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Fibromyalgia has stumped health-care professionals for years. Patients experience chronic and sometimes excruciating pain with no obvious physical reason.

It’s long been understood that fibromyalgia is somehow connected with co-existing psychiatric conditions. New research has examined this relationship more closely.

Fibromyalgia is the existence of widespread pain throughout the body. In order to be diagnosed with this condition, you must experience pain on both sides of the body, above and below the waist and in your back. In addition, pain must be felt in at least 11 of 18 tender points.

On top of body pain, fibromyalgia sufferers often experience some of the following: general fatigue, headaches, sleep disruption, psychiatric complaints such as depression or anxiety, numbness or tingling sensations, or irritable bowel syndrome.

In order for fibromyalgia to be diagnosed, these symptoms cannot be attributed to another systemic condition.

Fibromyalgia is not pleasant and it affects roughly two per cent of the population, and many more women than men.

Psychiatric symptoms are very commonly associated with fibromyalgia and seem to make the condition worse for those who experience pain and depression or anxiety. Patients with fibromyalgia have an eight-fold increase in lifetime prevalence for bipolar disorder and a three-fold increase for major depression. They also have a four-fold increase in lifetime prevalence for any anxiety disorder.

Those who have high levels of depression or anxiety also tend to experience more physical symptoms, worse general health, more dissatisfaction with their health, and more life disruption from pain and stress.

Depression is considered a risk factor for the development of fibromyalgia. Indeed, psychological problems often predict chronic pain.

Doctors are beginning to learn what’s happening inside the bodies of people with fibromyalgia that makes them experience chronic, debilitating pain. Studies now show that the condition seems to involve hyper-sensitivity to the perception of pain.

Where a patient may have a normal detection threshold for pain, he or she will have a much lower tolerance level. A lighter stimulus will be perceived as more painful than for someone without fibromyalgia.

This hyper-sensitivity exists for many kinds of stimuli, such as pressure, heat, noise and electrical stimulation.

This problem with sensory processing is also thought to account for the increased physical aches and pains experienced by depressed individuals.

Normally, countless sensory inputs are received by our bodies but are filtered out so we aren’t conscious of them. In depression and perhaps fibromyalgia, the filtering process is impaired so much more of the sensory input from our daily wear and tear reaches consciousness and results in symptoms. Antidepressant medications seem to bolster this filter, in addition to improving mood, and can be effective for treating fibromyalgia.

Although the exact cause of fibromyalgia is not yet understood, there seem to be genetic, biological and environmental factors involved. For example, abnormal pain processing could be the result of a biological difference.

Other biological factors could include dysfunction in smooth muscle activity or autonomic nervous system.

It has long been understood that there’s a strong family predisposition for fibromyalgia and recent studies have identified several specific genes that seem to be involved. First-degree relatives of someone with fibromyalgia have eight times the risk of developing fibromyalgia as someone without such a relative.

Several experiences can act as triggers to fibromyalgia. They include infections, physical trauma, psychological stress or distress, hormonal changes, drugs, vaccines or certain catastrophic events such as war.

If you have many unexplained pains all over your body, speak to your doctor about the possibility of fibromyalgia.

Dr. Paul Latimer is president of Okanagan Clinical Trials and a Kelowna psychiatrist.


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