{"id":1495,"date":"2026-04-11T17:40:13","date_gmt":"2026-04-11T14:10:13","guid":{"rendered":"https:\/\/drhamidyousefi.com\/fibromyalgia-disorder\/"},"modified":"2026-04-11T17:40:13","modified_gmt":"2026-04-11T14:10:13","slug":"fibromyalgia-disorder","status":"publish","type":"post","link":"https:\/\/drhamidyousefi.com\/en\/fibromyalgia-disorder\/","title":{"rendered":"Fibromyalgia disorder"},"content":{"rendered":"<p lang=\"en\"><strong>Fibromyalgia<\/strong><\/p>\n<p lang=\"en\"><em>Fibromyalgia<\/em> is a chronic pain disorder characterized by<\/p>\n<p lang=\"en\"><strong>widespread musculoskeletal pain<\/strong> accompanied by a cluster of neurological, psychological, and physical symptoms.<\/p>\n<p lang=\"en\">It occurs more frequently in women (about 70\u201380% of cases) and is usually diagnosed between the ages of <strong>30 and 50<\/strong>, although it can occur at any age.<\/p>\n<hr \/>\n<h2 lang=\"en\">1. Pathophysiology (Disease Mechanism)<\/h2>\n<p lang=\"en\">Fibromyalgia is considered a disorder of<\/p>\n<p lang=\"en\"><strong>central pain processing (Central Sensitization)<\/strong>,<\/p>\n<p lang=\"en\">meaning the central nervous system becomes <strong>overly sensitive<\/strong> to painful\u2014and even non-painful\u2014stimuli.<\/p>\n<p lang=\"en\">Key proposed mechanisms:<\/p>\n<ul lang=\"en\">\n<li>\n<p lang=\"en\"><strong>Increased pain neurotransmitters<\/strong> in the CNS, such as:<\/p>\n<ul lang=\"en\">\n<li>Substance P<\/li>\n<li>Glutamate<\/li>\n<\/ul>\n<\/li>\n<li>\n<p lang=\"en\"><strong>Reduced pain\u2011inhibiting systems<\/strong><\/p>\n<p lang=\"en\">Decreased levels of:<\/p>\n<ul lang=\"en\">\n<li>Serotonin (5\u2011HT)<\/li>\n<li>Norepinephrine<\/li>\n<\/ul>\n<\/li>\n<li>\n<p lang=\"en\"><strong>Dysregulation of the Hypothalamic\u2011Pituitary\u2011Adrenal (HPA) axis<\/strong><\/p>\n<\/li>\n<li>\n<p lang=\"en\"><strong>Disturbed deep sleep (N3 stage)<\/strong>, which worsens pain and fatigue<\/p>\n<\/li>\n<li>\n<p lang=\"en\">Altered pain processing in brain regions<\/p>\n<p lang=\"en\">(shown in fMRI studies)<\/p>\n<\/li>\n<\/ul>\n<p lang=\"en\">Important note:<\/p>\n<p lang=\"en\">In fibromyalgia, <strong>there is no structural damage<\/strong> to muscle or joints.<\/p>\n<p lang=\"en\">The problem lies in <strong>pain processing<\/strong>\u2014the pain is genuinely felt by the person.<\/p>\n<hr \/>\n<h2 lang=\"en\">2. Clinical Symptoms<\/h2>\n<p lang=\"en\">The main symptom:<\/p>\n<p lang=\"en\"><strong>Chronic widespread pain<\/strong> (for at least 3 months)<\/p>\n<p lang=\"en\">Pain characteristics:<\/p>\n<ul lang=\"en\">\n<li>Both sides of the body<\/li>\n<li>Above and below the waist<\/li>\n<li>Involvement of axial skeleton<\/li>\n<\/ul>\n<p lang=\"en\">Common associated symptoms:<\/p>\n<ul lang=\"en\">\n<li><strong>Severe fatigue<\/strong><\/li>\n<li><strong>Sleep