Fibromyalgia: neurological mechanisms and treatment approaches

Fibromyalgia is a chronic rheumatic condition considered to be incurable. Its primary symptoms are muscle pain, joint pain, and chronic fatigue. However, it is not an inflammatory condition like arthritis. The vast majority -- at least 80 to 90% -- of fibromyalgia sufferers are women, pointing to possible hormonal or genetic aspects of disease etiology (De Lucia, 2014). In fact, fibromyalgia does tend to run in families, prompting further research into a genetic component (Wright, et al., 2011). Emerging research reveals possible risk factors including the presence of rheumatoid arthritis and other autoimmune diseases ("Fibromyalgia," 2014). Stress factors in as well, as there is a strong concurrence with other conditions including tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression (MayoClinic, 2014; Schmidt-Wilcke & Clauw, 2011). Fibromyalgia is diagnosed using tools like the American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia (Wolfe, et al., 2011). However, diagnostic criteria often rely also on subjective reports of pain measured at pressure points (Wright, et al., 2011). Research has yet to elucidate a single disease etiology, but "abnormal sensitization," and "more acute somatosensory perception or allodynia," have been suggested as possible mechanisms whereby individuals feel heightened pain (Wright et al., 2011, p. 745).

Treatments range from stress reduction techniques to pharmacological treatments, including monoamine modulators, calcium channel modulators, and ?-aminobutyric acid modulators (Scmidt-Wilcke & Clauw, 2011). The basis for pharmacological interventions is research revealing the neurological mechanisms of fibromyalgia symptoms. In particular, abnormal changes in the neurochemistry of cerebrospinal fluid may lead to a "proexcitatory state," (Wright et al., 2011, p. 746). "Cortical hyperactivation in response to both noxious and non-noxious stimuli," as well as "disruptions in central dopaminergic neurotransmission" have also been observed (Wright, et al., 2011, p. 746). These findings lead to specified neurological treatments, which can be used in conjunction with psychological interventions and complementary medicine.

Non-pharmacological interventions that have been researched include balneotherapy, "in heated pools with or without exercise," cognitive-behavioral psychology, meditation, physical therapy, and exercise regimes (Wright, et al., 2011, p. 747). Acupuncture, myofacial treatment, biofeedback, and other complementary interventions may also help alleviate symptoms. Of these interventions, the most promising may be cognitive-behavioral therapy because of its widespread application over a number of the symptoms of fibromyalgia including anxiety, depression, and sleep disorder. Moreover, the impact of cognitive-behavioral therapy on fibromyalgia patients has been substantiated in the research. Edinger, et al. (2013) found that CBT reduces insomnia, which in turn reduces sensitivity to pain.