Fibromyalgia or fibromyalgia syndrome (FMS) is a condition characterized by severe pain throughout the body. The causes are not yet understood, and treatment is primarily directed at relieving the symptoms. Fibromyalgia currently has no cure, but the severity of symptoms may lessen with age.
What is fibromyalgia?
Infographic of pain regions in fibromyalgia. Click image to enlarge. Fibromyalgia, also called fibromyalgia syndrome (FMS), is a condition that causes pain in muscles, tendons, and bones. Usually, other diseases are initially suspected, such as rheumatism or back injuries. Fibromyalgia is a generalized disease, which means that it causes discomfort not only in certain areas or in a few parts of the body, but it affects the whole body. Fibromyalgia usually spreads symmetrically. Patients suffer particularly from muscle pain, but generally have a lower pain threshold. Depression often occurs as the disease progresses. Organs may be impaired in their functioning as a result of fibromyalgia. The syndrome is divided into two types, primary and secondary fibromyalgia. The primary form has no identifiable trigger, while the secondary form occurs as a secondary condition after rheumatic inflammation, infection, or autoimmune disease.
Causes
The causes of fibromyalgia are not yet fully understood. Although it is now known that the disease runs in families, suggesting a genetic predisposition. It is also known that the secondary form of fibromyalgia occurs as a result of viral infections and rheumatic inflammation. Secondary fibromyalgia also occurs after so-called autoimmune diseases, in which the immune system is directed not against harmful pathogens but against the patient’s own body. Furthermore, it has been observed that after tumors, accidents or operations, pain can persist and turn into fibromyalgia. Also a disturbance in the brain is considered as a trigger. It is suspected that the pain memory does not function properly and thus sends permanent pain signals even though there is no organic cause. In recent biochemical studies, it has also been found that in fibromyalgia, certain substances in cerebrospinal fluid (CSF) and blood serum are lower and higher than normal, respectively.
Symptoms, complaints, and signs
The symptomatology of fibromyalgia syndrome usually develops gradually over many years. Rarely, it occurs suddenly after an accident or other injury. The main symptom of fibromyalgia is chronic pain that lasts for months and can affect the entire musculoskeletal system. The pain is found in different parts of the body at the same time and occurs spontaneously. Particularly noticeable are painful pressure points, which are often located in the area of muscle-tendon junctions. These points are referred to as “tender points”. Overall, patients are significantly more sensitive to pain than unaffected people. In addition to the chronic pain conditions, a variety of accompanying symptoms can occur. Many of those affected suffer from fatigue, exhaustion and reduced performance. In addition, there are sleep disturbances, headaches or migraine attacks and an increased sensitivity to cold. Particularly in the arms and legs, sensory disturbances and insensitivity can occur. Another symptom is functional heart and breathing problems, i.e. complaints for which no physical cause can be found. In many cases, the disease also has a psychological component. Patients tend to experience depressive moods, dejection and increased irritability. The gastrointestinal tract can also be affected. Nausea, dry mouth, or other so-called gastrointestinal problems may occur. Less common symptoms of fibromyalgia include dizziness, tinnitus, bladder discomfort in the form of an irritable bladder or the feeling of having a lump in the throat.
Diagnosis and course
In fibromyalgia, severe pain occurs in muscles and tendon attachments. These usually occur symmetrically and not only in the arms and legs but also in the entire trunk. The back is particularly severely affected. The pain is perceived as burning or drilling over a large area, the tissue feels sore and swollen.In addition to pain, fibromyalgia causes numerous other complaints, such as insomnia, depression, panic attacks, tremors or intestinal irritation. For the diagnosis, a detailed physical examination will first take place and the patient’s medical history will be obtained. Furthermore, the doctor will test the so-called pain pressure points (tender points). These 18 points are located on the shoulders and neck, as well as on the back and hips. If at least 11 of the 18 points react painfully to pressure and the complaints have already existed for longer than three months, this is considered a definite indication of fibromyalgia.
Complications
Due to fibromyalgia syndrome, the patient suffers from extremely severe pain that occurs all over the body. In this case, it is not possible to limit the pain to certain areas or to treat it specifically. The affected person is restricted in his actions and the quality of life is reduced enormously. The back is often particularly affected by the pain of fibromyalgia syndrome. As a rule, the pain does not disappear even if the patient does not engage in physical activity or rests. The so-called pain at rest occurs. The pain can also lead to depression and to sleep disturbances. Often there is an aggressive attitude, because the patient is permanently irritated. Treatment is primarily by taking painkillers. In most cases, the pain cannot be completely reduced by this. Furthermore, the affected person must attend physiotherapy. If there is an improvement, light sports are also performed. This does not lead to any further complications. In case of psychological complaints, treatment by a psychologist and, if necessary, medication is necessary. Unfortunately, it is impossible to predict whether fibromyalgia syndrome will heal or not. Some patients suffer from fibromyalgia syndrome throughout their lives.
When should you see a doctor?
