Symptoms of fibromyalgia

Fibromyalgia may have multiple symptoms, but the main clinical sign is diffuse (widespread) pain in muscles, tendons and ligaments. It is no coincidence that fibromyalgia is considered one of the types of the main disease called myalgia, from the Greek words myos and algos - muscle and pain. Previously, the disease had various names - fibrositis, tendomyopathy, as well as psychogenic or muscular rheumatism. Myalgia, unlike arthritis and arthrosis, is not accompanied by pain in the joints, only soft tissues hurt, the nature of the pain is diffuse or intermittent.

Symptomatically manifested pain in fibromyalgia is localized in such areas as the shoulders, neck, back of the head and lower back. Painful sensations are not associated with inflammation or pathological changes in the skeleton or muscular system, they are difficult to describe and verbally specify, in addition, fibromyalgia demonstrates symptoms that are extremely similar to the manifestations of other diseases, perhaps this is why fibromyalgia is diagnosed at the late stages of its development. Fibromyalgia is the leader in diseases that provoke depression, which significantly reduces the patient's quality of life. Today, statistics register about 20 million patients with this disease, and the prevalence of myalgia is growing every year. In European countries and the United States, fibromyalgia is considered a separate nosological unit and ranks second after arthritis in the number of diagnosed cases in the category of pathologies of the musculoskeletal system

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Signs of fibromyalgia

The pain starts with minor sensations, which a person initially does not pay attention to, then almost all of his waking time is devoted to the painful struggle with pain, which cannot be “attached” to any specific disease. Misunderstanding and, sometimes, irritation of people around the patient grows, and such manifestations can often be from ignorant doctors. The sick person is redirected to various narrow specialists - from a therapist, surgeon, neurologist to a psychiatrist or psychotherapist. By the way, the help of the latter will not be superfluous in any case, since fibromyalgia also has psychoneurological symptoms, that is, it is always accompanied by a depressive state.

The symptoms continue to increase, fatigue, apathy, insomnia appear. Even small emotional, intellectual or physical stress becomes a serious test for the patient. Few people believe it, but a simple movement, such as bending over to put on shoes, sometimes causes unbearable pain to a person, not to mention doing any more difficult work. Feeling misunderstood, distrustful and unable to explain and, most importantly, prove their problems, a person with myalgia falls into despair. It is no coincidence that the few doctors who study and can diagnose fibromyalgia call the disease the invisible disability.

In addition to the fact that diffuse pain affects the entire body, fibromyalgia symptoms include the following:

• Constant fatigue, feeling of exhaustion, even after rest and sleep.
• Constant stiffness of muscles and joints, especially in the morning. The body takes a long time to "wake up".
• Disrupted slow phase sleep (deep sleep), during which the body truly rests and relaxes. As a result - a feeling of exhaustion in the morning.
• Periodic headaches that occur following pain in the shoulder girdle and neck.
• A feeling of numbness in the limbs, swelling of the tissues around the joints, especially in the morning (the joint does not hurt).
• Increased sensitivity of trigger points (see below), areas around joints.
• Periodic disturbances in the functioning of the digestive system not associated with poisoning, nutritional disorders or gastrointestinal diseases.
• RLS - restless legs syndrome, a neurological symptom characterized by paresthesia of the legs (excessive motor activity, often during sleep).

Most often, patients describe painful sensations vaguely, but very emotionally, the most typical description is "pain throughout the body" or "from head to toe". Obviously, this is true, especially if the pain is accompanied by intermittent cramps and numbness. In recent decades, signs of fibromyalgia have increasingly been observed not only in adults, but also in children, especially in pubertal girls. The manifestations of myalgia in adult patients and the symptoms of the disease in children differ from each other.

Symptoms of fibromyalgia that are common in adults

FMS (fibromyalgia – fibro/ligaments, my/muscles, algia/pain) exhibits the following clinical symptoms:

