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Fibromyalgia

Disease Details

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Description: Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas.
Type: Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. The exact genetic transmission of fibromyalgia is not well understood, but it is believed to have a genetic component. The condition tends to run in families, suggesting a hereditary risk, possibly involving multiple genes and environmental factors. However, no single gene has been identified as the cause.
Signs And Symptoms: The defining symptoms of fibromyalgia are chronic widespread pain, fatigue, and sleep disturbance. Other symptoms may include heightened pain in response to tactile pressure (allodynia), cognitive problems, musculoskeletal stiffness, environmental sensitivity, hypervigilance, sexual dysfunction, and visual symptoms. Some people with fibromyalgia experience post-exertional malaise, in which symptoms flare up a day or longer after physical exercise.
Prognosis: Although in itself fibromyalgia is 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. However, most patients learn to adapt to the symptoms over time. The German guidelines for patients explain that:

The symptoms of fibromyalgia are persistent in nearly all patients.
Total relief of symptoms is seldom achieved.
The symptoms do not lead to disablement and do not shorten life expectancy.An 11-year follow-up study on 1,555 patients found that most remained with high levels of self-reported symptoms and distress. However, there was a great deal of patient heterogeneity accounting for almost half of the variance. At the final observation, 10% of the patients showed substantial improvement with minimal symptoms. An additional 15% had moderate improvement. This state, though, may be transient, given the fluctuations in symptom severity.A study of 97 adolescents diagnosed with fibromyalgia followed them for eight years. After eight years, the majority of youth still experienced pain and disability in physical, social, and psychological areas. At the last follow-up, all participants reported experiencing one or more fibromyalgia symptoms such as pain, fatigue, and/or sleep problems, with 58% matching the complete ACR 2010 criteria for fibromyalgia. Based on the WPI and SS score cut-points, the remaining 42% exhibited subclinical symptoms. Pain and emotional symptom trajectories, on the other hand, displayed a variety of longitudinal patterns. The study concluded that while most patient's fibromyalgia symptoms endure, the severity of their pain tends to reduce over time.Baseline depressive symptoms in adolescents appear to predict worse pain at follow-up periods.A meta-analysis based on close to 200,000 fibromyalgia patients found that they were at a higher risk for all-cause mortality. Specific mortality causes that were suggested were accidents, infections and suicide.
Onset: Fibromyalgia is characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues. Its onset can be subtle and often develops after a physical trauma, surgery, infection, or significant psychological stress. However, in some cases, symptoms gradually accumulate over time with no single triggering event. The exact onset mechanisms are not fully understood and can vary significantly from person to person. The term "nan" likely refers to "nanometers", which isn't relevant for the onset of fibromyalgia. If "nan" was intended as an abbreviation for something else, please clarify.
Prevalence: Fibromyalgia affects approximately 2-4% of the population worldwide. It is more commonly diagnosed in women than in men.
Epidemiology: Fibromyalgia is estimated to affect 1.8% of the population.Despite the fact that more than 90% of fibromyalgia patients are women, only 60% of people with fibromyalgia symptoms are female in the general population.
Intractability: Fibromyalgia is often considered intractable because it is a chronic condition with no known cure. While its symptoms can be managed through a combination of medications, lifestyle changes, and therapies, the condition itself persists over time.
Disease Severity: Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. The severity of fibromyalgia can vary significantly among individuals. Some may experience mild symptoms that are annoying but manageable, while others suffer from severe, debilitating pain that affects their quality of life and ability to perform daily activities.

The Numeric Analog Scale (NAS) is often used by healthcare professionals to assess the severity of pain in fibromyalgia patients. This scale allows patients to rate their pain on a scale from 0 (no pain) to 10 (worst possible pain). This, combined with evaluations of sleep disturbances, fatigue, and emotional well-being, helps create a comprehensive understanding of disease severity.

