Sick and Tired: Understanding and Managing Sleep Difficulties in ...

Chapter One. The Context of Fibromyalgia Syndrome (FMS)
This chapter will first review the evidence of the clinical presentation and underlying
cause of FMS, and will then describe the history of the condition and diagnostic criteria.
The current literature on the extent and effect of FMS on individuals, their families and
society will then be reviewed, before exploring how the condition is currently managed
in clinical practice.
Clinical Presentation of FMS
FMS is a chronic medical condition where the most prominent symptom is widespread
chronic pain. Additional symptoms include fatigue, sleep disturbance and cognitive
difficulties (Mease, 2005). Emerging evidence suggests that the condition may arise
from irregularities in the neuroendocrine and autonomic nervous systems (Mease et al.,
2007). People with FMS have been found to have increased sensitivity to stimuli (such
as temperature and pressure) in comparison to controls (Berglund, Harju, Kosek, &
Lindblom, 2002; Lautenbacher, Rollman, & McCain, 1994). Although these initial
studies were based on people‟s subjective interpretations of the term „painful‟, more
recent advances in functional magnetic resonance imaging (fMRI) have provided
objective, supporting evidence of this finding. For example, studies using fMRI have
shown that people with FMS have increased blood flow in a greater number of areas of
the brain in response to the application of painful pressure or heat stimuli in comparison
to controls. The higher levels of activation are reported to occur in the areas of the brain
involved in processing pain and twice as much pressure was needed to yield the same
levels of activation in the control group (Cook et al., 2004; Gracely, Petzke, Wolf, &
Clauw, 2002). In a subsequent study using magnetic resonance imaging, people with
FMS were found to have significantly lower gray matter volume in the cingulo-frontal
cortex and the amygdala (areas associated with the modulation of pain processing) in
comparison to controls, although the authors noted that these differences in gray matter
volume could be a result of medication taken to relieve symptoms rather than linked to
FMS directly (Burgmer et al., 2009).
Lower levels of the neurotransmitters, serotonin and norepinephrine, which are involved
in the inhibition of pain responses, have also been observed in people with FMS
(Russell, 1998). This suggests that people with FMS have both augmented sensitivity
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