disturbance (non\u2011restorative sleep)<\/strong><\/li>\n<li><strong>Morning stiffness<\/strong><\/li>\n<li><strong>Fibro fog (cognitive dysfunction)<\/strong>, including:\n<ul lang=\"en\">\n<li>Poor concentration<\/li>\n<li>Short\u2011term memory difficulties<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p lang=\"en\">Other symptoms:<\/p>\n<ul lang=\"en\">\n<li>Headache or migraine<\/li>\n<li>Irritable Bowel Syndrome (IBS)<\/li>\n<li>Restless Legs Syndrome<\/li>\n<li>Anxiety and depression<\/li>\n<li>Dysmenorrhea<\/li>\n<li>Sensitivity to sound, light, and touch<\/li>\n<\/ul>\n<hr \/>\n<h2 lang=\"en\">3. Tender Points<\/h2>\n<p lang=\"en\">In older criteria (ACR 1990),<\/p>\n<p lang=\"en\">having <strong>\u226511 out of 18 tender points<\/strong> was required.<\/p>\n<p lang=\"en\">Classical tender points include:<\/p>\n<ul lang=\"en\">\n<li>Occiput (back of the head)<\/li>\n<li>Trapezius (shoulders)<\/li>\n<li>Supraspinatus (shoulder blade region)<\/li>\n<li>Lateral epicondyle (outer elbow)<\/li>\n<li>Gluteal region<\/li>\n<li>Greater trochanter (outer thigh)<\/li>\n<li>Knee<\/li>\n<\/ul>\n<p lang=\"en\">These criteria are used less commonly today.<\/p>\n<hr \/>\n<h2 lang=\"en\">4. New Diagnostic Criteria (ACR 2016)<\/h2>\n<p lang=\"en\">Diagnosis is based on two scales:<\/p>\n<p lang=\"en\">1\ufe0f\u20e3 <strong>Widespread Pain Index (WPI)<\/strong><\/p>\n<p lang=\"en\">Number of painful body regions (0\u201319)<\/p>\n<p lang=\"en\">2\ufe0f\u20e3 <strong>Symptom Severity Scale (SS)<\/strong><\/p>\n<p lang=\"en\">Severity of:<\/p>\n<ul lang=\"en\">\n<li>Fatigue<\/li>\n<li>Sleep disturbance<\/li>\n<li>Cognitive problems<\/li>\n<li>Other physical symptoms<\/li>\n<\/ul>\n<p lang=\"en\">Diagnosis is made if:<\/p>\n<ul lang=\"en\">\n<li>WPI \u2265 7 and SS \u2265 5<\/li>\n<\/ul>\n<p lang=\"en\"><strong>or<\/strong><\/p>\n<ul lang=\"en\">\n<li>WPI 4\u20136 and SS \u2265 9<\/li>\n<\/ul>\n<p lang=\"en\">Plus:<\/p>\n<ul lang=\"en\">\n<li>Symptoms present \u2265 3 months<\/li>\n<li>No other condition that better explains them<\/li>\n<\/ul>\n<hr \/>\n<h2 lang=\"en\">5. Differential Diagnosis<\/h2>\n<p lang=\"en\">Very important, since there is no specific lab test.<\/p>\n<p lang=\"en\">Conditions to rule out:<\/p>\n<ul lang=\"en\">\n<li><strong>Hypothyroidism<\/strong><\/li>\n<li><strong>Polymyalgia rheumatica<\/strong><\/li>\n<li><strong>Rheumatoid arthritis<\/strong><\/li>\n<li><strong>SLE<\/strong><\/li>\n<li><strong>Myopathies<\/strong><\/li>\n<li><strong>Chronic fatigue syndrome<\/strong><\/li>\n<li><strong>Vitamin D deficiency<\/strong><\/li>\n<\/ul>\n<p lang=\"en\">Lab tests are usually <strong>normal<\/strong>.<\/p>\n<hr \/>\n<h2 lang=\"en\">6. Treatment<\/h2>\n<p lang=\"en\">Treatment should be <strong>multimodal<\/strong>.