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Fibromyalgia is an illness characterized by chronic, widespread tenderness and pain and affects nearly 5 million American adults. It mainly affects the central nervous system. Wolfe, Brähler, Hinz & Häuser, (2013) conducted a study on the risk factors associated with fibromyalgia. The researchers identified factors such as environmental triggers, genetic and family factors, as well as defects in automatic and neuroendocrine nervous systems. The researchers noted that many risk factors are close to those of other illness featuring persistent and recurrent pain and emotional distress such as major depressive disorder (MDD) (Wolfe, Brähler, Hinz & Häuser, 2013, p. 13). Fibromyalgia is a comorbid of migraine and tension headaches, chronic fatigue syndrome, irritable bowel syndrome, and chronic autoimmune diseases, for example rheumatoid arthritis.
According to Häuser, Wolfe, Tölle, Üçeyler, & Sommer, (2012) fibromyalgia belongs to affective spectrum disorder (ASD). Therefore, their study suggested that it is an inherited illness that contributed to more pain sensitivity, mood disorders, and reduced pain inhibitory functioning addition; the research supported that fibromyalgia is part of ASD (Häuser, Wolfe, Tölle, Üçeyler, & Sommer, 2012, p. 7). The results of the study by Moore, Wiffen, & Kalso, (2014) reported that patients suffering from fibromyalgia regularly satisfied the diagnostic conditions for MDD or fibromyalgia and exhibited enhanced pain sensitivity. Therefore, the study indicated that fibromyalgia is a heritable physiological defect (Moore, Wiffen, & Kalso, 2014, p. 5). A single heritable factor may be shared by many ASD in one nucleotide polymorphism in the regulatory region.
Moreover, Wolfe, Brähler, Hinz & Häuser, (2013) study investigated the effects of environmental triggers on the pathophysiology of fibromyalgia. The researchers concluded that environmental triggers in combination with other risk factors contribute to fibromyalgia (Wolfe, Brähler, Hinz & Häuser, 2013, p. 10). Additionally, the researcher investigated the effects of triggers such as physical and mechanical injury and trauma, and psychosocial stressors. The result of the study indicated that manual work factors such as heavy lifting, squatting for long period, and repetitive motions are substantially associated with musculoskeletal pain circumstances and chronic pain. Due to poor psychosocial support, that workers received at workplaces is linked to a higher level of widespread pain (Häuser, Wolfe, Tölle, Üçeyler, & Sommer, 2012, p. 9). In addition, the study identified that working in hot conditions produced higher risk of fibromyalgia, but it was not significantly leading to widespread pain. Exposure to a short period psychosocial stressors influenced person`s pain perception linked to fibromyalgia.
Moore, Wiffen, & Kalso, (2014) used women suffering from osteoarthritis or fibromyalgia as participants in their study. After exposure to negative mood factors and psychosocial stressors, women with fibromyalgia indicated a higher increase in severity of pain (Moore, Wiffen, & Kalso, 2014, p. 6). Most notably, after stressor-recovery time, the severity of pain was higher in women with fibromyalgia (Häuser, Wolfe, Tölle, Üçeyler, & Sommer, 2012, p. 11). The results of the study showed that through continuous exposure to psychosocial stressors in the job places it promotes the risk of widespread pain that change the perception of pain severity among fibromyalgia patients (Häuser, Wolfe, Tölle, Üçeyler, & Sommer, 2012, p. 12).
In the autonomic nervous system`s function there exist defects for fibromyalgia patients. These defects include reduced microcirculatory vasocirculatory vasoconstriction, sleep disturbance, heart rate variability, and higher rate of hypotension. Wolfe, Brähler, Hinz & Häuser, (2013) noted that the variability of heart rate in patients with fibromyalgia varies between women and men and that reduced heart rate variability is caused by poor Chronobiology leading to fatigue and sleep disturbance. Häuser, Wolfe, Tölle, Üçeyler, & Sommer, (2012) argued that fibromyalgia is usually linked to sleep defects such as poor sleep quality, insomnia, non-restorative sleep, and early morning awakening. In addition, sleep abnormalities may lead to pain caused by patients with fibromyalgia via minimum growth hormone production and growth factor, for example insulin.
Fibromyalgia patients have higher sensitivity to a wide range of stimuli. Moore, Wiffen, & Kalso, (2014) researched sensitivity of pain to five testing roles and identified that fibromyalgia patients had lower thresholds of pain compared to healthy people. The researchers argued that the primary cause of enhanced sensitivity to lower level stimuli is central sensitization in patients with fibromyalgia (Wolfe, Brähler, Hinz & Häuser, 2013, p. 14). Anxiety and depressive symptoms are frequent and usually severe in patients with fibromyalgia.
These patients share primary pathophysiologic associations with anxiety and mood disorders. Moore, Wiffen, & Kalso, (2014) argued that these patients should be regularly evaluated for existence of psychiatric comorbidity. In this regard, the treatment of fibromyalgia involves recognizing and focusing on psychiatric comorbidity that enhance the long-term effects of patients (Häuser, Wolfe, Tölle, Üçeyler, & Sommer, 2012, p. 17). The treatment of the illness involves the use of antidepressant medication, particularly in patients with anxiety and mood symptoms. Tricyclic antidepressants (TCAs) and Serotonin-norepinephrine Re-uptake Inhibitors (SNRI) such as duloxetine, milnacipran, and venlafaxine are antidepressants used in the treatment of the illness (Moore, Wiffen, & Kalso, 2014, p. 9).
These drugs have the therapeutic influence of pain that do not affect their mood due to nor- and serotonin-epinephrine-mediated influences. Moore, Wiffen, & Kalso, (2014) argue that fibromyalgia patients have either lifetime or short-term anxiety disorders; this makes antidepressants efficient for both the painful symptoms of anxiety (Moore, Wiffen, & Kalso, 2014, p. 23).
The treatment of fibromyalgia using antidepressants is used to relieve pain in combinations with bipolar disorder; they should be used together with mood stabilizers in order to reduce the risk of a patient to a hyperactive phase. It also helps to prevent rapid cycling induction. Patients suffering from type II bipolar diseases may show response to low doses of antidepressants immunotherapy (Wolfe, Brähler, Hinz & Häuser, 2013, p. 16). However, they should be under close observation of mood instability development. Therefore, it is crucial to understand thorough patient’s history with fibromyalgia addressing the anxiety and mood disorders. In addition, utilizing medication to manage fibromyalgia and comorbid psychiatric disorders helps to improve the overall outcomes of patients. Utilizing suitable non-pharmacologic therapies also assist in the treatment of the illness (Häuser, Wolfe, Tölle, Üçeyler, & Sommer, 2012, p. 16).
Häuser, W., Wolfe, F., Tölle, T., Üçeyler, N., & Sommer, C. (2012). The role of antidepressants in the management of fibromyalgia syndrome. CNS drugs, 26 (4), 297-307.
Moore, A., Wiffen, P., & Kalso, E. (2014). Antiepileptic Drugs for Neuropathic Pain and Fibromyalgia. JAMA, 312 (2), 182-183.
Wolfe, F., Brähler, E., Hinz, A., & Häuser, W. (2013). Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: results from a survey of the general population. Arthritis care & research, 65 (5), 777-785.