What Is Fibromyalgia?

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Today is Fibromyalgia Awareness Day, an event dedicated to increasing public knowledge of the musculoskeletal chronic pain condition that afflicts five million adult Americans. Chances are that, if you're a woman, you know somebody with fibromyalgia, particular as you enter middle age; for reasons we're not quite sure of, the condition seems to disproportionately affect women, and the over-40 years are often the point of diagnosis.

Symptoms of fibromyalgia are pretty intense: they can include severe pain all over, particularly in pressure spots, rising in the morning but also triggered by stimuli including depression or over-exertion at any time in the day. The expansive ways in which the disease shows up can hinder diagnosis, as it's most often officially written up as a condition after people have gone through tests for basically every other chronic pain condition first. There's also no definitive test for it, though one blood test can provide clues, and scientists in 2016 thought they may have found a distinctive neural signature in the brains of fibromyalgia sufferers, which might help diagnosis in the future.

If it's not something you've ever heard of, that's not entirely surprising, as it's had less of a media presence than, say, chronic fatigue syndrome or lupus. However, it still matters deeply that people know the signs and how it might turn up — ignorance can make the lives of people living with fibromyalgia more difficult.

We Don't Have A Clear Idea Of What Causes Fibromyalgia

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One of the supremely odd things about fibromyalgia is that there's no definitive source for the pain; another is that it manifests differently in different people, in response to different events and stimuli. Research has found that having a genetic relative who also has fibromyalgia raises your own risk of getting it, but it also seems to be related to both mental and physical trauma; some people report developing it for the first time after some severe shock or accident. Arthritis Research UK (fibromyalgia sufferers are often referred to arthritis and rheumatic disease specialists who help with chronic pain) also notes that severe sleep deprivation seems to bring on fibromyalgia-like symptoms, and that unrestful sleep is a key part of the illness.

While what actually spurs the onset of the illness is still reasonably mysterious, scientists have intriguing theories about what might actually be happening in the body of a fibromyalgia sufferer to distinguish it from a healthy one. One aspect they've found is that fibromyalgia sufferers have unique hands: they are far more crammed with sensitive nerve fibers on their palms, indicating an extraordinary sensory capacity for pain and high sensitivity to outside conditions on the limbs. Whether or not this is a risk factor unique to fibromyalgia sufferers, though, remains unclear.

It Seems To Be Based In The Brain

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In addition to the presence of huge amounts of sensitive fibers, scientists have also pinpointed a potential cause for the massive pain (and consequent side effects, like "fibro fog," a sense of mental confusion and inability to remember things) that distinguishes fibromyalgia. It's unclear how it develops and whether it's genetic, but the brains of fibromyalgia sufferers appear to process painful and non-painful stimuli in ways that are different from how people without fibromyalgia process the stimuli.

It seems that their brains "misprocess" things to be classified and experienced as pain, including daily levels of stimuli delivered by everything from normal touch to temperature and sound. It's something called "neurosensitivity," and together with the over-abundance of nerve fibers in vulnerable places like hands, it may explain why humans who have no physical reason to experience pain (fibromyalgia sufferers usually don't) feel it in such intense quantities.  

It's Most Common Among Women (But Scientists Don't Know Why)

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Fibromyalgia isn't just a woman's disease, but it's overwhelmingly found in female patients. The Office On Women's Health estimates that between 80 and 90 percent of all patients with current fibromyalgia diagnoses are women, and many historical figures who are believed to have had fibromyalgia, like the famous nurse (and bed-bound invalid) Florence Nightingale, have also been female. (Note: it's also entirely possible that Nightingale had some other chronic condition, or something else entirely. Diagnosing historical figures is really difficult.)

Why this is remains a mystery. It may be because there is an increased propensity in female brains to develop the miscommunications necessary for fibromyalgia, or perhaps because the genetic conditions behind it are much more likely to be passed down the female line.It also means that the types of pain suffered by female fibromyalgia sufferers include things like menstrual cramps.

There's Strong Connection Between Fibromyalgia & IBS

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People who are experiencing chronic pain should know that along with the fibro fog, intense pain and other symptoms, there's a strong record of crossover between fibromyalgia and irritable bowel syndrome, with many people who have one of the disorders also experiencing the other — and doctors think it's down to a sensitivity problem.

The two issues are related to one another in the ways in which they spark abnormal pain: IBS is distinguished by hypersensitivity to internal sensations, while fibromyalgia is about sensitivity to stimuli on the skin and within tissue. It's been suggested that they're actually part of one single syndrome that centers on miscommunication in the brain and nerves. How the relationship between them actually occurs, and how it's treated, is a subject of intense scientific interest — as are all the functions behind fibromyalgia.

A Lot Of The Medications For It Treat Other Conditions, Too

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As many people with chronic pain conditions know, treatment can be a long, arduous process of balancing side effects with effectiveness and functionality. Interestingly enough, though, the treatments currently available for fibromyalgia are largely taken from treatments for other disorders that appear to provide at least some relief for sufferers.

The biggest treatment combination is a doubling-up of anti-epileptics and antidepressants, a reasonably common double act for severe pain conditions. Anti-convulsants, as anti-epileptic drugs are technically known, are one of the standard treatments for chronic pain, though a study found that only certain varieties of them seem to provide decent relief for people with fibromyalgia. The most effective combination, according to research done in 2016, is the anti-convulsant pregabalin with the antidepressant duloxetine.

However, there may be another avenue open to fibromyalgia sufferers. A study in 2015 found that two months of treatment in a hyperbaric oxygen chamber, in which people are exposed to 100 percent oxygen in 90-minute sessions, completely reduced the need for any pain medication in 70 percent of the fibromyalgic sufferers who did it. Hyperbaric oxygen treatment is usually reserved for serious wounds and decompression sickness, but its effectiveness for fibromyalgia may mean this is where it's at for people with the condition in the future. There's still a lot more for researchers — and the rest of us, too — to learn about fibromyalgia.