<\/p>\n<h3 lang=\"en\">A) Non\u2011pharmacological treatment (most important)<\/h3>\n<ol lang=\"en\">\n<li><strong>Patient education<\/strong><\/li>\n<li><strong>Regular aerobic exercise<\/strong>:\n<ul lang=\"en\">\n<li>Walking<\/li>\n<li>Swimming<\/li>\n<li>Stationary cycling<\/li>\n<\/ul>\n<\/li>\n<li><strong>Cognitive Behavioral Therapy (CBT)<\/strong><\/li>\n<li><strong>Improving sleep hygiene<\/strong><\/li>\n<li><strong>Stress reduction<\/strong><\/li>\n<li>Yoga or Tai Chi<\/li>\n<\/ol>\n<p lang=\"en\">Exercise is the <strong>most effective long\u2011term treatment<\/strong>.<\/p>\n<hr \/>\n<h3 lang=\"en\">B) Medications<\/h3>\n<p lang=\"en\"><strong>First\u2011line medications:<\/strong><\/p>\n<ul lang=\"en\">\n<li><strong>Duloxetine<\/strong><\/li>\n<li><strong>Milnacipran<\/strong><\/li>\n<li><strong>Pregabalin<\/strong><\/li>\n<\/ul>\n<p lang=\"en\"><strong>Other helpful medications:<\/strong><\/p>\n<ul lang=\"en\">\n<li><strong>Amitriptyline<\/strong> (low dose at night)<\/li>\n<li><strong>Cyclobenzaprine<\/strong><\/li>\n<li><strong>Gabapentin<\/strong><\/li>\n<\/ul>\n<p lang=\"en\"><strong>Medications not recommended:<\/strong><\/p>\n<ul lang=\"en\">\n<li><strong>NSAIDs<\/strong> (limited benefit)<\/li>\n<li><strong>Opioids<\/strong> (strongly discouraged)<\/li>\n<\/ul>\n<hr \/>\n<h2 lang=\"en\">7. Prognosis<\/h2>\n<p lang=\"en\">Fibromyalgia is:<\/p>\n<ul lang=\"en\">\n<li><strong>Non\u2011inflammatory<\/strong><\/li>\n<li><strong>Non\u2011destructive<\/strong><\/li>\n<li><strong>Not life\u2011threatening<\/strong><\/li>\n<\/ul>\n<p lang=\"en\">But it can significantly reduce quality of life.<\/p>\n<p lang=\"en\">With a combination of:<\/p>\n<p lang=\"en\"><strong>exercise + psychological therapy + medication<\/strong><\/p>\n<p lang=\"en\">symptoms are usually manageable.<\/p>\n<hr \/>\n<p lang=\"en\"><strong>\u201cSociety and Mental Health\u201d<\/strong><\/p>\n<p lang=\"en\">In this space, materials related to psychology and psychiatry are shared.<\/p>\n<p lang=\"en\">\ud83c\udd94 ID:<\/p>\n<p lang=\"en\"><a href=\"https:\/\/ble.ir\/jamehvasalamtravan\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/ble.ir\/jamehvasalamtravan<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Fibromyalgia Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal pain accompanied by a cluster of neurological, psychological, and &#8230; <a class=\"cz_readmore\" href=\"https:\/\/drhamidyousefi.com\/en\/fibromyalgia-disorder\/\"><i class=\"fa fa-angle-left\" aria-hidden=\"true\"><\/i><span>\u0627\u062f\u0627\u0645\u0647 \u0645\u0637\u0644\u0628<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":1496,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[94],"tags":[],"class_list":["post-1495","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-psychiatric-experiences"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.3 (Yoast SEO v27.4) - 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