Fibromyalgia is More Common in Women

According to the American College of Rheumatology, it is estimated that about 2% to 4% of adults have fibromyalgia. About 80% to 90% of people with fibromyalgia are women, typically between the ages of 40 and 75, and the symptoms tend to be more severe in women.

In recent years, more men have been diagnosed than in the past, possibly as a result in shifts of the diagnostic criteria beginning in 2010. In children, the condition is most often diagnosed in adolescence and is known as juvenile-onset fibromyalgia.

Under-diagnosis of Fibromyalgia is a major concern. It is believed that up to 75 percent of those with fibromyalgia have not been diagnosed.

Symptoms of Fibromyalgia

Fibromyalgia symptoms typically intensify, or flare, periodically. These flares can be unpredictable- what was an invigorating walk one day could be excruciatingly painful the next. Symptoms may ease considerably or even disappear for days, months, or longer, only to re-appear again later.

The number and type of fibromyalgia symptoms vary with the individual, but chronic pain and stiffness, fatigue, sleep problems, and cognitive impairment are common.

• Musculoskeletal pain. The body pain can range from a dull ache to a burning or shooting pain, and parts of the body may feel sore. Some individuals compare the body pain to that of the flu. The pain may be worsened by a variety of factors, such as physical activity, cold or damp weather, stress, or the time of day.

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• Tender points. A characteristic sign of fibromyalgia is the small, sensitive spots around the body known as tender points. Tender points are discreet areas of tenderness in the muscular and tendinous tissue in the body. Pain radiates out from these points, and some individuals have pain in all 19 tender points. These points are painful when minor pressure is applied, as when a doctor presses his or her finger on the area during a physical examination. The pain is felt in the body’s soft tissues, such as muscles and ligaments.

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• Stiffness. Many patients report stiffness, which is generally widespread and diffuse. As is typical of other rheumatic diseases, the stiffness is usually worse in the morning and may improve as the day progresses. It is usually exacerbated the day after physical exertion or exercise.

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• Fatigue. Patients sometimes report feeling exhausted or weighed down by fibromyalgia. It is common to experience short periods of energy (such as for 24 to 48 hours), only to rebound into feeling fatigued and tired again. For some, fibromyalgia fatigue is more of a disability than the muscle pain itself, as it can substantially impact quality of life. Fatigue can make it difficult to sustain or progress in a career, make social plans, and participate in life's milestones, such as family events. Lack of social interaction can in turn contribute to a feeling of isolation or depression.

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• Non-restorative sleep. Most individuals with fibromyalgia have sleep problems and feel tired upon waking no matter how long they sleep. Pain is often one cause, but individuals with fibromyalgia are also more likely than average to have sleep-related problems such as restless legs syndrome and sleep apnea, which causes breathing to stop briefly while sleeping. These sleep disruptions may prevent an individual from getting the deep sleep that allows muscles to relax and tissues to rebuild. Some doctors think the lack of quality sleep may contribute to fibromyalgia’s mental sharpness and fatigue issues. Sleep deprivation has been shown to make pain worse even for those without chronic conditions.

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• Difficulty focusing. Difficulties with focusing, paying attention, and retaining new information are sometimes referred to as “brain fog” or “fibro fog.” Patients may also have trouble using the right words when they talk or have short-term memory loss. These cognitive issues tend to occur most when the individual is feeling tired, stressed, or anxious. The lack of sharpness varies from person to person, and can last hours, weeks, or longer. For some people, the problem can be serious enough to affect job performance. Driving is unsafe if the impairment is severe.

Modulating Factors That Influence Fibromyalgia
While the timing of some symptom flares is unpredictable, the following situations typically lead to an exacerbation of symptoms:

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• Cold, damp weather

• Stress

• Overexertion

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The reverse is also true. Patients feel better with warm weather, hot baths, or even vacations from home or work. Non-steroidal anti-inflammatory medications (NSAIDs), such as ibuprofen and naproxen,
usually do not alleviate symptoms.

Criteria For Diagnosing Fibromyalgia
Before being considered for a diagnosis of fibromyalgia, symptoms must have been experienced for at least three months and all other causes for the symptoms ruled out.

If that is the case, the diagnosis is then based on scores in two major areas, widespread pain and symptom severity, experienced by the patient during the past week. To be classified as widespread, the pain must be on the upper part of the body as well as below the waist. It must also be felt on both sides.

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• Widespread Pain Index: Patients are typically asked if they have pain in any of 19 potential tender points. Each tender point where pain is experienced counts as 1 point, with the score on this index ranging from 0 to 19.

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• Symptom Severity Score: Fatigue, waking unrefreshed, and cognitive symptoms are ranked by severity in this assessment. The extent of additional symptoms typically associated with fibromyalgia is recorded, but these are not ranked by severity. Possible scores are between 0 and 12.

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A major step in the diagnosis is met when the scores match one of these categories:

• A Widespread Pain Index score of 7 or more, and a Symptom Severity Scale of 5 or more.

• A Widespread Pain Index score of 3 to 6 and a Symptom Severity Scale of 9 or more.