The Role of Genes in Fibromyalgia - Essay Example

There is evidence that genes play an important role in Fibromyalgia. It was observed there is a high aggregation of Fibromyalgia in families of Fibromyalgia patients.  The mode of inheritance followed is probably polygenic.  An association between Fibromyalgia and polymorphisms of the genes in the serotoninergic, dopaminergic, and catecholaminergic systems was observed in research. However, these polymorphisms are not specific to Fibromyalgia and are associated with a range of somatic disorders and with depression (Buskila 332-8).

Stress is often considered a risk factor for Fibromyalgia It has also been hypothesized that because exposure to stressful conditions can alter the function of the hypothalamic-pituitary-adrenal (HPA) axis, the development of fibromyalgia may stem from stress-induced disruption of the HPA axis (McBeth et al . R992–R1000)

There is strong evidence that major depression and fibromyalgia are associated with each other. The symptoms of fatigue,  sleep disturbances, and cognitive disturbances that are characteristic of Fibromyalgia are also present in depressive illness. Patients with Fibromyalgia often improve with antidepressant medications. Although current major depression was found in only about 18-36% of Fibromyalgia patients, a lifetime history of depression was observed in 50-70% of the cases in a study (Goldenberg 778-779).  Gender and age are the other important risk factors in Fibromyalgia as Fibromyalgia is 10 times more prevalent in women than in men and is most likely to be diagnosed between the ages of 20 and 50 (Chakravarty and Zoorob 247).

The most important signs of Fibromyalgia are a pain in multiple sites, fatigue, and poor sleep. Patients often complain of low back pain, which may radiate into the buttocks and legs. Also common are complaints of pain and tightness in the neck and across the upper posterior shoulders. The pain may be described as a burning or gnawing soreness, stiffness, or aching. Many patients awaken frequently at night and have difficulty falling back to sleep. Upon waking, many patients feel exhausted and complain of stiffness, which improves as the day passes by. The pain must last for more than 3 months in all four quadrants of the body. Fibromyalgia is diagnosed if there is a history of widespread pain lasting more than three months—affecting all four quadrants of the body and the presence of 11 tender points among the nine pairs of sites specified by the American Rheumatology College (Chakravarty and Zoorob 248-249)

Many patients with fibromyalgia complain of cognitive difficulties (known as "brain fog" or "fibrofog") such as short and long-term memory problems, groping for words, and poor vocabulary. Headaches, including migraine type, also are common.

A feeling of swollen joints without actual swelling, and paresthesias without objective neurologic findings, are considered two important features of Fibromyalgia (Chakravarty and Zoorob 248).

As a medically unexplained syndrome, there is no known cure or universally accepted treatment for fibromyalgia, and treatment is typically aimed at symptom management. Along with pharmaceutical treatment, research was done on a variety of alternative treatments for Fibromyalgia with varying results. Short-term exercise programs for individuals with fibromyalgia have consistently improved physical function, especially physical fitness, and reduced tender point pain; however, the exercise must be done at moderate intensity and consistently. The exercise should start at intensities below the capabilities of the patient and should gradually increase, as high-intensity workouts, in the beginning, would result in the short-term raise in the severity of the symptoms (Gowans and deHueck).

The effectiveness of alternative therapies such as acupuncture and biofeedback has been supported by some studies. Serum levels of substance P and serotonin were significantly elevated after acupuncture treatment, suggesting possible mechanisms in pain relief (Chakravarty and Zoorob 253).

The first drug to be used for Fibromyalgia that is approved by FDA is Pregabalin, which is an anti-seizure drug (FDA). Gabapentin, a drug similar to Pregabalin is also used but is not approved by FDA. Both drugs act by increasing GABA levels after blocking calcium channels and it is reported that there is up to a 50% reduction in pain. 

Strong evidence was found for the efficacy of antidepressants in reducing pain, sleep disturbances, and depressed mood in Fibromyalgia patients. Tricyclic antidepressants, especially amitriptyline, were the most effective against pain, fatigue, and sleep problems, but have many side effects due to interaction with adrenergic, cholinergic, or histaminergic receptors, and sodium channels. Selective serotonin reuptake inhibitors (SSRIs) and Serotonin-norepinephrine reuptake inhibitors (SNRIs) had lower effects. Among the antidepressants, the only drug to be approved by FDA is Duloxetine, an SSRI.

The use of other drugs including investigational medications such as cannabinoids and the 5-HT3 receptor antagonist tropisetron and Dopamine agonists is currently under research.