Fibromyalgia Pain

The symptoms that commonly affect patients with fibromyalgia syndrome include pain, sleep problems, stiffness (especially after rest in the morning), fatigue, bowel upset (irritable bowel syndrome), depression, headaches etc. The pain and the symptoms of the condition tend to last a life time in most patients.

American College of Rheumatology (ACR) pain criteria

Fibromyalgia syndrome is defined by the American College of Rheumatology (ACR) as pain that is widespread and lasts for over 3 months. The pain needs to be present:-

• on the left side of the body
• on the right side of the body
• above the waist
• below the waist
• axial skeletal pain or central body pain (this includes the cervical spine in the neck or anterior chest or thoracic spine in the chest or low back pain).

Left or right shoulder and buttock pain is considered to be pain on either side. Low back pain is considered lower segment pain.

Of the 18 defined tender points, the pain should be present in at least 11 points according to this definition on application of manual pressure of approximately 4 kg over the points.  These criteria for fibromyalgia was and is still widely used as prescribed by ACR in 1990.

New criteria

The criteria for diagnosis were revised in 2010. The new criteria were an alternative method of diagnosis in which the tender point criteria was excluded. The latest criteria for diagnosis includes:-

Widespread pain index (WPI) of more than or equal to 7 and Symptom severity (SS) scale score of more than or equal to 5

OR

WPI of 3-6 and SS scale score more than or equal to 9

Widespread pain index (WPI) and Symptom severity (SS)

The symptoms should be present for at least 3 months and other conditions need to be ruled out. In the new criteria the WPI consists of a total of 19 body areas. At each of these points the patient is asked to score his or her pain during the most recent week between 0 and 19.

Similarly for the SS score the patient is asked to report the severity of three features of fatigue, waking un-refreshed and cognitive symptoms in a score of 0 to 12. The level of severity is rated on a Likert scale that ranges from 0 to 3, where 0 is no problem and 3 is severe problem.

Fibromyalgia and daily activities

The fibromyalgia pain is accompanied by a high degree of impairment in the patients in performing their daily functioning.

If compared with other chronic or long term pain conditions, patients with fibromyalgia report higher levels of pain and disability in performing their daily activities.

Fibromyalgia patients also report a poorer quality of life compared to other chronic pain patients.

The chronic pain makes regular and extensive use of health services a necessity for fibromyalgia patients. This leads to high costs for medical and societal care.

Types of fibromyalgia pain

Types of fibromyalgia pain include:-

• Paresthesia – in this the nerves are automatically stimulated and the patient may feel a crawling, tingling, burning, itching or numbing sensation over the area. Paresthesia may also be painful.
• Hyperalgesia – this is typical pain amplification seen in fibromyalgia where the pain felt is much larger than the stimulus.
• Allodynia – in this symptom even a mild touch or pressure from clothing or gentle massage leads to intense pain. Allodynia may be tactile or caused by pain from touch or gentle pressure. Allodynia may be mechanical or caused by something moving over the skin. Allodynia may also be thermal in which the pain from mild heat or cold is felt intensely.
• Stabbing pain or burning pain.
• Randomly moving pain.
• Pain or symptoms brought upon by stimulus like repetitive, loud, grating sounds, flashing or bright lights, stress etc.