About fibromyalgia
Fibromyalgia is understood as a nociplastic pain condition: pain that arises from changes in how the nervous system processes pain signals, sometimes called central sensitization. It's diagnosed clinically, based on how widespread the pain is and how severe the other symptoms are, lasting at least three months. It can occur on its own or alongside other conditions.
Common symptoms and challenges
- Widespread pain and tenderness
- Fatigue and unrefreshing sleep
- Difficulty concentrating and remembering
- Headaches or migraine, and irritable bowel symptoms
- Sensitivity to light, noise, temperature or touch
Biological factors
Well established: Fibromyalgia involves altered pain processing in the central nervous system. It tends to run in families, which suggests a genetic contribution, but many genes are likely involved and none can diagnose it. Physical injury, infection and major stress can act as triggers.
Emerging research: Some studies have found reduced small nerve fibres in skin biopsies from a subset of people with fibromyalgia, and researchers are investigating possible immune contributions.
Laboratory testing
There is no laboratory test for fibromyalgia. Clinicians may order blood tests to look for other conditions with similar symptoms, such as thyroid disease or inflammatory arthritis.
Medication response
Some medications sometimes prescribed for fibromyalgia, such as certain tricyclic antidepressants, are broken down by liver enzymes including CYP2D6 and CYP2C19. Variation in the genes for these enzymes is studied in pharmacogenetics, and published guidelines exist for some medications.
Important limitations: A pharmacogenetic test doesn't test for fibromyalgia. It may provide information to discuss with your prescriber or pharmacist. Never start, stop or change a medication based on a genetic result on your own.
