Imagine a scenario where you feel pain all the time for no apparent reason. You just wake up in the morning and you feel a surge of unprovoked pain throughout your body. Sounds like a bad horror story right? Well this is the case for two percent of the population which consist of mostly women.

This phantom pain, otherwise known as fibromyalgia, has had scientists stunned for decades, as it apparently has no observable symptoms and is often diagnosed based on the patient’s experience. In fact, fibromyalgia is often confused with other illnesses as it seems to mimic or come with other chronic conditions such as chronic fatigue, anxiety and mood disorders. To make matter worse, some doctors don’t even believe it’s a real, physical illness.

Tender points in fibromyalgia patients. Source: Wikipedia. License: Creative Commons Attribution-Share Alike 4.0 International

For many, being diagnosed with fibromyalgia seems like a bad dream because for a while, it was believed that there is no cure is available and treatment options seem only partially effective. Recently however, a few studies have shown potential in treating this bizarre condition. Before we jump into that, we need to understand what fibromyalgia is.

What is fibromyalgia?

Fibromyalgia can be described as a consistent pain signal that cannot be shut off. Fibromyalgia is diagnosed under the criteria of having generalized pain in multiple regions (usually around the axial skeletal areas), sleep disturbances, fatigue and stiffness. The pathophysiology of fibromyalgia include amplified responses to the peripheral input of the central nervous system and is thought to be caused by neuronal inflammation, muscle abnormalities or nerve pathologies. Specifically, it is thought to be caused by persistent nociceptive input leading to sustained hyperalgesia. In addition, nerve damage was suggested as a potential cause of fibromyalgia caused by a disease called small-fiber polyneuropathy (SFPN), but this does not account for all patients diagnosed with fibromyalgia. However, there is good news for those who have underlying SFPN as the source of their fibromyalgia as treatment can be effective and a cure is possible. Viral, bacterial, fungal or parasitic infections are often suggested as another reason for the cause of fibromyalgia. These infections are often seen in suffering patients but it is unknown whether the infections are the cause of the pain or a by-product of the weakened immune response due to fibromyalgia.

Structure of sensory system. Source: Wikipedia License: Creative Commons Attribution-Share Alike 3.0 Unported

Another interesting observation is that fibromyalgia tends to run in families, which suggests a genetic factor in the development of fibromyalgia. To further add to this, those who suffer from fibromyalgia tend to be women, possibly suggesting a link with the sex chromosomes. The specific genes linked to fibromyalgia have yet to be fully understood but polymorphisms of genes in the serotoninergic dopaminergic and catecholaminergic systems are suspected to be involved.

Lastly, physical or emotional trauma can also trigger the illness as the vast amount of cases seem to involve some sort of psychological disturbances. Thus, environmental factors such as stress and trauma cannot be ruled out as a cause or trigger to the emergence of the illness.

In recent times, there have been major breakthroughs in understanding how fibromyalgia functions by observing the brain. Using functional MRI scans, CU Boulder researchers have unravelled brain pattern that can diagnose fibromyalgia with 93 percent accuracy which marks one of the first steps in documenting physical symptoms of the illness. Many of the cases are diagnosed by a process of elimination of potential causes, leading to fibromyalgia when other explanations do not fit the symptoms.

Modern day treatments

Diagnostic tools are not the only advancements we have made in recent years; treatment options are slowly arising which show potential in treating the phantom illness. Possible pharmaceutical treatments show potential, especially drugs which deal with serotonin and norepinephrine-reuptake inhibitors such as duloxetine and milnacipran. These drugs work by inhibiting select neurotransmitters (serotonin and norepinephrine) and are used to treat major depressive disorders are well as fibromyalgia and neuropathic pain.

Non-pharmaceutical methods are also showing some promise. Acupuncture has shown some minor improvements without additional side effects. The idea behind acupuncture is that it causes anti-inflammatory responses and releases endorphins, leading to pain reduction.  Emotional Awareness and Expression Therapy (EAET) a method where patients discuss and explore their emotions seems to be effective in managing the pain from fibromyalgia. This form of treatment focuses on the emotional and social aspects of fibromyalgia and by treating the mind, the patient is able to cope more efficiently. Additionally, a 2018 case study show a potential use of therapeutic ultrasound and laser therapy as a treatment option in the future. This new treatment works by applying ultrasound and laser towards patient’s palm. The theory for this treatment is that the pain was caused by deregulated blood flow and thermoregulation. The therapeutic treatment is thought to provide enzymatic modulation, forming higher amounts of ATP and anti-inflammatory action which helps to bring the pain threshold back to normal.

Where does this leave us?

Overall, the disease once thought to be non-existent has seen major advancements since its discovery in 1904, where it was has described as widespread pain without physical symptoms, to a future where there could be potential future treatments for an illness that was once considered untreatable. The advancements in health sciences has provided hope for those who suffer from this mysterious condition. With more research, perhaps one day we will be able to understand the mechanisms behind fibromyalgia and use that knowledge to treat those who suffer from the illness as well as being one step closer to understanding how the brain works.