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Fibromyalgia Causes, Symptoms and Treatment

The fibromyalgia is a syndrome characterized by diffuse painthroughout the body, pain associated with fatigue and sleep disturbances.

This syndrome does not cause serious complications, but is very stressful and often prevents the sufferer from performing daily activities or providing full-time work.

The existence of this syndrome has been recognized since 1992 by the World Health Organization.

However, fibromyalgia is still poorly understood and misunderstood. Although the pains are real and very painful, doctors cannot detect any lesion or inflammation to explain these symptoms. For this reason, fibromyalgia has sparked some controversy in the scientific community, so much so that doctors did not believe in its existence. Today, it seems that certain physiological factors (abnormalities of the nervous system, hormonal disturbances, etc.) and genetic factors are involved. External events (trauma, infection …) could also be involved. The exact causes, however, remain uncertain.

The term fibromyalgia comes from “fibro” for fibrosis, “myo” which means muscles and “algie” which means pain. It has been criticized by some doctors because there is no fibrosis of the muscles causing pain. The term “diffuse idiopathic polyalgal syndrome”, or SPID, has also been proposed but has not been internationally agreed.

Prevalence of Fibromyalgia

Statistics show that in industrialized countries, fibromyalgia affects 2% to 6% of the population. In Canada, 900,000 people have it. In France, the Ministry of Health estimates that about 2% of the population has fibromyalgia.

About 80% of those affected are women. The disease often appears around 30 years to 60 years. Few cases of fibromyalgia have been described in children, though it is not certain that this is the same disease.

Diagnostic of Fibromyalgia

Its numerous symptoms and its similarity or cohabitation with other diseases or syndromes (rheumatoid arthritis, systemic diseases, chronic fatigue syndrome, irritable bowel syndrome, migraine, etc.) complicate the diagnosis of fibromyalgia. Thus, in North America, sufferers must wait an average of 5 years (and a dozen medical visits) before obtaining the diagnosis of fibromyalgia, although this time has tended to decline in recent years. Before asking a diagnosis of fibromyalgia, doctors ask for additional examinations (especially blood tests and X-rays) to rule out other diseases that would be treated differently.

Then, all over the world, the diagnosis of fibromyalgia is based on two criteriaestablished by the American College of Rheumatology, accepted and approved by an international committee:

  • The presence of diffuse pain for more than 3 months. Pain should be present on both sides of the body (left-right), at the top and bottom of the waist, and at the spine.
  • A pain sensation on at least 11 of the 18 characteristic points of the disease (see diagram).

Note. These criteria are however criticized by many doctors, among others because the number of 11 pain points is arbitrary. So some people having 8 or 9 tender points can still be fibromyalgia. In addition, the location and number of pain points can vary from one person to another day to day. Finally, some severe forms of fibromyalgia cause pain all over the body, not just the muscles.

The chronic fatigue syndrome , characterized by profound fatigue and joint and muscle pain, much like fibromyalgia and it is not always easy to differentiate. The main difference between these two conditions is the fact that fatigue predominates in case of chronic fatigue syndrome, and rather pain in case of fibromyalgia.

Associated diseases: Fibromyalgia is often associated with problems such as headaches, bowel disorders (irritable bowel), restless leg syndrome, eye disorders, and tremors.

Causes of Fibromyalgia

The causes of the syndrome are not yet known. Although fibromyalgia causes chronic muscle pain, there is no visible lesion in the muscles that can explain the pain. It is a disease where many factors are probably the cause of the symptoms. Several hypotheses have been put forward. These are the ones that get the most attention from researchers.

Exhaustion of the hypothalamic-pituitary-adrenal axis or axis of stress:
It is thought that there could have been in the predisposed persons, a succession of 2 very important elements:
– In adolescence or childhood, an event very emotionally stressful, a powerful stress eg incest.
– In adulthood, on this predisposed ground, generally between 30 and 50 years, at the time of a new stress, the person switches in fibromyalgia syndrome.
This type of sequence is often found in people with fibromyalgia.

