Fibromyalgia

The prevalence of fibromyalgia in France was estimated at 2.2%, with a clear predominance of the female population. On the other hand, according to the French Society of Rheumatology, 5% of people consulting in general medicine would be affected by fibromyalgia.

Definition

The name fibromyalgia comes from the words “fibro” which means  tendons , “myo” which corresponds to the  muscles  and “algie” to the  pain . Fibromyalgia is a complex pathology characterized by the appearance of   diffuse, chronic and multiple muscular pains and  fatigue associated  with  sleep disorders . Fibromyalgia has been recognized as a disease since 1992 by WHO  (World Health Organization).

Diffuse idiopathic polyalgic syndrome

Fibromyalgia, or diffuse idiopathic polyalgic syndrome, is characterized by the presence of chronic muscle pain. These pains can be rarely localized, but are most commonly diffused to many areas of the body. They are usually accompanied by significant fatigue, as well as a   psychological exhaustion induced by these  symptoms . In the vast majority of cases, this pathology affects the woman, young adult or middle-aged, active. The examinations performed find no explanation for these pains, hence the notion of ”  idiopathic In the name of the syndrome which explains the absence of cause explaining the symptoms. Fibromyalgia is not a serious disease but it has many repercussions on the daily life of patients who have it. Fibromyalgia is a  chronic pathology that  can evolve for many years.

Statistics

Fibromyalgia affects about 1 to 3% of the population, that is to say about 2 million people in France and 14 million Europeans. This pathology represents 14 to 20% of rheumatology consultations  . Fibromyalgia concerns women, aged between 30 and 50 years old. It affects 4 times more women than men. It usually starts after age 40 but can be observed earlier. Children can present this disease. Sufferers are people with sleep disorders. People who are emotional,  anxious , fragile, lacking self-confidence or people who have experienced difficult situations traumatized them.

Causes

The causes of fibromyalgia are poorly known, but many hypotheses are more and more mentioned. The hypersensitivity  to pain remains the main point of this pathology. In patients with fibromyalgia, the  brain  does not properly analyze pain messages because of dysfunctions. There is a painful and abnormal perception of stimulation compared to normal subjects. On the other hand, the  central nervous system  can not properly modulate the activity of the nerve cells involved causing an increase in the pain felt by the patient. The corticotropic system would release fewer growth hormones and thus disrupt sleep. The sympathetic system would be less responsive to  stress . Fibromyalgia is associated with changes in certain genes involved in the production of mediators such as  serotonin  or  dopamine . Serotonin is a  neurotransmitter  that allows the transmission of pain signals in different parts of the brain. When serotonin decreases, observed during fibromyalgia, the  sensation of pain can be increased due to a poor brain transmission of signals to modulate it. The allele Short S of the serotonin transporter gene is more common in people with fibromyalgia. Stress, sleep disturbances, trauma,  immune deficiency  or  viral infection  can be triggers for fibromyalgia.

sYMPTOMS

During a fibromyalgia appear usually diffuse muscle pain,  bone pain , the  joint pain  or any other type of pain affecting many areas, no real connection between them but also a great physical and psychological fatigue or exhaustion and that a significant sensitivity to the touch or the mobilization of painful areas. To note an improvement of the symptoms during the holidays or days of rest.

The main symptoms of fibromyalgia are diffuse muscular pains. Patients with fibromyalgia complain of pain everywhere throughout the day. The pains progress for at least 3 months and are present in a diffuse manner on the right and left side of the body and sit above and below the waist. Pains mainly occur in the  neck ,  shoulders ,  arms ,  pelvis  and  knees  and can persist for many months. 
The pains are dull and / or violent, resembling  burns  or bites, accompanied by  tingling  or numbness muscle. Areas near the  spine , such as the neck, shoulders, the area between the shoulders, shoulder blades, lower back, hips, are the most affected. The pains are localized in the muscles surrounding the  joints . Pains that change during the day and according to the state of fatigue, stress and physical activity . The pains are accompanied by diffuse stiffness.
Some specific areas of the body are painful to the touch. There are specific tender points sensitive to palpation on 18 specific bilateral points. The reaction at 11 of the 18 pain points at the pressure: This pressure of 4kg / cm² corresponds to the whitening of the pulp of the examiner. 11 points out of 18 are needed for fibromyalgia to be diagnosed in a patient suffering from more than three months. In the most extreme situations, touch causes pain all over the body.

