2. FIBROMYALGIA 2
Fibromyalgia
Etiology
Fibromyalgia is characterized as a widespread chronic pain syndrome without a well-
defined underlying organic disease. This pain is related to the genetics affecting transport or
metabolism of dopamine, epinephrine, norepinephrine, and serotonin. However, the etiology and
pathogenesis of fibromyalgia are not fully understood. There are several factors that seem to be
affected by the process of fibromyalgia. These factors include the dysfunction of the central and
autonomic nervous systems, neurotransmitters, hormones, immune system, external stressors,
and lastly psychiatric aspects (occurs mostly in people who do not express signs of depression).
Gower’s first described fibromyalgia in 1904. He then coined the term “fibrositis”, which was
used until the seventies and eighties, until the etiology of the central nervous system was
discovered by Graham. In 1950, Graham introduced the modern concept of fibromyalgia,
following the coined term by Smythe and Moldofsky in the mid-1970s. Fibromyalgia was then
identified to be " the regions of extreme tenderness or the so-called ‘tender points'"
("Fibromyalgia: MedlinePlus")
Neurologic Signs and Symptoms
Signs and Symptoms
Mood disorders, fatigue, cognitive dysfunction, nonrestorative sleep, insomnia
Consciousness
Difficulty concentrating
Communication and Memory
Impaired: working memory, ability to recall specific events, ability to think quickly
3. FIBROMYALGIA 3
Sensory, Autonomic & Motor
Widespread pain, stiffness
Inconsistent reports
Normal
(Ludy- Ekman, 152) Neurological Damage
The main region of the nervous system affected by fibromyalgia is the central nervous
system. The central nervous system dysfunction attributes to the atypical sensory processing in
the central nervous system, the dysfunction of skeletal muscle nociception, and the dysfunction
of the hypothalamic pituitary adrenal axis. Research shows that the brain of an individual who
suffers from fibromyalgia has significantly less grey matter density. In addition, the pain
inhibition areas are significantly less active than in healthy individuals. Therefore, those who
have the neurological condition of fibromyalgia have impaired descending pain inhibition. Also,
the neural responses to afferent signals are amplified (“Fibromyalgia”).
Main Goals of Treatment/ Intervention
The main goal of treatment for those who have fibromyalgia is to identify and explain
one's symptoms, along with encouragement to develop and maintain an active exercise program.
In addition, another main goal is to control the pain and to improve pain function. These goals
mentioned prior could be met by using a variety of techniques. Often one will benefit from the
low- dose use of an antidepressant. The antidepressants that are most commonly used to treat
fibromyalgia are 25 mg of amitriptyline (Elavil) or 20 mg of fluoxetine (Prozac). However, the
dosage of the drug has to be individualized (Millea & Holloway).
On the other hand, if one does not receive well to the use of antidepressants, there are
alternative therapeutic measures. Some of these therapies include exercise, hypnosis, growth
4. FIBROMYALGIA 4
hormone therapy, behavior therapy, acupuncture, or chiropractic treatment. More specifically,
the use of exercise intervention, involving aerobic and strength training, significantly improves
the patient's pain, but the maintenance of the exercise regimes tends to be poor. However, one
must find the appropriate therapy measure for him or her that fits best (Millea & Holloway).
Future Directions
Currently, The Journal of Alternative and Complementary Medicine has conducted a
study that involves tilting whole body vibration. The objective of this study was to analyze the
effect of 12-week tilting Whole Body Vibration therapy (WBV) on the Health Related Quality of
Life (HRQoL) in fibromyalgia. The subjects of the study were thirty-six women with
fibromyalgia, who met the diagnostic criteria of the American College of Rheumatology. The
following exclusion criteria were applied: physical trauma, frequent migraines, peripheral nerve
entrapment, inflammatory rheumatic disease, and severe psychiatric illness (Olivares, Gusi &
Parraca et al).
The tilted WBV was self- administered. The group attended initial thirty -minute
instruction session to familiarize them with equipment and explain the training protocol. The
WBV sessions were performed three times a week for a period of twelve weeks. Each session
included ten-minute warm up which involved slow movements. Following the warm up, was six
repetitions of tilting WBV at the frequency of 12.5 Hz (hertz) with sixty seconds between each
repetition. The duration of each repetition was thirty-seconds during weeks 1-4, forty-five
seconds during weeks 5-8, and sixty seconds during weeks 9-12. The individual would alternate
between two stances at each repetition. One stance would have the left foot positioned slightly
ahead, the other with the right foot positioned slightly ahead. The stance alteration was done
throughout the twelve weeks (Olivares, Gusi & Parraca et al).
5. FIBROMYALGIA 5
In conclusion, the main finding from the study was that the Whole Body Vibration
therapy was a feasible intervention that prevented the loss of Health Related Qualities of Life in
those who suffer from fibromyalgia.
6. FIBROMYALGIA 6
References
Fibromyalgia: MedlinePlus. Retrieved from
https://www.nlm.nih.gov/medlineplus/fibromyalgia.html
Fibromyalgia. Retrieved from http://www.mayoclinic.org/diseases-
conditions/fibromyalgia/basics/definition/con-20019243
Result Filters. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23213512
Fibromyalgia. Retrieved from http://www.niams.nih.gov/health_info/fibromyalgia/
Lundy-Ekman,L. (2012). Neuroscience fundamentals for rehabilitation 4th Ed. Philadelphia, PA:
Elsevier Saunders Company.
Millea, P., & Holloway, R. Treating Fibromyalgia. Retrieved from
http://www.aafp.org/afp/2000/1001/p1575.html
Olivares, P. R., Gusi, N., Parraca, J. A., Adsuar, J. C., & Del Pozo-Cruz, B. (2011). Tilting
Whole Body Vibration Improves Quality of Life in Women with Fibromyalgia: A
Randomized Controlled Trial. Journal Of Alternative & Complementary Medicine, 17(8),
723-728 6p. doi:10.1089/acm.2010.0296
