Fibromyalgia – difficult pain diagnosis and treatment

Proven content

This pain will come suddenly and will last for a long time. It will overwhelm the muscles and make it difficult to concentrate. When the drugs do not soothe him, we will start wandering around the doctors. We will hear from many that … we are fine, because the tests are fine, a few will refer us to a psychiatrist. It will be a while before we find one who says we have fibromyalgia.

Fibromyalgia (FM) undoubtedly belongs to the group of those mysterious, contemporary civilization diseases, from which it is not known where they came from and how to treat them. The word itself means chronic muscle pain. The name was first used in 1976, but only in 1990, thanks to the American Society of Rheumatology, which provided the classification and diagnostic criteria for fibromyalgia, did it become a disease entity. It has been included in the group of rheumatic diseases of soft tissue of unknown origin. It is characterized by generalized skeletal muscle pain, tendon tendon tenderness, and other functional disorders. However, there is still debate in the medical community as to whether fibromyalgia exists, and if so, what it is and whether it should be a rheumatic disease.

A vicious cycle of pain

What confirms that the body is not working properly is pain. Patients describe it as deep, spilled, piercing, twisting, stabbing, shooting. They feel it in one part of the body or in the entire area. Usually, its original habitat is around the cross. From there, it radiates upwards along the spine to the back of the head (sometimes including the jaws) to the shoulders, elbows and hands, or downwards to the hips, knees and ankles.

Fibromyalgia pain is said to form a kind of vicious circle. It leads to muscle tension, which in turn aggravates the pain. Often with this type of pain, neurological disorders in the form of numbness and tingling, as well as – usually occurring in the morning – a feeling of stiffness in the muscles and spine appear. Pain can also vary in severity. Sometimes it grows and sometimes it decreases, but it is not known yet why. Patients suggest that they usually feel it more strongly on cold or damp days, as well as during sleepless nights or after hard physical or mental work.

In addition to muscle pains, patients complain of general fatigue, so strong that they cannot perform simple activities, constantly accompanied by a feeling of anxiety, lack of energy, weakened immunity, disturbed vision, concentration and sleep, as well as enlarged lymph nodes. With FM, there may also be migraines, gastrointestinal discomfort (constipation and diarrhea), ringing in the ears and dizziness, skin hypersensitivity, rashes, dry eyes and mouth, restless legs syndrome, constantly cold legs and hands, uncontrolled, rapid breathing and heart palpitations at rest.

Tender points

Research on fibromyalgia has confirmed that with such a wide variety of symptoms, it is extremely difficult to meet two people who suffer in a similar way. All of the aforementioned ailments can also be successfully attributed to other diseases, which means that patients with fibromyalgia syndrome often “wander” to the doctors for many years, rarely finding help from them. It has been estimated that during the 5-year duration of the disease, a patient with FM visits up to 15 specialists in various fields of medicine, each of whom recommends something, prescribes drugs, but the patient does not feel any improvement. Many doctors who have not dealt with fibromyalgia misdiagnose other conditions – such as rheumatoid arthritis, Crohn’s disease or multiple sclerosis. There are also those who claim that the reported complaints are a symptom of hysteria or hypochondria.

An additional difficulty in diagnosing fibromyalgia is the fact that laboratory tests do not show any changes that would indicate that the patient is ill. Blood analyzes do not show the presence of the so-called rheumatoid factor characteristic of other rheumatic diseases. What’s more – fibromyalgia can occur not only as an independent disease, but also along with other diseases – e.g. cancer, hypothyroidism or hyperthyroidism, or lupus erythematosus.

So how is it possible to diagnose this disease correctly? Thanks to the bone and muscle points located symmetrically on both sides of the body. There are 18 of them, and they are found, for example, at the entrance of certain nerves or at the places where muscles attach to bones. They are called painful (or tender) points, because they hurt especially when they are under pressure. Their sensitivity is measured with a device – a dolorimeter. The doctor first sets the pressure to a certain level and then gradually increases it to see when the person is starting to feel the pressure as pain.

Guided by the location of the pain points, the American Rheumatology Society has developed strict criteria for the diagnosis of fibromyalgia. First, the patient reports pain that has spread to all parts of the body for more than 3 months. Secondly – pain occurs after pressure exerted with a force of approx. 4 kg, in at least 11 (out of 18) painful points.

Whose fibromyalgia is this?

Most experts agree that people with fibromyalgia feel more pain in certain parts of the body because of incorrect processing of sensory inputs in the central nervous system. As if their bodies lack a certain “brake” of pain sensations. The reason for the formation of FM formulated in this way, however, calls into question the validity of classifying this disease as rheumatic diseases. According to the old definition, rheumatic diseases are defined as various types of non-inflammatory and non-traumatic conditions, which manifest themselves in pain in muscles, tendons and joints. FM could therefore be counted among them, were it not for the fact that although it manifests itself in muscle soreness, it does not directly depend on their abnormal condition or functioning. In turn, in the new approach, rheumatic diseases narrow down to the group of the so-called systemic diseases of connective tissue, and fibromyalgia affects muscles.

