Unlocking a Medical Mystery
Fibromyalgia (FM) is a widespread chronic pain disorder, including symptoms of severe pain and fatigue that last for 3 months or longer. FM is also characterized by generalized aching, muscle stiffness, non-restorative sleep, chronic fatigue, depression, cognitive impairment, and disturbances in bowel function. According to Dr. Dan Clauw, FM affects 2% to 8% of the US population and is the second most common “rheumatic disorder,” second to osteoarthritis.
Key symptoms/characteristics of fibromyalgia, in addition to widespread pain, include:
Fatigue, Severe Continued Tiredness
Lack of Energy
Trouble Sleeping and Insomnia
Depression or Anxiety
Memory Problems and Trouble Concentrating ("Fibro Fog)
Chronic Headaches (15+ per month)
Chronic Pain ( > 3 months)
Muscle Twitches or Cramps
Numbness or Tingling in Hands and Feet
Estimates vary, but epidemiologic surveys suggested that fibromyalgia is present in at least 2% and possibly as high as 8% of the U.S. population, and between 3-6% of the worldwide population.
Still, despite the increase in research FM since the late 1970s, there are no specific lab tests for diagnosis of fibromyalgia and there is no cure for fibromyalgia. For the most part, the exact cause of fibromyalgia is not completely understood.
Scientists and clinicians can agree that FM patients exhibit a problem with central pain processing. The exact nature of the heightened pain sensitivity in fibromyalgia patients is poorly understood; nonetheless, it is generally believed that the central sensitization is secondary to some combination of genetic and environmental factors that predisposes the patient.
Physical trauma, infection, emotional distress, endocrine disorders, and immune activation have all been hypothesized as potential triggering phenomena in susceptible patients. Virios Therapeutics believes that activated herpes viruses may be a root cause of FM.
Despite a very high disease burden, estimates suggest that just over one in two (56%) patients currently diagnosed with FM are actively being treated with prescription medication. Furthermore, there are only three medicines approved to treat FM, reflecting the limited treatment of fibromyalgia options available to FM patients.
While effective at treating the pain component of FM, the three approved medications (pregabalin, duloxetine, and milnacipran) can give rise to a side-effect burden that limits their use.
Furthermore, the dearth of viable treatment options has led to 40% of FM patients being treated with opioids, despite the fact that published studies confirm opioid-treated FM patients have worse outcomes than FM patients not treated with opioids.
In short, there is ample opportunity to advance FM patient care with a safe and effective new treatment option.
Modern therapies have been focused on treating the symptoms of FM (eg, pain), but current options to treat fibromyalgia do not address the underlying cause of the disease. While any progress is welcomed, there is still significant room for improvement in expanding FM treatment options. Based on the belief that HSV-1 may be the trigger for FM, Virios is developing a combination antiviral treatment for patients with FM.
Virios is committed to improving the treatment standards for the millions of FM patients across the globe and hopes to one day bring to market a way to treat fibromyalgia that targets a root cause of the condition.
Everything You Need to Know About Fibromyalgia
Fibromyalgia (FM) affects between 2% and as high as 8% of the total American adult population. What causes fibromyalgia isn't well understood, but it is currently treated and managed with medication or through self-management strategies associated with lifestyle changes.
After they develop FM, many patients seek ways to improve their quality of life. This may be through lifestyle changes, self care, exercise, diet, or other ways they have found to help manage their disease. Most common symptoms include relieving the condition that causes fibromyalgia pain throughout the body, sleep problems, fatigue, and often emotional and mental distress.
Fibromyalgia symptoms resemble that of other conditions like rheumatoid arthritis and Sjogren's syndrome making the diagnosis of fibromyalgia difficult. Due to the difficulty encountered when attempting to diagnose fibromyalgia, some people may even be diagnosed with each of these conditions. Your doctor could also recommend other symptoms and conditions such as thyroid health after having fibromyalgia diagnosed.
Due to the broad array of fibromyalgia symptoms, many patients see several doctors before having their fibromyalgia diagnosed. Doctors may find it difficult to separate other causes of these symptoms from their diagnoses. The major symptoms of fibromyalgia are widespread pain and fatigue, which must be persistent for 3 or more months to conform to an FM diagnosis. Doctors can use American College of Rheumatology guidelines to help diagnose the condition.
Causes of Fibromyalgia
It is generally agreed that patients with FM have a problem with central pain processing. The exact causality of the heightened pain sensitivity in FM is poorly understood.
What is generally agreed is that the central sensitization seen in FM is secondary to a combination of genetic and environmental factors that render the patient susceptible to developing the widespread condition that causes pain and related symptoms seen in FM.
At Virios Therapeutics we believe that, when FM patients are exposed to significant life stressors, be they physical or emotional, that can result in an abnormal stress or herpes virus mediated-immune response.
Herpes viruses are unique in that they remain in a dormant state (latency) in neuronal nuclei as nonintegrated, circular DNA associated with nucleosomes, with recurrent reactivations for the life of the host. We believe it is likely that nerve resident viral herpetic reactivation is necessary for the nociceptive response seen in FM. This cyclical process of virus reactivation and lytic infection of HSV-1 is postulated to perpetuate FM symptoms in these patients. Research suggests that fibromyalgia patients who also have chronic gastrointestinal disorders, exhibit activated herpes virus when biopsied.
Symptoms of Fibromyalgia
A diagnosis of fibromyalgia requires the presence of pain and fatigue for three or more months. Pain can affect the entire body and when particularly acute during a flare-up, cause symptoms of pain, fatigue, anxiety, etc. to progressively worsen. Some people say there is pain that will get worse and more persistent with severe temperature changes or weather patterns. Pain and fatigue associated with fibromyalgia are often comorbid with symptoms of gastrointestinal distress, mood disorders, stiffness, and disruptive sleep patterns.
