MOD Report Fibromyalgia - Gov.uk

Hello fellow members !

A handy document to reference to maybe?

3.1. No single specific cause of FMS has yet been identified. The absence of any peripheral pathology and the presence of widespread tissue hyperalgesia suggest a central mechanism for the syndrome rather than some pathological process in the muscles themselves. Patients with the condition experience allodynia, i.e. pain on normally painless (non-nociceptive) stimulus, such as touch or light pressure; another pointer to a central mechanism.

3.2. Abnormalities in sensory processing A number of investigators have found that while patients with FMS are not able to detect nociceptive stimuli at lower levels than normal subjects, (e.g. heat, electrical current, pressure), the threshold at which these stimuli induce a sensation of pain is lower. This observation is interpreted by some as being attributable to an abnormality in the normal pain-suppressing neural pathways between brain and spinal cord.4

3.3. Neuroendocrine aberrations Several studies have identified subtle abnormalities of the hypothalamic-pituitary-adrenal axis along with a loss of the normal rhythmic diurnal fluctuation in blood cortisol levels. Other evidence emerging from this line of enquiry includes low blood levels of serotonin relative to healthy controls, and unusually high levels of substance P (a peptide involved in the transmission of pain impulses) in the cerebrospinal fluid. Changes have also been noted in the growth hormone axis that suggest abnormal hypothalamic function. However these and other related anomalies have not led to greater understanding of the cause of the condition and their significance is not yet clear.5

3.4. Psychological factors Although some symptoms of FMS suggest a psychological component, careful studies have revealed no consistent relationship between the condition and psychological status. However in a number of studies an increased frequency of life stress has been found, accompanied in a significant proportion of patients by anxiety, low mood and poor coping skills. Most patients are not depressed and any onset of depression does not correlate with an alteration in the level of pain.6,7,8

3.5. Genetic factors A number of studies have suggested familial aggregation and so possibly an as yet unidentified genetic link.9

3.6. Sleep abnormalities One of the original proposals with regard to causation was that patients suffering from the syndrome exhibited abnormal alpha-wave activity on electro-encephalography during certain phases of sleep. However the specificity of this observation has been queried and its reproducibility and causal significance challenged.10,11

3.7. Other investigators have proposed that there may be impairment of the normal 24-hour

5 variability of heart rate, and postulate that excessive nocturnal sympathetic activity may result in non-restorative sleep and ensuing fatigue.12

3.8. However, although sleep abnormalities and morning fatigue are common in FMS, it is well-recognised that disrupted sleep, of whatever variety, and of whatever origin may result in muscle pain, fatigue and poor concentration.

3.9. Peripheral mechanisms A large number of investigators have attempted to identify abnormalities in the muscle tissue in FMS. However despite isolated abnormal findings no consistent relationships have been found.

3.10. Reactive or secondary fibromyalgia Fibromyalgia may arise insidiously and unheralded in an otherwise healthy individual, but in a proportion of cases there appears to be an initiating factor; for example a stressful event, or physical trauma, such as a whiplash injury or surgical operation. In some, there is a history of an influenza-like illness but immunological investigation in such patients has produced inconclusive or inconsistent results and there is at present no clear evidence that FMS is attributable to an infective process.

3.10.1. Trauma Between 14 and 23 per cent of patients with FMS associate the onset of their symptoms with physical trauma. However no convincing evidence has been produced that there is any consistent causative link between traumatic events and fibromyalgia.13,14,15

3.10.2. A number of studies suggest that patients with so-called reactive fibromyalgia have more perceived disability, self-reported pain and affective distress than those in whom no initiating event was identified.

3.10.3. There is however no single environmental exposure that is likely to trigger this illness. Instead, data from a wide variety of sources has led many investigators to conclude that when certain people who are genetically predisposed are exposed to any of a wide variety of stressors, including infections or other types of immune stimulation, drugs, physical trauma, infections or emotional stress – acute or chronic – they will develop a multisystem illness of this type. 6

Here's the link;

gov.uk/government/uploads/s...

Best Wishes

Emma :)

FibroAction Administrator

17 Replies

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  • I have heard about most of that or been told by doctors some of it. It all boils down to they don't know why some people get Fibro and some don't. They don't know what causes it or why it affects some more than others. The just plain in simple don't know. After all the studies and research that has been done it is still very mysterious!

  • Very informative, thank you for sharing this information with us all x x

  • This makes sense. I had an abscess on the jaw and had already undertaken 2 root canal fillings in an attempt to relieve it. It had started to grow again and I was seeing the dentist the next day. I collapsed on the way although I felt fine on the bus. I ended up in the hospital after loosing all co-ordination in arms and legs although I felt fine. The dental hosptial said it wasn't the abscess and I made a full recovery before they took the tooth out. Howver I have never felt a 100 per cent since.

    Thank you for sharing I will pass on.

  • Hi Emma,

    I can not seem to open link either in acrobat, Firefox or Explora.

    Please can you send me again?

    Tx

  • Hello Kittyletmein,

    Sorry it's because it is a PDF file link - Maybe if you google you'll find it to access it straight from the computer.

    As Budgiefriend mentions below it doesn't feature the 2010 Criteria which can be found here;

    fibroaction-public.sharepoi...

