Many patients experience cognitive dysfunction (known as "brain fog" or "fibrofog"), which may be characterized by impaired concentration, problems with short and long-term memory, short-term memory consolidation, impaired speed of performance, inability to multi-task, cognitive overload, and diminished attention span. Fibromyalgia is often associated with anxiety, and depressive symptoms.
Other symptoms often attributed to fibromyalgia that may possibly be due to a comorbid disorder include myofascial pain syndrome, also referred to as chronic myofascial pain, diffuse non-dermatomal paresthesias, functional bowel disturbances and irritable bowel syndrome (possibly linked to lower levels of ghrelin), genitourinary symptoms and interstitial cystitis, dermatological disorders, headaches, myoclonic twitches, and symptomatic hypoglycemia. Although fibromyalgia is classified based on the presence of chronic widespread pain, pain may also be localized in areas such as the shoulders, neck, low back, hips, or other areas. Many sufferers also experience varying degrees of facial pain and have high rates of comorbid temporomandibular joint disorder.
Fibromyalgia continues to be a disputed diagnosis. Many members of the medical community do not consider fibromyalgia a disease because of a lack of abnormalities on physical examination, and the absence of objective diagnostic tests.
Many members and facets of the medical community propose that fibromyalgia is a psychosomatic illness.
Several controversial issues exist with regard to fibromyalgia that range from questions regarding the validity of the disorder as a clinical entity, to issues regarding primary pathophysiology and the potential existence of fibromyalgia subtypes.
According to Frederick Wolfe, highly cited fibromyalgia researcher and lead author of the 1990 paper that first defined the ACR fibromyalgia classification criteria, "the large majority of physicians, sociologists, and medical historians" are skeptical about the validity of fibromyalgia as a clinical entity. Some call fibromyalgia a “non-disease” and “an over-inclusive and ultimately meaningless label.” Wolfe now questions the validity of fibromyalgia as a disease.
He considers fibromyalgia a physical response to stress, depression, and economic and social anxiety, and believes the associated symptoms are a normal part of everyday life. In 2009, he wrote, "the tendency to respond with distress to physical and mental stressors is part of the human condition." Wolfe notes that opponents of the fibromyalgia concept say that labeling fibromyalgia as a "disease" simply legitimizes patients’ sickness behavior, slowing their recovery and harming them.
In a study of 100 individuals identified as having fibromyalgia, physical functioning decreased slightly over time, and individuals who had been diagnosed earlier had larger numbers of reported symptoms and greater severity. However, there was also a statistically significant improvement in satisfaction with health following classification. The authors of the study concluded that the ‘fibromyalgia label’ does not have a meaningful adverse effect on clinical outcome over the long term.
The validity of fibromyalgia as a unique clinical entity is also a matter of contention because "no discrete boundary separates syndromes such as FMS, chronic fatigue syndrome, irritable bowel syndrome, or chronic muscular headaches." Because of this considerable symptomatic overlap, some researchers have proposed that fibromyalgia and other syndromes with overlapping symptoms be classified as functional somatic syndromes for some purposes.
Some researchers believe that differences in psychological and autonomic nervous system profiles among affected individuals may indicate the existence of fibromyalgia subtypes. A 2007 review divides individuals with fibromyalgia into four groups as well as “mixed types”:
- "extreme sensitivity to pain but no associated psychiatric conditions" (may respond to medications that block the 5-HT3 receptor)
- "fibromyalgia and comorbid, pain-related depression" (may respond to antidepressants)
- "depression with concomitant fibromyalgia syndrome" (may respond to antidepressants)
- "fibromyalgia due to somatization" (may respond to psychotherapy).
There is strong evidence that major depression is associated with fibromyalgia, although the nature of the association is debated. A comprehensive review into the relationship between fibromyalgia and major depressive disorder (MDD) found substantial similarities in neuroendocrine abnormalities, psychological characteristics, physical symptoms and treatments between fibromyalgia and MDD, but currently available findings do not support the assumption that MDD and fibromyalgia refer to the same underlying construct or can be seen as subsidiaries of one disease concept.
Indeed, the sensation of pain has at least two dimensions: a sensory dimension which processes the magnitude and location of the pain, and an affective-motivational dimension which processes the unpleasantness. Accordingly, a study that employed functional magnetic resonance imaging to evaluate brain responses to experimental pain among fibromyalgia patients found that depressive symptoms were associated with the magnitude of clinically-induced pain response specifically in areas of the brain that participate in affective pain processing, but not in areas involved in sensory processing which indicates that the amplification of the sensory dimension of pain in fibromyalgia occurs independently of mood or emotional processes.
This reminds me of my mentor, Dr. B - He is the reason I became a nurse. He lit the fire. When I was a medical assistant and back in school (and to some degree while nursing too) Fibro was thought of as a non-disease and the joke behind the scenes was "House Wife Disease" - Kind like the 5 F's (if you are medical you will get the joke)
I dunno what I believe...it seems that within the last 2-5 years Fibro is becoming more reccognized as a disorder - but again, is that Drug Company propaganda or is it the need for those that desperately desire a diagnosis or "label" to finally have one?
I don't know - It is still a very confusing and controversial subject for me and for those colleagues within the medical community I am still friends with.
My feeling are - If you FEEL it, then it is REAL - where it is driven from may be of dispute. I have no doubt patients feel very badly and seek help to stop their pain - but where the pain comes from is where it gets tricky and sticky.
It is psychosomatic, anxiety driven, depression (Depression Hurts...) or is it a neurogenic nerve pathway syndrome that no one can find? Who knows.....
I just wish there wasn't such a stigma of Anxiety and Depression - I think if people were more open minded about entertaining the idea that many of there symptoms may be somatic in origin, they would feel so much relief so much faster. I swear I have had patients that would rather of heard they had CANCER than be told it was anxiety. Honest to goodness.
It's baffling to me... But again, I work in the industry, so to me Anxiety and Depression ARE diseases that deserve some serious respect because the symptoms and devastation they cause is enormous and disabling at times. I have some stories I could share -
I have anxiety, I have admitted that in my blog before - I have more quirks and neurosis than Woody Allen sometimes... It comes and goes in its prevalence and its severity - and I take medication daily to keep it in it's place. I respect it just as I do "The Big S"
I am not ashamed... I am open about my quirks.... and my sisters and friends razz me about them. That's part of who I am and I think I'm pretty great. Phone Phobe and all!!
Anyway - For the record, I do not have Fibromyalgia - I came across this while, believe it or not, being bored to tears turning on my utilities for Louisiana and it made me think about Dr. B so much.
He is one of my greatest and most valuable friends on the planet and I love him dearly. He is now an Army Surgeon in Iraq/Italy (Yep, he got sick of HMO and Healthcare reform) and I miss him!!
This one is for you Dr. B!