Fibromyalgia : Causes, Diagnosis and Treatment
Neurology / / May 03, 2016
Fibromyalgia - the state of the body, caused by the constant and sometimes debilitating pain in the muscles, which is accompanied by fatigue of the whole body.No one knows exactly what causes it, but fibromyalgia can be a consequence of both physical and emotional trauma, as well as viral infections.Fibromyalgia is also known as fibrosis or fibromyositis.
main cause of fibromyalgia is not known.Physical or emotional trauma, as well as viral infections can cause general disorder of the body, but has not yet been proven that they are the primary agents of fibromyalgia.
Many experts believe that fibromyalgia is not a disease, but rather a state of chronic pain caused by a number of abnormal reactions to stress.area of the brain which are responsible for the pain sensation in healthy people and patients suffering from fibromyalgia, in the same areas respond differently.
Individuals with fibromyalgia observed decrease in activity of opioid receptors in the parts of the brain tha
Some studies have helped to clarify the main possible causes of fibromyalgia:
- Hormonal disorders in brain chemicals.Many hormonal, chemical, and metabolic brain abnormalities have been described in studies of fibromyalgia patients.The changes mainly occur in several brain chemicals.Fibromyalgia can result from exposure to stress and pain to the central nervous system that leads to changes in the brain but not to the brain disease.
- Serotonin. particular interest to researchers is a serotonin - an important chemical mediator of the nervous system in the brain, gut, and other areas of the body.Serotonin helps to create a feeling of well-being, regulates levels of pain and promotes deep sleep.Lower serotonin levels have been observed in some patients with fibromyalgia.
- Stress hormones. researchers also found irregularities in the hormonal system, known as the axis of the hypothalamus-pituitary-adrenal (HPA).HPA axis controls important functions, including sleep, responses to stress and depression.Changes in the HPA are characterized by lower levels of stress hormones noradrenaline and cortisol.Lower levels of stress hormones lead to crashes when psychological or physical stress.Several factors can cause the inappropriate human stress response and contribute to the development of fibromyalgia, including:
- infection (Epstein-Barr virus, Lyme disease);
- physical trauma (such as a car accident);
- emotional stress;
- hormonal changes (such as thyroid disease);
- medication intake.
- Low levels of IGF-1 hormone. Some studies have shown that approximately one third of patients with fibromyalgia have low levels of insulin-like growth factor-1 (IGF-1).IGF-1 is a hormone that promotes the growth of muscles and bones.Low levels of growth hormone may impair thinking, lack of energy, muscle weakness, and intolerance to cold.Studies have shown that changes in the growth hormone is likely to come from the hypothalamus in the brain.While the researchers found no link between IGF-1 levels and fibromyalgia, the level of growth hormone in the blood may be a marker of the disease.
- abnormal pain perception. Some studies have shown that people with fibromyalgia may perceive pain differently than healthy people.Fibromyalgia may cause too much activity in those parts of the central nervous system, which process pain (nociceptive system).Brain scans of fibromyalgia patients have found irregularities in the processing centers of pain.Some fibromyalgia patients may be hypersensitive to external stimulation, and not worry too much about pain.This increased awareness is called generalized hypervigilance.Fibromyalgia patients are also more sensitive to sound and light.
- Immune disorders.Fibromyalgia has symptoms resembling some rheumatic diseases, including rheumatoid arthritis and lupus (systemic lupus erythematosus).These autoimmune diseases in which the immune system mistakenly attacks the body's own healthy tissues, creating inflammation and damage.However, the pain of fibromyalgia is not associated with autoimmune factors, and there is no evidence to support the role of the inflammatory response in the study of fibromyalgia.
Psychological and social factors are the main causes of fibromyalgia, but they can contribute to the state in three ways:
- they make people more susceptible to fibromyalgia;
- they can play a role in triggering the onset of the state;
- they can perpetuate the condition.