Decreased threshold of pain perception
People with fibromyalgia feel more pain than others. In other words, their nervous system responds abnormally to external stimuli: a slight pressure is enough to trigger a message of “pain” in people with fibromyalgia. This greater sensitivity to pain is related to the dysfunction of certain areas of the brain and abnormal transmission of nerve messages.

Physiological abnormalities of the nervous system
several studies have shown a decrease in neurotransmitter levels , such as glutamate or serotonin , in people with fibromyalgia. Similarly, hormonal abnormalities (concerning the pituitary and thalamus, in the brain) have been described in fibromyalgia patients. None of these observations, however, alone can explain the disease.

Genetic factors
it is now proven that fibromyalgia also has a genetic component, many people being affected in some families. Several genes may be involved in triggering fibromyalgia, but studies in this area have not yielded satisfactory results.

Other tracks explored

Biological Factors
A metabolic disorder of substance P would increase sensitivity to pain. His association with stress, anxiety and depression is also known.

A chronic lack of restful sleep. It may be that poor sleep is not only a symptom but also a cause of fibromyalgia.

External Events
many infectious agents have been implicated in explaining the onset of fibromyalgia, such as hepatitis C or B viruses, for example, or the bacteria involved in Lyme disease . About 10% of people with fibromyalgia say they have suffered from an infection before the onset of symptoms.

In many cases, physical trauma (accident) is involved in triggering fibromyalgia. Car accidents causing a “whiplash”, that is to say a traumatism of the cervical vertebrae, are often blamed. The emotional trauma may be involved, but they do not apply to all cases fibromyalgia. This is the case of sexual violence or violence that occurred early in life, as well as certain dramatic events (aggression, attack …).

Fibromyalgia and psychological profile

Many studies show a strong link between fibromyalgia, the anxiety and depression that are present in a third of cases. Anxiety disorders are often present before the onset of pain (3/4 of patients), while depression appears most often after the onset of fibromyalgia. People with fibromyalgia often have a particular psychological profile, defined by a propensity for “catastrophism” or “dramatization”, especially in the face of pain. This attitude tends to amplify the intensity of the pain, the feeling of helplessness and distress. In addition, depressive syndromes help to lower the threshold of pain. The result is a vicious cycle that makes it even more difficult to alleviate symptoms.

It should be noted that chronic depression naturally causes pain and chronic pain eventually leads to depression. Hence a link between the two fibromyalgia and depressive syndromes.

 

Evolution

Fibromyalgia is not a serious illness in the sense that it does not lead to major health complications. It is nonetheless a painful and disabling disease for people who suffer from it. The pains are chronic AND often resistant to different treatments, whether medical, physical or psychological. However, they tend to remain stable over the long term, or to diminish. There is usually no aggravation.

The intensity of pain and fatigue limits daily activities and can sometimes have repercussions on professional activity. However, maintaining one’s professional activity is both psychologically and physically beneficial, as shown by a Swedish study in 2005. Adjustments of working time and post are sometimes necessary when the pains are very important.

The symptoms of fibromyalgia

The fibromyalgia is characterized by extensive and widespread pain, mainly muscle, associated with chronic fatigue and sleep disturbances. However, the symptoms differ from person to person. In addition, the climate, the time of day, the level of stress and physical activity are factors that influence the severity of symptoms and their variability over time. Here are the main symptoms.

