Instruct: Given a question, retrieve relevant documents that can help answer the question.
Query: How is Fibromyalgia caused?
The cause of fibromyalgia is unknown; however, it is believed to involve a combination of genetic and environmental factors, with each playing a substantial role.[4][5] The condition runs in families and many genes are believed to be involved.[8] Environmental factors may include psychological stress, trauma and certain infections.[4] The pain appears to result from processes in the central nervous system and the condition is referred to as a "central sensitization syndrome".[3][4] Fibromyalgia is recognized as a disorder by the US National Institutes of Health and the American College of Rheumatology.[5][9] There is no specific diagnostic test.[5] Diagnosis involves first ruling out other potential causes and verifying that a set number of symptoms are present.[4][5]
Chronic widespread pain had already been described in the literature in the 19th century but the term fibromyalgia was not used until 1976 when Dr P.K. Hench used it to describe these symptoms.[12] Many names, including "muscular rheumatism", "fibrositis", "psychogenic rheumatism", and "neurasthenia" were applied historically to symptoms resembling those of fibromyalgia.[128] The term fibromyalgia was coined by researcher Mohammed Yunus as a synonym for fibrositis and was first used in a scientific publication in 1981.[129] Fibromyalgia is from the Latin fibra (fiber)[130] and the Greek words myo (muscle)[131] and algos (pain).[132]
Fibromyalgia was defined relatively recently. It continues to be a disputed diagnosis. Dr. Frederick Wolfe, lead author of the 1990 paper that first defined the diagnostic guidelines for fibromyalgia, stated in 2008 that he believed it "clearly" not to be a disease but instead a physical response to depression and stress.[140] In 2013 Wolfe added that its causes "are controversial in a sense" and "there are many factors that produce these symptoms – some are psychological and some are physical and it does exist on a continuum".[141]
There is strong evidence that major depression is associated with fibromyalgia as with other chronic pain conditions (1999),[44] although it is unclear the direction of the causal relationship.[45] A comprehensive review into the relationship between fibromyalgia and major depressive disorder (MDD) found substantial similarities in neuroendocrine abnormalities, psychological characteristics, physical symptoms and treatments between fibromyalgia and MDD, but currently available findings do not support the assumption that MDD and fibromyalgia refer to the same underlying construct or can be seen as subsidiaries of one disease concept.[46] Indeed, the sensation of pain has at least two dimensions: a sensory dimension which processes the magnitude and location of the pain, and an affective-motivational dimension which processes the unpleasantness. Accordingly, a study that employed functional magnetic resonance imaging to evaluate brain responses to experimental pain among people with fibromyalgia found that depressive symptoms were associated with the magnitude of clinically induced pain response specifically in areas of the brain that participate in affective pain processing, but not in areas involved in sensory processing which indicates that the amplification of the sensory dimension of pain in fibromyalgia occurs independently of mood or emotional processes.[47] Fibromyalgia has also been linked with bipolar disorder, particularly the hypomania component.[48]
The cause of fibromyalgia is unknown. However, several hypotheses have been developed including "central sensitization".[17] This theory proposes that people with fibromyalgia have a lower threshold for pain because of increased reactivity of pain-sensitive nerve cells in the spinal cord or brain.[3] Neuropathic pain and major depressive disorder often co-occur with fibromyalgia – the reason for this comorbidity appears to be due to shared genetic abnormalities, which leads to impairments in monoaminergic, glutamatergic, neurotrophic, opioid and proinflammatory cytokine signaling. In these vulnerable individuals, psychological stress or illness can cause abnormalities in inflammatory and stress pathways which regulate mood and pain. Eventually, a sensitization and kindling effect occur in certain neurons leading to the establishment of fibromyalgia and sometimes a mood disorder.[25] The evidence suggests that the pain in fibromyalgia results primarily from pain processing pathways functioning abnormally. In simple terms, it can be described as the volume of the neurons being set too high and this hyper-excitability of pain processing pathways and under-activity of inhibitory pain pathways in the brain results in the affected individual experiencing pain. Some neurochemical abnormalities that occur in fibromyalgia also regulate mood, sleep, and energy, thus explaining why mood, sleep, and fatigue problems are commonly co-morbid with fibromyalgia.[15]
Hypermobility has been associated with chronic fatigue syndrome and fibromyalgia. Hypermobility causes physical trauma (in the form of joint dislocations, joint subluxations, joint instability, sprains, etc.). These conditions often, in turn, cause physical and/or emotional trauma and are possible triggers for conditions such as fibromyalgia.
