What is Fibromyalgia Syndrome?

Fibromyalgia is a chronic pain syndrome that affects connective tissues, which we call soft tissues, such as muscles, ligaments and tendons in different parts of the body, causing widespread body pain and extreme sensitivity. Pain and tenderness of patients are generally chronic, widespread, come and go, and are migratory in nature, lasting for 3 months or longer. Neuropathic pain, described as burning, stinging, sharp pain, touch sensitivity, tingling and itching, is a common symptom in patients. Many patients may also experience fatigue, sleep disturbances, headaches, and mood disorders such as depression, distress, and anxiety. Most patients complain about not being able to have a satisfactory and restful sleep (not being able to wake up fresh). Other additional symptoms that may occur include irritable bowel syndrome (IBS) which causes gas in the intestine and indigestion, migraines, painful menstruation, pelvic pain, difficulty concentrating & memory problems & “fibrofog” condition called confusion, dry eyes, mouth and nose, skin tenderness. , itching and jaw joint problems (such as pain in jaw movements, jaw joint clicking and jaw locking). Some patients complain of intense pain and tenderness as well as a subjective feeling of swelling. The feeling of swelling can be felt in different parts of the body and is felt even though there is no actual swelling in the felt area.
All of these symptoms may be worse, especially when you are under stress or when other fibromyalgia symptoms worsen. Fibromyalgia symptoms may vary from individual to individual, and symptoms can often be associated with other diseases.

How Is Fibromyalgia Diagnosed?

Diagnosis of fibromyalgia syndrome is made through a clinical physical examination and exclusion of other potential causes. Diagnosis of fibromyalgia syndrome involves the use of criteria established by the American College of Rheumatology (ACR). These criteria are based on factors such as the presence of widespread areas of pain and tenderness, duration of symptoms, and exclusion of other symptoms. Diagnosis of fibromyalgia symptoms according to current diagnostic criteria is no longer made on the number of pain points, but on a comprehensive clinical evaluation based on the signs and symptoms of the disease. This evaluation may include common symptoms such as pain, fatigue, insomnia, difficulty concentrating, mood changes, as well as medical tests to rule out other causes. Other medical tests, such as blood tests and imaging, may be ordered by your physician to rule out other potential diseases. However, in some patients, the response to medication used to reduce symptoms may also help confirm the diagnosis.

Why is Fibromyalgia Important?

The importance of fibromyalgia is that these symptoms seen in the disease can seriously affect daily activities and quality of life. For this reason, it is important for people with fibromyalgia syndrome to get help from specialist physicians, start treatment and be under medical supervision. However, diagnosing fibromyalgia can be difficult because it can often be similar to symptoms of other diseases. Despite ongoing research, the cause and optimal treatment of fibromyalgia are still unclear; Although some existing treatment methods are used, the ability of medications to reduce symptoms in some patients is another factor that makes the disease important.

What Causes Fibromyalgia?

The cause of fibromyalgia is not fully known. Although many patients report a lifelong history of chronic pain, it is thought that a variety of physical or emotional factors (such as after trauma, injury, infection, or significant psychological stress) may play a role in triggering symptoms.

•  Effect of Genetics in Fibromyalgia

It is thought that genetic factors may play an important role in the formation of the disease. Various studies have shown that similar symptoms occur more frequently in family members of fibromyalgia patients. In addition, genetic factors are thought to be effective in the development of fibromyalgia due to their effects on pain perception, brain chemistry and other physiological processes. However, the genetics of fibromyalgia are still not fully understood. It is thought that more than one gene may have an effect and that these genes interact with many factors, and studies on genetic predisposition are continuing.

• Fibromyalgia and Sleep Disorders

There is thought to be a strong connection between fibromyalgia and Non-REM sleep disorders. Non-REM sleep is the deep phase of sleep and is very important for the body to rest and regenerate. Most fibromyalgia patients are people who cannot constantly enter the Non-REM phase of sleep or have poor quality sleep in this phase. It is thought that stress, anxiety, depression, pain, insomnia, lack of physical activity and other factors may be effective in the development of Non-REM sleep disorders. This sleep disorder can make symptoms of fibromyalgia worse.

• Serotonin Effect in Fibromyalgia

Research has shown that there are abnormalities related to serotonin metabolism in fibromyalgia patients. Serotonin functions as a neurotransmitter in the central nervous system and regulates mood, sleep patterns and pain perception. In fibromyalgia patients, serotonin levels may be low and serotonin receptors may vary. This can increase the perception of pain and cause sleep disturbance. However, the exact cause of serotonin metabolism disorder in fibromyalgia patients is not fully understood. Some researchers suggest that psychological factors such as stress and depression may have an impact on serotonin metabolism. Additionally, since digestive problems are also common in fibromyalgia patients, serotonin production and metabolism in the digestive tract may also contribute to these problems.

• “Central Sensitization”, Increased Pain Perception

It is thought that in fibromyalgia syndrome, the brain perceives pain signals in an exaggerated way. In people with fibromyalgia, muscles and tendons become extremely irritated by various painful stimuli. This is thought to be due to an increased perception of pain, a phenomenon called "central sensitization." As a result, a change occurs in the way of communication between the body, spinal cord and brain; Levels of chemicals and proteins between nerve cells and in the brain may change. Researchers believe that repeated neural stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in the levels of certain chemicals (neurotransmitters) in the brain that stimulate pain, lowering the pain threshold. Additionally, the brain develops a type of pain memory and becomes more sensitive, meaning that there may be an overreaction to pain.

In recent years, fibromyalgia syndrome has been named under the umbrella of "Central Sensitization Sydnrome", which means that the volume of pain sensation in the brain is very high. The term Central Pain Amplification Disorder (Central Sensitization Syndrome) is an umbrella that includes fibromyalgia as well as various chronic pain disorders such as irritable bowel syndrome, migraine, temporomandibular jaw joint disorders, chronic pelvic and bladder pain, chronic fatigue syndrome. This disorder is a process that affects the central nervous system, which normally controls pain signals. In this case, it causes the central nervous system to overreact to pain, which can increase the sensation of pain. For this reason, the patient's perception of pain increases and they become hypersensitive even to stimuli that would not normally cause pain, causing the person to experience chronic pain.

This term means that pain signals are excessively amplified and processed by the central nervous system. For this reason, it is thought that patients with fibromyalgia feel pain more intensely and react above their normal pain thresholds. Therefore, treatment strategies focus on pain management and often include medications and therapies that act on the central nervous system.

There is no generally agreed upon explanation for how and why central sensitivity develops in some people. The most plausible theory suggests that there is a genetic component, meaning that some people are predisposed to having an increased feeling of pain. For example, people who have a parent or sibling with fibromyalgia have a higher chance of developing it themselves. In some cases, a variety of stressors appear to trigger the development of fibromyalgia, including infection (e.g., Lyme disease or viral illness), diseases involving arthritis (e.g., rheumatoid arthritis or systemic lupus erythematosus), physical or emotional trauma, or sleep disorders.
Brain imaging studies in people with fibromyalgia and related chronic pain disorders have also shown changes in brain function and connections between different parts of the brain. As further research continues, the factors that lead to chronic pain in fibromyalgia will become better understood, hopefully allowing the development of better treatments.

Why Should Fibromyalgia Be Treated?

If fibromyalgia is left untreated, symptoms may gradually worsen and it may become more difficult to do daily activities as the disease progresses. Some studies show that in people with chronic pain syndromes such as fibromyalgia, the patient's neglected and untreated chronic pain may create a pain memory in the brain that is resistant to treatment in the future. This memory occurs as a result of repeated stimulation of nerve pathways in the brain and can cause the feeling of pain to persist. Therefore, it is very important to diagnose fibromyalgia patients early and initiate appropriate treatments as soon as possible.
Also Associated with Different Health Problems

Additionally, fibromyalgia may be associated with other health problems. For example, fibromyalgia patients may also experience other discomforts such as headaches, digestive problems, anxiety, depression, and insomnia. Leaving fibromyalgia untreated can cause these conditions to worsen and further reduce quality of life.
Another reason it needs to be treated is that fibromyalgia can be a risk factor for other health problems. For example, fibromyalgia patients also have a higher risk of developing diseases such as migraines, heart disease, and diabetes. It is thought that fibromyalgia may cause chronic inflammation in the body. Chronic inflammation can increase the risk of developing other health problems in the body. Therefore, treating fibromyalgia is important both to reduce the symptoms of the disease and to reduce the risk for other health problems. Additionally, fibromyalgia patients may often have decreased physical activity levels, which may increase the risk of developing other health problems. Physical activity is important in preventing heart disease, diabetes and other diseases. Therefore, it is important for fibromyalgia patients to have regular doctor check-ups to monitor their health and prevent the development of other health problems. This way, other health problems can be diagnosed and treated early.
As a result, fibromyalgia is a disease that needs to be treated. If left untreated, symptoms may gradually worsen and the disease may also be a risk factor for other health problems. Treatment is important to control symptoms and improve quality of life.

How to Treat Fibromyalgia?

There is no clear definitive treatment for fibromyalgia. However, patients' symptoms can be controlled and treated with both drug-free and drug-based treatments, thus improving their quality of life significantly. Generally, the best results are achieved with more than one treatment method and a multidisciplinary approach that includes a physical therapist, physiotherapist, psychiatrist/clinical psychologist and dietitian. First of all, the treatment plan should be specific to each patient and should be determined and managed by a physical therapist who is an expert in his field. Individual treatment varies depending on the type and severity of symptoms and individual needs.

When prescribing medication to the patient, the physician's detailed explanation of the mechanism of the medication will increase compliance and adherence to treatment. We must explain that we want to prevent permanent pain memory by giving antidepressants to the patient not to treat depression, but to regulate serotonin levels, pain-sensing receptors and pain-transmitting pathways. According to my clinical experience, patients who are afraid of the label of using antidepressants and whose treatment logic is not explained in detail either hesitate to start treatment or abandon their treatment.

In addition to drug treatments; Treatment options such as physical therapy agents, exercise, sleep pattern changes, stress management, Cognitive Behavior Therapy (CBT) and Balneotherapy (water therapy) are very effective in managing fibromyalgia symptoms. In addition, alternative and complementary treatment methods such as yoga, meditation, acupuncture, ozone therapy, neural therapy, music & dance therapy, detoxification, intravenous antioxidant treatments, nutritional changes and lifestyle changes may also be beneficial for pain management. However, it is thought that the chemical balances in the brains of fibromyalgia patients are also affected by Non-REM sleep disorders. Therefore, if the patient has a coexisting sleep disorder, treating it is an important component to managing symptoms.