Fibromyalgia - Taking A Look At Serotonin Syndrome Masked By Fibromyalgia
A condition known as fibromyalgia is distinguished by widespread aches and pains, extreme tiredness, and heightened sensitivity.
Alterations in mood, difficulty sleeping, and problems remembering things are a few additional symptoms that may be present.
There are approximately 3.94 million people in the United States who are affected by it, and its prevalence is 1.75%.
It is believed that a lower pain threshold in the central nervous system ("central sensitization") is the cause of the condition, despite the fact that the complete pathophysiology is unknown.
It is possible to lessen the severity of this hyperactivity by activating the pain modulatory circuit that is located in the CNS3.
Selective serotonin reuptake inhibitors (SSRIs), which have been shown to be effective in the treatment of fibromyalgia-related pain, are the substances that are most likely to be involved in this circuit.
Fibromyalgia is a condition that lasts for a long time. It can manifest itself in a variety of ways, including:
- Sleep and cognitive disturbances
- General fatigue
- Musculoskeletal pain, also known as pain that occurs in the muscles and bones
This condition can be difficult to understand, even for those who work in the medical field. There are no tests that can definitively confirm a diagnosis, despite the fact that its symptoms are similar to those of other conditions. Because of this, fibromyalgia is frequently diagnosed incorrectly.
In the past, some medical professionals even cast doubt on the existence of the condition known as fibromyalgia. It is now widely recognized and understood.
Fibromyalgia affects approximately 4 million adults in the United States, which corresponds to approximately 2 percent of the adult population. Most fibromyalgia cases are diagnosed in females. Fibromyalgia affects people of all ages, but the condition is typically identified during the middle years of life.
Although there is less of a social stigma attached to having fibromyalgia today than there was in the past, the condition can still be difficult to treat. You can improve the quality of your life and manage your symptoms with the help of medications, therapy, and changes in your lifestyle.
It is also possible for you to go through periods that are similar to remission, during which both your pain and fatigue will decrease.
Both medical professionals and researchers are at a loss to explain what triggers fibromyalgia.
The most recent research suggests that a genetic predisposition combined with one or more triggers (such as infection, trauma, or stress) may be the root of the problem.
Both the chronic and widespread nature of fibromyalgia pain and its causes are poorly understood by experts.
According to one theory, the brain lowers one's pain threshold. Over time, feelings that were not painful at first become extremely painful.
Another hypothesis is that the brain and nerves may interpret typical pain signals incorrectly or overreact to them. Their sensitivity increases to the point where they inflict unnecessary or excessive pain. This might be brought on by a chemical imbalance in the brain or a problem with the dorsal root ganglion, a collection of neurons in the spine.
Fibromyalgia often runs in families. If you have a family member with this condition, you’re at a higher risk of developing it.
Researchers think certain gene mutations may play a role. They’ve identified a few possible genes that affect the transmission of chemical pain signals between nerve cells.
An earlier illness has the potential to either trigger the onset of fibromyalgia or to make the symptoms of the condition more severe. According to the findings of some studies, fibromyalgia can be caused by infections such as the following:
- Infections of the gastrointestinal tract, such as those triggered by the Salmonella and Shigella bacteria
- Epstein-Barr virus
Fibromyalgia is sometimes triggered in people who have been through severe psychological or physical trauma. Post-traumatic stress disorder (also known as PTSD) has been associated with the condition.
Similar to the effects that are left behind by trauma, stress can leave permanent scars on your body. There is evidence that stress is linked to changes in hormone levels, which may play a role in the development of fibromyalgia.
What are now known as "regions of pain" were originally caused by fibromyalgia.
A few of these regions overlap with the areas of tenderness that are traditionally referred to as tender points or trigger points. On the other hand, not all of these previously mentioned tender spots are included in the map of painful regions.
The discomfort is best described as a constant throbbing. If you have experienced musculoskeletal pain in four out of the five regions of pain outlined in the 2016 revision to the fibromyalgia diagnostic criteria, a healthcare professional will take into consideration the possibility of a diagnosis of fibromyalgia.
The pain associated with fibromyalgia is referred to as multisite pain in the current diagnostic criteria. On the other hand, the diagnostic criteria for fibromyalgia were updated in 1990, and they defined fibromyalgia pain as chronic widespread pain.
In addition to this, the process of diagnosis now places an emphasis on the level of pain as well as the musculoskeletal regions that are being affected. In the past, one of the primary considerations in a fibromyalgia diagnosis was the length of time one had been experiencing pain.
Fibromyalgia is characterized by a wide range of symptoms, including the following:
- Bladder issues like interstitial cystitis
- Pain or a dull ache in the lower abdomen
- Dry eyes
- Trouble focusing or paying attention
- Nonrestorative sleep, or long stretches without feeling rested
- Trouble sleeping
This condition has the potential to impact both your body and your emotions.
A serotonin syndrome, also known as serotonin toxicity, is a drug reaction that has the potential to be life-threatening. It is thought to take place when there is an abnormally high concentration of serotonin in the body. Serotonin is made in the body by cells of the nervous system.
