Fibromyalgia

Introduction

Fibromyalgia is a long -term health condition that causes extensive pain, fatigue and tenderness in muscles and soft tissues. This is often accompanied by sleep problems, memory difficulties and mood disturbances. Unlike arthritis, fibromyalgia does not harm joints or organs, but it can significantly affect a person’s daily life and quality of life. The exact cause is not fully understood, but it is believed that it involves abnormal pain processing in the brain and nervous system. With proper medical care, lifestyle changes and support, patients can manage symptoms and improve overall well -being.

Types of Fibromyalgia Diseases

Primary Fibromyalgia

A chronic pain disorder without any other underlying medical condition. It’s the most common type, marked by widespread muscle pain, fatigue, and tender points across the body.

Secondary Fibromyalgia

Occurs as a complication of another health problem, such as rheumatoid arthritis or lupus. Pain and fatigue are often more intense due to overlapping symptoms.

Post-Traumatic Fibromyalgia

Develops after a physical injury, surgery, or severe emotional trauma. Symptoms often begin suddenly and may include heightened sensitivity to pain.

Juvenile Fibromyalgia

A less common type where pain and tenderness are concentrated in a specific body region rather than spread throughout the body.

Causes of Fibromyalgia

Genetic Factors – Family history increases the risk of developing fibromyalgia.
Infections – Certain viral or bacterial infections can trigger symptoms.
Physical Trauma – Accidents or injuries may initiate long-term pain.
Emotional Stress – Ongoing stress can affect the nervous system, leading to pain sensitivity.
Hormonal Imbalance – Abnormal hormone levels can influence pain perception.
Sleep Disturbances – Poor or irregular sleep worsens fatigue and pain.
Nervous System Abnormalities – Changes in how the brain processes pain signals.
Autoimmune Conditions – Diseases like lupus or rheumatoid arthritis can be linked.
Chronic Fatigue Syndrome – Similar mechanisms may overlap with fibromyalgia.
Post-Surgical Effects – Some people develop symptoms after major surgery.
Environmental Factors – Weather changes, pollutants, or lifestyle habits may aggravate symptoms.

Clinical Features of Fibromyalgia

Widespread Pain

Persistent, dull pain lasting for at least three months, affecting both sides of the body and above and below the waist.

Fatigue

Constant tiredness despite getting adequate sleep, often worsened by physical or mental activity.

Sleep Disturbances

Difficulty falling asleep or staying asleep, and non-restorative sleep that leaves the patient feeling unrested.

Cognitive Difficulties (“Fibro Fog”)

Daily tasks become difficult when one has issues with mental clarity, memory, and concentration.

Tender Points

Certain soft tissues and muscles have sensitive spots that hurt when pressed.

Symptoms associated with Fibromyalgia

Widespread, ongoing musculoskeletal pain.

Constant fatigue and lack of energy.

Sleep problems, including insomnia or unrestful sleep.

Difficulty concentrating and memory issues (“fibro fog”).

Increased sensitivity to pain, touch, or temperature.

Frequent headaches or migraines.

Digestive issues such as bloating, diarrhea, or constipation.

Mood changes, including anxiety or depression.

Investigations in Fibromyalgia

To assess stability/progression: compare to previous results

Haematuria and proteinuria may indicate glomerular disease and need for biopsy (p. 566).Proteinuria indicates risk of progressive CKD requiring preventive ACE inhibitor or ARB therapy

To identify hyperkalaemia and acidosis

Assessment of renal osteodystrophy

If anaemic, exclude common non-renal explanations, then manage as renal anaemia

Cardiovascular risk high in CKD: treat risk factors aggressively

Consider with obstructive urinary symptoms, persistent haematuria, family history of polycystic kidney disease or progressive CKD. Small kidneys suggest chronicity. Asymmetric renal size suggests renovascular or congenital disease

If dialysis or transplant is planned. Hepatitis B vaccination recommended if seronegative

Consider relevant tests from Box 18.26, especially if the cause of CKD is unknown (ACE = angiotensin-converting enzyme; ARB = angiotensin II receptor blocker; CKD = chronic kidney disease; HIV = human immunodeciency virus; 25(OH)D = 25-hydroxyvitamin D)