Risk factors for fibromyalgia
Some evidence suggests that certain factors can make people more susceptible to Fibromyalgia.These risk factors include:
- Female sex. Nine out of 10 patients suffering from fibromyalgia, women.Women may be particularly prone to develop fibromyalgia during menopause;
- Intense cultural or social environment;
- Increased psychological vulnerability;
- The physical and emotional trauma of childhood. Studies have reported that physical and emotional violence against the people expose their most occurrence of fibromyalgia than in other lyudey.Chasche all attackers are family members or partners.Sexual violence, mainly, is not a risk factor for fibromyalgia, however, women who are victims of rape, may face an increased risk of disease occurrence.
- Age. disorder usually occurs in people 20 to 60 years.Some studies have noted peaks outbreaks around the age of 35 years.Others note that fibromyalgia is the most common in middle-aged women.In one study, fibromyalgia cases increase with age and reaches more than 7% frequency among individuals 60 to 70 years.There is such a thing as juvenile primary fibromyalgia.This type of fibromyalgia appears in adolescents, most often girls.The disease usually occurs after age 13 and reaches its peak at the age of 14 years.Cases of primary fibromyalgia are rare, but studies show that the incidence may be increasing.Symptoms are similar to those in adult and fibromyalgia, however, the treatment results in significantly better adolescents.
- Hereditary factors. Studies have reported an increased prevalence of fibromyalgia among family members.Children, brothers and sisters of people with fibromyalgia eight times more likely to have the disease than other population groups.Family members are also more sensitive to pain, and is likely to have a similar condition similar syndromes.
symptoms of fibromyalgia
main symptom of fibromyalgia is pain.It can concentrate in one place or all over the body.The exact location of the pain are called tender points.People diagnosed with fibromyalgia is very sensitive to pain, at least 18 specific disease can identify some points 11.
mostly begins in muscle pain, usually in the neck and shoulders, and then extend further from those regions.Usually it does not affect the joints, although many patients feel it and in the joints.The skin becomes more sensitive to touch.
pain can be aching, burning and causing fatigue of the whole body.The intensity of pain can increase or decrease.It can vary depending on the time of day, changes in the weather, physical activity or inactivity.The most intense pain is sleep disorders.
- fatigue and disturbance sleep are also common symptoms in patients with fibromyalgia.At the same time he felt restless legs syndrome (RLS) and periodic limb disorder (PLMD).
Many patients complain that they can not sleep or sleep, so that they feel tired when you wake up.Some report that they are more concerned about fatigue than pain because it interferes enjoy life, the body does not relax during sleep.Some experts believe that if a person does not have problems with sleep, his risk of the occurrence of fibromyalgia significantly reduced.
- Depression and bad mood . About a third of fibromyalgia patients suffer from depression.Disturbances in memory and concentration are also very common.These symptoms are often diagnosed.
- Digestive problems, including irritable bowel syndrome with excessive flatulence, constipation often replaces diarrhea;: When illness fibromyalgia the following symptoms may occur
- Dry mouth;
- Painful menstruation;
- Problems with balance in the body;
- Tingling or numbness in hands and feet;
- Frequent urination caused by spasms of the bladder.
symptoms of fibromyalgia in children
Children with fibromyalgia often have sleep disorders and severe pain.They may also experience fatigue, stress, depression, and headaches.
Some studies have shown muscle disorders in fibromyalgia patients, including:
- Biochemical disorders: fibromyalgia patients may have lower levels of phosphocreatine muscle cells, and adenosine triphosphate (ATP).These chemicals regulate the level of calcium in the muscle cells.Calcium is an important component in the ability of muscles to contract and relax.If the ATP level is low, the calcium is not released into the cell, and muscle weakening.
- Functional disorders: pain and stress caused by fibromyalgia themselves can harm muscle function.
- Structural and blood abnormalities: Some researchers have seen overly thickened capillaries (tiny blood vessels) in the muscles of fibromyalgia patients.Abnormal capillaries may produce lower levels of compounds necessary for the muscle function and reduce the flow of oxygen-rich blood to the muscles.
To date, none of these anomalies is not well-defined relationship with fibromyalgia.
