Skip to content

Patients › General-Health

Fibromyalgia

PDF In-depth PDF

Widespread pain and fatigue from an over-sensitised nervous system — what it is, and why movement, sleep and pacing help most.

Ilustrasyon ng malawak at pinalakas na pananakit — isang katawan na may 'dial' ng pananakit na nakapihit sa pula.
Sa fibromyalgia, itinataas ng nervous system ang 'pain volume', kaya nararamdaman ang sakit sa malawak na bahagi ng katawan. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ang iyong nararamdaman

Ang Fibromyalgia ay malawakan at pangmatagalang pananakit: isang kirot, paghapdi o pananakit na maaaring lumipat-lipat sa katawan at tila nararamdaman sa halos lahat ng bahagi sa halip na sa isang kasukasuan lamang. Kasabay ng pananakit, karamihan sa mga tao ay matinding napapagod, at hindi ito naaayos ng pagtulog: maaari kang gumugol ng buong gabi sa kama at magising pa ring hindi refreshed, na tila hindi ka talaga nakapagpahinga.

Maraming tao rin ang nakapapansin na ang kanilang pag-iisip ay tila malabo: hirap mag-concentrate, maghanap ng mga salita, o makaalala ng mga bagay. Napakakaraniwan nito kaya mayroon itong pangalan: "fibro fog". Bukod dito, ang katawan ay madalas na nagiging mas sensitibo sa pangkalahatan: ang hipo, pressure, liwanag, tunog o temperatura ay maaaring maramdamang sobra na, at ang isang pagkakauntog na hindi naman makakaabala sa karamihan ng mga tao ay maaaring talagang makasakit. Ito ay nakakapagod, at madaling maramdaman na walang sinuman ang lubos na naniniwala sa bigat ng iyong pinagdaraanan.

Ano ang aktwal na nangyayari

Narito ang mahalagang bahagi: ang fibromyalgia ay hindi pinsala sa iyong mga kasukasuan o mga kalamnan, at hindi ito pamamaga. Iyan ang dahilan kung bakit ang mga scan, X-ray at blood test ay karaniwang lumalabas na normal. Walang anumang "nakaligtaan", at ang normal na resulta ay hindi nangangahulugang hindi totoo ang sakit.

Ang nangyayari ay nasa paraan kung paano pinoproseso ng iyong nervous system ang sakit. Sa fibromyalgia, ang sistema na nagdadala ng mga signal ng sakit ay nagiging masyadong mataas: ang volume ay nakatakda nang mas malakas kaysa sa dapat. Ang mga normal na sensasyon ay napapalakas at nagiging sakit, at ang totoong sakit ay nararamdaman nang mas matindi. Tinatawag ito ng mga doktor na central sensitisation. Ito ay isang tunay at pisikal na pagbabago sa kung paano hinahawakan ng mga nerve at utak ang mga signal: hindi ito isang bagay na "nasa isip mo lang", at hindi ito tanda ng kahinaan. Ang fibromyalgia ay karaniwan, ito ay totoo, at ito ay kinikilala.

Madalas din itong kasabay ng iba pang mga kondisyon (mga bagay tulad ng irritable bowel, pananakit ng ulo, low mood o iba pang pangmatagalang sakit), at maaari itong magpalakas ng sakit pagkatapos ng isang operasyon. Ang huling puntong iyon ay mahalagang ipaalam sa iyong surgical team, dahil ang pagkaalam na mayroon kang fibromyalgia ay tumutulong sa kanila na planuhin ang iyong pain relief at recovery upang mas mabuti kang maalagaan.

