Do you experience chronic pain throughout your body? Is this pain unexplained and unchanged in at least three months?
Fibromyalgia syndrome affects approximately 2-3% of the population or more than seven hundred thousand Canadians. It is not specific to any one ethnic or financial demographic and has been reported at the same rates worldwide.
Females are affected six to nine times more than their male counterparts, and in fact, make up between 75-90% of all patients. While fibromyalgia syndrome is most prevalent in middle-aged women, it can also affect children, teenagers, and the elderly. (1)
Just because it is classified as a syndrome and not a disease does not make fibromyalgia any less serious or the symptoms any less real. It is classified as a syndrome simply because there is no known cause. For more information on the difference between a disease and a syndrome check out this post.
Fibromyalgia is characterized by chronic pain in the body’s muscles and soft tissue surrounding the joints. It can also include symptoms such as fatigue, brain fog, depression and non-restorative sleep.
The biggest obstacle to the successful treatment of fibromyalgia is a proper diagnosis. There isn’t a specific diagnostic exam, like a blood or urine test, to conclusively prove that you do or do not have fibromyalgia. It is instead a matter of ruling out other, similar conditions that can be mistaken for fibromyalgia. These include endocrine diseases such as hypothyroidism, rheumatic conditions like arthritis, and neurological conditions like multiple sclerosis. To get a correct diagnosis it is imperative that your practitioner rule out all other possible causes of your pain.
If all of these tests come back in normal ranges, a much more thorough investigation into your health history is required.
How is fibromyalgia diagnosed?
Before 2010, once all other possible illnesses had been ruled out, fibromyalgia was then diagnosed through the tender point evaluation. Developed in 1990, this initial test was a scoring system based on a physical examination by your medical doctor.
To qualify for the diagnosis of fibromyalgia, you had to have a minimum of 11 of the 18 anatomical areas that were tender to moderate pressure, as well as pain above and below the waist, on both sides of the body, along the torso, and on the extremities. (2)
While this diagnostic method seems to make good sense, it was actually created specifically for researchers studying fibromyalgia and was never meant to be used by practicing doctors to diagnose their patients. (3) As a result, it was an unstable diagnostic platform and as of 2010, the criteria for a positive diagnosis of fibromyalgia has since changed.
Please note that if you were diagnosed with fibromyalgia via the tender point examination you should familiarize yourself with the new diagnostic criteria. Ensure you discuss this information with your medical doctor at your next visit as you may have been misdiagnosed.
Thankfully, in 2012, The Canadian Pain & The Canadian Rheumatology Association adopted more robust criteria for the diagnosis of fibromyalgia. The new diagnostic criteria no longer use the tender point diagnosis, instead focusing on four specific presentations:
- This is, of course, the primary concern. The new diagnostic criteria state that pain must be present for at least three months.
- There must also be no physical abnormality of the tissue where the pain is experienced. This means that when the area of pain is palpated, there should not be a lump of tissue or ropey muscle fibers.
- The pain can vary in location and intensity.
- Associated symptoms
- Waking unrefreshed (nonrestorative sleep)
- Brain fog and/or poor memory (cognitive dysfunctions)
- The above symptoms last at least three months at a similar level. (4)
- Most importantly, no other health problem that would explain the pain and other symptoms.
What causes fibromyalgia?
Although there isn’t a definitive cause known, there are a number of factors that are thought to contribute to the development of fibromyalgia.
So while there is certainly some associated genetic risk, as of yet there has been no individual gene associated with fibromyalgia. However, it does seem that epigenetics plays a large role. Epigenetics is the environmental factor that turns genes “on” or “off”.
For example, many of us suffer from digestive issues – a trait that in some cases is passed on through the genes we inherited from our parents.
The symptoms experienced in the digestive tract can be activated, or triggered, by the food consumed. If a particular food or food group is eaten, digestive issues are experienced. However, if these foods, or triggers, are identified and removed from the diet, this gene can then be turned off. This is how our environment can influence our genetics.
In fibromyalgia the presenting symptom is chronic, widespread pain, however, the genetic link is still being explored. The current theory is that our body’s stress response system and how it processes pain, be it physical or emotional, plays a central role.
There are a number of factors that seem to be early indicators of fibromyalgia:
- Negative feelings and emotions that interfere with the ability to cope have been shown to predict the onset of chronic widespread pain (7)
- Adversity in childhood has been linked to chronic widespread pain in adults; (8)
- Sexual, physical or psychological abuse, especially during childhood, has been reported with greater frequency in fibromyalgia patients than in controls. (9)
The common thread here is negative and painful experiences, whether they are physical or psychological, during early life seem to predispose certain people to fibromyalgia as adults. However, while up to a third of patients suffering from fibromyalgia report traumatic experiences in early life, not all people who suffer early traumas develop fibromyalgia. This is where the ‘trigger’ may be important.
A sudden, stressful event and the body’s inappropriate response to this stress often seems to be associated with the start of fibromyalgia. Normally, following a stressful event the nervous system and body’s stress response system return to a state of rest. However in those with fibromyalgia, it seems as though these systems remain stuck in the ‘on’ position. Why this occurs is one of the many questions about fibromyalgia that remain unanswered.
What should I do if I’ve been diagnosed with fibromyalgia?
I always recommend starting with stress. What I don’t mean by stress is the usual finances, relationship, work stress. All the things we commonly associate as stressful are usually not the main contributors to fibromyalgia. Instead, we want to look at factors such as:
- Blood sugar imbalance
- Hidden sources of inflammation
- Irregular sleeping habits
If you’ve been diagnosed with fibromyalgia, creating an environment where the nervous system and stress response system can return to a state of relaxation is the key to proper treatment.
Treating fibromyalgia is not as simple as taking medication. As there are multiple factors at play, treatment also needs to be multifactorial. A diversified approach to treatment offers the best chance at eliminating the debilitating effects of fibromyalgia.
I recommend all patients start their journey by altering their diet. Often, the food we eat is the most common cause of a stressed nervous system. For more information on diet alterations, including eliminating gluten, take a look at this series of blog posts:
- The Fibromyalgia Diet: Weight Loss
- The Fibromyalgia Diet: Food Type
- The Fibromyalgia Diet: Gluten Free
Looking for more information about fibromyalgia? Check out all our writings on how fatigue affects your body.
Functional Medicine offers a diversified approach to the treatment of fibromyalgia, looking into blood sugar imbalances, hidden sources of inflammation and irregular sleeping habits contribute to your condition. You can read more about Functional Medicine and if it’s a good fit for you here:
Also published on Medium.