LivingIs fibromyalgia a real disease or a 'catch-all'?

Is fibromyalgia a real disease or a 'catch-all'?

 

Surely more than one of you has heard of fibromyalgia, or perhaps you have heard one of the other names by which it used to be known: fibrositis or fibromyositis syndrome.

Fibromyalgia is a chronic disorder characterized by widespread muscle and skeletal pain , often accompanied by fatigue, and sleep, mood, and memory dysfunction. It currently affects around 2.4% of the Spanish population, which may not seem like much, but if I tell you that this means around 900,000 people, it already gives a little more respect.

Interestingly, it is approximately seven times more frequent in women than in men, and, although it is not a dangerous or fatal problem, the persistence of symptoms can negatively affect the life of the person and their loved ones.

Causes of fibromyalgia

The exact cause of fibromyalgia is unknown , but many factors are thought to be involved.

Today, considerable progress has been made in what we know about this syndrome, and study hypotheses are already being considered that focus attention on certain changes in the spinal cord and brain of affected people, giving rise to difficulties in processing pain properly. . As a consequence, pain receptors in the brain tend to create some kind of “memory” of the associated pain, which in turn increases their sensitivity to it, overreacting to both painless and painful signals.

There are people who develop the disease without an apparent cause, it just appears. Others can identify what caused the appearance of the condition, such as a traumatic event (infection, blow, car accident,…) or a previous disease (rheumatoid arthritis, lupus erythematosus,…). It should be noted that, although it seems that strokes and certain diseases are triggering agents, it is most likely that we are facing a case of correlation, without causality proven to date.

Among the factors described that could be the risk of developing fibromyalgia we find: family history of the disease, genetic alterations, certain underlying diseases, trauma, or even a prolonged psychological condition, such as emotional trauma, stress, sleep disturbances, etc. .

Fibromyalgia symptoms

Fibromyalgia is a syndrome, that is, a condition that groups several signs and symptoms. The main symptom, the most prominent, is widespread musculoskeletal pain . This pain is normally defined as a continuous dull ache that persists for more than 3 months. In addition to being intense, it can worsen with fatigue or overexertion.

Those affected often also report tiredness even after sleeping for a long period. This may be because sleep is often interrupted by pain, or associated sleep disorders such as sleep apnea or restless legs syndrome.

As a consequence of this fatigue, some mental problems can arise, such as difficulty concentrating or a feeling of mental daze (what is known as fibrofog), as well as anxiety disorders or depression.

In addition, many other symptoms may appear, such as tension headaches or migraines, bladder pain when urinating (cystitis), irritable bowel syndrome, tingling, or sleep problems.

By way of clarification, it may seem that fibromyalgia and chronic fatigue syndrome are the same, but there is a distinctive feature between the two, and that is that the main symptom of fibromyalgia is pain, while that of chronic fatigue is lack of energy. Although both have similar symptoms, they are distinguished by their most disabling symptom.

Affected people may also feel frustrated because they appear to be “okay,” showing no signs of being unwell, even though they don’t feel well.

Diagnosis of fibromyalgia

You may have noticed that when talking about the different aspects of this condition, whether it is the possible causes, symptoms or various definitions, ambiguous terms and the conditional form of verbs are often used. This is no accident, as prior to 1990 there were no accepted guidelines for identifying fibromyalgia patients for study. This made researching this condition really complicated. Furthermore, when guidelines for detecting people with fibromyalgia were finally established two years later, these criteria did not work well in the clinic, failing to identify nearly half of fibromyalgia patients.

The lack of evidence and consensus essentially meant that this condition was not known. What’s more, until recent decades, many doctors questioned the existence of fibromyalgia. However, over time, a growing body of evidence has established that fibromyalgia is a syndrome that comprises a specific set of signs and symptoms.

Currently, for a doctor to consider whether someone has fibromyalgia, the person has to have had widespread pain for at least 3 months, in addition to negative tests carried out to rule out other diseases with similar symptoms.

As you may have noticed, it is very difficult to diagnose someone with fibromyalgia , since none of the symptoms are objective. There is no inflammation, no altered lab results, much less pathological X-rays or MRIs. Therefore, the diagnosis is completely clinical, and the doctor will explore the symptoms and rule out other possible disorders.

Under the old guidelines, doctors examined 18 pressure points on the body (“trigger points”) to see if they were tender and painful when firm pressure was applied. However, things have changed and today doctors can diagnose a patient with fibromyalgia when they find widespread pain throughout the body lasting at least 3 months. Of course, after having ruled out other possible causes .

