What is Fibromyalgia?
Fibromyalgia

What is Fibromyalgia?

Fibromyalgia

What is Fibromyalgia and Why You Shouldn’t Believe That You Won’t Get Better

Do you, or does someone you love, suffer from chronic pain? Diagnosed with fibromyalgia? Told by doctors that you will never get better? That you can only manage symptoms and will be dependent on medication for the rest of your life?

I was that person, but I proved them all wrong!!

What Is Fibromyalgia?

Fibromyalgia syndrome is a complex, chronic health condition that affects multiple systems in the body, such as the nervous system and the gastrointestinal system. Currently, the cause is not known but the symptoms are well documented. The most common, widely accepted symptoms of the condition include: widespread musculoskeletal (muscle and joint) pain; neuropathic (nerve) pain; extreme sensitivity; sleep disturbances; fatigue; cognitive problems (“fibro-fog”); gastrointestinal problems (including irritable bowel syndrome); and depression and anxiety. Due to the complexity of the condition, the exact number of people with fibromyalgia is unknown.

However, some sources estimate that fibromyalgia affects 2-4% of the general population; 1. while others estimate that it affects 1 in every 20 (5%) people; 2. and others still estimate that it may be prevalent in as many as 10% of the population. 3. According to the NHS, the condition can develop at any age, but mainly develops in those between 30 and 50 years old. For some, unknown reason, fibromyalgia affects 7 times more women than men. 2. One reason that it is difficult to estimate the true number of people with fibromyalgia, is the difficulty in diagnosing the condition.

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A Short History of Fibromyalgia

Fibromyalgia syndrome is a relatively new term, although the condition itself is not. Fibromyalgia is thought to have been around for hundreds of years. For example, Florence Nightingale (1820-1910) and artist Frida Kahlo (1907 – 1954) were both likely sufferers. Muscle pain not caused by injury was first described by Guillaume de Baillou in 1592. He named this disorder, rheumatism. 3. Subsequently, in 1815, William Balfour used the term fibrositis to describe a “special pain in muscles and joints”. This was later agreed by Gowers when he characterised fibrositis as “inflammation of the fibrous tissue” in 1904.

Fibrositis became “Fibromyalgia” in 1976 because there was no evidence of inflammation alongside the pain. Surprisingly, the first scientific research study on fibromyalgia was published in 1981. Only a mere 40 years ago, when the currently known symptoms and tender points were confirmed. 4. Due to the difficulties in diagnosing the condition, the American College of Rheumatology (ACR) first established criteria for classification and diagnosis in 1990. These were later modified in 2010, 2011 and 2016.

How is Fibromyalgia Diagnosed?

Unfortunately, there is no clinical diagnostic test to determine if a person has fibromyalgia. Therefore, diagnosis is only made after every other possible health condition or disease is ruled out, in conjunction with the ACR criteria. This is a difficult task due to fibromyalgia having a variety of presentations or symptoms; as well as patients having coexisting medical and psychiatric conditions that make diagnosis challenging. 5. Additionally, the condition mimics other disorders, such as systemic lupus erythematosus, hypothyroidism, inflammatory rheumatic diseases, and other auto-immune disorders. As a result, diagnosis is an often long, drawn out process for most people.

what is fibromyalgia

Diagnosis between 1990 and 2016

Having ruled out other possible conditions, from 1990, doctors diagnose fibromyalgia using the ACR criteria. The first version of the criteria stated that patients should have: 1) widespread pain, in combination with; 2) tenderness at 11 or more of the 18 specific tender point sites. 6. However, only 75% of patients satisfied the ACR 1990 criteria. As a result, a severity scale for characteristic symptoms was added in 2010. So, this severity scale provided an alternative means of diagnosis from the tender point examination. 7.

A year later, in 2011, a modification of the 2010 criteria was published. The 2011 criteria included the addition of a fibromyalgia severity (FS) score. (FS = the sum of the widespread pain index score and the symptom severity score.) 8. Consequently, for the first time, the FS score allowed for a quantitative (numerical) measurement of the severity of symptoms. However, there was still some errors when diagnosing fibromyalgia.

Diagnosis from 2016 onwards.

As a result, the criteria were updated again in 2016. The 2010/11 criteria led to misclassification when applied to regional pain syndromes. The 2016 criteria allow a fibromyalgia diagnosis in adults when all of the following criteria occur:

a. Generalised pain, defined as pain in at least 4 of 5 regions, is present;

b. Symptoms present at a similar level for at least 3 months;

c. Widespread pain index (WPI) ≥ 7 and symptom severity scale (SSS) score ≥ 5 OR WPI of 4–6 and SSS score ≥ 9; and

d. A diagnosis of fibromyalgia is valid irrespective of other diagnoses. In other words, a diagnosis of the condition does not exclude the presence of other clinically important illnesses. 8.

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Next: What Triggers Fibromyalgia?

References

  1. Schreibman, C., 2021. Understanding Fibromyalgia 2020. Physician Assistant Clinics, 6(1), pp.89-96.
  2. NHS UK, 2021. Fibromyalgia – Overview. https://www.nhs.uk/conditions/fibromyalgia/ Accessed June 2021.
  3. Berger, A.A., Keefe, J., Winnick, A., Gilbert, E., Eskander, J.P., Yazdi, C., Kaye, A.D., Viswanath, O. and Urits, I., 2020. Cannabis and cannabidiol (CBD) for the treatment of fibromyalgia. Best Practice & Research Clinical Anaesthesiology.
  4. Inanici, F.F. and Yunus, M.B., 2004. History of fibromyalgia: past to present. Current pain and headache reports, 8(5), pp.369-378.
  5. Frontera, W.R., Silver, J.K. and Rizzo, T.D., 2018. Essentials of Physical Medicine and Rehabilitation E-Book. Elsevier Health Sciences.
  6. Wolfe, F., Smythe, H.A., Yunus, M.B., Bennett, R.M., Bombardier, C., Goldenberg, D.L., Tugwell, P., Campbell, S.M., Abeles, M., Clark, P. and Fam, A.G., 1990. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 33(2), pp.160-172.
  7. Wolfe, F., Clauw, D.J., Fitzcharles, M.A., Goldenberg, D.L., Katz, R.S., Mease, P., Russell, A.S., Russell, I.J., Winfield, J.B. and Yunus, M.B., 2010. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis care & research, 62(5), pp.600-610.
  8. Wolfe, F., Clauw, D.J., Fitzcharles, M.A., Goldenberg, D.L., Häuser, W., Katz, R.L., Mease, P.J., Russell, A.S., Russell, I.J. and Walitt, B., 2016, December. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. In Seminars in arthritis and rheumatism (Vol. 46, No. 3, pp. 319-329). WB Saunders.
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