While the syndrome is often misunderstood and large portions of it are still a mystery, research is beginning to find observable physiological reasons for it.
Certainly there is still a very long way to go, however, the syndrome has a long history of misunderstanding and dismissal, so even a beginning on the project of finding further physical connections is a good step.
Fibromyalgia is often misunderstood, but there’s no real confusion about how it presents. The syndrome is characterized by widespread pain that commonly involves the muscles or the joints.
It can affect any area of the body, however, including tissues. It results in back pain and muscle pain, a feeling of general fatigue, and specific tender areas.
Despite having multiple spots that are tender to palpation, called “tender points,” the patient will have a normal neurological exam that gives no clue as to what is happening. Tender points are specific spots on the body and when pressure is put on these points, it causes pain.
The syndrome most commonly affects middle-age women who are otherwise healthy. However, it can affect women of different ages as well as men and children.
In addition to pain, individuals with fibromyalgia often experience other symptoms as well, including sleep fatigue, other difficulties with sleep, and difficulties with memory and concentration. It can also cause bowel disturbances.
First, the syndrome can be responsible both for sleep disturbances and sleep fatigue. The later refers to the fact that sleep is often not restful or refreshing because of fibromyalgia. As a result, the syndrome is often confused with chronic fatigue syndrome.
The syndrome can also be responsible for something called “brain fog.” What this refers to is the inability to concentrate or think clearly that often accompanies the syndrome.
It isn’t clear that this is, in fact, directly related to fibromyalgia, or whether it is caused by the chronic pain and fatigue that the condition brings on.
Fibromyalgia can also be responsible for digestive upsets. It’s not uncommon for the syndrome to cause bowel irritations.
In addition to pain, the syndrome can also cause you to feel sensations of burning or itching. This is a rare side effect, but it does happen occasionally.
Finally, it is not uncommon for people suffering with fibromyalgia to also suffer from other psychological conditions at the same time.
This can be a problem, since fibromyalgia has a long history of being dismissed as “all-in-your-head” by doctors and other health professionals previously.
However, this is not to categorize this syndrome as psychosomatic, only to recognize that there may be other things going on at the same time as fibromyalgia. Like sleep disturbances, it is not clear that this is directly related to the syndrome, however.
It is not at all surprising if patients who suffer from chronic pain and are experiencing the other kinds of frustration that fibromyalgia can create, might also suffer from depression.
This isn’t a direct result of fibromyalgia, but rather the cause of symptoms that the syndrome brings with it. That doesn’t make it any less the result of fibromyalgia, it just means that it won’t be treated as a direct result.
Pathophysiology or physiopathology is the combination of pathology with physiology.
Pathology is the medical discipline that describes conditions typically observed during a disease state, whereas physiology is the biological discipline that describes processes or mechanisms operating inside a patient.
Pathology describes the abnormal or undesired condition, and pathophysiology seeks to explain the physiological processes or mechanisms whereby such condition develops and progresses.
Ultimately, pathophysiology can be described simply as the observable changes that occur physiologically because of a medical condition.
Pathophysiology is not the cause, but rather the effect that a condition has on the body.
This needs to be understood as distinct from etiology which is the term used for causes.
Pathophysiology does not describe the causes of anything, which in terms of fibromyalgia, is good, since the causes of the syndrome is unknown.
Pathophysiology of Fibromyalgia
So what changes in the body of the patient are caused by fibromyalgia? This will naturally be difficult, since almost everything about this syndrome is shrouded in uncertainty.
However, there are at least some aspects of the disease that are observable and so can be seen as part of the pathophysiology of the syndrome.
The most obvious, observable symptom is pain. This is understood to be a problem with oversensitivity to stimuli in general, which then manifests as pain.
This oversensitivity is possibly a result of neurobiologic changes or from “hypervigilance.”
This latter is a psychological syndrome in which a patient is extremely sensitive to stimuli, as well as extremely stressed and anxious.
There are also observable changes in the body’s chemistry. Most important of these is the changes to brain chemistry.
Sufferers of fibromyalgia have a significant shortage of certain neurotransmitters, including:
- Serotonin: pain regulation, sleep quality, fatigue level, appetite, temperature regulation, mood, emotion, libido.
- Norepinephrine: alertness, memory, level of interest, concentration, sleep.
- Dopamine: fine motor skills, muscle function, cognitive function, attention, balance.
These are many of the same neurotransmitters that are suffering imbalances in patients with depression. As a result, treatment for fibromyalgia will generally include anti-depressants.
These will include newer selective serotonin reuptake inhibitors or SSRIs and the older tricyclic antidepressants, including Amitriptyline.
Another observable condition is an elevation in levels of a chemical called Substance P. This chemical is the best understood neuropeptide transmitter. The chemical is largely responsible for transmitting pain signals to the brain.
Increased levels of this substance will inhibit the activity of endorphins, which are the body’s natural pain killers.
There can also be disturbances in the levels of growth hormone in the body. A deficiency in growth hormone often accompanies the syndrome.
A lack of growth hormone can cause a variety of symptoms to occur that mimic or contribute to symptoms of fibromyalgia.
All of these changes to the biological chemistry of the body can indicate a disturbance in the operation of the autonomic or sympathetic nervous system.
The connection isn’t clear enough to create a blood test, but the connection has attracted attention.
“Fibromyalgia – The Misunderstood Syndrome.” The Wolfe Clinic. http://www.thewolfeclinic.com/index.php/information-and-tools/dr-wolfe-article-archive/235-fibromyalgia-the-misunderstood-syndrome.
“Fibromyalgia: Pathophysiology.” By Chad S. Boomershine. Medscape.com. http://emedicine.medscape.com/article/329838-overview#a0104.
Fibromyalgia Health Center: Overview and Facts. WebMD. http://www.webmd.com/fibromyalgia/guide/fibromyalgia-overview-facts.