplified pain. The pain also may be felt in a small region of specific muscles, and not over the full muscle.
“Fibromyalgia causes discomfort and may feel like burning, soreness, stiffness, aching or gnawing pain, often with sore spots in certain parts of muscles,” says Dr Krishnan.
Fibro fog is another aspect of the syndrome.
“Fibro fog is brain fog associated with fibromyalgia,” says Dr Krishnan. “It includes forgetfulness and problems remembering new information, reduced ability to think quickly and efficiently, difficulty in concentrating, reduced alertness and difficulty in holding on to conversation or quick recall of information.”
Diagnosis and treatment
There are 18 fibromyalgia tender points in the body. The tender points are present symmetrically on both sides of the body. They are small points about the size of a coin and all of them are situated around joints.
According to a 2021 review article — Fibromyalgia: Pathogenesis, Mechanisms, Diagnosis and Treatment Options Update by Siracusa R, Paola RD, Cuzzocrea S and Impellizzeri D —fibromyalgia can be diagnosed using two variables:
—by observing centralised bilateral pain above and below the waist, and
–if the individual has been feeling chronic pain for at least three months and on physical examination is able to feel the pain in at least 11 of the 18 tender points.
“Fibromyalgia is diagnosed based on symptoms, especially the pain that individuals experience all over the body, since there are no specific laboratory or imaging tests that can be done for it,” adds Dr Krishnan.
Usually, pharmacological treatment or medications are provided but they alone are inadequate in most cases. While there is no cure for the syndrome, it can still be managed through some medications and stress relaxation sessions.
Higher occurrence in women
Fibromyalgia is seen in 5% of the population and has a higher incidence in women, especially among those aged between 30 and 35 years.
“Hormonal changes and the likelihood of women having higher stress — especially during the menstrual cycle, menopause or pregnancy — are the reasons for this,” says Dr Krishnan.
Takeaways
- Fibromyalgia is a syndrome in which the brain’s pain processing system gets affected.
- Individuals with fibromyalgia experience pain in specific points of certain muscles. These are also called tender points.
- The syndrome cannot be cured but can be managed with medications, stress relieving and relaxation therapies after diagnosing its exact cause.
