Fibromyalgia, or fibromyalgia syndrome, is a condition that causes aches and pain all over the body. It is defined as a disease complex or syndrome.

1. SUBMITTED BY-
SANDHYA DHYANI
(Research Scholar)
G.B.P.U.A.T, Pantnagar,
Uttarakhand

2. CONTENTS
 Introduction
 Statistics
 Symptoms related to fibromyalgia
 Mimics of FM
 Difference : arthritis and fibromyalgia
 Diagnosis of FM
 Aetiology of FM
 Pathophysiology of FM
 Preventive measures
 Management of FM
 Conclusion
 References

3. INTRODUCTION
 Fibromyalgia, or fibromyalgia syndrome, is a condition that
causes aches and pain all over the body.
 It is defined as a disease complex or syndrome.
 People with FM often experience other symptoms, such as:
1. extreme tiredness or sleeping
2. mood or memory problems
 FM can affect your ability to work or do daily activities.
 Treatment can help relieve pain and help prevent
flare-ups of symptoms.

4.  People with FM have widespread pain and “tender points” on
their bodies that hurt when slight pressure is put on them.
 FM may also be associated with depression and anxiety.
 A person with FM may have other, coexisting chronic pain
conditions.
 Such conditions may include:
1. Chronic Fatigue Syndrome
2. Endometriosis
3. Interstitial Cystitis (Painful Bladder Syndrome)
4. Irritable Bowel Syndrome
5. Temporomandibular Joint Dysfunction
6. Vulvodynia (Chronic Vulvar Pain)

5. FIBROMYALGIA IS HARD TO DIAGNOSE:
Acc. To National
Fibromyalgia
Association, it
takes about
3-5 years for the
condition to be
diagnosed.
Fibromyalgia is
an unspecific
constellation of
symptoms
fallings into a
number of
medical
specialities.
The symptoms
have a wide
range and are
often overlapped
by conditions
such as
rheumatoid
arthritis.
Pain of
fibromyalgia is
not localised so
it is
misdiagnosed.

6. STATISTICS
 Fibromyalgia affects women more than men of middle
age group.
 Ratio – 9:1(W:M)
 Prevalence increases with age of the person.
 Acc. to NHP India report : 2-4% of total population are
affected by fibromyalgia.

7. TENDER POINT is
defined as a site of
ex-quisite
tenderness in soft
tissues, in contrast to the
trigger points of
myofascial pain
syndrome

8. TENDERNESS POINTS IN FIBROMYALGIA PATIENTS

9. SYMPTOMS OF FIBROMYALGIA:
 Extreme tiredness, called fatigue
 Cognitive and memory problems (sometimes called “fibro fog”)
 Trouble sleeping
 Mood problems
 Morning fatigue
 Muscle fatigue, causing muscles to twitch or cramp
 Headaches
 Irritable bowel syndrome (IBS)
 Painful menstrual periods
 Numbness or tingling of hands and feet
 Restless legs syndrome
 Temperature sensitivity
 Sensitivity to loud noises or bright lights
 Depression or anxiety

11. FIBROMYALGIA
MIMICS
1. RHEUMATOID
ARTHRITIS
3. MULTIPLE
SCLEROSIS
4. POLYMYALGIA
RHEUMATICA
2. LUPUS
5. CHRONIC
FATIGUE
SYNDROME

12. DIFFERENCE BETWEEN FIBROMYALGIA AND ARTHRITIS
FIBROMYALGIA ARTHRIIS
Pain is not caused by injury but a problem with the
way the brain and
nervous system process pain from that area.
Pain occurs only when the area of the body is
damaged.
FM is a chronic pain syndrome that causes muscle,
joint, and bone pain and tenderness, fatigue.
Rheumatoid arthritis is an inflammatory
autoimmune disease where the immune system
attacks the joints and causes joint damage.
It doesn’t cause elevated inflammation levels in the
bloodstream.
It causes elevated inflammation levels in the blood
stream
It does not cause any damage to muscle and is not
organ-threatening.
It causes joint damage as in case of rheumatoid
arthritis

