Fibromyalgia: symptoms, causes, treatment and tender points

By Cristiano Antonino On Jun 29, 2022

Fibromyalgia (also known as fibromyalgia syndrome, FM, or Atlas syndrome) is an idiopathic syndrome characterised by widespread muscle pain associated with fatigue, stiffness, insomnia, memory problems, and mood swings

Although there is no real cure for this problem, both medication and a targeted approach to relaxation and stress reduction can help alleviate the symptoms.

Its very diagnosis and clinical features have been, and still are, controversial.

Fibromyalgia is described as a generalised form of non-inflammatory extra-articular rheumatism with an uncertain origin

It is not a psychic disorder, although psychophysical stress and anxiety can affect it, and still some specialists see it as a disparate set of symptoms often treated as psychological, or as the physical effects of depressive disorder.

Obvious signs of blood, muscle, neurological and radiographic changes are absent; there are no definite histopathological features (tissue damage detectable by microscopic examination) characteristic.

The body’s indices of inflammation are normal, but the sufferer’s perception of pain is multiplied.

Fibromyalgia is diagnosed by exclusion of other pathologies and subsequent pain on palpation of the tender points.

Fibromyalgia most often affects women in adulthood.

The disorder may appear gradually and worsen over time, or it may appear after a triggering event such as a physical trauma, infection or psychological stress.

What are the causes of fibromyalgia?

The exact causes of the onset of fibromyalgia are not known.

It is probably a combination of factors that lead to the onset of its symptoms, including genetic, infectious, hormonal, physical trauma and psychological factors.

The most widely accepted hypothesis is that it is the way the brain processes pain that is compromised.

In particular, in fibromyalgia sufferers, the pain threshold would be lower than normal due to an increased brain sensitivity to painful stimuli.

Fibromyalgia and psychological problems

Fibromyalgia is not a psychiatric disease, and anxiety problems worsen it (and vice versa) but do not cause it: it has been shown that the psychopathological traits of the proportion of fibromyalgia patients who did not suffer from previous anxiety problems are identical to those of patients with other diseases characterised by chronic pain (e.g. rheumatoid arthritis) and are therefore to be regarded as a reaction to the underlying disease.

Since serotonin is involved (by unclear mechanisms), many patients may also suffer from depression and anxiety disorders, which together with tiredness are often complained of by patients.

Some forms, although not psychic disorders, may be related to the field of psychoneuroendocrinoimmunology (e.g. neuropsychiatric syndromes such as somatoform disorder or somatisation disorder).

The risk of developing anxiety disorders (such as obsessive-compulsive disorder and post-traumatic stress disorder) is about five times higher in fibromyalgia patients.

A Spanish study showed that between 36.4 % and 50 % of cases also had a previous history of psychological and psychiatric problems.

The former percentage, however, overlaps with that of other chronic illnesses.

These patients, who are often accused of hypochondria due to existing psychological problems by doctors and relatives (given the difficulty of detecting clinical data in examinations, which often turn out to be negative), the diagnosis of fibromyalgia is many times greeted with relief.

Fibromyalgia sufferers taken into account in psychological studies have shown irritation when their complaints are traced back to the depressive syndrome alone, often refusing treatment with antidepressants if they are not already treated with them, even though these drugs are also widely used in fibromyalgia without concomitant psychological disorders.

What are the symptoms of fibromyalgia?

The pain associated with fibromyalgia is a dull, constant pain, usually coming from the muscles, affecting various body sites with symmetrical distribution.

This pain is exacerbated when intense pressure is exerted on specific points of the body, known as sensitive or tender points (see next section), and is assessed with a score that allows a diagnosis of certainty.

A wide range of symptoms may therefore occur in the subject suffering from fibromyalgia, not necessarily all manifesting at the same time.

The most common are listed below:

insomnia or non-restful sleep
decreased muscle strength (hyposthenia) in the hands and arms;
asthenia, especially under stress (climbing stairs, lifting legs and arms);
Raynaud’s phenomenon (tingling, paleness and cyanosis, loss of sensation and pain as momentary effects of vasoconstriction, especially in the hands and as a result of cold or emotion) and bruising more easily;
rigidity and clumsiness in movement upon awakening;
urinary disorders, such as interstitial cystitis;
cramps (especially nocturnal);
fasciculations, myokymia, spasmophilia and tremor;
temporomandibular joint dysfunction and craniomandibular disorders in general;
skin sensations similar to tingling, stinging, sudden heat;
numbness (paresthesia, dysesthesia);
headache;
anxiety;
depression;
panic attacks;
balance disturbances;
gastrointestinal dysfunctions;
dyspepsia (difficult digestion);
dysphagia (difficulty in swallowing, pharyngeal bolus);
alteration of nails (thickening, brittleness, ridges from onychorrhoea and lamelline or senile nails, onychodystrophy, trachyonychia)
sense of confusion or dizziness (“mental fog”)
difficulty concentrating;
dryness of the eyes, mouth, skin;
blurred vision, especially in low light;
altered temperature or altered perception of heat and cold;
intolerance to cold or hot and humid, or both;
hypersensitivity of the skin, sight, smell, hearing;
tinnitus;
vestibulitis (chronic inflammation of the vulvar vestibule);
photophobia and intolerance to light signals such as light bulbs, PC monitors, television;
persistence of pain even after treatment with traditional painkillers and anti-inflammatories;
perception of ‘different’ pain from what one was used to before falling ill;
sensitivity to weather changes and seasonal changes (meteoropathy)
multiple chemical sensitivity (intolerance, even without allergy, to numerous substances).

Diagnostic criteria for fibromyalgia

After excluding other muscular, neurological or skeletal pathologies, there are two elements that, once ascertained, allow a correct diagnosis of fibromyalgia:

An accurate medical history showing that the pain is symmetrically spread and has persisted for at least 3 months.
Palpation of the 18 body points known as tender points, which in the healthy subject do not cause pain, while in the fibromyalgia sufferer no fewer than 11 are painful.

How to prevent fibromyalgia?

There are no preventive measures against fibromyalgia.

Diagnosis

The diagnosis of fibromyalgia involves the persistence of widespread pain in symmetrical body sites for at least three months, associated with the positivity of at least 11 of the 18 sensitive points.

However, it is necessary to ensure that the pain is not associated with any other underlying pathology, so tests can be prescribed to exclude the presence of other diseases, including complete blood tests that also assess the autoimmune picture.