Understanding fibromyalgia

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Publication Date: 
Mon, 2013-10-07
  1. Neurological Manifestations: Numbness and tingling in the muscles, cramps, muscle weakness, headaches, generalized weakness, sensitivity to light and sound.
  2. Neurocognitive Manifestations: Poor concentration and short-term memory loss, impaired speed of performance, inability to multi-task, and/or cognitive overload.
  3. Fatigue: Persistent and reactive fatigue accompanied by reduced physical and mental stamina.
  4. Sleep Dysfunction: Sleep is unrefreshing. There may be disturbance in sleep quantity or rhythm including daytime; hypersomnia or nighttime insomnia.
  5. Autonomic and/or Neuroendocrine Manifestations: irregular heartbeat, dizziness, heat/cold intolerance, respiratory disturbances, intestinal and bladder disturbances, stress intolerance, blunted emotions and/or reactive depression.
  6. Stiffness: It is common to have generalized or regional stiffness that is most severe upon awakening and typically lasts for hours. Stiffness can return during periods of inactivity during the day.

In 2010, the American College of Rheumatology published an article proposing new diagnostic criteria described as “preliminary,” “provisional” and “alternative.” A modification was published in 2011. Under the 2010/11 criteria, two scores are calculated to make a diagnosis. The Widespread Pain Index measures how many of 19 parts of the body have pain. The Symptom Severity Index measures the degree of activity reduction, sleep problems, cognitive difficulties, and other physical symptoms. While the proposed definition may have been intended to provoke discussion, that discussion has not taken place in Canada, leading to confusion about which definition should be used.

Causes of fibromyalgia

"Most of the research findings in fibromyalgia point to a malfunctioning of the central nervous system (CNS), which includes the brain and spinal cord. Yet, there appear to be a variety of abnormalities occurring in the peripheral soft tissues (muscles and connective tissue) and the peripheral nervous system that communicates with the CNS. This dysfunctional interplay between the CNS and peripheral systems is believed by most investigators to be the source of the many body-wide symptoms." - Fibromyalgia Network

There are a number of ways of understanding fibromyalgia, including as a rheumatologic illness, as a neurological illness, and as a chronic pain condition (but not exclusively any of these conditions.

In 2012, the Canadian Rheumatology Society and the Canadian Pain Association endorsed new guidelines, which described fibromyalgia as “neurophysiological.” These guidelines, the Canadian Guidelines for the Diagnosis and Management of Fibromyalgia Syndrome for Adults, did not indicate a role for rheumatologists, neurologists or chronic pain specialists. Responsibility for fibromyalgia was assigned to family doctors, an unrealistic strategy considering how much research and communication need to be done and how complex some of the cases can be.

Impacts of fibromyalgia

Statistics Canada data provides us with a picture of the current understanding of the impacts of fibromyalgia in Canada. The Canadian Community Health Survey is a major survey with the target population being Canadians aged 12 and over living in the community (not institutions). In 2001, 2003, 2005 and 2010, respondents of the survey were asked if they had been diagnosed with fibromyalgia by a health professional.

The 2010 survey found that there were 439,000 Canadians with a diagnosis of fibromyalgia, about 1.5 per cent of the target population. It found that other pain conditions are more prevalent: 5.5 million Canadians reported back pain and 4.5 million Canadians reported arthritis. Many well-known conditions were found to be less prevalent: 111,500 Canadians reported Alzheimer's, 108,500 reported Multiple Sclerosis and 102,500 reported Crohn's disease.

The profile of someone with fibromyalgia is primarily female and working age. Women accounted for 80 per cent of the cases, making it the most female predominant of the conditions surveyed. Other female predominant diseases included multiple chemical sensitivities (72 per cent), bowel disorders (71 per cent), migraines (70 per cent) and chronic fatigue syndrome (66 per cent). Male dominant conditions included heart disease (42 per cent female), diabetes (44 per cent) and Alzheimer's (48 per cent).

Half of people with fibromyalgia are between 40 and 60 years old, a time of life when they are supposed to be contributing to family and the economy. Many of the people we hear from are struggling to continue working or struggling to qualify for disability benefits. Many are struggling to care for themselves and their families.

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