Severe Fibromyalgia: Symptoms, Causes, and Consequences

Fibromyalgia, also known as ” Diffuse Idiopathic Polyalgic Syndrome,” is a disease of unknown origin whose main symptom is chronic, widespread pain. Long considered purely psychological and little known by doctors, much research is now being conducted to try to better understand this condition and thus better treat it.

Fibromyalgia, the second most common rheumatic condition after osteoarthritis, affects all segments of the population. However, the prevalence is higher among women, particularly those between the ages of 30 and 50. To learn more about changes after 50, we recommend this article.

The three main symptoms of fibromyalgia are:

• Generalized pain
• Intense and chronic fatigue
• Sleep disturbances

Generalized pain

Generalized pain is always present in fibromyalgia (it is part of the diagnostic criteria). Patients typically have “all-over pain,” although some areas are more sensitive than others (neck, shoulders, interscapular region, lower back, hips). The pain is usually diffuse, migratory, and constant. It can also fluctuate throughout the day, with a typical exacerbation in the morning upon waking.

Chronic fatigue

Chronic fatigue is a very common symptom of fibromyalgia, affecting 70% to 80% of those affected. Efforts are difficult, and sleep (even if it may seem normal) is not restorative. This fatigue can be very disabling in daily life, particularly because of the feeling of exhaustion that limits physical or intellectual activities. In the most severe cases, the slightest effort can become intolerable, making the disease particularly debilitating.

Sleep disorders

As for sleep, it is often disturbed. We find:

• difficulty falling asleep
• night awakenings
• impressions of unrestful or fragmented sleep
• waking up accompanied by fatigue and sometimes muscle stiffness

In some cases, sleep does not reach its deep phase (the most restorative), thus explaining this chronic fatigue.

Other possible symptoms

In addition to these three cardinal symptoms, fibromyalgia patients sometimes describe many other symptoms. To name a few:

• Headaches
• Muscle fatigue, feeling of stiffness, or pins and needles
• Digestive disorders (bloating, irritable bowel syndrome)
• Increased sensitivity to odors, light, and noise
• Problems with memory, attention, or concentration

Finally, it is important to note that (due to the disabling nature of this disease), patients often suffer from additional psychological symptoms (stress, anxiety, depressive syndromes ). Indeed, the prevalence of depression among fibromyalgia sufferers is higher than in the general population.

Today, the precise causes of fibromyalgia are unknown. However, recent discoveries (particularly through functional brain MRI) have shed light on the cause. For now, scientists believe the causes lie in two places: the brain itself and peripheral nerve receptors.

Using functional brain MRI, researchers discovered that fibromyalgia patients had:

• overactivation of one of the brain regions measuring pain (the somatosensory parietal cortex)
• Under-activation of certain regions moderating and controlling pain.

This could partly explain why fibromyalgia patients have this typical hypersensitivity to pain. However, the mechanisms that generate these over- (and under-) activations are not known. Some leads suggest that this could be linked to an anxious personality or having suffered psychological trauma (the mechanisms of stress and pain regulation are, in fact, closely linked).

Additionally, some studies suggest that there may be disruptions in the neuroendocrine and dopaminergic systems: two neuronal conduction systems that use small molecules. In particular, an increase in substance P (a pain neurotransmitter) and a decrease in norepinephrine and serotonin (two neurotransmitters that inhibit pain) have been observed in fibromyalgia patients. Another substance, IGF-1 (Insulin-like Growth Factor type 1) – involved in muscle regeneration – is frequently disrupted in fibromyalgia. This may partly explain daily muscle pain.

At the peripheral level, studies have highlighted abnormalities in fibromyalgia patients. These include:

• abnormal muscle electrical activity,
• dysfunctions at the mitochondrial level,
• a decrease in the density of nerve fibers carrying pain impulses…

As you can see, the causes are little or nothing known. Many doctors and researchers believe that fibromyalgia has only a psychosocial origin. There’s still a lot of work to be done before we better understand this disease!

Diagnosing fibromyalgia is primarily based on patient interviews and a thorough examination in the doctor’s office. This diagnosis is difficult to make for several reasons:

• The symptoms are found in other little-known diseases (chronic fatigue syndrome, irritable bowel syndrome, clinical manifestations of purely psychosomatic origin)
• Another disease that could pose a short-term, life-threatening risk and could benefit from curative treatment must be eliminated.
• No laboratory or radiological examination can confirm the diagnosis of fibromyalgia.

To address these challenges, the American Society of Rheumatology has established diagnostic criteria for fibromyalgia:

• generalized pain
• present for more than 3 months
• affecting both sides of the body (above and below the waist)
• a painful sensation when palpating at least 11 of the 18 points shown in the following figure: