What is Fibromyalgia?

Fibromyalgia is a chronic musculoskeletal disorder characterized by chronic widespread pain accompanied by symptoms such as fatigue, sleep disturbances, cognitive impairment, and mood disorders, the exact cause of which is not fully understood.

Fibromyalgia can occur at any age and in any gender, but its frequency increases between the ages of 40 and 60. Approximately 5% of the general population suffers from fibromyalgia, with 85-90% being women. The incidence of fibromyalgia in women is 9-10 times higher than in men. In men with fibromyalgia, there are fewer tender points and symptoms compared to women.

The prevalence of fibromyalgia, which increases with age, is the second most common rheumatic disease after osteoarthritis. In our country, approximately 100,000 people are diagnosed with fibromyalgia each year, and this number is increasing. Ethnicity, genetic predisposition, socio-cultural factors, psychological conditions, and gender significantly affect the prevalence rate of fibromyalgia.

Fibromyalgia Causes

Fibromyalgia is a chronic pain syndrome with an unknown cause that is not attributed to a single factor. However, several potential factors are thought to contribute to the development of fibromyalgia.

• Genetic Factors Fibromyalgia is frequently observed among family members. Studies have reported an eight-fold increased risk of developing fibromyalgia among first-degree relatives of individuals diagnosed with fibromyalgia.
• Environmental Factors Some environmental factors, such as trauma, physical injuries, or chemical exposure, are believed to contribute to the development of fibromyalgia.
• Psychological Factors Chronic stress, trauma, depression, anxiety, and other psychological factors can exacerbate fibromyalgia symptoms. Additionally, psychological stress in individuals diagnosed with fibromyalgia can worsen symptoms.
• Personality Traits Individuals with tendencies towards perfectionism, constantly striving for high standards, and feeling stressed when unable to achieve these goals, may increase susceptibility to fibromyalgia. Individuals with obsessive-compulsive personality traits may also have a higher predisposition to fibromyalgia.
• Fibromyalgia Risk Factors
• Genetic factors
• Being female
• Advanced age
• Physical traumas (falls, impacts, etc.)
• Surgical operations
• Traffic accidents
• Infections (such as Borrelia Burgdorferi, Parvovirus, Coxsackievirus, Epstein-Barr Virus-EBV, HCV, Hepatitis B Virus-HBV, HIV, HTLV-1, and Lyme disease)
• Chronic stress
• Physical or psychological violence in childhood (such as parental separation, natural disasters, fire, etc.)

Fibromyalgia Tender Points

Fibromyalgia tender points are specific areas in the body described as sensitive and painful areas. These points become overly sensitive to pressure and cause pain. They are mainly found in muscles and tendons. According to the American College of Rheumatology (ACR) criteria (1990) for fibromyalgia diagnosis, there should be pain lasting for at least three months on both sides of the body, above and below the waist, and in the cervical spine, chest, thoracic spine, or lumbar spine. Additionally, according to the 1990 ACR criteria, out of 18 tender points, at least 11 should be painful. These points are primarily used to rule out suspected diseases. The fibromyalgia tender points include:

• Back of the head
• Neck
• Shoulder tops
• Upper chest
• Hips
• Knees
• Elbows

Fibromyalgia Symptoms

Fibromyalgia symptoms are chronic widespread pain lasting for more than three months, not explained by any other medical condition, fatigue, and sleep disturbances. The most common complaint after pain in fibromyalgia patients is sleep disturbances. Approximately 80% of patients experience sleep disturbances. Fibromyalgia symptoms may include:

• Chronic widespread body pain
• Chronic fatigue syndrome
• Stiffness
• Sleep disturbances
• Depression
• Anxiety
• Irritable bowel syndrome
• Muscle weakness
• Chronic headaches
• Abdominal pain
• Chest pain
• Numbness
• Tingling
• Dizziness
• Irritable bladder syndrome

Fibromyalgia Symptoms in Women

In women with fibromyalgia, tender points and symptoms are more prevalent compared to men. Pain, chronic fatigue syndrome, and irritable bowel syndrome are more frequent in women than in men. Hormonal changes in women can affect fibromyalgia symptoms, especially during menstruation, causing an increase in symptoms. Pain is generally more prominent in body areas such as the neck, shoulders, and lower back in women.

Fibromyalgia Symptoms in Men

Diagnosing fibromyalgia in men can be more challenging because it is generally more widespread in women. This situation may lead men to hesitate to express their symptoms or hinder the diagnosis. Pain in men is often more prominent in areas such as the back, chest, and lower back.

Fibromyalgia Symptoms in Children

In children, benign joint hypermobility syndrome or joint laxity is more commonly observed than in adults.