13. SEVERE
PAIN
AND
MORNING
STIFFESS
FIBROMYALGIA AND RHEUMATOID ARTHRITIS

15. FIBROMYALGIA AND LUPUS:
FIBROMYALGIA
1.Sensitivity to
touch
2.Persistant
pain
LUPUS
1.Skin lesions
2.Sensitivity to
sunlight and cold
temperature
3.Painful joint and
swollen ankles
Fatigue,
brain fog,
Depression,
headache

16. FIBROMYALGIA AND MULTIPLE SCLEROSIS
FIBROMYALGIA
1. Persistent pain
2.Depression
3.Irritable bowel
syndrome
MULTIPLE
SCLEROSIS
1.Numbness and
tingling
2.Muscle spasm
3.Vision problem
and bowel problem
Fatigue
and
depression

17. FIBROMYALGIA AND POLYMYALGIA RHEUMATICA
FIBROMYALGIA
1. Multiple tender
points
2.Increased
sensitivity
POLYMYALGIA
RHEUMATCA
1.Stiffness in
shoulder, hips and
lower back
2. Muscle tenderness
Morning
stiffness,
headache,
depression

18. FIBROMYALGIA AND CHRONIC FATIGUE SYNDROME
FIBROMYALGIA
1.Stiffness and
sleep disturbances
2.Psychological
distress
3.Multiple chemical
sensitivity
4.Tenderness to
touch
CHRONIC FATIGUE
SYNDROME
1. Swollen glands
2. Tender lymph
nodes
and sore throat
3.Joint and muscle
pain
4.Light sensitivity
Headache,
Fatigue,
Brain fog

19. DIAGNOSIS FOR FIBROMYALGIA:
 Diagnosis is difficult and frequently missed as symptoms are vague
and generalized.
 According to AMERICAN COLLEGE OF RHEUMATOLOGY (ACR)
2010/2011 criteria for diagnosis of FMS:
1) A history of widespread pain (involving all 4 limbs and the trunk) of at
least 3 months’ duration.
2) Tenderness on specific tender points when a standard pressure of 4
kg is applied (at least 11 of 18).
 TPT is now replaced with a widespread pain index(WPI) and
symptom severity ( SS) score.

20. WPI( WIDESPREAD PAIN INDEX)
• Patients endorses different body
regions in which pain is
experienced.
• One point is given for each
• Score is between 0-19
• This number is referred to as
WPI
SYMPTOM SEVERITY SCALE:
• It is the evaluation of the person’s
symptoms
• The patients ranks special symptoms
on a scale from 0-3
• Symptoms includes: Fatigue,
Cognitive symptoms
• Somatic symptoms in general(
headache, dizziness,
numbness/tingling, hair loss)
• The numbers assigned to each are
added up for a total of 0-12

21. REPRESENTATION OF RESULTS:
 The diagnosis is based on both WPI score and SS score either
 WPI of at least 7 and SS score of at least 5
or
 WPI of 3-6 and SS score of at least 9

23. DRAWBACKS OF ACR CRITERIA 2010 (WPI
AND SSS):
Misclassification of
patients with multiple
severe regional pain
disorders
Misdiagnosis occurred
as 2010/2011 criteria
did not consider the
spatial distribution of
painful sites

24. ACR CRITERIA PUBLISHED IN 2016
 In 2016 a revised set of criteria was published.
 This revision introduced “generalised pain criteria”,
DEFINITION OF GENERALISED PAIN CRITERIA:

25. ETIOLOGY OF FM:
 CNS sensitization
 Sleep disturbances( reduced levels of serotonin and increase P
substance levels)
 Genetic factors
 Immune system response
 Psychiatric aspects
 Trauma or injury
 Hormonal changes during the menstrual cycle or pregnancy
 Chronic Stress: Chronic (long-term) stress may raise risk for getting
fibromyalgia.
 Changes in weather: when the temperature drops from warm to cold
or on hot, humid days.