  • Of diffuse muscle pains which are accompanied by morning stiffness, and specific locations of the body painful to touch (see diagram). The neck and shoulders are usually the first painful places, followed by the back, chest, arms and legs.
    In extreme situations, a simple touch or even a touch causes pain all over the body (a phenomenon called allodynia). The pain may be accompanied by the impression that the painful areas are swollen.
  • Constant pain, but aggravated by effort, cold, humidity, emotions and lack of sleep.
  • light sleep and non-restorative, causing tiredness on waking.
  • persistent fatigue (all day), present in 9 cases out of 10. The rest does not make it disappear.
  • These principal symptoms may be added less characteristic symptoms, but equally troublesome.
  • Headaches or severe migraines, possibly caused by muscular tension in the neck and shoulders, and by a disruption of the natural ways of controlling pain.
  • Irritable bowel syndrome: diarrhea, constipation and abdominal pain.
  • Depressive state or anxiety (in about one-third of people with fibromyalgia)
  • Difficulties of concentration.
  • Increased sense sensitivity, increased sensitivity to odor, light, noise and temperature changes (in addition to sensitivity to touch).
  • Numbness and tingling in the hands and feet.
  • Painful menstruation and marked premenstrual syndrome.
  • Irritable bladder syndrome (interstitial cystitis).

People at risk for Fibromyalgia

  • The women. Fibromyalgia affects about 4 times more women than men 1. Researchers believe that sex hormones influence the onset of this disease, but they do not yet know exactly how.
  • People whose family member is suffering from or has suffered from fibromyalgia or depression.
  • People who have trouble sleeping because of nocturnal muscle spasms or restless legs syndrome .
  • People who have had traumatic experiences (physical or emotional shock), such as an accident, a fall, sexual abuse, surgery or a difficult delivery.
  • People who have contracted a major infection, such as hepatitis, Lyme disease or Human Immunodeficiency Virus (HIV).
  • People with rheumatic disease, such as rheumatoid arthritis or lupus.

Risk factors

As risk factors, these characteristics are mostly aggravating factors of the disease.

  • The lack or excess of physical activity.
  • The tendency to have catastrophic thoughts, that is, to focus on all that the pain brings negative in one’s life.

Prevention

Can we prevent?
Since the cause of fibromyalgia has not been formally identified, no way of preventing it is recognized.

Let’s just mention that it is recommended not to be overweight, because this one accentuates the pains with the articulations and the muscles. Calculate your body mass index (BMI) and waist circumference .

Medical treatments of Fibromyalgia

There is currently no formally proven effective treatment for fibromyalgia. Medicine can only help better manage pain. Although there is no known cure for fibromyalgia, there is support.

Pharmaceuticals

Because little is known about the mechanisms involved in fibromyalgia, medical treatments offered to patients rely on the blocking mechanisms involved in pain and sleep disorders.

To alleviate pain, one of the best results is obtained with Tramadol. The analgesics or powerful painkillers like morphine, can mitigate the pain, but obviously cannot be used for prolonged periods. Tramadol (Ralivia, Zytram), from the opioid family (such as morphine), has, however, been effective in several recent trials in fibromyalgia patients. It is recommended for the treatment of fibromyalgia by many experts, alone or in combination with acetaminophen. However, this medication should only be used as a last resort when other treatments have proven ineffective. Its use must be under close supervision of the doctor because of the risk of dependence.

The anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil or Motrin as), naproxen and acetaminophen (Tylenol) may help alleviate pain and muscle stiffness. Their effectiveness varies from person to person. They are especially useful when fibromyalgia occurs in a person with an inflammatory disease, such as rheumatoid arthritis. In cases of “simple” fibromyalgia, they are rarely recommended.
Warning.  In the long term, the use of NSAID medications can cause serious side effects: stomach pain and bleeding, stomach ulcers, kidney damage and high blood pressure.

Watch out for the abuse of painkillers.  Analgesics are widely used by people with fibromyalgia. They are often not very effective, which leads patients to use them inappropriately, at high doses and by combining different drugs. Be careful!  Antalgics and anti-inflammatories have potentially dangerous side effects, especially in the long term. Always seek the advice of your doctor or pharmacist before using any medicine.

To restore a restful sleep, if sleep disorders are in the foreground and also in the case of anxio-depressive backgrounds, we can use some anti-depressants IRS half-strength doses than in the case of depressive syndrome.

