Fibromyalgia: What It Is, Symptoms, and Treatment

Fibromyalgia is a rheumatic disease characterized by widespread pain throughout the body, affecting the musculoskeletal system. It can occur at all ages, but it is most commonly seen in middle-aged individuals. Women are more likely to be affected by this disease than men. A close examination of the symptoms of the disease, the conditions that may cause it, and its diagnosis and treatment will help us better understand fibromyalgia.

Symptoms of Fibromyalgia

The symptoms of fibromyalgia may vary from person to person. The most common symptoms include:

• Widespread pain: This is the primary symptom of fibromyalgia. Pain is felt throughout the body, and it may be more intense in areas like the back and neck. The pain can last for a long time and may either improve or worsen over time. The pain may feel burning, sharp, or stabbing.
• Increased sensitivity: In fibromyalgia, sensitivity to pain increases. The patient may feel pain even with the slightest touch. The pain felt from small touches or mild bumps may last longer than usual.
• Stiffness: Patients often feel stiff, especially after staying in the same position for a long time, and may have difficulty moving. For example, they might experience trouble getting out of bed in the morning.
• Muscle cramps: The muscles can contract tightly and painfully, causing discomfort.
• Fatigue: The level of fatigue can vary from person to person. It can range from mild tiredness to feeling too exhausted to do anything.
• Disrupted sleep quality: Even if patients sleep for an adequate amount of time, they may not feel rested or relaxed. This is due to a shortening of the deep sleep phase, which is crucial for body restoration, in fibromyalgia patients. Changes in sleep quality can manifest as fatigue or difficulty concentrating.
• Cognitive problems: People with fibromyalgia may experience difficulties in thinking and learning. They may describe their mental state as foggy or cloudy. Symptoms such as difficulty learning new things, trouble remembering past events, lack of focus, and slowed speech may also occur.
• Feeling excessively hot or cold: This occurs because the body is unable to regulate its temperature properly.

Fibromyalgia can also occur alongside other diseases. Common conditions that are often seen together with fibromyalgia include:

• Chronic headaches
• Depression/Anxiety
• Irritable bowel syndrome
• Painful bladder syndrome
• Primary dysmenorrhea (painful menstruation)
• Restless leg syndrome
• Raynaud's phenomenon

What Causes Fibromyalgia?

The exact cause of fibromyalgia has not been fully clarified. However, there are several factors known to play a role in the development of the disease.

• Changes in the nervous system: The sensation of pain in different parts of the body is transmitted to the brain through specialized nerve cells. It is thought that changes in these transmission pathways or in the chemicals involved in this process may contribute to the onset of fibromyalgia.
• Hormonal changes: Changes in the levels of hormones that play a role in pain transmission and brain processing are significant in the development of the disease. The levels of serotonin, norepinephrine, and dopamine hormones are found to be low in people with fibromyalgia. These hormones have been shown to play an important role in regulating not only pain but also general mood, appetite, sleep, behavior, and the body's response to stress. The decrease in these hormone levels in patients may affect not only pain but also the other functions regulated by these hormones.
• Sleep disorders: A decrease in sleep quality may be both a symptom and a cause of fibromyalgia.
• Genetics: It is believed that some people have a genetic predisposition to the disease, and it may emerge after encountering a triggering factor. The clustering of the disease in certain families supports this idea.

What Triggers Fibromyalgia Flare-ups?

Fibromyalgia can be triggered by physical or psychological stress. These situations include:

• Trauma
• Infection
• Undergoing surgery
• Loss of a loved one
• Separation

What Are the Risk Factors for Fibromyalgia?

• Female gender: Fibromyalgia is about twice as common in women as in men.
• ​​​​​​​Traumatic events: Events that cause trauma, such as car accidents, can be both physical and psychological stressors, thus increasing the risk of developing the disease.
• Repetitive injuries: Recurrent injuries in the same area or joint can increase the risk.
• Infections
• Family history of fibromyalgia: Since there is a genetic component to the disease, having fibromyalgia in close family members increases the risk.
• Obesity

What Are Fibromyalgia Tender Points?

In people with fibromyalgia, pain can develop with minimal pressure applied to certain points on the body. These areas are referred to as tender points. The tender points are symmetrically located on the body. There are a total of 18 tender points, with 9 on the right side and 9 on the left side. The locations of these points are as follows:

• Occiput (back of the head)
• Trapezius
• Supraspinatus (along with the trapezius, located at the upper part of the back near the medial side of the shoulder blade)
• Gluteal (upper outer part of the buttocks)
• Greater trochanter (located near the hip joint on the upper thigh, outward)
• Neck
• Second rib (just below the point where the clavicle connects to the ribs)
• Elbow (inner side)
• Knee (inner side)

Tender points are important indicators used to differentiate fibromyalgia from other rheumatic diseases that cause similar pain.

How is Fibromyalgia Diagnosed and Treated?

There is no specific test for diagnosing fibromyalgia. Imaging methods also do not provide clues about the disease. To make a diagnosis, other conditions that may cause the symptoms must be ruled out. Blood tests or biochemical tests may be requested to assess the patient's general condition and to investigate the presence of other potential diseases. While the presence of tender points is no longer as heavily relied upon in diagnosing fibromyalgia, these points can still bring the doctor closer to a fibromyalgia diagnosis. Chronic pain that is commonly described, lasts for more than 3 months, and is seen on both sides of the body can lead to a fibromyalgia diagnosis if no other cause is found. When diagnosing fibromyalgia, other syndromes that may be associated with the disease should be considered, and additional tests related to those conditions may be performed if necessary.

Fibromyalgia is a disease that cannot be fully cured. Complete recovery is not expected in patients. The treatment is aimed at alleviating symptoms and improving quality of life.

Medications used in the treatment:

• Pain relievers: Ibuprofen and acetaminophen group drugs can be used for fibromyalgia pain.
• Antidepressants: Medications containing active ingredients like duloxetine and milnacipran are used to treat both pain and fatigue. They also have a positive effect on sleep quality.
• Antiepileptics: These are effective in relieving neuropathic pain.
• Muscle relaxants: Agents used for patients experiencing muscle cramps.
• Sleep medications: Since fibromyalgia negatively affects sleep quality, these medications help individuals get adequate rest. They may also be effective in relieving symptoms such as fatigue caused by disrupted sleep patterns.

In addition to medical treatment, lifestyle changes and certain therapies have been found to be effective in alleviating the symptoms of fibromyalgia. These include:

• Sitting or swimming in warm/hot water, also known as hydrotherapy
• Activities with personalized exercise programs
• Psychotherapy, allowing patients to explain their situation and relax by sharing their emotions
• Relaxation techniques
• Group therapies

Methods like acupuncture, aromatherapy, and massage are also tried treatments for fibromyalgia. However, there is insufficient research to confirm their effectiveness.

One crucial point in treatment is that other diseases that may coexist with fibromyalgia should also be treated. Failing to treat these conditions alongside fibromyalgia may lead to the failure of fibromyalgia treatment as well.

Although full recovery is not possible in fibromyalgia, reducing pain during flare-ups and eliminating triggering factors can greatly improve the patient's quality of life. Patients should not view fibromyalgia as unsolvable and fall into despair. With appropriate medical treatment and various therapies, their quality of life can be improved.

If you are experiencing widespread, long-lasting pain in your body, it is recommended to visit the nearest healthcare facility.