Neurotransmitters, like serotonin, are chemicals that play a role in the regulation of a variety of bodily functions, including but not limited to the following:
- Body temperature
- Blood flow
In addition to this, it is thought to have an effect on mood and is critically important to the proper functioning of nerve and brain cells.
It is possible to have an unsafely high level of serotonin in your body if you take multiple prescription medications at the same time. Medications used to treat conditions such as depression and migraines, as well as those used to manage pain, are examples of the kinds of drugs that can cause serotonin syndrome.
An overabundance of serotonin can result in a spectrum of symptoms ranging from mild to severe. These symptoms can have an effect on the brain in addition to other parts of the body, such as the muscles.
If you take an excessive amount of a medication that raises serotonin levels, you run the risk of developing serotonin syndrome.
It's possible given the following conditions:
- When two or more medications are taken at the same time, the risk of developing this condition is significantly increased.
- You combine two substances, one of which is a medication, the other a supplement, or even an illegal drug, both of which lead to increased serotonin levels.
- The dosage of a medication that you are already taking is increased by your physician.
- You have started taking a new medication that has an effect on serotonin.
In the absence of immediate medical attention, serotonin syndrome can quickly become fatal.
It is possible that you will start experiencing symptoms just minutes or hours after beginning a new medication or having the dosage of one that you are already taking increased. This can happen either immediately or after some time has passed. The following is a list of some of the possible symptoms that might be present:
A stretching upward of both big toes on stimulation, known as Babinski sign
- Roving eye movements
- Increased bowel sounds or diarrhea
- Flushed skin
- A dry mouth and throat
- Twitching, jerking or muscle spasms
- Dilated pupils
- Muscle rigidity
- A rapid heart rate
In cases where the condition is more severe, symptoms may include the following:
- Loss of consciousness
In extreme circumstances, it may pose a risk to the patient's life.
After being exposed to a drug, symptoms will typically appear almost immediately. The majority of people who experience toxicity will develop symptoms within 24 hours, with thirty percent of people experiencing symptoms within one hour and sixty percent experiencing symptoms within six hours.
For this reason, it is imperative to seek help as soon as possible in the event that anyone displays symptoms that may indicate serotonin syndrome.
When a patient with fibromyalgia presents with changed symptoms, it is necessary to perform a comprehensive history and physical exam to rule out other systemic problems that can mimic fibromyalgia and cause similar symptoms. It is common practice to prescribe a combination of medications to treat psychiatric, cognitive, and pain disorders. This puts them at risk for adverse drug interactions, which can make it difficult to differentiate between fibromyalgia flare-ups and serotonin syndrome symptoms. The stimulation of 5-HT receptors results in an increase of serotonin in the central nervous system, which is the cause of serotonin syndrome.
This can occur from an overdose of a single serotonergic drug or from the combined effects of two drugs that work synergistically to release serotonin. The symptoms of serotonin syndrome can range from being relatively mild to being quite severe. In terms of severity, mild to moderate signs and symptoms include tachycardia, diaphoresis, myoclonus, hypertension, and hyperthermia. Patients suffering from conditions that are more severe may exhibit symptoms such as shock, seizures, renal failure, or metabolic acidosis. Maintaining a high level of clinical suspicion for serotonin syndrome in a patient who is exhibiting atypical fibromyalgia symptoms is required.
Fluoxetine (Prozac, Sarafem), paroxetine (Brisdelle, Paxil, Pexeva), and sertraline (Zoloft) are SSRIs that are used to treat the symptoms of fibromyalgia. These medications help to lessen the signs and symptoms of anxiety and depression by raising serotonin levels in the brain.
Pregabalin and duloxetine are the only two medications that the Food and Drug Administration (FDA) of the United States has currently approved for the treatment of fibromyalgia. Milnacipran, a dual norepinephrine and serotonin reuptake inhibitor, may hold promise for the treatment of fibromyalgia, according to more recent research.
Although the cause of fibromyalgia is reportedly unknown, scientists generally agree that the symptoms are brought on by a nervous system sensitization that causes it to act like an amplifier. Because of this, pain worsens and common stimuli become painful.
Despite the numerous cerebral alterations, fibromyalgia might not be a primary disorder of the brain but may be a consequence of early life stress or prolonged or severe stress, affecting brain modulatory circuitry of pain and emotions in genetically susceptible individuals.
The severe condition known as serotonin syndrome is almost always brought on by the concurrent use of multiple medications. This condition has the potential to be fatal. Patients who have been determined to have chronic fibromyalgia and whose symptoms have worsened since the time of their initial presentation are required to undergo extensive diagnostic testing. In this particular instance, the symptoms of serotonin syndrome and fibromyalgia can be seen to overlap with one another.
When a patient comes in complaining of fibromyalgia, it is imperative that a thorough review of all of the medications they are currently taking be carried out. When dealing with patients like these, a high clinical suspicion of serotonin syndrome is warranted, particularly when the patients are being heavily medicated. This is especially true when the patients' symptoms are exacerbated by the medications.