What is Fibromyalgia?
Fibromyalgia (FM) is an ongoing (chronic) illness that can have life impacting symptoms for patients diagnosed with this condition. Fibromyalgia has similar underlying symptoms to many others chronic conditions which makes diagnosis sometimes difficult.
Fibromyalgia causes “wide spread” pain all over the body, meaning all quadrants of the body are typically tender and/or painful. The most common side effects of fibromyalgia in addition to pain are extreme tiredness/ fatigue, difficulty with obtaining restful sleep, mood changes and memory impairment.
Fibromyalgia is believed to be due to changes in the way the brain processes pain signals. FM seems to “turn up the gain” on how pain and other sensations are experienced. Typically this heightened sensitivity leads to increased sensitivity to pain, to temperature extremes (hot or cold), bright lights, loud noises, and/or strong smells when compared to someone who does not have fibromyalgia.
There was a time when many medical providers questioned whether fibromyalgia was even real in their patients. Luckily, some of the stigma that surrounded the condition has been reduced today though basic research and the development of FDA approved treatments for fibromyalgia.
Learn more below about the symptoms of fibromyalgia and how they may have an impact on quality of life, as well as how fibromyalgia is diagnosed and the current treatment options for fibromyalgia.
Who has Fibromyalgia?
Fibromyalgia is estimated to affect anywhere from 4 - 10 Million individuals throughout the United States while the median age group for fibromyalgia diagnosis is 35-45 years old. By the time a diagnosis of fibromyalgia is made, patients will typically have had symptoms for many years.
According to Dr. Daniel Clauw the Director of the Chronic Pain and Fatigue Research Center at the University of Michigan, fibromyalgia affects between 2% to 8% of the US population and is the second most common “rheumatic disorder,” behind osteoarthritis. Dr. Clauw’s group was one of the first to demonstrate that FM involved a change in the way the brain processes sensory signals, including pain signals from the body.
Because there is no specific single test for fibromyalgia, doctors often use a variety of tests along with physical exams to rule out the alternative causes of pain. Symptoms may improve with exercise, physical therapy, massage or other ways to relieve stress.
Fibromyalgia can be classified as mild, moderate or severe depending on the number of symptoms you have and their severity. The American College of Rheumatology (ACR) has put forward criteria to help health care providers diagnose FM and differentiate it from other potential causes of chronic pain. These so-called ACR 2016 fibromyalgia criteria require a certain number of tender areas throughout the body, as well as presence of typical symptoms of FM such as fatigue and poor quality sleep.
What Causes Fibromyalgia?
While the cause of fibromyalgia is unknown, there are many theories as to why it occurs with many believing it's due to multiple contributing factors rather than one single cause. This is because some people who suffer with the condition notice that symptoms occur or are triggered with certain events or periods of their lives such as emotional or physical trauma.
Fibromyalgia runs in families so there is a hereditary susceptibility and sometimes, but not always, people can trace their symptoms back to an event which happened during childhood.
Any combination encompassing the above factors could be identified as a cause of FM to happen. This is what makes it difficult for doctors and researchers to understand completely what causes the condition.
At Virios Therapeutics we postulate that when significant physical stressors or emotional life stressors are experienced, these will tend to make the immune system less effective at suppressing viral infections. For patients who are otherwise susceptible due to genetics or previous life stresses, this decrease in immune system activity can result in herpes viruses that are generally always present in the nervous system but inactive, suddenly activating and initiating a cascade of events. This reactivation of herpes viruses can also maintain or amplify existing FM symptoms through flare ups.
Herpes viruses are unique due to the way in which they remain dormant (latent) in neuronal nuclei as nonintegrated, circular DNA associated with nucleosomes. We believe that the reactivation of nerve resident viruses may be associated with the pain response seen in FM. The overall cyclical process that occurs when the HSV-1 virus reactivates combined with lytic infection (killing the cell) is believed to increase symptoms in FM patients.