26. CNS
SENSITIZATION
SPONTANEOUS
NERVE
ACTIVIY
GLIAL
CELL
ACTIVATION
LEVELS
OF
NEUTRANSMITTER
AUGMENTED
NEURONAL
MECHANISM

27. BIOCHEMICAL
CHANGES
RESULTS IN
CAUSES

28. PATHPHYSIOLOGY
 Neuroendocrine:
1. Dysfunction of the hypothalamic-pituitary-adrenal axis, including blunted cortisol responses;
2. abnormal growth hormone regulation
 Neurotransmitter:
1. Decreased serotonin in the central nervous system;
2. Elevated levels of substance P
3. Nerve growth factor in the spinal fluid
 Neurosensory:
1. Central amplification of pain (central sensitization)
 Genetic:
1. Strong familial aggregation for FM;
2. evidence for a role of polymorphisms of genes in the serotoninergic, dopaminergic, and
catecholaminergic systems in the etiology of FM

29. EXCITOTOXICITY MAY ALSO LEAD TO FM
1.Multiple studies have demonstrated a link between glutamate and
pain occurrence.
2.Glutamate is an excitatory neurotransmitter, with the job of
increasing action potentials in both the brain and the periphery.
3.Glutamate is released in high enough amounts, it also has the
ability to overexcite postsynaptic neurons to the point that they die.
This process is called excitotoxicity.
4. Glutamate accumulates excitotoxicity and result in CNS
sensitization.
GLUTAMATE
(in high
amounts)
Overexcitation
of neurons i.e.
EXCITOTOXICITY

30. ACCORDING TO SOME RECENT STUDIES ANALYSED BY
FUNCTIONAL BRAIN IMAGING IT HAS BEEN SEEN THAT:
Accelerated
gray matter
loss
Mixed findings
for several
brain regions
There are
abnormal
response to
pain
Decreased
thalamic blood
flow

31. PREVENTION OF FM:
 There is no way known to prevent FM.
 Some of the main preventive measures are as follows:
1.Healthy lifestyle
2.Balanced diet
3Daily exercise
4.Stress management
5.Proper sleep

32. Selenium ,
magnesium,
zinc
Protein and mainly
aeromatic amino
acids
Vitamin D and
B-complex
Antioxidants
FM PATIENTS HAVE DEFICIT OF SOME NUTRIENTS:

33. MANAGEMENT OF FM:
 Acc. to European League Against Rheumatism (EULAR) guidelines,
the management of FM should give priority to non-pharmacologic
treatment.
 Management of FM involves a combination of medication, stress
management, exercise and rest with enough sleep.
 Stress management techniques such as meditation, yoga, and
massage.
 Good sleep habits to improve the quality of sleep.
 New evidences have proved that dietary management can help in
relieving the pain.

34.  Excitotoxicity can cause oxidative stress through increased production of reactive
oxygen species in the nervous system.
 Oxidative stress can be countered through the dietary intake of antioxidants.
 The two main vitamin antioxidants in the diet are vitamin C and vitamin E.
 Selenium also acts as anti-oxidant and it increases the activity of vit E.
 The other chemicals found that have important antioxidant capabilities, such as
resveratrol in grapes and polyphenols in green tea.

