Reviewed by: Kevin Hackshaw, MD
Written by: Ashley Lawrence
Fibromyalgia is one of the most common chronic pain syndromes, affecting anywhere between 4 and 12 million people in the United States. This condition is often confused with inflammatory arthritis, a group of diseases caused by an overactive immune system in which the body’s defense system begins to attack the tissues of the joints, resulting in pain, swelling, and tenderness of the joints. Unlike inflammatory arthritis, fibromyalgia does not cause joint damage and is not a threat to other organs. However, fibromyalgia is often associated with persistent muscle, joint, bone, or soft tissue pain, particularly in areas that have been noted as trigger points or localized points of pain, as well as fatigue. Emotional symptoms may also be caused by fibromyalgia due to stress, lack of sleep, and chronic pain.
While patients with fibromyalgia may feel as though their muscles, joints, tendons, and tissues are inflamed, measurable levels of inflammation in blood testing will appear normal. As a result, patients often seek out the help of several different specialists with expertise in the areas in which their pain is localized with the hopes of receiving a diagnosis that will put them on the path to recovery. Oftentimes, these patients undergo unnecessary diagnostic testing that is not only costly, but may also be invasive at times. As patients are dismissed from various practices without a determined diagnosis, it’s easy to become discouraged and begin to wonder if the pain is just an exaggerated response to symptoms that are made up in one’s head.
“Fibromyalgia is a response to various environmental stressors,” explains Kevin Hackshaw, MD, who is a board-certified rheumatologist in UT Health Austin’s Rheumatology Clinic. “While interplay exists between psychiatry, rheumatology, and neurology with regard to this condition, ample evidence has been provided that indicates fibromyalgia is a true condition caused by neurochemical changes that are occurring in the brain chemistry.”
With more than 30 years of experience, Dr. Hackshaw specializes in fibromyalgia and other conditions that are central sensitivity syndromes as well as rheumatoid arthritis, psoriatic arthritis, gout, systemic lupus erythematosus, vasculitis, and more. Additionally, Dr. Hackshaw is an associate professor and serves as both the interim Associate Chair of Research and the Chief of the Division of Rheumatology for the Dell Medical School Department of Internal Medicine.
“Rheumatologists primarily focus on joint-related pain, and rheumatoid arthritis is the classic definition of joint-related pain,” says Dr. Hackshaw. “However, as we recognize, there are many types of arthritic conditions as well as other syndromes, such fibromyalgia, that would not be exclusively considered an arthritic problem. Therefore, rheumatologists take care of a whole host of joint- and muscular-related complaints, which all fall into the same spectrum. My initial attraction to rheumatology stemmed from my mother who had rheumatoid arthritis. While that was my first exposure to this specialty, I tried not to be completely swayed by that experience. Nonetheless, when I chose to explore rheumatology as an elective during medical school, I found it fascinating, and the decision to pursue this specialty was made for me. Over the last 30 years or so, I have been investigating mechanisms of pain, predominately pain that affects patients with various arthritic disorders, and in the last 20 years, I have shifted my focus to nerve pain syndromes, specifically that of fibromyalgia.”
Fibromyalgia is a diffuse pain syndrome, meaning the pain is widespread and affects most areas of the body. Individuals with fibromyalgia are often thought of as having an enhanced sensitivity to a variety of environmental triggers. Those increased sensitivities can become so severe that they cause disruptions throughout an individual’s daily activities. This often leads to debilitating symptomatology that greatly impacts an individual’s quality of life.
“The cause of fibromyalgia is unknown,” explains Dr. Hackshaw. “However, we do know that genetics does play a role. For instance, if a patient has fibromyalgia, their families may have a three-to-four-fold increased risk for developing fibromyalgia compared to non-genetic associated individuals. We also know that certain types of emotional trauma could perhaps resurface later on in life, resulting in various types of sensitivity or syndromes, such as fibromyalgia. Childhood traumas and posttraumatic stress disorders may even be at the root of up to 33% of those individuals’ subsequent development of fibromyalgia; however, this remains an area of active investigation.”