Ano ang maaari nating gawin tungkol dito

Walang lunas, ngunit ang fibromyalgia ay maaaring mapamahalaan, at maraming tao ang nakakapagpababa ng kanilang mga sintomas sa antas na mas madaling dalhin. Ang pinakamalakas at pinaka-maaasahang tulong ay hindi nagmumula sa tableta; nagmumula ito sa ilang matatag na gawi:

  • Banayad at unti-unting paggalaw. Ang ehersisyo ang pinaka-sinusuportahang gamutan. Ang sikreto ay magsimula nang napakaliit at dahan-dahang dagdagan: ang paglalakad, pag-uunat (stretching), o ehersisyo sa tubig ay mabubuting panimula. Ang sobrang pagpilit nang masyadong maaga ay nagpapalala ng sakit, kaya ang mabagal at matatag ang nagtatagumpay.
  • Mas mabuting pagtulog. Dahil ang hindi nakakapagpanibagong tulog ay nagpapalala sa sakit at sa "fog," ang regular na routine at mabubuting gawi sa pagtulog ay nagbibigay ng tunay na pagkakaiba.
  • Pacing. Ang paghahati-hati ng aktibidad sa buong araw at linggo (sa halip na gawin ang lahat sa isang araw na maayos ang pakiramdam at pagkatapos ay biglang manghina) ay nagpapanatili sa iyong katatagan.
  • Pamamahala ng stress at mga sikolohikal na pamamaraan. Pinatataas pa ng stress ang tindi ng nararamdaman. Ang mga teknik tulad ng CBT (cognitive behavioural therapy), relaksasyon, at mindfulness ay tumutulong na pakalmahin ang isang over-sensitive na sistema.

Ang mga gamot ay maaaring makatulong sa ilang tao, ngunit ang mga kapaki-pakinabang ay hindi mga painkiller sa ordinaryong kahulugan: pinapakalma nila ang nervous system sa halip na harangan ang mga signal ng sakit. Kabilang dito ang amitriptyline, duloxetine at pregabalin; maaari kayong magbasa nang higit pa sa aming pahina ng nerve-pain medicines. Sa kabilang banda, ang mga ordinaryong anti-inflammatories ay hindi gumagana para sa fibromyalgia (dahil walang inflammation na dapat pakalmahin), at ang mga opioid ay hindi nakakatulong at maaaring magdulot ng tunay na pinsala: may tendensiya silang palalain ang mga bagay sa paglipas ng panahon, hindi pagbutihin. Ang aming pahina tungkol sa managing pain after surgery ay nagpapaliwanag kung bakit kami umiiwas sa mga ito.

Ano ang dapat asahan

Ang Fibromyalgia ay madalas na isang long-term condition na pabago-bago: may mga panahon na bumubuti at may mga flare, na madalas na na-ti-trigger ng stress, kulang sa tulog, sakit o sobrang pagkapagod. Maaari itong maging nakaka-discourage, ngunit ang trajectory para sa karamihan ng mga tao na nananatili sa approach ng paggalaw, pagtulog at pacing ay tunay na nagbibigay-pag-asa. Kumakalma ang mga sintomas, mas madali nang malampasan ang mga flare, at muling bumubukas ang buhay.

Ikaw ang mamumuno sa prosesong ito, ngunit hindi mo ito kailangang gawin nang mag-isa. Isang supportive team (ang iyong GP, kung minsan ay isang physiotherapist o pain service) ang makakatulong sa iyo na bumuo ng plano, i-adjust ito sa paglipas ng panahon, at panatilihin kang gumagalaw sa tamang direksyon. Ang self-management ay makapangyarihan dahil ikaw ang siya na maaaring magpababa ng tindi ng mga sintomas, araw-araw.

Kailan dapat kumonsulta

  • Isang bagong sintomas, o isang malinaw na pagbabago sa dati nang sintomas: huwag ipalagay na ang lahat ng bago ay "fibromyalgia lamang". Ang biglaan o matinding sakit sa isang bahagi, pamamaga, lagnat, hindi maipaliwanag na pagbaba ng timbang, o bagong panghihina o pamamanhid ay nararapat na suriin nang maayos, dahil maaaring ito ay ibang kondisyon.
  • Mababang mood, pagkabalisa, o pagkawala ng interes sa mga bagay na karaniwan mong kinagigiliwan: ang mga ito ay madalas na kasabay ng fibromyalgia, maaari itong gamutin, at ang paghingi ng tulong ay nakatutulong din upang mas madaling mapamahalaan ang sakit. Kung nakararamdam ka ng kawalan ng pag-asa o hindi ligtas, humingi agad ng tulong.
  • Mga sintomas na nakakaapekto na sa iyong pang-araw-araw na buhay sa kabila ng iyong pinakamahusay na pagsisikap: iyon na ang sandali upang magtanong sa iyong GP tungkol sa karagdagang suporta, kabilang ang referral sa isang pain o rheumatology service.