Many patients convey that fatigue is the biggest problem with fibromyalgia. This can result in difficulties with recall or thinking which is sometimes considered “brain fog”, often associated with confusion with what's going on in a person's short-term memory.
Fibromyalgia also presents the potential for widespread muscle degeneration resulting from tiredness and insomnia resultant from trouble sleeping. An imbalance in the chemical compounds within brain cells and muscles can cause the brain and nerves to misunderstand or overreact to usual pain signals compounding the symptoms of fatigue.
Read More: Fibromyalgia Symptoms & Causes
Headaches are one of the most common symptoms of fibromyalgia with many patients reporting that they experience headaches at least once per week. People with fibromyalgia can experience more than 15 headaches a month.
For some, fibro-headaches can be worse in the morning and may have a dull or tightening sensation. Additionally, people who suffer from fibromyalgia report that their headaches are associated with other symptoms, including fatigue, anxiety, depression, and sleep disturbances.
The majority of headaches associated with fibromyalgia are tension-type headaches. However, some individuals report migraine-like headache symptoms as well.
Overall, more than half of all individuals that experienced a Fibromyalgia-related headache reported some degree of difficulty with daily life as a result of their headache. In cases where the headache pain is mild, there are still significant effects on emotion and physical function.
Cognitive Impairment ("Fibro Fog")
Fibro fog, or brain fog, is a term that refers to the fuzzy nature of thinking, often experienced by people with fibromyalgia. It's generally described as an inability to process information quickly and accurately enough to hold a conversation, including short-term memory loss and disorientation. As many people with FM are painfully aware, this cognitive impairment can be quite frustrating both for the person affected and for those in their company. People with FM may be able to concentrate on something for a few minutes but often find their thinking gets fuzzy as time passes.
Is brain fog a symptom common to all people with fibromyalgia? No. Some people with the condition do not experience it at all; others report varying degrees of difficulty with mental processing that range from mild to severe. One study of FM patients found that brain fog is more likely to occur in people whose pain is constant, widespread, and has lasted for years. It's important to note that the presence or absence of mental fuzziness does not predict how severe a person's symptoms of fibromyalgia are in general.
Individuals with fibromyalgia have a relatively high number of tender points across their bodies. Tender points are specific places on the body, typically located in the neck, back, chest, elbows, and knees, that elicit pain in response to light pressure.
Pain and tenderness of the body, similar to the flu, is another of the common fibromyalgia symptoms.
It is generally understood that fibromyalgia patients suffer from pain, but most are not aware of the emotional impairment that can go along with this disease. The specific symptoms of anxiety and depression vary widely between individuals but have been observed in many who have fibromyalgia.
Emotional impairment can be detrimental to interpersonal relationships and has been observed in many patients with decreased family satisfaction, along with a decrease in overall happiness and life satisfaction.
Oftentimes, emotional impairment can cause a downward spiral of symptoms that perpetuate the cycle. Individuals with fibromyalgia may become so overwhelmed with the symptoms that they become immobilized by depression or anxiety.
Fibromyalgia patients often face other obstacles as well, such as decreased productivity which can lead to lower socioeconomic status and a significant decrease in the overall quality of life for individuals with the disorder.
Not all fibromyalgia sufferers will experience emotional impairment, but it is something that should be considered by both patients and medical professionals when chartering the treatment course for a particular patient.
Insomnia is defined as repeated difficulty with falling asleep or staying asleep that occurs despite adequate time and circumstances for sleep. Insomnia is more than just having trouble sleeping on occasion. It's a chronic problem for patients in the fibromyalgia community.
In some cases, insomnia is caused by emotional distress which can lead to feelings of sadness about not being able to perform daily tasks. Estimates suggest that up to one in two fibromyalgia patients miss work due to their illness.
Insomnia has a negative impact on our physical and emotional health as the symptoms of insomnia alone include:
Decreased motivation and productivity
Social isolation and withdrawal
Feelings of sadness or depression
Millions of people suffer from chronic pain however, fibromyalgia is unique because the pain signals and triggers can be even more significant making it a defining characteristic of this condition.
Chronic pain is defined as any pain that persists beyond the normal healing time for a particular tissue type. Widespread pain, as well as fatigue, must be present for longer than three months for a patient to meet the diagnostic criteria fibromyalgia.
Fibromyalgia is different from other types of pain because it impacts all body parts, not just one. The most common misconception about fibromyalgia is that the pain experienced is only in the patient's head or there's no way to treat the pain; however, this isn't true.
Most in the scientific community agree, that fibromyalgia is related to abnormal pain sensitization by the central nervous system. The brain sends signals to the rest of the body through an extensive network of nerves called the central nervous system. The central nervous system regulates all movement, sensations, thoughts, and feelings that occur in the body. When a person has fibromyalgia, processing errors are being made by the brain and central nervous system which lead to a patient's body's increased sensitivity to the effects of pain.
Fibromyalgia can cause chest pain like heartburn which can cause patients distress and difficulty breathing. The pain and fatigue associated with fibromyalgia can interfere with a patient's ability to perform daily tasks.
Irritable Bowel Syndrome & Gastrointestinal Issues
Studies have shown that 6-15% of people suffering from Fibromyalgia also showed signs of Irritable Bowel Syndrome (IBS). People with fibromyalgia often suffer from gastrointestinal problems. The exact reason for this is still unknown, however, some known factors might play a role. Furthermore, research from the University of Alabama has demonstrated the presence of activated viral infection in patients with IBS.
Many patients suffering from fibromyalgia report chronic gastrointestinal-related symptoms, including diarrhea, constipation, and nausea; the feeling of incomplete defecation (tenesmus); and also meteorism, which is the swelling of the abdomen due to trapped gases in the intestine.