The Prevalence of Fibromyalgia in Other Chronic Pain Conditions
- Source: Pain Research & Treatment, Nov 17, 2011
By Muhammad B Yunus, MD
[Ed Notes: Researchers have only recently begun to recognize that fibromyalgia syndrome involves many neurochemical-endocrine changes that: 1) cause suffering (what Dr. Yunus, an internationally recognized fibromyalgia researcher, calls "functional pathologies"); 2) are not now routinely tested for; and 3) are not as easily detected as "structural pathologies" such as cartilage and joint erosion in diagnosis of osteoarthritis.
Dr. Yunus specializes in the study of FMS and other conditions involving functional pathologies - dubbed “central sensitivity syndromes” (CSS) because they share central nervous system sensitization. He explains that:
• FMS is frequently co-morbid with other CSS – e.g., based on the average of published studies, 55.2% of people diagnosed with Chronic Fatigue Syndrome also have FMS; 40.7% of those with IBS have FMS, and 67% of ‘idiopathic’ chronic low back pain patients have FMS.
• However, fibromyalgia also frequently co-exists with chronic conditions that can be diagnosed by structural pathology – such as rheumatoid arthritis and osteoarthritis, systemic lupus, diabetes mellitus, and inflammatory bowel disease.
In this open access article (you can read the free full text here www.ncbi.nlm.nih.gov/pmc/articles/PMC3236313/pdf/PRT2012-584573.pdf), Dr. Yunus provides data on fibromyalgia overlaps with functional pathologies, making the case that it is irresponsible for physicians not to take functional symptoms that cause suffering (associated with so-called “invisible” illnesses) as seriously as structural ones: “Differentiating between illness and disease is artificial and contrary to patient interest, and hampers proper management of CSS conditions.”
For example: 17.5% of people diagnosed with hypothyroidism also have FMS; 30.4% of those with ankylosing spondylitis (arthritis affecting the spine); 16.2% of those with SLE; 15.4% of those with RA, and so on.
Dr. Yunus also points out that new technologies have begun to identify structural changes in fibromyalgia as well (such as a changes in the sizes and activation/organization of specific parts of the brain). But again, these tests are for now difficult to measure in routine diagnosis.
The bottom line: It’s important for physicians to recognize patients with overlapping illnesses involving functional ("invisible") and structural pathologies in treatment planning. For example, an RA patient with FMS whose pain or fatigue has increased may not automatically require a higher dose of a ‘peripherally acting’ pain drug, but rather a centrally acting one; or help with sleep.]
Central sensitivity syndromes (CSS) include fibromyalgia syndrome (FMS), irritable bowel syndrome, temporomandibular disorder, restless legs syndrome, chronic fatigue syndrome, and other similar chronic painful conditions that are based on central sensitization (CS). CSS are mutually associated.
In this paper, prevalence of FMS among other members of CSS has been described.
An important recent recognition is an increased prevalence of FMS in other chronic pain conditions with structural pathology, for example:
• Rheumatoid arthritis (RA),
• Systemic lupus (SLE),
• Ankylosing spondylitis,
• Diabetes mellitus,
• And inflammatory bowel disease.
Diagnosis and proper management of FMS among these diseases are of crucial importance so that unwarranted use of such medications as corticosteroids can be avoided, since FMS often occurs when RA or SLE is relatively mild.
Source: Pain Research & Treatment, Nov 17, 2011; PMID:22191024, by Yunus, MB. Section of Rheumatology, Department of Medicine, University of Illinois College of Medicine at Peoria, Illinois, USA [Email: firstname.lastname@example.org]