Sleep is not or little restorative: The patient wakes up tired, sometimes even more than when he goes to bed. Awakening difficult and painful. The awakening is accompanied by stiffness. Difficulty falling asleep, frequent awakenings, loss of deep sleep, restless sleep. The duration of sleep is shorter. Fatigue is another very debilitating symptom of fibromyalgia. Fatigue is important in the morning because of little or no restorative sleep. It can occur for small efforts. The person feels exhausted, exhausted and exhausted. It is more of a “feeling of total loss of strength”. Standing still is difficult. Rest improves little this fatigue. Fatigue can become disabling. Social, family, psychological and professional repercussions can be important.

Many other symptoms, not always so specific, can disrupt the life of patients with fibromyalgia. These symptoms cause patients to increase the number of doctors’ consultations, which in particular leads to a misunderstanding in the diagnosis of the disease.

  • Migraine ,  headaches  caused by muscle tension located in the neck.
  • Diarrhea ,  constipation , or  abdominal pain .
  • Depressive episodes or anxiety.
  • Difficulty concentrating and memory problems.
  • Exacerbated sensitivity to noise and light.
  • Abnormal intolerance at temperatures (cold and heat).
  • Dry eye, dry mouth and dry  skin  ( Sjögren’s syndrome ).
  • Numbness and tingling at the extremities (hands and feet).
  • restless legs syndrome .
  • Painful periods.
  • Frequent urination

Diagnostic

The main difficulty in diagnosing fibromyalgia lies in the absence of any abnormalities. Biological, histological or radiological assessments are normal. The term ghost disease is sometimes even mentioned for fibromyalgia. 
The diagnosis is made by a doctor once he has eliminated other pathologies with similar symptoms. It is after a long consultation lasting about 45 minutes that such a diagnosis can be made. Fibromyalgia is indeed a diagnosis of elimination, that is to say that it is worn when no explanation or cause is found at the origin of the symptoms. To carry a diagnosis,  sex of the patient, diffuse and non-systemized symptoms (that is, not responding to an organized system, affecting unrelated areas), long-term progression of the disease, improvement of symptoms during periods of rest and its aggravation at the time of the resumption of the activities, the absence of improvement in spite of numerous tried treatments are arguments of value.

The test for measuring the impact of fibromyalgia is a questionnaire designed to measure the impact of fibromyalgia on your health. The answers provided to this questionnaire will make it possible to know the impact of this pathology on the patient’s everyday life.

According to the American College of Rheumatology,  the diagnostic criteria include   diffuse chronic pain that has occurred for more than 3 months, associated with a sensitivity to palpation of at least 11 points out of 18 previously defined.

The 18 points of fibromyalgia are distributed in 9 bilateral sites

  • the sub-occipital region.
  • the anterior region of the neck.
  • the region of the second coasts.
  • trapezes.
  • the origin of the supraspinous (muscles of the posterior region of the shoulder).
  • the elbow region.
  • the upper outer quadrants of the buttocks (below and behind the iliac crest).
  • large trochanters (bony prominences at the upper end of the femur).
  • the fat pads of the knees.

This classification system has limitations. Some patients being sensitive to less than 11 points may be affected by fibromyalgia.

Treatment

There is no cure for fibromyalgia. The many treatments tested are generally not very effective. All specialists agree on the need to adapt multidisciplinary programs to each person with fibromyalgia.

Non-drug treatment

The education of the patient, as in any pathology remains paramount: to understand well his illness, to accept it, to anticipate and to know how to manage the periods of aggravation make it possible to better accept the proposed treatments.

The practice of a physical activity or sport is highly recommended. It is essential to consider a rehabilitation exercise because people with fibromyalgia often have a decrease in their muscle strength accompanied by  amyotrophy , as well as an  increase in heart rate .

Aerobic exercises can improve physical fitness and reduce pain: water aerobics, swimming in the pool, and stretching are particularly recommended. Walking, on the other hand, is particularly beneficial for people with fibromyalgia.

Psychological care has a very beneficial effect on the management of pain, fatigue and mood disorders. Being able to express oneself freely in a professional setting frees speech and makes it easier to accept this chronic illness.

The  behavioral therapy  and cognitive seem to have demonstrated some efficacy in the treatment of this pathology. Relaxation can appear as a simple and effective method to relieve the symptoms of the disease. Several techniques can be proposed.