35. DIETARY MANAGEMENT
• EAT FOR ENERGY 1. Avoid high sugar foods
2. Balanced diet
3. Eat fresh, whole foods and fibre rich
foods
4. Avoid canned food products
• AVOID FOODS THAT TRIGGER
SYMPTOMS
1. Excitotoxins such as MSG
2. Food additives and food chemicals
3. FODMAPs( fermentable oligosaccharide,
disaccharide, monosaccharides and polyols
4. Gluten-rich foods
• MAINTAIN A HEALHY WEIGHT 1. Healthy diet
2. Loose weight if obese

36. • HERBAL REMEDIES 1. Herbal tea
• GO VEGETARIAN 1. Avoid red meat, processed meat and cured
meat
2. Add more antioxidants in diet
• ADDITION OF FLAXSEEDS, CHIA SEEDS
FOR OMEGA-3 FATTY ACIDS
1. Reduce oxidative stress
2. Lower levels of inflammation and boost
immunity.
• DASH DIET 1. Improves blood pressure and cholesterol
level
2. Reduce the inflammation in the body.
• AVOID ARTIFICIAL SWEETNERS AND
LIMIT SUGAR
1. Cut back on sugar.
2. Avoid artificial sweetners such as aspartame.

37. Vitamin B6 serves as an co-
factor for enzyme GLUTAMATE
DECARBOXYLASE which
convert glutamate into GABA(an
inhibitory neurotransmitter).
Tryptophan helps in
normalizing the level of
neurotransmitters associated
with sleep and mood control.
Anti-histamine and lactose
free foods helps in reducing
systematic and neuronal
inflammations.
Anti-oxidants through diet
helps in minimizing the
excitotoxicity that finally
results in CNS sensitization
Minerals like magnesium, zinc
etc. helps in supporting optimal
neural functioning.
Magnesium is necessary for
helping to prevent excitotoxicity.

38. Avoid taste
enhancer i.e.
monosodium
glutamate
(MSG)
Include whole
foods instead of
processed ones
• As it is the source
of neurotransmitter
glutamate
• e.g.-quinoa,
amaranth, whole
wheat, rice

39. NON MEDICAL TREATMENT
ACUPUNCTURE HYPNOTHERAPY BALNEOTHERAPY
COGNITIVE
BASE
THERAPY
PHYSIOTHERAPY

40. ADVANTAGE OF NON-MEDICAL TREATMENT
Cost
effective
Patient’s
preferences
Easy
availability
Safety

41.  ACUPUNCTURE: It had a small pain-relieving effect.
 BALNEOTHERAPY: (Bath therapy) Balneotherapy may
provide benefit to patients with fibromyalgia, particularly for
improving pain.
 HYPNOTHERAPY: It helps in relaxation of the patients.
 CBT: Cognitive behaviour therapy is the combination of
cognitive therapy to modify maladaptive thoughts with
behavioural therapy to increase adaptive behaviour.
 This therapy is often employed as a treatment for depression
and anxiety.
 PHYSIOTHERAPY: It helps in changing physical functioning
and relieves pain.

43. CBT
(Cognitive Behaviour
Therapy)
Talk
Therapy
To
Treat depression
Changes the
way person
acts
Change the
way person
thinks

44. SOME DRUGS USED FOR TREATMENTS:
 PREGABALIN
 FLUOXETINE
 DULOXETINE,
 MILNACIPRAN
 AMITRIPTYLINE
 PIRLINDOL
 MOCLOBEMIDE
 GABAPENTIN
 ACETAMINOPHEN
 PCM
ANALGESICS
ANTICONVULSANT
ANTIDEPRESSANTS

45. CONCLUSION:
 FM is a complex syndrome that is often difficult to diagnose.
 Its aetiopathogenesis is still a matter of debate, but various
pharmacological and non-pharmacological therapies are currently
available for its treatment.
 The modern functional neuroimaging techniques are giving us important
data about the CNS involvement.
 FM subjects often have a deficit in selenium, magnesium, zinc, vitamins B
and D and proteins, and may benefit from the intake of anti-oxidants,
lactose-free and low-histamine food and aromatic amino acids .
 In addition, aromatic amino acids, like tryptophan, may normalise the level
of neurotransmitters associated to sleep and mood control.
 A multidisciplinary approach is optimal and the physician must take into
consideration both drugs and nonpharmacological treatment, such as
aerobic exercise and strength training, balneotherapy,CBT etc.

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47. THANK YOU!