These antidepressants, such as low dose serotonin reuptake inhibitors, are the most commonly used treatments for fibromyalgia. They have an effect on much chronic pain, including fibromyalgia pain, and are therefore frequently used even in the absence of depression. In addition, they increase the amount of serotonin in the brain. However, low levels of serotonin are linked not only to depression, but also to migraines, digestive problems and anxiety, which are symptoms of fibromyalgia.

Amitryptiline (Elavil) is used in people with fibromyalgia as a painkiller and for its effects on sleep disorders and fatigue. It is the most commonly used first-line treatment .  Duloxetine (Cymbalta) can also be used, as can fluoxetine (Prozac) or moclobemide, which will often be added as additional therapy. Finally, another antidepressant, milnacipran, has shown promising results against fibromyalgia and is being evaluated in Canada.

It appears that low-dose antidepressants are the best long-term treatment for muscle pain in fibromyalgia. However, not everyone finds relief.

The anticonvulsant or antiepileptic – initially designed to treat epilepsy – are also effective against chronic pain. These include gabapentin (Neurontin), pregabalin (Lyrica) and topiramate (Topamax). Some of these anticonvulsants improve the quality of sleep (especially gabapentin, and even pregabalin). In 2009, Lyrica even received an indication for the treatment of pain associated with fibromyalgia.

Sedatives are sometimes prescribed to facilitate sleep, but their long-term use is generally not recommended by doctors (eg, Imovane). In addition, most of the drugs mentioned above also have a sedative effect.

Muscle relaxants can also help relieve pain. The only effective muscle relaxant for fibromyalgia is Flexeril, which is similar to amitriptyline (Laroxyl).

To note. Corticosteroids (such as prednisone) have shown no efficacy in treating fibromyalgia.

Non-drug management

Medications alone are not enough to improve the quality of life for people with fibromyalgia. The care must therefore be multidisciplinary. The complementary approaches, including allowing relaxing and learning to manage her pain, are likely to present the most effective methods for living with fibromyalgia. In case of severe pain, the bathroom with hot water, with or without muscle exercises, can also bring fast relief.

Balneotherapy
– In case of severe pain, baths in hot water, with or without muscular exercises, can also provide rapid relief. A treatment in a rehabilitation center with balneotherapy, spa center with hot water swimming pool have demonstrated certain efficiency.

Aerobic exercises

The exercise is part of the basic salary. It leads the body to produce endorphins, hormones that provide well-being and soothe pain. Several syntheses of studies 6, 7.55, including one published in 2008, concluded that the practice of supervised aerobic exercises reduces the symptoms of fibromyalgia and improves sleep and physical abilities. Stretching and strengthening exercises would also improve some symptoms, but there is less evidence to that effect.

We should not fear of aggravating his disease through exercise, since fibromyalgia is not a problem of muscular origin. Moreover, it is known that a bad physical condition contributes to generate fatigue and anxiety. However, it is important to start gradually, with a program adapted to your physical condition.

The aerobic exercises practiced in the pool, preferably in hot water, can be a good starting point to get back in action. According to 2 clinical trials published in 2006, aquaform exercises (walking or running in water, for example) are effective in relieving the pain caused by fibromyalgia and improving the feeling of well-being . They must be adapted to the abilities of the person affected, and their intensity must be increased gradually.

Methods of letting go and managing stress and pain, such as relaxation, Ericksonian hypnosis, or music therapy, have been shown to be effective in this disease. They allow you to live better with pain and fatigue.

Psychotherapy

Psychotherapy can bring significant benefits to people with fibromyalgia. The cognitive behavioral therapy (CBT) is particularly effective. See the Complementary Approaches section.

Here are some tips from the Canadian Medical Association  to relieve the symptoms  :

  • Limit periods of stress, as symptoms increase with stress.
  • Have a regular sleep.
  • Do stretching and aerobic exercises.
  • Apply warm compresses on pain points.
  • Practice light massages.

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