Symptoms
Fibromyalgia is a disease that affects the musculoskeletal system, causing musculoskeletal pain and fatigue symptoms.
The fibromyalgia syndrome is commonly characterized by the coexistence of the following symptoms:
- Diffuse pain, that is symmetrical with respect to the waist and present on both sides of the body;
- Decreased pain threshold, with hyperalgesia and allodynia;
- Tender points (muscle and tendon insertion areas that evoke a particularly acute pain response in the patient, even after modest pressure);
- Anxiety or depression;
- Invalidating fatigue.
To learn more: Symptoms Fibromyalgia Syndrome
Characteristics of pain
The painful picture of fibromyalgia mainly affects:
- Muscle-tendon areas ;
- Joints .
The pain can vary in intensity and location in each patient, and is manifested by two peculiar characteristics:
- Hyperalgesia : consists in the perception of a very intense pain in response to mild painful stimuli;
- Allodynia : is the perception of pain in response to stimuli that are not normally painful.
Overall, the pain associated with fibromyalgia:
- It is described by fibromyalgia patients as a widespread, generalized and persistent pain arising from the muscles. To be considered "widespread", the pain must involve the whole body: it is necessary on both sides, right and left, of the body, both above and below the waist, and in the chest, neck, and the middle or lower back. Fibromyalgia is characterized by persistent pain even after treatment with traditional painkillers and anti-inflammatories.
- It can occur in any area of the body, but can also be multi-district, focusing mainly on the neck, back, shoulders and arms. In addition to the actual pain, alterations of normal sensitivity may occur locally.
- It is often associated with a subjective psychological substrate (example: emotional stress). The symptoms described, in some cases, refer to an amplified sensation and not to a real dysfunction.
The external factors that contribute to causing a worsening of the symptoms are:
- Anxiety and stress (special events, traumas, family losses);
- Physical and mental fatigue (work stress);
- Excessive physical activity or, on the contrary, physical inactivity;
- Lack of rest;
- Meteorological changes and changes in atmospheric pressure;
- Wet or cold environments.
Asthenia
The fatigue associated with fibromyalgia refers to a constant and limiting fatigue: it is an all-encompassing exhaustion of forces that can interfere with professional, personal or social activities. Symptoms include profound fatigue and poor stamina, even while performing trivial activities, such as cooking or shopping.
Sleep rhythm disorders
The difficulty of falling asleep and the sensation of pain are regulated directly by the brain. Fibromyalgia patients often wake up exhausted, even though they report sleeping for long periods of time. Night rest is often disturbed by pain and many subjects have insomnia and frequent nocturnal awakenings. Medical researchers have documented specific and distinctive abnormalities in phase 4 of deep sleep: fibromyalgia patients tend to constantly interrupt deep sleep with a return to "superficial" sleep, due to brain activity similar to that which occurs in the brain when they are awake (alpha-delta anomaly).
Other symptoms / coexisting conditions
The picture can be very variable from patient to patient: these clinical signs can appear alone or in combination. Primary fibromyalgia may be associated with:
- Decreased muscle strength in the hands and arms, stiffness and awkwardness in movement upon awakening, cramps (especially at night) and a feeling of swelling in the hands and / or feet (even if they are not actually swollen).
- Depression or anxiety : they are often secondary to the chronic state of the symptoms and to the scarce consideration that the family and the doctor dedicate to the patient. Commonly comorbid disorders with the clinical presentation of fibromyalgia (especially anxiety, depression, irritable bowel syndrome and chronic fatigue syndrome).
- Headache : headache and migraine are often a consequence of non-restorative sleep or secondary to muscle contractures in the neck and / or upper back.
- Sensitivity disorders : tingling or numbness in the fingers and / or toes, thermal dysesthesia (abnormal sense of cold and heat) and restless legs syndrome, which reflect an alteration of pain perception and sensitivity at the level of central nervous system. The medical term for these sensations is paraesthesia .
- Collation : consists in the spontaneous contraction, rapid and at regular intervals, of one or more motor units, without motor outcome. Sometimes, the phenomenon is associated with the appearance of muscle cramps.
- Memory alterations and difficulty concentrating : these are secondary to tiredness and lack of restful sleep (in English, these manifestations are called "fibro-fog", fibromyalgia).
There are also a number of other conditions that often occur simultaneously with fibromyalgia. Central and peripheral nervous system disorders can variably be associated:
- Gastrointestinal disorders: irritable bowel syndrome with abdominal pain, diarrhea, nausea, constipation or meteorism is present in about 40-70% of fibromyalgia patients; dyspepsia (gastric disorder related to digestive functions), gastroesophageal reflux disease, etc may also occur;
- Chronic pelvic pain;
- Raynaud's phenomenon (excessive vasospasm caused by a physiological stimulus of vasoconstriction, induced by sympathetic stimuli);
- Tachycardias and palpitations;
- Dysmenorrhea (painful menstrual cramps);
- Urological problems: partial incontinence, pollakiuria and painful urination;
- Blurry vision and photophobia (excessive light sensitivity);
- Hypersensitivity of the skin and skin rashes;
- Dry eyes and mouth;
- Tinnitus, coordination disorders and vertigo;
- Craniomandibular or temporomandibular disorders .
Secondary fibromyalgia
Fibromyalgia can occur alone or in association with other pathological conditions:
- Rheumatoid arthritis, systemic lupus erythematosus and Sjögren's syndrome: 20-30% of patients with rheumatoid arthritis and systemic lupus erythematosus may also suffer from fibromyalgia. Other systemic rheumatic conditions associated with fibromyalgia include: arthrosis, polymyalgia rheumatica, polymyositis, and major connectivitis.
- Infectious diseases: from mononucleosic syndromes (Epstein-Barr virus / EBV) to HBV (hepatitis B virus) and HCV (hepatitis C virus) infections.
- Neoplasms.