Quantifying the severity involves subjective assessments rather than specific nanometric measurements, as "nan" typically denotes "not a number" or missing data in numerical fields. The term "nan" does not apply directly in the context of fibromyalgia severity assessment.
Healthcare Professionals: Disease Ontology ID - DOID:631
Pathophysiology: As of 2022, the pathophysiology of fibromyalgia has not yet been elucidated and several theories have been suggested. The prevailing perspective considers fibromyalgia as a condition resulting from an amplification of pain by the central nervous system. Substantial biological evidence backs up this notion, leading to the term of nociplastic pain.
Carrier Status: Fibromyalgia is not a condition that is typically described in terms of carrier status. It is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. The exact cause is unknown, but it is believed to involve a combination of genetic, environmental, and psychological factors.
Mechanism: Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. The precise mechanism of fibromyalgia is not fully understood, but it is believed to involve abnormal sensory processing in the central nervous system.

Molecular mechanisms involved in fibromyalgia include:

1. **Neurotransmitter Imbalance**: Alterations in the levels of neurotransmitters such as serotonin, norepinephrine, and dopamine are thought to contribute to the heightened pain sensitivity and mood disorders commonly seen in fibromyalgia patients.

2. **Central Sensitization**: This refers to the increased sensitivity of neurons in the central nervous system to stimuli, leading to exaggerated pain responses. It involves enhanced excitability and reduced inhibition at the level of the spinal cord and brain.

3. **Glutamate Dysregulation**: Elevated levels of glutamate, an excitatory neurotransmitter, have been observed in brain regions involved in pain processing, suggesting that glutamate dysregulation may play a key role in maintaining chronic pain.

4. **HPA Axis Dysfunction**: The hypothalamic-pituitary-adrenal (HPA) axis, which regulates stress responses, may be dysregulated in fibromyalgia, contributing to symptoms such as fatigue, sleep disturbances, and pain.

5. **Genetic Factors**: Certain genetic polymorphisms may predispose individuals to fibromyalgia by affecting neurotransmitter systems, pain perception, and stress responses.

6. **Inflammatory Mediators**: Although fibromyalgia is not primarily an inflammatory disorder, some studies suggest that low-grade inflammation and cytokine imbalances may contribute to its pathophysiology.

Understanding these mechanisms helps in developing targeted treatments to manage symptoms and improve the quality of life for individuals with fibromyalgia.
Treatment: Fibromyalgia treatment typically involves a combination of medication, therapy, and lifestyle changes to manage symptoms. Medications can include pain relievers, antidepressants, and anti-seizure drugs. Non-drug therapies include physical therapy, counseling, and stress management techniques. Regular exercise, adequate sleep, and a healthy diet are also important for managing fibromyalgia.
Compassionate Use Treatment: Compassionate use treatments for fibromyalgia involve providing access to investigational drugs or therapies that have not yet been approved by regulatory bodies. These treatments are typically considered when standard therapies have failed and the condition significantly impacts the patient’s quality of life.

Off-label and experimental treatments for fibromyalgia include a range of medications and therapies that are used outside their approved indications or are still undergoing clinical trials. Some off-label medications include:

1. **Anticonvulsants**: Gabapentin and pregabalin (although pregabalin is FDA-approved for fibromyalgia, its use in other countries for fibromyalgia can be off-label).
2. **Antidepressants**: Low doses of tricyclic antidepressants (amitriptyline) and selective serotonin-norepinephrine reuptake inhibitors (duloxetine, which is FDA-approved but sometimes used off-label for other aspects).
3. **Muscle relaxants**: Cyclobenzaprine, typically used off-label for improving sleep.
4. **Low-dose naltrexone**: An opioid receptor antagonist that is being explored for its potential to reduce pain and inflammation.

Experimental treatments might include:

1. **Cannabinoids**: Emerging evidence suggests potential benefits, although more research is needed.
2. **Ketamine**: Administered under strict medical supervision for its analgesic properties.
3. **Transcranial Magnetic Stimulation (TMS)**: A non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain.
4. **Stem cell therapy**: Still in the experimental stages, with ongoing research to determine efficacy and safety.

It is crucial to consult healthcare providers for personalized treatment plans and to understand the potential risks and benefits of any off-label or experimental treatment.
Lifestyle Recommendations: ### Lifestyle Recommendations for Fibromyalgia:

1. **Physical Activity**: Engage in regular, low-impact exercises such as walking, swimming, or yoga to help reduce symptoms and improve overall well-being.

