Fibromyalgia

Fibromyalgia is a syndrome characterized by diffuse musculoskeletal pain, diffuse sensitivity and other general symptoms such as sleep and emotion disorders. The word is composed of fibrous (fibrous tissue) and -myalgia (muscle pain).

It is characterized as a syndrome and not as a disease. Disease is a medical condition with a specific cause or causes and recognizable signs and symptoms. In contrast, a syndrome is a set of symptoms and signs as well as medical problems that occur together but do not have a specific identifiable cause. Although it is associated with rheumatic diseases, it is not purely arthritis because there is no inflammation or damage to the joints.

However, it can cause severe pain, fatigue and disrupt a person’s daily life

Who can get fibromyalgia?

It is a very common condition. 3-6% of the population can be affected. 75-90% are women, however men and even children can be affected, less often. It can exist in a family, or between relatives. The diagnosis is usually made at the age of 20-50 years, but the frequency increases with age.

Symptoms of fibromyalgia:

Diffuse pain is the main symptom. At the same time, many people experience fatigue, hypersensitivity to touch, light and sound, and memory disorders.

• Fibromyalgia pain is described as persistent, deep muscle pain. It is observed all over the body, left and right, above and below the waist. The pain and rigidity are more intense in the morning after getting up. There may be neurological symptoms such as stings, numbness, that aggravate the feeling of discomfort. There is additional pain when pressure is applied to specific areas of the body called “sensitive areas”. These are generally described in the figure below.

• Tiredness. It is much more intense than the fatigue of a busy day or after a sleepless night. Fibromyalgia fatigue is experienced as “devastating” that can affect work, social, personal or educational activities. At the same time there is reduced “natural energy”.

• Sleep Disorders. Sleep is neither deep nor refreshing and people complain that they do not get enough rest even if they do not get enough sleep. Various studies have identified disorders in stage 4 of deep sleep. Sleep is constantly interrupted by sounds, “thoughts” significantly reducing its duration.

• Other symptoms

  • Irritable Bowel

  • Irritable bladder

  • Headaches

  • Migraines

  • Restless legs syndrome (anxiety of the legs at night)

  • Inability in concentration and memory

  • Dry mouth

  • Skin ‘sensitivities’ or rashes

  • Anxiety, depression

  • Pain during the period

  • Tinnitus, dizziness

  • Numbness and burning in the hands or feet

What causes fibromyalgia?

The causes are unknown. There are probably several factors to blame. It could be a trauma or emotional stress or even an illness (combined with rheumatoid arthritis or other illnesses). Several researchers suggest a genetic cause due to finding people with fibromyalgia in a family.

Most researchers, however, agree that there is a disturbance in the transmission of nerve impulses to the central nervous system. The result is that these people feel much more intense pain and ache more often than other people (hyperalgesia). Increased levels of stimulant neurotransmitters (such as substance P, cytokines, etc.) and decreased levels of suppressive neurotransmitters (such as serotonin, endorphins, etc.) have been found.

Research has begun to show a disturbance in the “interpretation” of signals in the central nervous system that causes a disturbed sensation of pain.

How is fibromyalgia diagnosed;

There are no specific laboratory tests for fibromyalgia. The diagnosis is made by history, symptoms and clinical examination. Finding the “points of sensitivity” as shown in the figure below, supports the diagnosis.

The diagnosis is delayed for an average of five years due to non-specific symptoms. Laboratory tests are usually normal, although the syndrome has recently been linked to low levels of vitamin in the blood.

It often coexists with other diseases (such as rheumatoid arthritis or lupus erythematosus) which must have been ruled out in the first place.

To be diagnosed, there must be diffuse pain in the body for at least three months and 11 of the 18 points in the image must be painful. However, these points are also disputed lately.

In order for the diagnosis to be possible, there must be a chronic sleep disorder, there must be some mental characteristics (such as anxiety or perfectionism, phobias or depression). Worsening of the mental state worsens the pain as a symptom of fibromyalgia.

The pain is caused by small stimuli and the resistance to pain is limited. The nervous system is generally characterized by “overstimulation”.

Image: sensitivity points on the body

The treatment of fibromyalgia

The key is to understand the person with fibromyalgia that he needs to change and shape his lifestyle.

Many refuse to make radical changes, however, recognizing the problem and trying to change some areas of life can bring significant improvement.

Good contact with the doctor is important. The doctor who can hear the problem and work with the patient, contributes substantially to the treatment.

Traditional treatments (anti-inflammatory, etc.) are usually not effective. Patients have often taken a wide variety of such drugs without much effect. Alternative therapies, relaxation techniques, diet and especially exercise play an important role in treatment.

Pain therapy. Anti-inflammatory drugs usually have no effect. There are medications for fibromyalgia (such as pregabalin, duloxetine) that work on the nervous system.

Low doses of mild antidepressants as well as non-narcotic painkillers (such as tramadol) help relieve the symptoms of fibromyalgia such as pain and lack of sleep. Larger doses may be needed for depressive symptoms. Topical anesthetic injections can help with sensitive points.

However, it is important to implement a program of gentle exercises with stretches that help maintain muscle tone and reduce pain and rigidity. Exercises should be done at regular intervals and can be swimming, cycling, walking and water aerobics.

Sleep management. Good sleep is absolutely necessary and is achieved by various methods.

Going to bed early and getting up at a regular time every day, either every day or on vacation, helps to normalize it.

The environment should be quiet, with a comfortable temperature and a good mattress.

Sugar, caffeine and alcohol should be avoided at bedtime.

Exercise should be done earlier in the day – at least 3 hours before bedtime – at regular intervals.

Sleeping with the TV on or other electronic devices should be avoided.

It is best to avoid sleeping during the day. If it is necessary, it is better not to exceed one hour and then there should be an exercise program.

Relaxation exercises before bedtime help significantly. Music or a warm bath before bed help with pain and sleep.

Psychological support. Emotional support and communication with family and friends is very helpful. Organized group therapy or individual psychological therapy may be necessary. A basic condition is the knowledge and understanding of the problem and the syndrome by the patient.

Reducing stress. Avoiding overexposure to stressful stimuli is important. It takes organization of personal time for relaxation and a consistent routine of actions. Functions must be stable on good and “bad” days.

Other treatments. Physiotherapy, therapeutic hand massage, acupuncture, hydrotherapy, gentle aerobics, yoga and tai-chi exercises can be especially helpful. They combine muscle toning with relaxation and gradually have a significant improvement in pain.

Relaxation exercises, breathing exercises, aromatherapy, dietary supplements and herbs can have good results. Mental exercises to deal with cognitive impairment (lack of concentration, memory problems, etc.) are especially useful, such as memory and attention games, puzzles and mental challenges.

Patients, in addition to their symptoms, also have to deal with their inability to understand the environment. It is necessary for them to understand the nature of their condition, but also their familiar people.

The exercises, despite the fatigue that the patient feels, must be gradually increased in order to have an analgesic effect.

Finally, patients must follow the instructions of the specialists of the group that takes care of them, take their medication correctly, get enough sleep, do the recommended physical exercise, follow a healthy diet, maintain a normal body weight and adjust their way of life and work.

The European Parliament, given that around 14 million people in the EU suffer from fibromyalgia, given that it has been recognized as a disease since 1992 by the WHO (World Health Organization) and that they have more visits to specialists, more examinations, more licenses causing significant financial burden, has developed a community strategy for addressing and raising public awareness and developing specific programs.

*May 12 is World Fibromyalgia Day.

Sources

National Fibromyalgia Association

American College of Rheumatology

Fibromyalgia Network

Katsalira Aikaterini

Rheumatologist