Fibromyalgia Syndrome (FMS) is a pathological entity that has reached definite clinical and scientific recognition only recently. New diagnostic criteria were proposed by the American College of Rheumatology in 2010 (ACR 2010) but have really only been accepted widely since 2015.

FMS is a chronic pain condition whose main features are widespread, often disabling musculoskeletal pain and tenderness, accompanied by a number of nonspecific secondary symptoms detailed below. FMS affects all ages, all ethnic groups and cultures with a seemingly increasing prevalence in recent years. The onset may be fast or slow and it often follows an acute illness or injury (a triggering event).

 

Classification

The cause of fibromyalgia syndrome (FMS) is essentially unknown. However, what is known is that it is a syndrome of altered pain processing with contribution from multiple neuroendocrine, neurotransmitter and neurosensory dysfunctions. There are almost certainly elements of neuropathic pain, nociceptive pain and peripheral and central sensitization. It affects more females than males and the incidence tends to increase with age.

FMS may co-exist with other chronic health conditions like rheumatoid arthritis or chronic pelvic pain. Up to 25% of patients may also have rheumatoid arthritis (RA), 30% may have co-existing systemic lupus erythematosis (SLE), and Sjogren’s syndrome is present in up to 50% of fibromyalgia sufferers.

 

Clinical Presentation

FMS is associated with some or all of the following:

  • Widespread pain (myofascial pain)
  • Tender points
  • Lethargy (low energy levels)
  • Trouble remembering and concentrating (foggy brain)
  • Waking up feeling unrefreshed
  • Sleep disturbance
  • Gastrointestinal disturbance / Irritable Bowel Syndrome (IBS)
  • Depression / Anxiety
  • Headache
  • Chronic fatigue syndrome
  • Interstitial Cystitis or Irritable Bladder Syndrome
  • Temporomandibular dysfunction
  • Other functional Somatic Syndromes

The common theme is that patients have chronic pain and other somatic symptoms, but without apparent tissue damage or inflammation.

 

Management

There is no cure for fibromyalgia. Generally, by the time a sufferer of fibromyalgia syndrome is referred to a specialist pain service they may have had opinions from many experts without obtaining a formal diagnosis. Quite often they are at their wits’ end and have a sense of hopelessness about ever having a life with less pain and suffering. Before this becomes too severe to live with you may need some help from the specialists at QPain.

QPain specialists are able to diagnose your pain and tailor a treatment program to suit you specifically.

This may involve:

  • Non-procedural treatments:
    • Pharmacotherapy (medications)
      • Antidepressants
      • Anti-neuropathics
      • Analgesics
      • Other medications
    • Physiotherapy/Physical Activity
      • Physical activity or exercise is one treatment that is almost always appropriate for fibromyalgia.
    • Psychological therapy
      • There is almost always an emotional component to chronic pain. The QPain specialist pain psychologists can help to reduce the suffering and experience of pain as well as help you to cope with a life with pain and become more resilient.
      • Cognitive Behavioural Therapy has been shown to be effective.
    • Procedural treatments:
      • Are generally not indicated for fibromyalgia but they may be useful for co-existent conditions like lower back pain, or joint pain. These may include non-surgical treatment and minimally invasive surgery.

Often the best treatment is a combination of all of these and can be termed multimodal or multidisciplinary treatment. You may benefit from involvement in a pain management program to improve quality of life and function. QPain specialists can arrange a program for you.