In this article I will continue to discuss topics related to Fibromyalgia (FM), summarized from the Drs Williams and Clauw paper, I referred to in the previous article.

Other factors operating in FM

Familial and genetic factors: First degree relatives of patients with FM display an 8-fold greater risk of developing the condition. They are also at higher risk for other disorders such as IBS, TMD, headaches etc. Recent studies have identified some gene clusters that may increase the risk of developing FM. (I would like to make a comment here: One should not forget that in general, people who grow up in a household where relatives have chronic pain, have a greater risk to develop pain later in life. In other words, one should never undermine the “modeling effect” that chronic pain has in the perceptions and expressions of pain as part of behavioural changes).

Environmental stressors and FM: Physical trauma, certain infections and hormonal changes at times can trigger or exacerbate FM. On the other hand, psychological and emotional stressors, particularly when they are very specific to the patient (such as a death of a loved one, abuse or some event where the patient him/herself is the victim), are known to precipitate or aggravate FM. “In genetically vulnerable individuals,” one single stressor or stressors may trigger FM, or in other situations a life-long history of pain and other conditions (IBS, TMD, headaches etc) may eventually evolve into Chronic Widespread Pain”.

Psychological/ cognitive/ behavioural factors: Psychological factors affecting pain perception in general can be divided in 2 types: a) psychiatric disorders such as major depression or anxiety (diagnosable by very specific criteria) and b) psychosocial influences. For example, depression has been shown to co-exist with chronic pain in 52% of the time in pain clinics, 27% of the time in family doctors offices and 18% of the time in studies of general population (and not necessarily only those who visit doctors). While chronic pain and psychiatric conditions can co-exist they are not necessarily one and the same and both conditions need to be treated.

Apart from physiological factors, cognitive beliefs about pain play a major role in both physical function and emotional symptoms. Two cognitive factors have been researched extensively. The first one is the “locus of control” (an external locus of control means that the person feels that life events are outside his/her own control, while internal locus of control means that the person feels he/she has personal control for what happens in their lives). The second cognitive factor that is a very important contributor to the experience of pain is “catastrophizing”, a term used to indicate that the person tends to think and interpret events as “awful, horrible or unbearable”. Several studies show that most individuals with FM have a more external locus of control, even when compared with other chronic conditions, while functional imaging studies also provide evidence of increased catastrophizing in patients with FM.

FM and treatments
Evidence based treatments are treatments arising from a thorough, systematic and well organized review of the existing knowledge from studies. Such evidence based medicine shows that FM needs multifaceted approach with treatments tailored to each individual patient with education, certain medications, exercise and cognitive therapy.