Higit pang kalaliman

Advanced reading: the deeper science (optional)

Ang seksyong ito ay higit pa sa kailangan mo para sa iyong sariling mga desisyon sa paggamot. Ang Fibromyalgia ay karapat-dapat sa karagdagang pagbabasa dahil ang pinakamahalagang ideya tungkol dito ay siya ring pinaka-hindi intuitive: sa kabila ng pagpapakita bilang problema sa kalamnan at kasukasuan, ang mga ebidensya ay tumuturo palayo nang lubos sa mga kalamnan at kasukasuan.

Ang pahiwatig na walang kinalaman sa mga kasukasuan

Kung ang fibromyalgia ay isang sakit ng kalamnan o connective tissue, dapat ay limitado lamang ito sa mga tisyung iyon. Ngunit hindi ito ganoon.

Sa isang population study ng 44,494 na tao, ang mga may fibromyalgia o iba pang musculoskeletal pain ay mas malamang na mag-ulat ng pagkabingi (hearing loss). Ang interpretasyon ng mga may-akda ang mahalagang bahagi: ang natuklasan ay naaayon sa fibromyalgia bilang may kaugnayan sa isang pangkalahatang dysregulation ng central nervous system, at maaaring totoo rin ito sa iba pang malawakang musculoskeletal pain [1].

Ang pandinig ay walang mekanikal na relasyon sa masakit na mga balikat. Kapag ang isang kondisyon na tinukoy ng musculoskeletal pain ay tumutugma rin sa kung paano pinoproseso ng tainga at utak ang signal, ang karaniwang salik ay ang pagproseso, hindi ang tisyu. Ito ang central-sensitisation model sa isang hindi inaasahang obserbasyon: ang volume control sa sensory input ay nakataas, at ang sakit ay ang pinaka-halatang bunga sa halip na ang tanging bunga.

Bakit normal ang iyong mga test, at bakit hindi ito pagbalewala

Madalas na sinasabihan ang mga pasyente na ang lahat ay lumabas na normal, at naririnig ito bilang kawalan ng paniniwala. Ipinapaliwanag ng pananaliksik kung bakit normal ang mga test nang hindi ipinapahiwatig na hindi totoo ang sakit.

Isang meta-analysis ng mga cytokine, ang mga inflammatory signalling molecule na magiging abnormal sa isang inflammatory arthritis, ang nagsama-sama ng 1,255 na kalahok at nagkonkluda na ang kanilang pathophysiological role sa fibromyalgia ay hindi pa malinaw, at kailangan ng mas mabuti at mas malalaking pag-aaral [2]. Ang imbestigasyon sa gut microbiome bilang isang contributor ay nakarating sa katulad na hatol: isang kapani-paniwalang direksyon sa loob ng umuusbong na gut–musculoskeletal axis, at kakulangan ng de-kalidad na pananaliksik hanggang ngayon [3].

Kaya walang blood test na mahahanap, dahil ang abnormality ay nasa signal processing sa halip na sa pinsala ng tissue o pamamaga. Ang normal na inflammatory screen at normal na scan ay ang mga inaasahang resulta, at inaalis nito ang posibilidad ng ibang mga kondisyon sa halip na alisin ang posibilidad ng kondisyong ito.

Ano ang aktwal na napatunayang nakakatulong

Ang treatment na nakabase sa paggalaw ang may pinakamalakas na sumusuportang data, at hindi gaanong mahalaga ang anyo nito kaysa sa katotohanan ng pagsasagawa nito. Isang meta-analysis sa 936 na pasyente ang nakatuklas na ang tradisyunal na ehersisyong Tsino — tai chi, qigong at mga katulad na low-intensity, movement-and-breathing practices, ay nagdulot ng makabuluhang pagbuti sa sakit (pain), kalidad ng pagtulog at mga sintomas ng anxiety at depression [4].

