Understanding Fibromyalgia; How Experts are Diagnosing and Treating Their Patients - Episode 4
Experts discuss known risk factors of fibromyalgia (FM).
Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: We heard from you that being female is a risk factor. What are some other risk factors that the group can send out to our audience tonight?
Kostas Botsoglou, MD: History of physical or emotional trauma, patient who was involved in a bad accident or had surgery or if they served overseas and were exposed with post-traumatic stress. Those can be known triggers as well as other inflammatory- active inflammatory diseases as well.
Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: And viruses, correct as well, including things like potentially COVID as well as potentially other infections such as Lyme disease. What are your thoughts on all of that?
Daniel Clauw, MD: There's no question that this can be triggered by different types of stressors being deployed to war, having viral infections or other types of infections. We understand that well and we see it over and over again.
Benjamin Natelson, MD: And I'm seeing some horrible pain syndromes after COVID. Some of these patients have horrible faint, but it's not widespread, but it is horrible. And so COVID can certainly produce pain syndromes.
Daniel Clauw, MD: But in population-based studies, sleep problems are one of the biggest predictors of someone subsequently developing. Sleep is the pendulum that has swung back and forth where Harvey Moldofsky did seminal studies in the 70s where sleep depriving healthy college students led to fibromyalgia like symptoms. And then a lot of us moved away from sleep being important. But a lot of the studies are suggesting that- especially where we do work in young adolescents, and often the sleep problem comes first, and then the memory and mood problems, and then the pain in longitudinal studies and cognitive behavioral therapy for insomnia has been shown to be an effective treatment for a lot of pain conditions. One of the messages today for providers is pay attention to the sleep and manage the sleep aggressively.
Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: And I know we're going to talk about that, but I've said for years that for many of my patients, until I can help them to sleep, I don't stand a chance at really helping them to feel better. Can I just ask one other question of the group before we move on from this section and then get really into the diagnosis of fibromyalgia. Do you see in your research or in your- over your career, do you think- is there a genetic factor with this?
Daniel Clauw, MD: Yes.
Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: Do we- what do we know about it Dr Clauw?
Daniel Clauw, MD: There've been really nice twin studies with- and they haven't just looked at fibromyalgia alone. They've looked at all these chronic overlapping pain conditions. CATO has done several elegant studies, and what you find is that the individuals with fibromyalgia will have a family history of things like, again, tension, headache, fibromyalgia, irritable bowel, those chronic overlapping pain conditions. They run in individuals and they run in families. And the latest study suggest it's about 50% environmental, 50% genetic, but not any single genes that are super powerful. It's really a polygenic risk, it seems.
Transcript edited for clarity.