• Stiffness – stiffness, ossification of the whole body. A symptom that is most often noticeable in the morning, but it can also appear depending on the change in temperature.
• Signs similar to migraine symptoms. Pain may start in the back of the head, radiate to the temples or the area behind the eyes. The temporomandibular joint is affected in 25-30% of patients diagnosed with FMS.
• Insomnia or sleep disorder, sleeplessness. The duration of sleep time may correspond to the norm, but the person does not leave the feeling of fatigue. Also, there is a violation of the stage of falling asleep, there are often cases of feeling a lack of air during sleep, up to respiratory arrest, asphyxia.
• Constant complaints that can be attributed to gastrointestinal problems: flatulence, irritable bowel syndrome, diarrhea or constipation. Often painfully unable to swallow food, this is associated with neurological disorders, which fibromyalgia is also "famous for".
• Disorders of the genitourinary system - frequent urge to urinate without infection or inflammation of the bladder. Women, who most often suffer from fibromyalgia, note an excessively long menstrual cycle, painful and protracted.
• Disturbance of sensitivity in the extremities, burning, tingling or numbness – paresthesia of the extremities.
• Thermosensitivity is a reaction to the slightest temperature changes, both in the environment and in internal sensations. Also, patients with fibromyalgia have the so-called Raynaud's syndrome - angiodystonia, in which an ischemic area that changes color forms on the limb. 8.
• Dermatological manifestations – dry skin, often symptoms similar to ichthyosis (keratosis, keratinization of the skin). Fingers often swell, the swelling is not associated with joint diseases, i.e. arthrosis.
• Chest pain, which Western doctors call thoracic pain and dysfunctio. Such pain most often appears after a person has been in one position for a long time (working while sitting at a desk, working while standing, etc.). Pain in the thoracic region is accompanied by symptoms similar to those of cardialgia (mitral valve prolapse).
• Fibromyalgia symptoms can manifest as imbalance - ataxia. Incoordination of muscle groups provokes impaired motor coordination, dizziness up to nausea and loss of consciousness.
• Ophthalmological problems can also be one of the symptoms of fibromyalgia. Sensory disturbances in the form of difficulty focusing the gaze, difficulties in reading, according to experts, are caused by weakened, atonic neck muscles that cannot adequately participate in the transmission of nerve impulses.
• Blood pressure surges, mostly in the direction of a sharp decrease, are one of the secondary symptoms of FMS. This is especially evident when the patient abruptly changes the position of the body from horizontal to vertical.
• Cognitive impairments – decreased concentration, memory (especially operational, short-term). In clinical practice, such phenomena are called fibro-fog - "fibromyalgic fog".
• Neurological symptoms - restless legs syndrome, which is observed in almost every third patient with fibromyalgia.
• Increased sensory reactivity, sensitivity. Any smell, color or flashes of light can provoke an attack of myalgic pain, almost the same as with migraine, with one difference - hemicrania is accompanied by headache, not muscle pain.
• Allergic symptoms are rare, but it can also be a secondary symptom of fibromyalgia. Differentiation from the symptoms of the main allergic disease is based on additional pain sensations, such as in the sinuses, which are not typical for classic allergies.
• Fibromyalgia also manifests symptoms in the form of psychoemotional disorders – depressions, which must be differentiated from classical dysthymia and the psychiatric nosological category. FMS cannot be a form of hypochondriacal disorder or depression, on the contrary, these conditions are concomitant symptomatic syndromes of fibromyalgia.
• Subfebrile body temperature, transient feverish state is a common occurrence. Fibromyalgia symptoms also manifest in hyperthermia, when the temperature can rise rapidly and just as quickly fall to normal values.

Symptoms of fibromyalgia that are common in children

Fibromyalgia in children is diagnosed extremely rarely, since it is much more difficult for children than for adults to formulate and specify their feelings.

The main diagnostically obvious symptoms can be painful sensations in specific tender points of the body. These criteria were developed more than twenty years ago by specialists of the American Association of Rheumatologists (ACR). Adult patients also typically experience pain in these areas, but in children, fibromyalgia symptoms are more hidden, so the sensitivity of trigger points is determined from the outside during examination by palpation. If a child has pain in 5-7 points out of 18 proposed as diagnostic symptoms, this indicates the presence of the disease. Pain zones are located in the shoulder girdle, back, buttocks and lower back, and there are also control zones - the forehead and the area above the epiphysis of the fibula. Pain in these places for 2-3 months is a symptom of fibromyalgia in children.

Fibromyalgia symptoms can be unilateral, in which case the child tries to limit the movement of the arm or leg on the side of which discomfort appears. Also, children quite often involuntarily try to compensate for pain by a unilateral body position when performing simple actions, for example, when eating, doing homework (turning the body, neck). Over time, the pain begins to acquire a diffuse character and spreads to the second, previously unaffected part of the body.

A child may complain of pain in the arms or legs, although the joints look quite healthy. Pain in the heart area, which does not have objective indicators of cardiopathology, is also characteristic of fibromyalgia in children. Attentive parents usually notice such signs, but when consulting in medical institutions, the child is most often diagnosed with a disease with similar symptoms - a violation of body posture (scoliosis, kyphosis, etc.). Often, due to little study, the symptoms of childhood fibromyalgia are diagnosed as rheumatism or cardiac diseases, although laboratory and hardware examinations do not reveal significant deviations from the norm.

Additional signs that can help to identify fibromyalgia in children in a timely manner may include the following symptoms:

• Constant fatigue that has no objective causes – intense physical or mental stress. A characteristic feature of “childish” fatigue is the desire to sleep in the evening (between 5 and 7 p.m.).
• Sleep disturbances – problems falling asleep, morning fatigue, feeling exhausted.
• Depressive state, despondency, apathy, most often in the morning hours.
• Gastrointestinal disorders, most often diarrhea (in contrast to symptoms in adults, when such disorders are mixed).
• Unlike adults, children complain more often of headaches than muscle pain.
• Decrease in cognitive abilities. Unlike adults, children suffer not from working memory, but from long-term memory. Absent-mindedness develops, and school performance declines.
• Children are more likely to experience restless legs syndrome than adults.

Fibromyalgia symptoms increase, the child becomes withdrawn, depressed, feeling isolated and helpless due to the fact that he cannot specifically describe his feelings.

In general, the symptoms of fibromyalgia can be systematized according to the scheme proposed by American rheumatologists:

Criteria according to ACR	Description
Anamnestic information about pain sensations	The pain is diffuse, lasts for at least 3 months and spreads in 4 zones: above and below the lower back, on the left and right sides
Pain in trigger points (bilateral – right and left): 11 points out of 18 for adults; 4-5 points out of 18 for children	The back of the head, the lower part of the neck, the supraspinous muscles above the scapula, the trapezius muscles, the second rib, the epicondyle of the humerus, the gluteal muscles, the greater trochanter, the knee.
Clinical signs	Description of sensations from the patient's words (subjective signs)
Energy indicators (activity)	Fatigue, lethargy, apathy
Quality of life	Significantly reduced
General social and everyday functions	Significant decrease in activity, even to the point of helplessness
Sensitivity - physical, sensory	Increased
Dream	Sleep is shallow, difficulty falling asleep and waking up, insomnia
Cognitive abilities	Memory and attention are impaired
Rigidity	Increased
Psycho-emotional status	Depression