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Is Fibromyalgia Purely Psychological?

By Dr Ananya Mandal, MD

Fibromyalgia is a condition characterized by widespread pain and other somatic or physical symptoms like headaches, tender point pain, irritable bowel syndrome, fatigue etc. There are psychological features like depression, sleep disturbances and mood changes as well that arise with fibromyalgia syndrome.

The main controversy is it that many physicians believe this is a psychological condition and this is sometimes strengthened by the fact that the condition is diagnosed on the basis of history.

Thus as a summary some of the points that raise conviction that fibromyalgia may be a psychological disorder include:-

  • Physical examination and laboratory testing are usually non specific for this condition except for the presence of pain on characteristic soft tissue locations, termed tender points. There is however no pathology of the tissues at these points.
  • Antidepressants and drugs that modify the serotonin and norepinephrine in the brain seem to provide relief in fibromyalgia. In addition, cognitive behavioral therapy also helps patients with this condition. This strengthens the arguments of the camp that does not believe fibromyalgia is a true disease.
  • The camp that does not see fibromyalgia as a true physical disease considers it a 'non-disease'. Many of the patients with fibromyalgia continue to shuttle between numerous physicians and undergo numerous costly and sometimes unnecessary tests and ineffective treatments before the diagnosis. It has been seen that the mean duration of symptoms before the diagnosis of fibromyalgia is five years.
  • Several critics have also pointed out that malingering is a major problem in diagnosis of fibromyalgia. The problem is further aggravated by the potential of availability of compensation for the condition. Due to the lack of specific diagnosis and availability of information on tender points etc. patients may malinger more effectively.

Fibromyalgia - a true physical disease?

The points in favour of fibromyalgia being a true physical disease include the fact that there are several physical symptoms associated with the condition. These include migraine, irritable bowel syndrome etc.

Another point in favour of fibromyalgia being a truly recognizable condition includes the fact that in 1990 American College of Rheumatology devised classification criteria for fibromyalgia and several studies showed that based on these fibromyalgia can be differentiated from other rheumatic diseases, with an accuracy of 85%.

Furthermore fibromyalgia may present independently of any other medical disorder but may also be associated with other chronic rheumatic diseases, including rheumatoid arthritis, systemic lupus erythematosus, and osteoarthritis etc.

Fibromyalgia is also associated with some poorly understood syndromes like depression, irritable bowel syndrome, and chronic fatigue syndrome.

The basis of the widespread pain has been found in the interactions of abnormal peripheral and central pain mechanisms. There are changes in sleep patterns, mood disturbances and these are closely associated with the pain symptoms.

New research has found associations between fibromyalgia symptoms and growth hormone, the hypothalamic-pituitary-adrenal axis, serotonin and noradrenaline in the brain. This suggests altered stress regulation as well as neurohormonal changes resulting in fibromyalgia.

Reviewed by , BA Hons (Cantab)

Further Reading

Last Updated: Jul 31, 2013

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