With treatment approaches for fibromyalgia evolving over the course of modern medicine, many clinicians are reviewing the way they address potential symptoms of the common chronic, widespread pain condition. 

“We as clinicians have to be proactive but also be advocates for patients with this condition,” said Steven Stanos, DO, medical director of Swedish Pain Services at the Swedish Health Systems/Swedish Medical Group.

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What many may not realize is that fibromyalgia overlaps with related syndromes including chronic fatigue syndrome, regional pain syndromes such as tension headache, temporomandibular joint disorder, and idiopathic low back pain; psychiatric disorders such as major depressive disorder, obsessive-compulsive disorder, bipolar disorder, posttraumatic stress disorder, and general anxiety disorder;  and somatoform disorders.1

The pathophysiology of fibromyalgia includes central sensitization (amplification of pain in the spinal cord via spontaneous nerve activity, expanded receptive fields, and augmented stimulus responses), abnormalities of descending inhibitory pain pathways (dysfunction in brain centers that regularly downregulate pain signaling in the spinal cord), neurotransmitter abnormalities (where decreased serotonin in the central nervous system could lead to aberrant pain signaling), neurohumoral abnormalities (dysfunction in the hypothalamic-pituitary-adrenal [HPA] axis), and comorbid psychiatric conditions (persons with fibromyalgia have increased rates of psychiatric comorbid conditions).2

Clinical features of fibromyalgia include widespread pain, sleep disturbances, tenderness, and fatigue. Pain characterizations in patients with fibromyalgia include an increase in brain activity related to anticipation of pain, attention to pain, emotional aspects, and motor control.

Fibromyalgia shares several features with depression, said Dr. Stanos. These include a strong genetic predisposition and similar comorbidity; coaggregation in families; cognitive disturbances; dysfunction of the HPA axis; chronic stress-induced cytokine expression in the brain; and central monoaminergic neurotransmission. 

Dr. Stanos described the stepwise treatment algorithm for fibromyalgia: confirm the diagnosis of fibromyalgia; recommend treatment based on the individual evaluation; and if the patient is not responding to medication alone, consider cognitive behavioral therapy or group education.4

This article originally appeared on MPR