There is no known cure for fibromyalgia but there are treatments which can help reduce the pain and related symptoms. Treatments may improve sleep quality, release stress or reduce pain transmission in the spinal cord. These types of treatments can reduce the impact that FM has on your daily life and allow you to carry on with normal activities such as going to work and socializing.
The most important thing we all need to remember is that it's completely ok if you don't feel well enough for certain things, whether it be a physical activity or an outing. FM sufferers should make sure they look after their mental health as much as possible by taking part in activities which help reduce stress and anxiety such as meditation or joining a support group. There are forms of cognitive behavioral therapy (CBT) that teach patients how to be more relaxed and accepting of their condition that have proven to be effective in helping to manage FM symptoms.
You will feel pain throughout your body such as in your legs and back. Reports have shown that women with FM may suffer from a higher frequency of headaches, morning symptoms and IBS compared to men, though FM in men is more common than once believed.
Fatigue, Lack of Energy & Severe Continued Tiredness
Fatigue is very common in FM with sufferers describing it like having cement blocks on your eyelids. This fatigue can make life difficult, especially in the mornings when trying to get ready for work or prepare breakfast. FM sufferers often find they can sleep for hours and still feel tired.
Depression or Anxiety
FM can also cause depression and anxiety in some sufferers, these symptoms can be worsened by the other symptoms such as pain and fatigue. Anxiety is a common symptom because people with FM generally have to deal with long periods of pain or exhaustion which makes them stressed and anxious about what is going on around them. Depression is also a common symptom and for this reason sometimes it can be difficult to treat depression and FM together, which often brings its own problems.
Chronic Headaches (15+ per month)
Migraine and tension headaches are common in people who suffer from FM and can be very painful, along with neck pain. In addition to this you may also have tenderness all over your body including your muscles. Some patients have described FM as a “whole body migraine”.
Chronic Pain Lasting Longer Than 3 months
Extreme pain is one of what can be many symptoms experienced with FM. Sufferers can often experience pins and needles in their legs almost like restless leg syndrome but not quite the same. This over sensitivity to touch is common throughout a sufferer's body and can cause a burning sensation in your skin which feels similar to sunburn with clothes rubbing against it causing discomfort. Alongside this some people have reported feeling vibrations in their skin when touched by another person.
Additional symptoms can include tenderness throughout the body similar to the flu, memory problems and difficulty focusing or concentrating known commonly as Fibro Fog, trouble sleeping and insomnia, muscle cramps, spasms and twitches as well as numbness or tingling in the hands and feet.
It's important to note that antidepressants and opioids can have side effects and do not treat the root cause of FM.
How is Fibromyalgia Treated?
It can be difficult to treat, but medications, therapy and lifestyle changes can help manage symptoms and improve your quality of life.
Despite a very high disease burden, just over one in two (56%) patients currently diagnosed with FM are actively being treated with prescription medication. Furthermore, the three medicines approved to treat FM can give rise to a side-effect burden which limits their use. Even presently treated patients often have to manage the sub-optimal outcomes associated with using unapproved and/or potentially harmful medications to manage their FM disease.
At Virios Therapeutics we are currently researching innovative antiviral therapies that are designed to treat diseases such as FM that are believed to be associated with viral triggered abnormal immune responses.
We postulate that the overactive immune response that occurs when tissue resident Herpes Simplex Virus-1 (HSV-1) is activated may be a potential root cause of multiple chronic illnesses including FM, IBS (Irritable Bowel Syndrome), and FSS (Functional Somatic Syndrome).
Learn more about our current Phase 2b FORTRESS trial, (Fibromyalgia Outcome Research Trial Evaluating Synergistic Suppression of HSV-1) that is evaluating the effect of our antiviral combination treatment, IMC-1, in patients with FM.
This article was written and medically reviewed for accuracy by Virios Therapeutics Chief Medical Officer R. Michael Gendreau, M.D., Ph.D.