We call ” sophrology ” phases of meditation promoting body relaxation, in which the therapist releases  anxieties . The sophrology learns to relax to get away with his  emotions, his tensions and focus on listening to his feelings. The sophrology sessions for people with fibromyalgia melt like any session on dynamic relaxation and mental suggestion. Dynamic relaxation exercises rely on gentle muscle contractions and controlled breathing. This practice allows you to relax, strengthen your concentration and develop self-representation. The person, installed in a chair, can, for example, reach out over his head and gently lengthen the legs by breathing through the nose, then slowly stretch his entire body blocked breathing before returning to the initial position on expiration. This exercise of the whole body, to repeat three times, allows one to free oneself from tensions and to become aware of one’s relaxed and liberated body. Mental suggestion allows the visualization of positive images to stop the sensation of pain and to create positive images. The person can for example practice visualizing the various painful places in his body as red dots. It is then mentally to reduce the intensity of the color, so that the points change from red to pink before disappearing. By the force of the mind, we act on the intensity of the pain felt. Practiced daily, sophrology can fade the symptom and can play an important accompanying role in treatment. Mental suggestion allows the visualization of positive images to stop the sensation of pain and to create positive images. The person can for example practice visualizing the various painful places in his body as red dots. It is then mentally to reduce the intensity of the color, so that the points change from red to pink before disappearing. By the force of the mind, we act on the intensity of the pain felt. Practiced daily, sophrology can fade the symptom and can play an important accompanying role in treatment. Mental suggestion allows the visualization of positive images to stop the sensation of pain and to create positive images. The person can for example practice visualizing the various painful places in his body as red dots. It is then mentally to reduce the intensity of the color, so that the points change from red to pink before disappearing. By the force of the mind, we act on the intensity of the pain felt. Practiced daily, sophrology can fade the symptom and can play an important accompanying role in treatment. It is then mentally to reduce the intensity of the color, so that the points change from red to pink before disappearing. By the force of the mind, we act on the intensity of the pain felt. Practiced daily, sophrology can fade the symptom and can play an important accompanying role in treatment. It is then mentally to reduce the intensity of the color, so that the points change from red to pink before disappearing. By the force of the mind, we act on the intensity of the pain felt. Practiced daily, sophrology can fade the symptom and can play an important accompanying role in treatment.

Music therapy is based on a process of visualization in a musical environment, which allows to evacuate tensions while being supported by music.

Autogenic training is based on the principle of self- hypnosis  taught by the therapist, with a focus on the solar plexus to relieve pain.

Hypnosis relaxes the muscles of  breathing  and gives subject access to his unconscious to treat old and repressed problems. Only a member of the medical profession is able to practice hypnosis, usually psychiatrists, but also generalists and specialists confronted with pain and stress. In a medical setting, the practice of hypnosis is safe, its influence on our unconscious is not all powerful. (more info: French Institute of Hypnosis).

The acupuncture  is a technique often used in the treatment of fibromyalgia.

Sport

A patient with fibromyalgia should make sure to move as often as possible. One of the fundamental measures of the management of a patient affected by fibromyalgia is to maintain a certain level of physical activity, within the limits of his abilities. Practicing daily movements can also be considered as one of the treatments for the disease. The practice of a physical activity or sport is very strongly recommended. 
It is essential to consider a rehabilitation exercise because people with fibromyalgia often have a decrease in their  muscle tone accompanied by amyotrophy, as well as an acceleration of the heart rhythm. Exercise re-training is performed after a cardiac checkup, most often including a  stress test . Several exercises, called global dynamic exercises, may be proposed such as walking on a treadmill for example or rowing. It is sometimes impossible to perform this type of activity: in this case, other exercises limited to certain muscle groups may be proposed. Fighting stress remains essential for patients with fibromyalgia.

A professional activity must be kept in order to maintain a social activity and not to rest too much and avoid isolation. A professional activity requiring too much physical effort may require a change of position or a development.

Aerobics exercises can improve the physical condition of the patient and a decrease in pain. Water aerobics, swimming in the pool and stretching are strongly recommended. Walking is extremely beneficial for patients with fibromyalgia.

Medical treatment

There are several medications that can improve the symptoms of this chronic condition that combines chronic pain, unwanted fatigue and sleep disorders. 
The  analgesics  prescribed for pain are not all effective in the treatment of fibromyalgia. The Academy of Medicine recommends  tramadol , the only drug to have proven its action, in combination with  paracetamol .

Drugs  anti-inflammatory  are not very effective in the treatment of fibromyalgia.

Anti-epileptics, improve the pain of fibromyalgia and reduce the threshold of excitability of the nerves responsible for pain. Some antiepileptic drugs  improve sleep disorders and fatigue.

The  antidepressants  such as amitriptyline , the  duloxetine , the  venlafaxine  and  milnacipran , are not used for their antidepressant effects, but for their beneficial effects on sleep disorders, fatigue, pain as well as mood disorders . They are prescribed in lower dosages than in  depression  and are more active.

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