Fibromyalgia is estimated to affect 2–8% of the population.[4] Women are affected about twice as often as men.[4] Rates appear similar in different areas of the world and among different cultures.[4] Fibromyalgia was first defined in 1990, with updated criteria in 2011.[4] There is controversy about the classification, diagnosis and treatment of fibromyalgia.[12][13] While some feel the diagnosis of fibromyalgia may negatively affect a person, other research finds it to be beneficial.[4] The term "fibromyalgia" is from New Latin fibro-, meaning "fibrous tissues", Greek μυώ myo-, "muscle", and Greek άλγος algos, "pain"; thus, the term literally means "muscle and fibrous connective tissue pain".[14]
Non-celiac gluten sensitivity (NCGS) may be an underlying cause of fibromyalgia symptoms but further research is needed.[49][50]
As an adult, Salleé became a successful bank teller. However, she began to develop medical problems; from about 1993 onwards, she was plagued by fibromyalgia as well as some ill effects of menopause. By the time of her early retirement, she had over 25 years expertise in the field of bank fraud investigation. Her retirement at age 55 was caused by the debilitating effects of the fibromyalgia. Although unable to be employed, she wished to remain active.
The film first screened on November 18, 2006 at the Dodge College of Film's Folino Theatre at Chapman University in Orange, California. Hosted by The National Fibromyalgia Association and Trillusion Media, the film had its world première in San Diego on March 22, 2007 at the Hillcrest Landmark Theatre. The documentary was screened, with free admission, around the United States as part of the National Fibromyalgia Association's May, 2007 Fibromyalgia Awareness Day campaign.
"extreme sensitivity to pain but no associated psychiatric conditions" (may respond to medications that block the 5-HT3 receptor) "fibromyalgia and comorbid, pain-related depression" (may respond to antidepressants) "depression with concomitant fibromyalgia syndrome" (may respond to antidepressants) "fibromyalgia due to somatization" (may respond to psychotherapy)
Although in itself neither degenerative nor fatal, the chronic pain of fibromyalgia is pervasive and persistent. Most people with fibromyalgia report that their symptoms do not improve over time. An evaluation of 332 consecutive new people with fibromyalgia found that disease-related factors such as pain and psychological factors such as work status, helplessness, education, and coping ability had an independent and significant relationship to FM symptom severity and function.[126]
Co-founders Matallana and Richards have both been diagnosed with fibromyalgia. They first met in 1997 through discussions in online fibromyalgia chat groups, and shared similar concerns over incorrect diagnoses as well as a lack of available information and patient support. Matallana had first experienced symptoms of pain and fatigue in 1993, and by 1997 had visited 37 doctors before being diagnosed with fibromyalgia. Richards said that she had become ill in 1989, but did not receive a diagnosis of Fibromyalgia until 1996. After the two met, they organized gatherings with other fibromyalgia patients who wanted to increase public awareness of the issue, initiating the National Fibromyalgia Awareness Campaign, which developed over the following five years to become the NFA. Matallana is past president of the NFA, having served through 2011 and is publisher and Editor-in-chief of "Fibromyalgia AWARE" magazine. Richards served as NFA's vice president from 1997 through 2006, and as executive editor of "Fibromyalgia AWARE" for four years after the magazine's 2002 launch.
Fibromyalgia is a poorly understood pain condition. Lactulose breath testing has shown that patients with fibromyalgia have a more pronounced degree of abnormal results compared to both IBS patients and the general population. This study also demonstrated positive correlation between the amount of pain and the degree of abnormality on the breath test. A subsequent study also demonstrated increased prevalence of intestinal hyperpermeability, which some believe occurs commonly with SIBO. One study showed that nearly all fibromyalgia sufferers have unidentified airway constriction during sleep in the form of Upper Airway Resistance Syndrome (UARS)--which is known to cause similar symptoms to fibromyalgia. One explanation being that it results from airway inflammation (as indicated by high Tumor Necrosis Factor Alpha (TnF-A) readings) caused directly or indirectly by SIBO and/or altered intestinal permeability. More research into this possible link is needed.
