Fibromyalgia is a rheumatic disease of an unclear origin and characterized by widespread pain. People suffering from fibromyalgia often go to different specialists and primary care physicians, receiving a high number of treatments and tests, often without any notable improvement.
Frequency
In general, fibromyalgia is thought to affect 2-4% of the population. Fibromyalgia predominantly affects women, with as many as 90% of cases affecting females. However, an increasing number of cases of fibromyalgia has been diagnosed in males, with these cases being often more difficult and complex to treat. Generally, most people are diagnosed between their 40’s and 60’s, although they may have experienced symptoms long before this time, even years, indicating a clear delay in its diagnosis.
Causes
The cause of fibromyalgia is unknown. Studies that correlate the disease to previous viral infections or digestive diseases such celiac disease have not been confirmed. On many occasions, there is a clear traumatic trigger, which could be of a physical and/or emotional nature that occurs prior to the start of symptoms.
Clinical symptoms
Musculoskeletal manifestations. Pain is the primary symptom in fibromyalgia. People with fibromyalgia describe their pain as a pain that affects almost the entire body and which worsens with movement or effort (not necessarily intense), and with temperature changes.
The areas that are most commonly affected by pain tend to be the neck and the lower back or thighs, with patients also experiencing pain frequently around the breastbone and rib cage and knees. On occasion, there is also muscle or joint stiffness, which gives those with the disease the feeling that they need to “loosen up”, making it difficult to make complete movements. This stiffness generally appears upon waking and may or may not ease throughout the day. Other symptoms attributed to fibromyalgia are episodes of overall swelling of both hands, colour changes of the fingers with cold and dry eyes or dry mouth. Other manifestations. Weakness (or asthenia) is another very relevant symptom of those suffering from fibromyalgia, because on occasion it is the most-limiting symptom affecting their lives. It is generally described as a feeling of extreme fatigue that usually requires rest; however, the patient does not improve with rest. Nor does Dr. Mariano Andrés Assistant Director of Rheumatology, General University Hospital of Alicante the patient improve with adequate sleep. When asthenia is the main symptom and there is little or no muscular or joint pain, it is referred to as chronic fatigue syndrome, an illness that is closely related to fibromyalgia. Other common symptoms are insomnia, mood swings, frequent headaches and tension headaches, blurry vision, poor digestion and abdominal pain, combined with bouts of diarrhoea and constipation or intense menstrual pain.
Diagnosis
Fibromyalgia is diagnosed clinically, which means that it is based on the patient’s symptoms and the detection of muscular pain (elbows, back of the shoulders, neck or thighs), which is generally produced by stimuli that would not normally cause pain. Diagnostic testing should not be performed (blood tests, x-rays, MRIs, ultrasounds, etc.) to diagnose fibromyalgia, because no changes will be observed (or any changes seen will not be due to the disease). However, testing may be conducted to rule out other types of rheumatic diseases.
Treatment
As we commented at the beginning, this difficult-to-treat condition will show periods of improvement and periods when the symptoms flare up. The numerous studies performed showed that patients exhibited the greatest probability of improvement with the following measures:
- Patient education. It is important to understand that this is not a serious disease, nor will it lead to deformations or serious disabilities.
- Physical activity. Exercise is essential for improving symptoms. Light exercise should be performed regularly (3-4 days a week). The type of exercise can vary from person to person, but generally activities such as tai chi, Pilates, swimming or aquagym may help relieve symptoms.
- Promoting a positive state of mind for patients with depression or anxiety. Psychological therapy and some antidepressants may prove useful, and may also improve sleep.
- Pain treatment. Despite the intensity of the pain, light or moderate pain medications should be used, such as paracetamol, metamizol (Nolotil), ibuprofen, naproxen or tramadol. Pain will be alleviated mainly by following the previous guidelines, not with medication. Analgesics such as morphine and its derivatives should be avoided, as they are ineffective in controlling pain in these patients and they frequently exhibit unwanted side effects.
Dr. Mariano Andrés Assistant Director of Rheumatology-General University Hospital of Alicante
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