The central symptom is pain experienced in the muscles and joints. The pain tends to move from one area to another over time, although some areas may remain consistently affected, and it can be markedly influenced by conditions such as the external temperature (cold and damp weather) and subjectively undesirable or distressing situations (generically described as stressful).
In particular, the pain increases when pressure is applied to certain characteristic points.
At present, the most general hypothesis is that fibromyalgia involves an alteration in the perception of pain. This may explain why, under certain circumstances, the person appears to experience little pain, often when engaged in stimulating or enjoyable activities or when exposed to positive stimuli. It may also explain why, despite pain described as constant and exhausting, the person often remains capable of carrying out ordinary daily activities, without a clear correspondence between physical effort and pain.
The pain is symmetrical, meaning that it is present on both sides of the body in the same areas, and it becomes more pronounced when pressure is applied to certain specific points. To avoid confusion with other types of acute pain syndromes, the clinical picture must have been present for at least three months.
In addition to the main symptom of “pain,” other movement-related symptoms are often present, such as weakness, a feeling of exhaustion even before any physical exertion, cramps, clumsiness and a sensation of tightness or constriction during movement, as well as involuntary twitching or trembling of small portions of muscle (fasciculations).
People often experience bodily sensations such as numbness in certain parts of the body, pins and needles, tingling, painful stabbing sensations, or burning.
Anxiety or depressive symptoms are also common and are not fundamentally different from those reported by people who do not have fibromyalgia. Furthermore, people with fibromyalgia may suffer from other somatoform syndromes, such as irritable bowel syndrome, or may experience various bodily symptoms that are also found in classical anxiety disorders.
As with other disorders of this type, the person generally interprets the condition as a problem located in the muscles or joints that inevitably has repercussions on their mood.
At present, it is still unclear whether a state of low-grade inflammation produces, as a secondary effect, a “depressive” pattern of brain metabolism, or whether, conversely, a cerebral state that precedes or clearly manifests itself as depression may trigger reflex irritative reactions in the muscle and joint areas, thereby producing the painful symptoms.
It is clear that the response to treatment, affecting both depressive and anxiety symptoms and pain symptoms, proceeds along two relatively independent pathways (that is, pain and depression/anxiety do not disappear and reappear as equivalents of one another). In these patients, somatic symptoms, as in other cases of somatoform disorder, could represent a “first-level” symptomatology that precedes depression, either in the short term (with depression emerging soon afterward) or over the long term.
Nevertheless, the majority of patients with a history of fibromyalgia subsequently require treatment for symptoms of psychiatric relevance.
Treatments
From a therapeutic standpoint, numerous antidepressants have been shown to be effective in reducing painful symptoms and associated symptoms by more than 50%, even at doses lower than those usually used in antidepressant treatment.
The most effective antidepressant compounds appear to be those with a combined mechanism of action (i.e., less selective).
Non-antidepressant pharmacotherapies (which are nevertheless also used in anxiety disorders) have likewise shown promising results. Not all patients respond well to individual compounds, with response rates ranging from 20% to 60% depending on the medication.
Combining antidepressant medications is possible and appears to be a useful strategy in terms of improving the quality of the response.