Fibromyalgia

Fibromyalgia, also known as fibromyalgia syndrome, is a long-term chronic condition associated with widespread pain of varying severity. It can affect people of either sex and any age, but is most common among young or middle-aged women around the ages of 25–55 years (NHS, 2022). Patients presenting with symptoms may have fibromyalgia for at least a year before being diagnosed, although in some cases this can be much longer.

A variety of symptoms are associated with fibromyalgia, and can easily be confused with symptoms of other conditions, making diagnosis challenging.

Common signs and symptoms of fibromyalgia include:

• pain and stiffness all over the body
• memory and thinking problems, poor concentration
• tiredness and fatigue
• sleep disturbance
• anxiety and depression
• headaches and migraines (Centres for Disease Control and Prevention, 2020)

Some patients may experience other, less common symptoms associated with fibromyalgia, which can complicate the clinical picture and diagnosis. Some of these symptoms include:

• restless legs – affecting around 1 in 5 people with fibromyalgia
• painful menstrual periods
• sensation of swollen hands and feet, even in the absence of swelling
• chronic fatigue syndrome, also known as myalgic encephalitis.
• pins and needles in the hands and toes (Lowth, 2023)

Many patients also experience comorbidities, such as irritable bowel syndrome and gastro-oesophageal reflux disease (Bhargava and Hurley, 2022).

Although the exact aetiology of fibromyalgia remains unknown, the condition is thought to occur as a result of central sensitisation - where the brain reacts abnormally to harmless stimuli - causing patients to develop a lower perception of pain (Jacobi, 2012). Causes of the condition are thought to be multifactorial, and may be attributed to a viral or systemic infection, or a traumatic event (NHS, 2022). Various factors may also trigger fibromyalgia flares, such as physical trauma, infections and certain chemical substances (GP Notebook, 2021). Patients with whiplash and neck injuries may also be at higher risk of developing the condition (Dedhia and Bone, 2009). Other possible causative factors include:

• stress
• anxiety
• depression
• exertion
• emotional trauma
• lack of sleep
• weather changes (Dedhia and Bone, 2009)

A potential genetic contribution has been shown in family studies of fibromyalgia (Boomershine, 2021), with genetic factors potentially being responsible for up to 50% of

Although there is no diagnostic test to confirm a diagnosis of fibromyalgia, a diagnostic criteria is available and occasionally updated. The most recent update states that the patient must have had widespread pain in the body for at least 3 months to be diagnosed with fibromyalgia (Mayo Foundation for Medical Education and Research, 2023).

Areas of the body affected by pain in patients diagnosed with fibromyalgia:

• left upper region – including shoulder, arm or jaw
• right upper region – including shoulder, arm or jaw
• left lower region – including hip, buttock or leg
• right lower region – including hip, buttock or leg
• axial region – including neck, back, chest or abdomen

In addition to a physical examination, blood tests may be needed to help confirm any contributing factors and the presence of inflammation (Table 1).

There is no cure for fibromyalgia, so current treatment options are primarily directed at alleviating symptoms (Maffei, 2020). For patients living with chronic pain, a support plan should incorporate their preferred treatment approach, priorities, abilities and goals as well as any techniques they are already using that has helped reduce symptoms (National Institute of Health and Care Excellence, 2021).

Most people with fibromyalgia require a combination of treatments, which may include both pharmacological and non-pharmacological options tailored to suit the patient, their symptoms and concerns. Research findings encourage a multidisciplinary approach to treatment, incorporating exercise, patient education and psychological approaches (Cohen, 2017). People with fibromyalgia who receive intensive patient education in combination with other treatments, such as behavioural therapy and exercise, have been shown to achieve effective results in terms of managing their condition (Chakrabarty and Zoorab, 2007). The European Alliance of Associations for Rheumatology (2005) guidelines strongly support

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