As if all this was not complicated enough, fibromyalgia can be hidden behind pathologies with similar symptoms . That is, someone who suffers from arthritis or lupus may also have fibromyalgia, but never be diagnosed because arthritis and lupus already cause widespread pain.

Fibromyalgia Treatment

There is no “treatment for fibromyalgia”, but what is going to be treated at all times are the symptoms that appear . As each person can have different symptoms, treatment strategies must be individual.

Within the treatment, before providing drugs, self-care guidelines will be given so that the symptoms are minor or as bearable as possible. Physiotherapy can help the patient improve their flexibility, strength and endurance with the help of certain exercises, especially aquatic training. A mix of low-energy aerobic and resistance exercises can help decrease tenderness, pain, and stiffness, as well as help combat sleep problems in some patients. It can also be useful to go to a psychologist , since it can not only boost your self-esteem, but it will give you tricks to face the moments of greatest stress and relaxation techniques.

In case these methods do not work , you can already choose to include pharmacology in the treatment. Usually, the first thing prescribed is medication to reduce the associated pain (analgesics) and improve sleep (antidepressants). Of course, to improve sleep, you have to avoid caffeine and favor a restful environment, having a quiet, comfortable room without light.

Prognosis and evolution

Fibromyalgia is a chronic condition, that is, it lives with the person for a long period of time, so the majority of affected people have pain, and other symptoms, for months or even years. That does not mean that the disease is for life. Sometimes, it can be resolved by reducing stress, or following an appropriate treatment.

Something that must be clear is that, despite the symptoms, it does not produce physical sequelae or influence the survival of those who suffer from it. Of course, the person’s quality of life can be quite affected .

The stigma behind fibromyalgia

As we have already mentioned, the reasons why this disease appears have not yet been discovered, since a biomarker or an empirical explanation of what causes it has not been found.

Consequently, there are people who maintain that “it is not a real disease”, or that the symptoms are false and patients “fake” pain, exhaustion or psychological discomfort. It can even be argued that there is nothing wrong with the health of patients and that they are only seeking care. These convictions give rise to a great stigma associated with fibromyalgia.

This can be very frustrating for people who suffer from it, since not only do they have symptoms that incapacitate, in a certain way, their daily activity, but they also live under the shadow of social accusations. As we have already commented, apparently “they are well”, and there are no physical or analytical signs that show that they are ill, but we must not forget that these people , it can be demonstrated empirically or not, are not well, and they need understanding.

Conclusions

In the past, doctors and the public used to dismiss fibromyalgia as a psychological disorder or a “catch-all” due to the absence of objective findings on physical examination and routine laboratory and imaging evaluations. Some doctors still do not accept fibromyalgia as a separate disease. However, basic and clinical investigations have clarified the neurophysiological basis of fibromyalgia and have led to its current classification as central sensitivity syndrome (CSS).

Strictly speaking, in terms of lexicon, there are those who defend that fibromyalgia should not be considered a disease. On the other hand, there are those who argue that whatever it is called, it is no less real and people who suffer from the condition do not suffer less.

Today we also know that fibromyalgia can be considered a neurosensory disorder characterized in part by abnormalities in the processing of pain by the central nervous system (CNS). Greater understanding of the biological bases underlying fibromyalgia is rapidly leading to a new era of disease-specific drug therapy.

Although we are making more and more progress in understanding this disorder, there is still a long way to go. People affected by fibromyalgia are often dissatisfied with their diagnosis, and tend to think that what they suffer from has not yet been discovered, so it is normal for them to feel misunderstood and ignored in a “hot-spot” .

references:

Biundo, J.J. (2020). Fibromyalgia. MSD Manuals. https://www.msdmanuals.com/en/home/disorders-of-the-bones,-joints-and-m%C3%BAscules/disorders-of-the-m%C3%BAscules-the-synovial-bags-and -the-tendons/fibromyalgia?query=fibromyalgia

Fibromyalgia (2017). MedlinePlus Medical Encyclopedia. https://medlineplus.gov/spanish/ency/article/000427.htm#:~:text=Es%20una%20afecci%C3%B3n%20en%20el,de%20cabeza%2C%20depresi%C3%B3n%20y %20anxiety.

Fibromyalgia: what is it, symptoms, diagnosis and treatment (2017). Spanish Foundation of Rheumatology. https://inforeuma.com/rheumatic-diseases/fibromyalgia/

Fibromyalgia. (2017). NIAMS: National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/es/informacion-de-salud/fibromialgia

‌Häuser, W., & Fitzcharles, M. A. (2018). Facts and myths pertaining to fibromyalgia. Dialogues in clinical neuroscience, 20(1), 53–62. https://doi.org/10.31887/DCNS.2018.20.1/whauser

 

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