Fibromyalgia Attacks

During fibromyalgia attacks, pain is typically more pronounced and intense. It is usually felt in the muscles, joints, and soft tissues. During attacks, there might be a more pronounced feeling of chronic fatigue. There might be a decrease in energy levels, and sleep quality might be affected. This can result in feeling less rested and decreased functionality throughout the day. Anxiety, depression, and other psychological symptoms might be more pronounced. Additionally, during periods of attacks, somatic symptoms such as numbness, tingling, swelling, or sensitivity in different parts of the body might be more frequent. Certain situations can trigger or exacerbate attacks. For instance, excessive physical activity, stressful situations, lack of sleep, or changes in weather can be triggering factors.

Fibromyalgia Diagnosed

Diagnosing fibromyalgia is generally challenging. A detailed medical history of the patient's symptoms is taken into account. Information such as the type, duration, and prevalence of pain, along with accompanying symptoms, is essential. During a physical examination, painful areas are assessed, and sensitivity is evaluated. In fibromyalgia patients, there is typically a sensation of pain when light pressure is applied to specific points (tender points). There is no specific laboratory test for fibromyalgia. However, doctors may request blood tests or imaging techniques (such as X-rays, MRI, etc.) to exclude other potential causes. Before diagnosing fibromyalgia, it is crucial to rule out other potential health issues since fibromyalgia symptoms can be mistaken for symptoms of other diseases. The role of psychological factors in fibromyalgia patients is also significant. Therefore, the patient's mental and emotional state is evaluated.

Differential diagnosis in children should also consider growing pains.

Fibromyalgia Treatment

The initial step in treating fibromyalgia is managing pain and improving sleep quality. The primary goal of treating this condition is to reduce pain, manage accompanying symptoms, and enhance the patient's functional capacity. Because fibromyalgia patients may present with symptoms related to various systems and accompanying conditions, treating fibromyalgia requires a multidisciplinary approach. Controlling fibromyalgia solely through medication is not feasible.

Patient education, cognitive-behavioral therapies, psychotherapy, physical therapy interventions, hydrotherapy, regular exercise, and medical treatment are among the primary treatment methods. A personalized treatment plan is created based on the individual's symptoms supported by scientific evidence since each patient's condition is different. Additionally, every patient is advised to adopt a healthy and balanced diet, avoid acidic foods, engage in regular exercise, consume adequate water, and ensure proper rest. These lifestyle changes play a crucial role in managing fibromyalgia symptoms.

Fibromyalgia Exercises

Fibromyalgia patients tend to lead more sedentary lives compared to the general population. Their ability to perform tasks can decrease by up to 80% compared to healthy individuals. Exercise stimulates muscles and soft tissues, increasing functional capacity; it also improves sleep patterns and positively affects mood. Studies have shown that aerobic exercises and relaxation techniques reduce fibromyalgia symptoms. Generally, research indicates that aerobic exercises, strength exercises, stretching, and hydrotherapies are effective in the treatment of fibromyalgia.

Fibromyalgia Diet and Nutritional Recommendations

A balanced nutrition plan including various vitamins, minerals, and other nutrients should be developed. A diet consisting of vegetables, fruits, protein sources, whole grains, and healthy fats is preferred. Omega-3 fatty acids may have anti-inflammatory effects. Obtaining these fatty acids from foods such as salmon, sardines, flaxseed, etc., or taking fish oil supplements can be beneficial. Consuming foods with anti-inflammatory properties such as ginger, turmeric, green tea may help in managing pain and inflammation. Protein is essential for muscle health. A balanced intake of protein sources like chicken, fish, red meat, beans, lentils, etc., should be ensured. In some fibromyalgia patients, sensitivity to gluten or lactose may exacerbate symptoms. The patient's sensitivity to these food substances should be evaluated. Excessive caffeine and sugar intake can fluctuate energy levels and disrupt sleep patterns. Therefore, limiting caffeine and sugar intake might be beneficial. Drinking adequate water is essential for bodily functions as it helps cells function properly and eliminates toxins. Taking vitamin, mineral, or other nutritional supplements as advised by the doctor can be helpful. It is essential to identify deficiencies such as Vitamin D or magnesium and supplement them accordingly. Some foods may exacerbate fibromyalgia symptoms. Therefore, personal experiences should be observed, and ideally, a journal should be kept to monitor post-meal conditions.

Usage of Fibromyalgia Medications

Each fibromyalgia patient is evaluated individually, and a treatment plan is developed. It should be remembered that long-term use of medications in fibromyalgia patients may be harmful. Antidepressants are among the medications that can be preferred for fibromyalgia syndrome. These drugs can aid in regulating sleep while also alleviating chronic painful conditions. However, it should be noted that prolonged use of these drugs can lead to dependency. Psychiatric medications should only be used when there are accompanying psychological conditions. When using painkillers, attention should be paid to blood pressure, stomach, and kidney problems.