People referred to rheumatologists may incorrectly receive a diagnosis of fibromyalgia in up to two thirds of cases.[70] Certain systemic, inflammatory, endocrine, rheumatic, infectious, and neurologic disorders may cause fibromyalgia-like symptoms, such as systemic lupus erythematosus, Sjögren syndrome, non-celiac gluten sensitivity, hypothyroidism, ankylosing spondylitis, polymyalgia rheumatica, rheumatoid arthritis, psoriatic-related polyenthesitis, hepatitis C, peripheral neuropathies, entrapment syndromes (such as carpal tunnel syndrome), multiple sclerosis and myasthenia gravis. The differential diagnosis is made during the evaluation on the basis of the person's medical history, physical examination, and laboratory investigations.[49][70][71][72]
The National Fibromyalgia Association (NFA) is a nonprofit organization based in Newport Beach, California, founded to support persons with fibromyalgia (FM) and other chronic pain illnesses.
First known as the National Fibromyalgia Awareness Campaign, the NFA was founded as a 501(c)3 nonprofit organization in 1997 in Orange, California, by Lynne Matallana and Karen Lee Richards. The organization developed an educational website FMaware.org In 2002, the organization also began publishing a magazine quarterly titled "Fibromyalgia AWARE", which at the time was the only consumer magazine that was focused on fibromyalgia patient community issues.
The film was created by Pacific Union College faculty members Daneen Akers and Stephen Eyer as a resource for fibromyalgia patients and their families and to help create awareness about the condition. It tells the stories of seven fibromyalgia patients. Interwoven with the patient stories are interviews with experts from the Fibromyalgia Rehabilitation Program at Cedars-Sinai Medical Center in Los Angeles, California. On their website, the filmmakers call "Living with Fibromyalgia" "the film they wished their family could have watched together when they first heard the word fibromyalgia."
Historical perspectives on the development of the fibromyalgia concept note the "central importance" of a 1977 paper by Smythe and Moldofsky on fibrositis.[133][134] The first clinical, controlled study of the characteristics of fibromyalgia syndrome was published in 1981,[135] providing support for symptom associations. In 1984, an interconnection between fibromyalgia syndrome and other similar conditions was proposed,[136] and in 1986, trials of the first proposed medications for fibromyalgia were published.[136]
Some research has suggested not to categorise fibromyalgia as a somatic disease or a mental disorder, but to use a multidimensional approach taking into consideration somatic symptoms, psychological factors, psychosocial stressors and subjective belief regarding fibromyalgia.[66] A review has looked at self-report questionnaires assessing fibromyalgia on multiple dimensions, including:[66]
Abnormalities in the ascending and descending pathways involved in processing pain have been observed in fibromyalgia. 50% less stimulus is needed to evoke pain in those with fibromyalgia.[51] A proposed mechanism for chronic pain is sensitization of secondary pain neurons mediated by increased release of proinflammatory cytokines and nitric oxide by glial cells.[52] Inconsistent reports of decreased serum and CSF values of serotonin have been observed. There is also some data that suggests altered dopaminergic and noradrenergic signaling in fibromyalgia.[53] Supporting the monoamine related theories is the efficacy of monoaminergic antidepressants in fibromyalgia.[54][55]
People with fibromyalgia generally have higher health-care costs and utilization rates. A study of almost 20,000 Humana members enrolled in Medicare Advantage and commercial plans compared costs and medical utilizations and found that people with fibromyalgia used twice as much pain-related medication as those without fibromyalgia. Furthermore, the use of medications and medical necessities increased markedly across many measures once diagnosis was made.[139]
Living with Fibromyalgia: A Journey of Hope and Understanding is a 2007 documentary film by Stephen Eyer and Daneen Akers from Trillusion Media, Inc. The documentary has been called the first feature-length film that explores the chronic pain condition known as fibromyalgia.
Flupirtine underwent a clinical trial as a treatment for multiple sclerosis and fibromyalgia. Flupirtine showed promise for fibromyalgia due to its different action than the three approved by U.S. FDA drugs: pregabalin, milnacipran, and duloxetine. Additionally, there are case reports regarding flupirtine as a treatment for fibromyalgia. Adeona Pharmaceuticals (now called Synthetic Biologics) sub-licensed its patents for using flupirtine for fibromyalgia to Meda AB in May 2010.
He has done extensive research in musculoskeletal medicine focusing on fibromyalgia, and the structure of the musculoskeletal system and how it affects function. He proposed an explanation for the articular crack (knuckle, neck and other joint sounds) that has caused debate in the medical community. Dr. Cymet's research has shown a potential protective joint effect from joint cracking.