It is important to diagnose fibromyalgia in the early stages of it, starting with the treatment as soon as possible.But since there are no clear methods of its diagnostics (such as laboratory tests or special surveys), three out of every four patients with fibromyalgia remain without diagnosis.Receiving a diagnosis may take an average of 5 years.
symptoms of fibromyalgia can be helpful in making a diagnosis, but if the patient has no obvious disorders, such as depression or arthritis, diagnosis can be complicated.However, do not identify any symptoms does not exclude the occurrence of the disease.Fibromyalgia should be suspected in any person who has the muscle and joint pain with no known cause.
American Rheumatology (ACR) College proposed to introduce a new set of diagnostic criteria, which take into account the symptoms, such as fatigue, sleep disturbances, and cognitive problems, in addition to pain.
classification criteria for fibromyalgia
In 1990, the ACR has established the following criteria for the classification of fibromyalgia:
- Severe pain should be present for at least 3 months.This pain should appear in all the following areas:
- both sides of the body;
- above and below the belt;
- over the entire length of the spine;
- Pain should be felt, at least 11 of 18 specific regions called sensitive points on the body.When the doctor clicks on the tender point, pain is very localized and palpable.Tender points are located in the following locations:
- left or right side of the back of the neck, just below the hairline;
- on the left or right side of the front of the neck, above the collarbone (clavicle);
- left or right side of the chest, just below the collarbone;
- on the left or right side of the upper back, near where the join neck and shoulders;
- left or right side of the spine in the upper back between the shoulder blades (scapula);
- in any hand where it bends at the elbow;
- on the left or right side of the lower back, just below the belt;
- on both sides of the lower pelvic bones (the buttocks);
- in the kneecaps.
physician should always carefully examine the personal and family medical history, which includes a psychological portrait and story of any factors that cause disease, such as:
- communicable diseases;
- muscle weakness;
- physical injury;
- recent changes in weight;
- sexual or physical disorders as well as substance abuse or alcohol.
Patients should tell their doctor about any medications they are taking, including vitamins and herbal medicines.
Methods of diagnosis of fibromyalgia
- Medical examination. Physical examination can provide much information about the disease, except sensitive points, which are included in the diagnostic criteria.These points must be painful when pressed.When the diagnosis of fibromyalgia, they should not show signs of inflammation (redness, swelling, or damage to the joints and soft tissues are not relevant).Medical practice and research should also examine the nails, skin, mucous membranes, joints, spine, muscles and bones to prevent arthritis, thyroid disease, and other diseases.
- Analyses. analysis of blood, urine or other laboratory tests can not definitively diagnose fibromyalgia.If these tests show abnormal results, the physician should look for other methods.To identify fibromyalgia can make the following tests and analyzes:
- antibody tests;
- complete blood count;
- C-reactive protein;
- erythrocyte sedimentation rate (ESR).
- studies of thyroid function and liver. In cases where the previous laboratory results do not indicate a particular disease, your doctor may suggest this study for diagnosis.
- exception diseases with similar symptoms. Approximately 10% -30% of patients visit doctors with symptoms that resemble fibromyalgia, including fatigue, malaise and widespread pain in the muscles.Because no laboratory test can confirm a diagnosis of fibromyalgia, doctors are usually the first thing considering the presence of the disease with similar symptoms.Starting
diagnosis of conditions of the following diseases, fibromyalgia not always exclude since several conditions may overlap or coexist with fibromyalgia, and furthermore it have similar symptoms.As fibromyalgia, a number of these diseases are not subject to easy diagnosis.It is not clear whether these symptoms of fibromyalgia cause, are risk factors for the disorder or it does not have to do with it.
list of diseases for similar symptoms with fibromyalgia
- chronic fatigue syndrome. There are significant similarities between fibromyalgia and chronic fatigue syndrome (CFS).As with fibromyalgia, the causes of CFS is unknown.A doctor can diagnose a disorder but only on the basis of symptoms occurring in the patient.In fibromyalgia and CFS are observed and treated most of the same symptoms.However, among them there are some differences:
- tender points are the primary symptom of fibromyalgia.Some patients with CFS exhibit similar point on pressure, but their muscular pain is less significant.
- fatigue is the main symptom of CFS.