Doctor visits are not uncommon for patients affected by fibromyalgia. Since hardly any doctors take this painful condition seriously, many patients with chronic muscle pain experience a veritable doctor’s odyssey. In many cases, they are accused of having psychological problems in disguise or are considered to be hypochondriacs. Even if the process of development and the causes of fibromyalgia have not yet been sufficiently clarified, those affected suffer severe and constant pain. In spite of the many pointless visits to the doctor, a further visit to the doctor makes sense in order to make a diagnosis in the case of constant pain all over the body. By differential diagnosis and questioning of the patient, the physician should exclude other causes of disease such as rheumatism, inflammation or severe tension due to displaced intervertebral discs. In the case of a higher degree of pain that appears unacceptable, referral to a pain therapist is advisable. This person can enable the patient to perceive his constant pain differently and deal with it better through multimodal pain therapy. People with fibromyalgia are also entitled to receive appropriate pain relief and treatment. Therefore, they should not be discouraged from seeing a doctor until the right medical professional is found. Unexplained chronic pain is highly distressing. If left untreated, it can lead to an inability to work. As a minimum, regular physical therapy and relaxation therapies can provide relief. In some cases, temporary pain medications are necessary.
Treatment and therapy
Fibromyalgia cannot be treated causally at the current state of medical research. Therefore, therapy consists of alleviating the symptoms. This involves several areas. The pain is treated with medication, and physiotherapy, connective tissue massage and heat therapy are also recommended. A certain amount of sporting activity, such as regular endurance training under the guidance of sports therapists, can also alleviate the symptoms. Exercising in water (swimming, aqua jogging) is particularly suitable, as the body feels lighter here and thus the movements are not so painful. Medication is usually prescribed for any depression that may be present, and behavioral psychotherapy is also recommended. Although the symptoms usually remain for life, they do not worsen and can certainly be alleviated with the right treatment.Therapy also includes long-term care with special programs through which patients learn to cope with their symptoms and to manage their daily lives despite them. In some cases, spontaneous improvement occurs with age, meaning that there is no apparent reason for the improvement.
Outlook and prognosis
The outlook for people with fibromyalgia depends a great deal on whether an understanding physician can be found. Often, the prevailing view among medical professionals is that fibromyalgia syndrome is imagined pain or pain that is due to emotional state disorders and incorrectly programmed pain memory. With this diagnosis, improvement becomes difficult to impossible. The prospects for improvement in the degree of pain and appropriate management of the pain are good if a sensible treatment strategy is adopted. Pain medications tend to be inappropriate for long-term improvement because of their potential for dependence. Instead, moderate exercise and physical therapy are useful in improving the prospects for a pain-free life. Multimodal pain management represents an interdisciplinary approach that is associated with a positive prognosis. Complete cure of soft tissue rheumatism is usually not possible. However, sufferers can be offered the prospect of relief through physical therapy, respiratory training, relaxation exercises, activity, and long-term medical care. The prognosis without adequate treatment approaches is worse. Here, sufferers face the possibility of permanent disability due to protective postures, an internalized memory of pain, and chronicity. It looks better if those affected join a self-help group. Here they receive important tips and addresses to which they can turn.
Prevention
Fibromyalgia cannot be prevented. If the pain is treated at an early stage, however, it is certainly possible to influence the course of the disease favorably.
Aftercare
In fibromyalgia, aftercare tends to be a difficult area. This painful disease of the soft tissues is still ridiculed by many physicians. It is considered by most physicians to be a psychologically caused pain syndrome or a psychosomatic disease. Consequently, there are orthopedists who retreat to being responsible only for existing skeletal damage, but not for the muscle and soft tissue pain. Because of this, many patients with fibromyalgia do not experience physical therapy. But fibromyalgia syndrome is more than a psychologically induced pain syndrome. It used to be called soft tissue rheumatism. If follow-up care is required, for example after a stay in hospital, psychological care is also provided in addition to somatic follow-up care. The aim of this care is to help the pain-stricken patient to cope better with the fibromyalgia syndrome by means of suitable strategies. In addition to psychological burdens, stress and physical strain, changes in the weather, cold and other factors also influence the degree of pain. The extent to which follow-up care applies to all areas of therapy that have already been treated varies from individual to individual. Possible options include continued exercise therapy measures, medication treatment steps, renewed pain therapy interventions in the event of exacerbations, or multimodal pain therapy with renewed hospitalization. Sufferers can also engage in moderate exercise. In addition, warm baths and aquatic exercise during follow-up relieve discomfort and improve quality of life.
What you can do yourself
All relaxation techniques help fibromyalgia patients develop a different relationship to pain. Depending on personal preference, a sufferer can choose from numerous offerings. These range from autogenic training to yoga and progressive muscle relaxation. As a result of pain management training, inner attitude and pain perception also develop positively. With certain breathing techniques, pain can be breathed away. For example, in addition to full yogic breathing (pranayama), women can use the same technique that midwives recommend for breathing away labor pains. Studies show that hypnosis reduces some of the discomforts of the disease, including sleep problems and increased pain. Willingness to accept pain also increases under trance.Special directories help sufferers find reputable hypnotherapists. Alternative healing methods – for example Reiki and Healing Touch – improve the overall condition. These release inner blockages, relax, reduce the sensation of pain and activate self-healing powers. Reiki can be learned by anyone and is suitable for self-treatment. Heat and water treatments loosen painful tense muscles. Warm full baths and a shower with a softly adjusted shower head are particularly effective. Targeted water pours and moist towels also relieve muscular discomfort. A hot water bottle, a cherry stone pillow or a red light lamp provide dry heat and also have a muscle relaxant effect. Targeted stretching exercises loosen tense parts of the body in the long term. Moderate, individually created strength and endurance training, as well as meditative exercise therapy, restore quality of life to the daily lives of fibromyalgia patients.