Early Signs of Fibromyalgia
Everyone will experience some form of joint-related complaint at some point in their life. However, most of us experience pain that is short-lived and doesn’t require an appointment with a rheumatologist. Typically, individuals with fibromyalgia will seek out a physician for alleviation when that pain is persistent; begins in one location and over time, evolves and spreads to other areas of the body; and is accompanied by chronic fatigue, difficulty sleeping, or memory problems.
Early symptoms of fibromyalgia may include:
- Fatigue or lack of energy
- Depression or anxiety
- Difficulty sleeping
- Memory problems or difficulty concentrating
- Muscle twitches or cramps
- Numbness or tingling in the hands and feet
Prior to 2010, diagnosing fibromyalgia was heavily focused on the presence of painful tender points, which are areas of the body that feel sore when touched. Tender points typically occur around the joints and the pain is felt just beneath the surface of the skin. In 2010, the diagnostic criteria evolved to include other severe symptoms, such as sleep disturbances and difficulty with concentrating or thinking, in addition to persistent pain and lack of a diagnosis.
The American College of Rheumatology has established three criteria for diagnosing fibromyalgia:
- Pain and symptoms identified across a minimum of 19 body parts and level of severity of other symptoms, such as fatigue, unsatisfactory sleep, or cognitive problems (e.g., memory problems or difficulty concentrating)
- Symptoms that have been ongoing for at least 3 months without improvement
- No presence of another health problem that would explain the symptoms
“On average, fibromyalgia will go undiagnosed for up to five years,” reveals Dr. Hackshaw. “By this time, patients have typically been seen by a variety of healthcare professionals on approximately 20 different occasions within one calendar year for the same complaints, but still have yet to receive a satisfactory diagnosis. Oftentimes, these patients are seen by neurologists to address numbness or tingling or have met with pain specialists who have prescribed narcotics to address the patient’s chronic pain, which, unfortunately, doesn’t really help nerve pain syndromes, such as fibromyalgia. When patients finally connect with a rheumatologist who understands their condition, there is a sense of relief to knowing their pain is real, their various symptoms do not need to be individually treated, and they are able to get better.”
Paving the Way for the Future of Fibromyalgia
Dr. Hackshaw’s current and ongoing research investigates potential biomarkers for fibromyalgia and is supported by the National Institutes of Health. His research was prompted by the lack of diagnostic blood tests for this particular condition that causes the condition to go undiagnosed for a substantial period of time. During this time, patients are often subjected to diagnostic testing that may include a variety of scans and tests that become astronomical in terms of cost. His long-term goal involves biomarker characterization that will lend itself towards more specific therapeutic options for conditions where there are currently no definitive blood tests.
“When initially conducting our research, we looked at 15 patients with fibromyalgia and 15 patients with rheumatoid arthritis, osteoarthritis, and lupus,” explains Dr. Hackshaw. “Then, we used some methodology called vibrational spectroscopy, which involves shining a laser through a blood sample. When the laser interacts with the chemicals in the blood cells, it vibrates, creating a signature, or what we call a fingerprint. The question we asked was, ‘Is the “fingerprint” of patients with fibromyalgia similar enough that we can differentiate individuals with fibromyalgia from rheumatoid arthritis, osteoarthritis, and other common arthritic conditions?’”
“In our initial study,” continues Dr. Hackshaw, “looking at the 15 patients with fibromyalgia compared to 15 patients in other groups, we had 100% accuracy in being able to differentiate individuals of fibromyalgia from the other rheumatic conditions. Then, we conducted the same study, looking at 50 patients with fibromyalgia as compared to 50 patients with rheumatoid arthritis and 50 patients with lupus. And again, we had 100% accuracy in being able to differentiate these fingerprints between subjects. We took this information to the National Institutes of Health and have proposed looking at 500 patients. If we are able to show the same level of sensitivity and specificity with this higher number of patients, then we have a diagnostic blood test. In the years to come, I hope we are able to report that we do, indeed, have a diagnostic fingerprint for fibromyalgia.”
A diagnostic fingerprint for fibromyalgia would not only support an earlier diagnosis of fibromyalgia, but could also help determine the severity of the condition as well as if there are any subsets of fibromyalgia that can be better targeted by other forms of treatment.