Fibromyalgia: Answers to Common Questions

From Current Research

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Fibromyalgia research has made great strides in recent years, but it's still common to hear questions about its validity, such as whether it's a "real" condition.

An article published in the May 2015 edition of Mayo Clinic Proceedings provides an up-to-date view of fibromyalgia that serves to answer many of the common questions about it. It was authored by Daniel Clauw, M.D., who's currently one of the strongest research voices for fibromyalgia.

The questions and answers below can serve as an easy reference for you as you try to answer questions both for yourself and for the people in your life. The material in quotes comes directly from the abstract for the paper; other material is provided to explain or expand upon the answers.

Question #1: What is fibromyalgia?

"Fibromyalgia is the currently preferred term for widespread musculoskeletal pain, typically accompanied by other symptoms such as fatigue, memory problems, and sleep and mood disturbances, for which no alternative cause can be identified."

Fibromyalgia has been known by several different names throughout its history, including rheumatism and fibrositis. Those names were eventually found not to be scientifically accurate.

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Question #2: If no cause is identified, does that mean it's not real or is a psychological disorder?

"Earlier there was some doubt about whether there was an 'organic basis' for these related conditions, but today there is irrefutable evidence from brain imaging and other techniques that this condition has strong biological underpinnings, even though psychological, social, and behavioral factors clearly play prominent roles in some patients."

Question #3: So what's going on, physically, to cause fibromyalgia symptoms?

"The pathophysiological hallmark is a sensitized or hyperactive central nervous system that leads to an increased volume control or gain on pain and sensory processing."

What that means is: the brain and nerves of the spinal cord are hypersensitive to pain and other sensory input, such as temperature, light, and noise.

The central nervous system takes this input and basically turns up the volume, leading to abnormally high pain levels and sensory overload — even from things that may seem mundane and insignificant to the person without fibromyalgia.

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Question #4: Why do people with fibromyalgia seem to have a bunch of different things wrong with them?

"This condition can occur in isolation, but more often it co-occurs with other conditions now being shown to have a similar underlying pathophysiology (eg, irritable bowel syndrome, interstitial cystitis, and tension headache) or as a comorbidity in individuals with diseases characterized by ongoing peripheral damage or inflammation (eg, autoimmune disorders and osteoarthritis)."

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Question #5: When it's so controversial that some doctors say it doesn't even exist, there's no lab test or imaging to diagnose it, and no universal treatment, is it even worthwhile to diagnose fibromyalgia?

"It is important to recognize this phenomenon (regardless of what term is used to describe it) because individuals with centralized pain do not respond nearly as well to treatments that work well for peripheral pain (surgery and opioids) and preferentially respond to centrally acting analgesics and nonpharmacological therapies."

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Clauw DJ. Mayo Clinic proceedings. 2015 May;90(5):680-692. Fibromyalgia and related conditions.

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