Definition and Overview
Fibromyalgia is a chronic pain syndrome that causes widespread musculoskeletal pain throughout the body that lasts for more than three months and is accompanied by fatigue, sleep disorders, and cognitive decline. It is characterized by pain occurring without tissue damage or clear signs of inflammation, and central sensitization is the core pathophysiological mechanism.
The global prevalence is estimated to be about 2-4%, and women are affected about 7 times more than men. It mainly occurs between the ages of 20 and 55, and it is not uncommon for it to be accompanied by rheumatoid arthritis.
Causes and Mechanisms
central sensitization
The most important mechanism of fibromyalgia is central sensitization. Pain processing circuits in the brain and spinal cord become hypersensitized, resulting in an excessive pain response to stimuli that normally do not cause pain. Functional MRI studies show that the activity of brain regions related to pain processing in fibromyalgia patients is significantly higher than in normal people.
Autonomic dysfunction
In many patients with fibromyalgia, decreased heart rate variability (HRV), sympathetic dominance, and decreased parasympathetic nerve activity are observed. Sympathetic overactivation reduces muscle blood flow and lowers pain threshold, forming a vicious cycle of pain.
Genetic and environmental factors
There is research showing that serotonin, dopamine, and norepinephrine-related gene polymorphisms are associated with the risk of developing fibromyalgia. Physical trauma, emotional trauma, viral infections, sleep disorders, and chronic stress act as triggers.
symptoms
main symptoms
The core symptoms of fibromyalgia are:
- Widespread pain: Musculoskeletal pain that occurs on both the left and right sides of the body, up and down
- Tenderness: Excessive pain response to pressure on a specific area, such as the neck, shoulders, ribcage, lower back, or extremities.
- Fatigue: Chronic fatigue that does not recover even with sleep
- Sleep disorders: difficulty falling asleep, frequent awakenings, non-restorative sleep
- Cognitive decline (fibro fog): decreased concentration, poor memory, and slow thinking.
accompanying symptoms
Headaches, irritable bowel syndrome, bladder hypersensitivity, restless legs syndrome, depression, and anxiety symptoms are often accompanied. According to studies, about 30-50% of fibromyalgia patients have depressive disorder.
diagnosis
2010 ACR diagnostic criteria
The American College of Rheumatology (ACR) 2010 diagnostic criteria uses the Widespread Pain Index (WPI) and Symptom Severity Scale (SS).
- When WPI ≥ 7 points + SS ≥ 5 points, or WPI 3~6 points + SS ≥ 9 points are satisfied
- When symptoms persist at a similar level for more than 3 months
- When there is no other disease to explain the pain
Differential diagnosis
It is necessary to differentiate it from hypothyroidism, rheumatoid arthritis, systemic lupus erythematosus, small fiber neuropathy, and chronic fatigue syndrome. Organic causes are ruled out through basic blood tests (CBC, ESR, CRP, thyroid function).
treatment
Non-drug treatment
Aerobic exercise is the treatment with the strongest evidence for improving pain, fatigue, and quality of life in fibromyalgia. It is effective when low-intensity exercise such as water exercise, walking, yoga, and tai chi is performed consistently at least three times a week.
Cognitive behavioral therapy (CBT) has been reported to significantly reduce pain intensity and functional disability by changing the perception and coping style of pain.
medication
The following drugs have been approved by the U.S. FDA to treat fibromyalgia:
- Pregabalin: Calcium channel modulator that inhibits central sensory signaling.
- Duloxetine: Serotonin/norepinephrine reuptake inhibitor (SNRI)
- Milnacipran: SNRI class of drugs
Tricyclic antidepressants (amitriptyline) are effective in improving sleep and reducing pain and are used in low doses.
autonomic nerve control treatment
If sympathetic nerve hyperactivation and decreased HRV are accompanied, autonomic nerve control treatments such as stellate ganglion blockade and transcranial magnetic stimulation (TMS) can be used as an adjunct to improving pain threshold and recovering sleep.
life management
- Sleep hygiene: maintaining regular bedtime and waking up times, limiting caffeine, improving sleep environment
- Stress management: abdominal breathing, mindfulness meditation, relaxation training
- Energy management (pace): Balanced distribution of activity and rest to prevent post-exertional malaise.
- Diet: Anti-inflammatory diet (Mediterranean diet), drink plenty of water.