    However what interested me was that it is a Gov.UK albeit for the MOD. The document says the roughly the same using research as Fibro charities have been saying yet there we still suffer Stigma about the illness. Amazing !?!?

    Best Wishes

    Emma :)

    FibroAction Administrator

  • I can't open the link either 😳

  • See above please Google - sorry PDF URL Link :)

  • Nor me and i dont like to copy direct from the site onto pinterest.

  • Likewise. "page not found" it may have been updated since you looked.

    I hadn't read any of that but much of it is unsurprising in that it explains much. Thanks for the heads up :)

  • Sorry please Google :)

  • I have not read this piece as is. Thanks for posting.

    Item 3.10 is quite interesting to me, especially having had both a whiplash injury following a surgical disc fusion ... as well as spinal meningitis, requiring hospitalization ~ all a few years before my FMS diagnosis. It does make one wonder about all the various "symptoms" ...

  • Found this when looking into the link

    gov.uk/government/uploads/s...

  • That looks like outdated information in terms of currently accepted criteria (CCC and ICC, as well as IOM recent report proposed criteria) It appears to all be descriptive of and based around Fukuda criteria which I have heard and seen many of the top ME experts say is very faulty as a diagnostic or research criteria either way.

    I believe researchers and experts in the field say the use of Fukuda criteria are partially responsible for many failures in treatment of both ME and Fibromyalgia.

    I got rather concerned upon reading the first paragraph in which it was stated in some manner that this illness has no causation.

    It presents the situation in terms of looking for another condition and if one is found, then the person does not have CFS. Latest researchers mostly are saying this is a poor way to treat patient symptoms, as many illnesses and symptoms are comorbid with ME/CFS.

    I am wondering when the government is going to update the standard and awareness of their information and training for doctors and other health care workers, and disseminate correct information to health professionals.

    Of course also being discussed in Ramsay's Disease forum with Bag End's question on what our ideas would be for updated NICE guidelines on ME.

  • Hello Budgiefriend,

    You are right this was written in 2008 and the criteria for diagnosis of Fibromyalgia was changed in 2010, which can be found here;

    fibroaction-public.sharepoi...

    What struck me most is that a Gov.UK document albeit for the MOD & in 2008 point out ;

    3.4. Psychological factors Although some symptoms of FMS suggest a psychological component, careful studies have revealed no consistent relationship between the condition and psychological status. However in a number of studies an increased frequency of life stress has been found, accompanied in a significant proportion of patients by anxiety, low mood and poor coping skills. Most patients are not depressed and any onset of depression does not correlate with an alteration in the level of pain.6,7,8

    Handy reference maybe when we get the it's 'All in your head' i thought maybe. I wish we had further NICE guidelines that addressed this issue too! :)

    It was posted just as a general interest that I stumbled upon :)

    Best wishes

    Emma :)

    FibroAction Administrator

  • Will someone explain to me exactly what is the relationship of this source with the NHS and the attitudes and protocol or lack of protocol doctors are supposed to follow when they have a patient with probable Fibromyalgia?

    Also, I am wondering if this is newly accepted by the UK health bodies, because so many people are still told by their doctors that there is nothing wrong with them and it's all in their imagination, or that Fibromyalgia does not even exist.

    So I am wondering in what way this article relates to the way doctors are routinely treating patients with the illness.

    It seems like such a fight to get them to accept many of these research findings, and treat us as sufferers of a very complex multi-system disease that causes sometimes extreme disability and pain. I have had them ask me what else is wrong with me because "fibromyalgia would not make someone as sick as you are."

    So if this is an official source why are doctors still getting by with such awful misinformation and poor guidance for patients?

  • Hello Budgiefriend,

    This is just a document I stumbled upon and thought as MOD that it was written for use for the MOD possibly due to a need as Fibromyalgia diagnosis has seen a rise within that sector maybe I am guessing - trauma & PSTD possibly. As you I am unsure why they wrote this for the MOD yet the general population have no NICE guidelines.

    FibroAction did try alongside FMA UK to get NICE guidelines implemented in 2009, please see details below;

    publications.parliament.uk/...

    As above. as you mentioned my main interest was the paragraph 3.4 as many Healthcare Professionals still outline people who receive a diagnosis of Fibromyalgia as having Depression before the diagnosis and many argue the depression is secondary.Obviously there will be people who did suffer depression before diagnosis but I would imagine the numbers are not that different from any other diagnosis maybe?

    Many use that as the reason for Fibromyalgia which leads on to the stigma from some Healthcare Professionals due to the Mental Health issues previous to diagnosis. I wonder if we did a poll what the results would be in regards to depression before & after diagnosis ?

    I don't know whether GP's would recognise this paragraph based on research as they will have read their own research and formed an opinion from that but it may be helpful with people who are struggling with family & friends maybe - I don't know but it is interesting .

    RE: GP's FMA UK fmauk.org have a resource pack that can be sent to GP surgeries I believe.

    fmauk.org/information-packs...

    Very interesting discussion - I thin the poll may be good to look at the anonymous answers too :)

    Best Wishes

    Emma :)

    Fibroaction Administrator

  • Thanks for telling us more of your thoughts about this, and your thoughts seem reasonable to me.

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