2. **Healthy Diet**: Maintain a balanced diet rich in fruits, vegetables, whole grains, and lean proteins to support overall health and energy levels.

3. **Sleep Hygiene**: Prioritize good sleep habits by maintaining a regular sleep schedule, creating a restful sleep environment, and avoiding caffeine or electronics before bedtime.

4. **Stress Management**: Practice stress-reduction techniques such as mindfulness, meditation, or deep-breathing exercises to help manage stress levels.

5. **Pacing and Activity Modification**: Learn to pace yourself and break tasks into smaller, manageable steps to avoid overexertion and worsening of symptoms.

6. **Support Networks**: Connect with support groups or counseling services to share experiences and receive emotional support from others with fibromyalgia.

7. **Avoiding Triggers**: Identify and try to avoid factors that exacerbate symptoms, such as certain foods, weather changes, or stressors.

8. **Ergonomic Adjustments**: Make ergonomic adjustments at your workplace or home to reduce strain and fatigue.

9. **Regular Medical Follow-ups**: Keep regular appointments with healthcare providers to monitor your condition and adjust treatments as necessary.

These lifestyle changes can complement medical treatments and help manage fibromyalgia symptoms effectively.
Medication: A few countries have published guidelines for the management and treatment of fibromyalgia. As of 2018, all of them emphasize that medications are not required. However, medications, though imperfect, continue to be a component of treatment strategy for fibromyalgia patients. The German guidelines outlined parameters for drug therapy termination and recommended considering drug holidays after six months.Health Canada and the US Food and Drug Administration (FDA) have approved pregabalin (an anticonvulsant) and duloxetine (a serotonin–norepinephrine reuptake inhibitor) for the management of fibromyalgia. The FDA also approved milnacipran (another serotonin–norepinephrine reuptake inhibitor), but the European Medicines Agency refused marketing authority.
Repurposable Drugs: Repurposable drugs for fibromyalgia include:

- **Duloxetine (Cymbalta):** Originally used as an antidepressant, it has been found to help reduce pain and improve function in fibromyalgia patients.
- **Pregabalin (Lyrica):** Initially used for epilepsy and neuropathic pain, it can alleviate fibromyalgia-related pain.
- **Amitriptyline:** An older antidepressant that can help with pain and improve sleep quality in fibromyalgia sufferers.
- **Cyclobenzaprine (Flexeril):** A muscle relaxant that may help reduce pain and improve sleep.

These drugs were originally developed for other conditions but have shown efficacy in treating symptoms of fibromyalgia. Always consult with a healthcare professional for personalized medical advice.
Metabolites: In fibromyalgia, various metabolites have been studied to understand the condition better. Notably, abnormalities in certain metabolites related to energy metabolism, oxidative stress, and neurotransmission have been observed. These include altered levels of lactate, pyruvate, and glutamate in different tissues. Elevated oxidative stress markers, such as malondialdehyde, and changes in antioxidant defense mechanisms have also been reported.
Nutraceuticals: Nutraceuticals, which are food-derived products with health benefits, may help manage fibromyalgia symptoms. Commonly discussed nutraceuticals for fibromyalgia include:

1. **Vitamin D**: May alleviate pain and improve mood.
2. **Magnesium**: Can help with muscle pain and cramps.
3. **Coenzyme Q10 (CoQ10)**: Might reduce fatigue and improve energy levels.
4. **Omega-3 Fatty Acids**: Known for their anti-inflammatory properties.
5. **SAMe (S-Adenosylmethionine)**: May improve mood and reduce pain.
6. **Melatonin**: Can enhance sleep quality, addressing one of the major complaints in fibromyalgia.

Always consult healthcare providers before starting any nutraceutical regimen, as they can offer personalized advice and check for interactions with other medications.
Peptides: Fibromyalgia is a chronic condition characterized by widespread pain, fatigue, and tenderness in localized areas. Research on the role of peptides and their potential therapeutic applications in fibromyalgia is ongoing. Some peptides are being investigated for their ability to modulate pain and inflammation, but no definitive peptide-based treatments have been widely adopted in clinical practice as of now. Nanotechnology-based approaches are also under exploration for drug delivery to improve the efficacy and targeting of treatments for fibromyalgia, but these are still largely in the experimental stages.