Addressing Challenges in Fibromyalgia in Primary Care - Part I

Research confirms that even low levels of pain over a lifetime can have great consequences on quality of life, so when viewed in this light, fibromyalgia becomes an emergency situation, and it’s not just damaging in a psychological fashion.

Data suggests that the biochemical changes associated with fibromyalgia—the three classic symptoms of fibromyalgia are fatigue, “fibro fog,” and non-refreshing sleep—literally eat away at the brain over the long term. The longer a patient has fibromyalgia, the smaller their brain will be.

These patients will lose cortical volume and have lower total brain volume compared to similar controls (research suggests that a fibromyalgia patient’s brain age is 20 years older than a healthy comparator). Further, the older a patient is, this shrinking accelerates.

You don’t want to let conditions continue. It is abundantly clear that this disease is a real, widely dispersed experience (especially in the brain), with bodily components that are both damaging and toxic. Hopefully this reality will push medicine largely past the tipping point in order that acceptance becomes widespread and in turn, treatment strategies can advance through concerted effort.

Sufferers and pain

In order for someone to be classified as having fibromyalgia, their pain must reside in all quadrants of the body — both sides above and below the waist. Upon examination, you will find that a person’s pain is primarily axial, in the same parts of the body that would manifest themselves in depressives.

The correlation with depression does not end there. Fibromyalgia sufferers typically fall within three groups of comorbid psychiatric diagnosis - comorbid anxiety, comorbid depression, and no concurrent psychiatric diagnosis. Those suffering from anxiety are typically in the worst shape, followed by those with depression, and (obviously) those with no psychiatric condition faring best.

Unfortunately, it is unlikely we will ever discover a gene for fibromyalgia, depression, or anxiety. The patterns that contribute to these conditions are created by perhaps 1000 genes or more, by countless interconnected bi-different pathways. The neurobiology underpinning fibromyalgia is so complex that we don’t have a 1:1 correspondence between disease and gene and we may never.

Click here for Part II