Fibromyalgia

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Introduction0:00–0:25

The term fibromyalgia can be broken down. Fibro- refers to fibrous tissue, -my- refers to muscle and -algia refers to pain.
Fibromyalgia is a chronic condition, which occurs more often in women, that causes widespread muscle pain, extreme tenderness in various parts of the body, and sleep disturbances.
Normally, if a person cuts their finger, a specific type of sensory neuron called a nociceptor or pain receptor, converts that stimulus into an electrical signal.

Physiology0:25–2:47

These are the first neurons and they’re primarily found in the skin, joints, or the walls of organs. The electrical signal goes from the dendrite of the nociceptor into its peripheral axon branch and heads up the hand and arm towards its cell body.
The cell body is located in the dorsal root ganglion which is a cluster of nerve cell bodies located in a dorsal root of the spinal nerve.
The dorsal root ganglia contains the cell bodies of many sensory neurons that receive information. So in this case, the cell body would receive the electrical signal, and if it’s strong enough, it would start to release substance P, which is a small chemical involved in pain perception.
Substance P would go down the other axon branch of the nociceptor and would get released from the neuron’s terminal button.
Substance P then binds to receptors on a second neuron which has its cell body located in the dorsal horn of the spinal cord, which makes up the back portion of the spinal cord that receives sensory information.
There is also a separate group of neurons called inhibitory neurons in the spinal cord that dampen or reduce the pain response, counteracting the effect of nociceptors.
These inhibitory neurons release neurotransmitters such as serotonin and norepinephrine and they also act on the second neuron in the spinal cord to inhibit the pain signal.
If the signal from the nociceptors is greater than the signal from the inhibitory neurons, then it triggers the second neuron in the spinal cord to fire an action potential.
This electrical signal goes all the way up the spinal cord to the brain where the pain is perceived. So while, the pain signal races towards the brain, important events are happening in the damaged finger as well.
Epithelial cells near the damaged area start to release nerve growth factor. That nerve growth attracts nearby mast cells which start to release even more nerve growth factor - amplifying the effect.
The high levels of nerve growth factor do a few important things to nociceptors. It boosts the growth, makes them more sensitive to pain, and makes them produce even more substance P.
In fibromyalgia, the underlying mechanism isn’t well understood, but there seems to be a problem with how the brain receives pain signals.

Pathology2:47–3:58

Generally speaking, individuals have low levels of serotonin, which is involved in inhibiting pain signals, and elevated levels of substance P, and nerve growth factor, which are involved in propagating pain signals.
Together, these are thought to play a role in the hypersensitivity to pain, which hints that fibromyalgia might be a condition of central sensitization.
In other words, if a person with fibromyalgia were to cut their finger, they would perceive more pain compared to other people.
In addition, central sensitization means that a person might have a wide range of sensitivities - affecting everything from how they sleep to how they feel to how they think.
If the person with fibromyalgia has negative emotions like depression, anxiety, and psychological factors like negative beliefs and attributions it can also amplify this sensitivity to pain.
Fibromyalgia often runs in families so there seems to be a strong genetic link too. And environmental factors like child abuse are also linked to fibromyalgia.

Diagnosis3:58–4:45

Diagnosis of fibromyalgia is generally based on a few factors. First, there’s pain in at least seven or more areas of the body, with a symptoms severity scale score of at least five points out of a possible twelve.
The symptoms severity scale gives points for a wide range of symptoms - everything from difficulty concentrating and remembering things - sometimes called “fibro fog” to fatigue to poor sleep and waking up unrefreshed and having a headache.
Alternatively, there might be pain in at least five or more areas of the body, with a symptoms severity score of at least nine points out of a possible twelve.
Additionally, the symptoms have to be present for at least three months, of course, the pain cannot be due to another disorder.

Treatment4:45–5:26

Treatment of fibromyalgia requires a holistic approach. Regular exercise like cardiovascular fitness training which includes fast walking, biking, swimming, or water aerobics can help by reducing pain and fatigue.
Relaxation techniques and good sleep hygiene can also help. If these approaches don’t work, medications can be used.
For example, amitriptyline, and serotonin-norepinephrine reuptake inhibitors, or SNRIs, can help by elevating serotonin and norepinephrine levels.
Finally, anticonvulsants like pregabalin and gabapentin which slow nerve impulses can help with sleep problems. All right, as a quick recap, fibromyalgia is a long-lasting condition that causes widespread muscle pain, excessive tenderness in many areas of the body, and sleep disturbances.

Review5:26–6:59

And people with fibromyalgia have a lower threshold to pain. The diagnosis is often made with a clinical history which shows over three months of widespread pain that cannot be due to another disorder.
Treatment of fibromyalgia involves in easing symptoms to improve the quality of life. In some people, regular exercise and sleep may reduce pain and fatigue.
In other people, antidepressants, like SNRIs reduce symptoms.