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Fibromyalgia is a chronic pain disorder that affects connective tissue, including the muscles, tendons and ligaments. Its main feature is muscle pain, non-localized, associated with excessive tenderness over many areas of the body. Other symptoms include headaches, fatigue, sleep disturbances, anxiety and depression.

In people under the age of 20 in the United states, the prevalence of fibromyalgia is about 2 percent, reaching about 10 percent by the 7th decade of life. It is more frequently diagnosed in women as compared to men and is recognized as the most common cause of generalized musculoskeletal pain in women between 20 and 50 years.

What Causes Fibromyalgia?

The cause of fibromyalgia remains unknown. However, symptoms are known to be triggered by a variety of physical and emotional signals. These include psychological stress, viral infections (Lyme disease, Epstein-Barr Virus infection, Hepatitis virus) (Buskila, Atzeni, & Sarzi-Puttini, 2008), and trauma (McLean et al., 2011).

The most common theory on the cause of fibromyalgia is that of a state of "centralized pain". Here, it is thought that pain signals reaching the brain are amplified, leading to a state of heightened pain perception in many organs. This is supported by the finding that patients with fibromyalgia have life-long histories of chronic pain (Hudson & Pope, 1994), and have increased post-operative analgesic requirements (Brummett et al., 2013).

Chronic pain syndromes are more common among family members of patients with fibromyalgia and genetic factors may play a role in the clustering of fibromyalgia within families (Holliday & McBeth, 2011).

What Are The Symptoms Of Fibromyalgia?

1. Pain

Pain is the hallmark of fibromyalgia. The pain is poorly localized and multifocal, with a wide variety of descriptions such as numbness, crawling, gnawing, burning, piercing or tingling. 

Some patients may describe a crawling sensation of a transient nature. The pain is experienced in multiple locations of the body and patients pain commonly originate from the lower back, shoulder, chest, lower limb joints and abdomen.the severity of pain is usually high in early stages of the disease, and this reduces progressively over months or years even in the absence of treatment. In some cases, pain may be severe enough to interfere with daily life. Tenderness may be observed of these areas on slight touch, in absence of any obvious inflammation. Symptoms of inflammatory bowel disease, migraines and arthritis tend to be more common in patients with fibromyalgia.

2. Other symptoms

 Sleep disturbances are very common in people with fibromyalgia. Patients may complain of difficulty in falling asleep, or repeated awakening with poorly sustained sleep rhythm. Tiredness and poor ability to concentrate on daily tasks are associated with chronic sleep deprivation. Mood disorders, like depression and anxiety are seen in about a third of patients at the time of initial presentation.

How Is Fibromyalgia Diagnosed?

Fibromyalgia is a clinical diagnosis and requires, by careful history and physical examination, the exclusion of all other possible causes of chronic musculoskeletal pain. Currently, there are no diagnostic laboratory or imaging investigations for fibromyalgia, although several tests may be required to rule out other diseases with similar symptoms, such as systemic Lupus erythematosus (SLE), rheumatoid arthritis, polymyositis, osteoarthritis, hypothyroidism, ankylosing spondylitis, polymyalgia rheumatica.

How Is Fibromyalgia Treated?

Treatment of fibromyalgia requires a multidisciplinary approach, involving the patient, the physician, psychologists and physiotherapists. In general, supportive approaches to treatment, such as exercise, meditation and relaxation therapies are first explored, with or without the use of medications. Good communication is of utmost importance in the long term treatment of fibromyalgia. It must be well explained from the outset, that fibromyalgia is not curable using currently available options in order to provide realistic expectations.

Anti-inflammatory drugs are useful in the relief of chronic pain. Other drugs used to treat fibromyalgia include pregabalin, duloxetine and milnacipran, which are selective norepinephrine and serotonin reuptake inhibitors. Other drugs include antidepressants such as amytriptyline, cyclobenzaprine, fluoxetine and sertraline. Therapy is best tailored to the individual patient and several factors such as side effect profile of drugs, severity of symptoms, age and other concurrent clinical conditions need to be considered.

Long term prognosis is generally good and with optimal treatment, most people with fibromyalgia are able to lead productive lives.

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