Pansinin kung ano ang sinusukat ng trial set na iyon. Ang mga pagbuti ay sumasaklaw sa sakit, pagtulog at mood nang magkakasama, na siyang inaasahan kung ang target ay isang sensitised nervous system sa halip na isang masakit na istruktura. Ang pagtulog ay hindi isang side issue rito; ang mahinang pagtulog ay nagpapababa ng pain thresholds, at ang dalawang ito ay nagpapatibay sa isa't isa.

Ang overlap sa menopause

Ang mga sintomas ng Fibromyalgia ay madalas na nagsisimula sa paligid ng menopause, may tendensiyang maging mas malala pagkatapos nito, at maaaring lumala pagkatapos ng hysterectomy mayroon o walang pagtanggal ng mga ovaries [5]. Ang mga listahan ng sintomas ay may malaking overlap sa musculoskeletal syndrome ng menopause.

Ang konklusyon ng review ay isang babala laban sa pagsasama ng dalawa: ang fibromyalgia ay nangyayari rin sa mga kababaihang hindi menopausal at sa mga kalalakihan, kaya ang mga sex hormone ay hindi ang buong mekanismo, at ang dalawa ay dapat kilalanin at gamutin bilang magkahiwalay na problema na maaaring magkasabay [5]. Tingnan ang aming pahina ng musculoskeletal syndrome of menopause.

Ano ang ibig sabihin nito kung tinatalakay ang operasyon

Dito nagiging praktikal ang central-sensitisation model. Itinatama ng isang operasyon ang isang structural problem. Kung ang bahagi ng iyong pananakit ay dulot ng binagong central processing, ang bahaging iyon ay mananatili pa rin pagkatapos, dahil hindi ito tinugunan ng operasyon.

Hindi ito argumento laban sa pagsasagawa ng operasyon kapag mayroong tunay na structural problem na dapat ayusin. Ito ay isang argumento para maging tumpak muna bago ang operasyon kung aling bahagi ng iyong pananakit ang inaasahang mawawala, at para gamutin ang fibromyalgia sa sarili nitong paraan sa halip na umasa na lulutasin ng operasyon ang lahat. Ang pagpasok sa operasyon kung saan ang pagtulog, aktibidad, at mood ay pinamamahalaan nang pinakamahusay hangga't maaari ay isang tunay na pagsisikap para sa kinalabasan, at hindi lamang paghahanda sa mga gilid.

Mga Sanggunian

[1] Stranden M, Solvin H, Fors EA, Getz L, Helvik A. Mas malamang bang mag-ulat ng pagkabingi ang mga taong may fibromyalgia o iba pang musculoskeletal pain? Isang HUNT study. BMC Musculoskelet Disord. 2016;17(1). https://doi.org/10.1186/s12891-016-1331-1

[2] Üçeyler N, Häuser W, Sommer C. Sistematikong pagsusuri na may meta-analysis: mga cytokine sa fibromyalgia syndrome. BMC Musculoskelet Disord. 2011;12(1). https://doi.org/10.1186/1471-2474-12-245

[3] Erdrich S, Hawrelak JA, Myers SP, Harnett JE. Pagtukoy sa ugnayan sa pagitan ng fibromyalgia, gut microbiome at mga biomarker nito: isang sistematikong pagsusuri. BMC Musculoskelet Disord. 2020;21(1). https://doi.org/10.1186/s12891-020-03201-9

[4] Wang X, Luo H. Mga epekto ng tradisyonal na Chinese exercise therapy sa mga pain score, kalidad ng pagtulog, at mga sintomas ng anxiety-depression sa mga pasyenteng may fibromyalgia: isang sistematikong pagsusuri at meta-analysis. BMC Musculoskelet Disord. 2024;25(1). https://doi.org/10.1186/s12891-024-07194-7

[5] Vidal-Neira LF, Neyro JL, Maldonado G, Messina OD, Moreno-Alvarez M, Ríos C. Climacteric at fibromyalgia: isang pagsusuri. Climacteric. 2024;27(5):458-65. https://doi.org/10.1080/13697137.2024.2376190

Reviewed by Dr Kieran Hirpara · 24 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.