Both these doubts and the results of patient studies have led neurologists to join the discussion. It turned out that the patients were diagnosed with such abnormalities as: disorders of the fourth phase of NREM sleep (without rapid eye movements), which means that sleep is constantly interrupted by sudden brain activity, and disturbances in the secretion of the hormones: melatonin, which regulates the circadian rhythms. , incl. sleep and wakefulness, cortisol, which in response to stress causes an increase in blood glucose levels, and DHEA, which slows down the aging process of the body.

Tests have also found that patients with FM have low levels of serotonin in the cerebrospinal fluid. And this hormone is extremely important for the proper functioning of the central nervous system. It regulates mood, sleep quality, sexual needs, appetite, impulsive behavior and pain sensation. If there is not enough of it, the pain is stronger. In patients with fibromyalgia, other abnormalities were found, such as increased levels in the spinal cord, the so-called substance P, which is responsible for the transmission of pain stimuli, low blood flow around the thalamus of the brain and the malfunctioning of cytokines that affect the growth and activation of immune system cells.

As anxiety and depressive mood changes also occur in patients with FM, psychiatrists also joined the debate. According to some of them, FM is a form of depression. If only because routine examinations do not show inflammation, fibromyalgic pain results from a lower threshold of pain sensitivity, and almost all additional ailments, e.g. constant fatigue, sleep disorders, decreased activity, feeling cold in the legs and hands, dry mouth, irregular work heart, lack of air, headaches and dizziness, a feeling of choking in the throat – these are typical symptoms of a depressive syndrome. Moreover, similarly to depression, the exacerbation of symptoms occurs in the morning and their very beginning occurs in the fall.

Treatment is not easy

Since the causes of the disease are not fully known, there is no cure for its complete eradication. In therapy, therefore, it is about alleviating ailments, especially muscle pain, which is done with the help of anti-inflammatory drugs, analgesics and relaxing preparations. Unfortunately, they do not reduce the pain to the level at which one can function. In some cases, therefore, also sedatives and antidepressants with the ability to block pain are introduced. A drug, Myalgan, is available in pharmacies for people with FM.

An inseparable part of the treatment are exercises, selected and performed under the supervision of an instructor, and physiotherapy treatments, e.g. massages, hydrotherapy, electrotherapy, cryotherapy, heat treatment, which alleviate pain and prevent muscle weakness or stiffness, as well as the use of relaxation techniques. Specialists emphasize that it is extremely important to make the patient aware of what the disease is and to persuade him to change his lifestyle to a more active, orderly and less stressful lifestyle. And although the treatment of fibromyalgia is still mainly dealt with by rheumatologists, they often recommend consulting a psychologist or psychiatrist who will help you cope with stressful situations, as well as the consequences of the disease – social, e.g. lack of understanding among relatives, as well as social ones, e.g. loss work.

Treatment of fibromyalgia is therefore becoming an interdisciplinary field, but the prognosis for the disease continues to be poor. Only about 25% of patients achieve remission, but the periods of “withdrawal” of the disease vary. Sometimes it can come back after a few years when we do not expect it at all.

Worth knowing

Pain points checked when diagnosing fibromyalgia:

1. occiput (on both sides) at the site of occipital muscle attachments;

2. the lower part of the cervical spine (bilaterally) on the anterior surface of the space between the transverse processes of the C5-C7 vertebrae;

3. trapezius muscle (bilateral) in the midpoint of its upper edge;

4. supraspinatus (bilaterally) in the initial part above the scapula crest;

5. second rib (on both sides) at the costal cartilage attachment on the upper surface;

6. lateral epicondyle of the humerus (on both sides) 2cm circumferentially from the epicondyle;

7. buttock (bilaterally) in the upper outer quadrant on the anterior muscle fold;

8. knee (bilaterally) on the medial part of the submatellar fat body, proximal to the joint space.

Findings

Who hurts the most?

According to estimates, from 1,2 to 2,4 million people in Poland alone, i.e. about 36% of the population, may suffer from fibromilagia. The disease is more common in women in the mature age – from 35 to 55 years of age. In men, it can occur between 45 and 55 years of age. But it can also appear in children and adolescents.

It has also been found that fibromyalgia occurs in people with a specific set of personality and sociological characteristics. Symptoms of FM may appear in educated, ambitious, professionally and privately active people who take on too many responsibilities and have too developed a sense of responsibility. A link was also found between fibromyalagia and traumatic experiences. It turns out that FM is more common in people who have suffered mental and physical traumas – many worries, separation from loved ones, emotional crises, harm, isolation, financial problems, mobbing in the workplace or sudden job loss.

Text: Magdalena Gajda

Consultation: lek. med. Katarzyna Suchoń, head of the Rheumatology Clinic at the Provincial Hospital in Opole, provincial consultant for rheumatology

Source: Let’s live longer