Fibromyalgia: diagnosis and treatment

Fibromyalgia is not a disease, but a set of symptoms that, to a greater or lesser extent, can be controlled. Fibromyalgia is a chronic condition of unknown etiology characterized by the presence of generalized chronic musculoskeletal pain with low pain threshold, hyperalgesia and allodynia (pain produced by usually non-painful stimuli).

In these patients, the presence of chronic pain usually coexists with other symptoms, mainly fatigue and sleep problems, but paresthesia, joint stiffness, headache, swelling in the hands, anxiety and depression, concentration problems and memory may also be present. The natural course of fibromyalgia fluctuates in the intensity of symptoms over time.

Diagnosis and treatment of fibromyalgia

Fibromyalgia is a disorder that affects women more than men. The average age at which symptoms begin to manifest is between 30 and 50 years of age.

This disorder does not represent a risk to the life of the patient, although it reduces the quality of life to those who suffer.

The diagnosis of fibromyalgia is clinical, due to the lack of an objective test, because today it is not supported by any specific analytical, imaging or anatomopathological tests.

The causes of fibromyalgia are unknown, but are believed to be due to abnormal central nervous system function, leading to “amplification” of normal pain signals. So stimuli that should not reach the threshold of pain, cause pain in people who have fibromyalgia. That is, it is a dysfunction of the nociceptive system, responsible for the detection of possible injuries and the control of them. It responds differently to psychophysical stimuli of various kinds (mechanical, thermal, electrical, auditory and psychological anticipatory), reacting in a faster and greater way for the same level of stimulation in patients with fibromyalgia.

These patients correctly detect the stimuli but the threshold of stimulation required to transfer a sensory stimulus to a possible threat is significantly reduced, being one of the main characteristics of the neurobiological process in this condition. In addition, it has been observed that such nociceptive hyperactivity not only occurs with stimulation, but is also observed in basal resting conditions, as demonstrated by observation by spectroscopic resonance of an elevation in glutamate concentrations, the main excitatory neurotransmitter.

However, it has been observed that the alterations observed in the nociceptive system are not exclusive to patients with fibromyalgia, but also in patients with chronic pain, such as chronic low back pain, visceral pain of the irritable colon, among others, reinforcing the relationship Pathophysiology among these groups of patients. There are a number of diseases that may share clinical manifestations with fibromyalgia, such as systemic lupus erythematosus, myopathy (metabolic or inflammatory), rheumatoid arthritis, polymyalgia rheumatica, spondyloarthropathies, major depressive disorder, multiple sclerosis, polyarthrosis, hypothyroidism, Drugs, peripheral neuropathies, hyperparathyroidism, mechanical or degenerative structural alterations of the spine.

Symptoms of Fibromyalgia

The main symptom is widespread pain, which is aggravated by anxiety, depression, cold, lack of restful sleep or maintained physical activity. The pain is usually present in several areas of the body, although it can be started in a region, such as the neck, shoulders and then expand to other areas after a certain time.

The pain produced by fibromyalgia has been described in a variety of forms, such as burning, stiffness or a strong and permanent pain. Many people with fibromyalgia claim that they always feel some pain, although it can increase at some times of the day.

The pain is frequently accompanied by morning articular stiffness, paresthesias in the hands and feet, fatigue-asthenia and sleep disturbances. Fatigue-asthenia can range from a simple reluctance and less effort resistance in certain activities to exhaustion and may also vary from day to day.

Sleep disturbances associated with fibromyalgia include the difficulty of falling asleep and / or the lightness of sleep with many interruptions. Interruption of one of the phases of sleep, called “deep sleep”, is known to alter certain crucial functions of the human body, such as the production of the hormones necessary to restore muscle tissue, and the levels of substances that control the way That a person perceives the pain. Therefore, sleep problems can worsen the symptoms of fibromyalgia.

And also headaches, tinnitus, instability, alterations of concentration or memory, tendency to sadness or decay, temporomandibular dysfunction, myofascial and clinical pain compatible with irritable colon. Patients with fibromyalgia may present intolerance to stimuli, olfactory and auditory, so avoid environmentally damaging conditions.

Even fibromyalgia can lead to stomach pain, bloating or bloating, and constipation with diarrhea (called irritable bowel syndrome), irritability and spasms of the bladder (causing frequent urination and / or urgency to urinate). The patient may also experience acute pelvic pain. Some of the problems that can be related to fibromyalgia include dizziness, restless legs, endometriosis, tingling and numbness of the hands and feet.

Symptoms of Fibromyalgia

Diagnosis of fibromyalgia

Fibromyalgia can not be diagnosed through laboratory tests. The results of X-rays and blood tests are normal. Therefore, the diagnosis is based on a thorough physical examination and the patient’s clinical history.

It has been agreed that a person suffers from fibromyalgia when he suffers from generalized or extensive chronic pain (duration> 3 months) (there is pain in some regions of the axial skeleton and in at least three of the four body quadrants), with pain at Palpation in various areas of the body (in more than 11 points, over 18 previously defined). If, in addition to these symptoms, fatigue, insomnia, anxiety or depression, headache, anxiety or symptoms associated with other syndromes, such as irritable bowel or restless legs, can be confirmed the diagnosis of fibromyalgia.

Treatment of fibromyalgia

The treatment of fibromyalgia is symptomatic, since its etiology is not known. The treatment must be personalized and requires follow-up and adjustment as the symptoms evolve.

Sometimes drugs are not required because changes in lifestyle such as reducing stress, sleeping better, more adequate food, aerobic exercise and / or psychological help may be enough. There is no drug approved by the Spanish Agency for Medicines and Health Products nor by the European Medicines Agency with specific indication for fibroma. The drugs that may be useful are: antidepressants, muscle relaxants, painkillers and treatments to improve sleep

But, as mentioned earlier, in the treatment of fibromyalgia is particularly interesting:

  • Exercise programs and activities that improve overall health: aerobic exercises are convenient with them you achieve a feeling of well-being, greater endurance and less pain. It is important to move forward to the extent that exercise can be tolerated without a substantial increase in the degree of pain
  • Relaxation techniques to relieve muscle tension and anxiety
  • Educational Programs That Help Understand and Manage the Symptoms of Fibromyalgia
  • Adopt a lifestyle that avoids sleep disturbances.
  • Set a bedtime and get up. The room should be kept cool, dark and silent. The room must be intimate and for sleeping, it can not be shared with other activities. Do not do intense physical exercise near bedtime.

Summary

Fibromyalgia, as a chronic condition, that is, its treatment is complex. Drugs are good, but none have no side effects. Therefore, long-term treatments with drugs are treatments that must be done with great caution and always assessing the pros and cons.

Obviously, improving the quality of life of everyone who undergoes a chronic process, whatever it is, is fundamental. And the case of fibromyalgia is not one less. For this, in addition to conventional medicine it is advisable to take advantage of the benefits of alternative therapies, which are not exclusive but additive.

With an appropriate alternative therapy you will surely reduce your intake of drugs, which will improve your health especially if you suffer from some kind of chronic condition. For example, auriculotherapy , acupuncture , counseling,  nutritional therap , etc. are effective in these cases  .

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