Fibromyalgia, a chronic illness that is still poorly diagnosed and treated.
Fibromyalgia is a chronic illness that causes pain and stiffness in the muscles, tendons, and joints. Fibromyalgia is also characterized by restless sleep, fatigue upon waking, a state of chronic fatigue, anxiety, a tendency toward depression, and intestinal function disorders. While fibromyalgia is one of the most common diseases affecting muscles, its exact cause is currently unknown. The various pains experienced are not caused by local inflammation of the affected tissues. As a result, people with fibromyalgia do not suffer from the side effects of inflammation such as wear and tear or deformation of the joints prevalent in cases of chronic inflammatory rheumatism.
A low serotonin level is observed in these individuals. In cases of fibromyalgia, studies on pain suggest that the central nervous system may be hypersensitive: there may be a malfunction in the perception of pain. Furthermore, patients with fibromyalgia often suffer from a deficiency in "non-rapid eye movements." In other words, this means that their sleep is not sufficiently restorative, with the deep sleep phase being insufficient. This is one of the reasons why people suffering from fibromyalgia wake up feeling tired. Fibromyalgia mainly affects women (more than 80% of patients) aged 35 to 55. Less frequently, it can also affect men, children, and the elderly. Fibromyalgia can occur alone or in association with another disease, such as lupus or rheumatoid arthritis.
Fibromyalgia: the most common symptoms
- Pain
The universal symptom of fibromyalgia is pain. As mentioned earlier, fibromyalgia pain is not caused by tissue inflammation. Instead, patients seem to suffer from increased sensitivity to many sensory stimuli and an abnormally low pain threshold. Thus, these minor sensory stimuli can sometimes cause severe and disabling pain in fibromyalgia patients. This pain can be exacerbated by noise, climate change, and emotional stress. Fibromyalgia pain affects all parts of the body and simultaneously both sides of the body. Pain usually affects the neck, buttocks, shoulders, arms, upper back, and chest. Some localized areas of the body are sensitive even to light touch. These tender points or pressure points are usually located on the elbows, shoulders, knees, hips, behind the head, and on the sternum.
- Fatigue
90% of patients suffer from fatigue. This fatigue may be related to structural sleep disturbances associated with fibromyalgia. Indeed, there are two types of sleep: slow (or deep) sleep and paradoxical sleep. To benefit from restorative sleep, the duration of deep sleep is more important than the total number of hours of sleep. However, people with fibromyalgia have insufficient slow sleep. They often wake up in the morning feeling unrefreshed, even when they have slept enough. Others wake up with pain and a feeling of muscle fatigue.
- Emotional disorders
More than half of people with fibromyalgia suffer from emotional disorders. The most common symptoms include difficulty concentrating, occasional memory lapses, mood swings, irritability, depression, and anxiety. Since the diagnosis of fibromyalgia is difficult, affected individuals are sometimes considered to suffer only from depression.
There are other symptoms of fibromyalgia such as migraines, abdominal pain associated with irritable bowel syndrome and irritable bladder, or tingling in various parts of the body. Each patient with fibromyalgia is unique. One of the previously described symptoms may occur intermittently and in different combinations.
- How is fibromyalgia diagnosed?
There are no blood tests or medical imaging tests that allow the doctor to confirm the diagnosis of fibromyalgia. However, some tests are performed to exclude other possible diagnoses. Therefore, the diagnosis of fibromyalgia is established only on clinical and physical criteria. In patients with chronic generalized body pain, the diagnosis of fibromyalgia can be made by identifying the pressure points, which must be concomitant with the finding that none of the sensitive areas are subject to inflammation. Certain situations can cause pain similar to that of fibromyalgia, for example: hypothyroidism, parathyroid diseases, vitamin D deficiency, muscle diseases (such as polymyositis), or bone diseases (causing bone pain), a high level of blood calcium (hypercalcemia), certain infectious diseases (hepatitis, AIDS) or certain cancers.
- What are the treatments for fibromyalgia?
Since the symptoms of fibromyalgia are diverse and vary among patients, treatment should be individualized. It is more effective when it combines patient education and information, stress reduction, regular physical exercise, medications, and natural medicine.
- Education
Patient education is crucial for the successful outcome of comprehensive treatment. It is interesting to refer to patient associations (inquire at the National Center for Fibromyalgia Associations, cenaf.org) which allow for exchange and provide support in daily life.
- Stress reduction
Stress levels vary greatly among patients. Therefore, stress reduction in the treatment of fibromyalgia must be individualized. It is imperative to reduce stress at home and at work, using relaxation tapes or seeking psychological support from one's surroundings or a professional. Optimal sleep is encouraged.
- Physical exercise
Practiced regularly, gentle gymnastics, swimming, cycling, walking can contribute to improving the comfort of people suffering from fibromyalgia. The cause-and-effect relationship, which is nevertheless undeniable, of this effect is not known. Some scientists believe that physical exercise could influence the quality of sleep by lengthening periods of deep sleep.
- Diet
In theory, there is no specific diet to follow in case of fibromyalgia. Avoiding alcohol and caffeine before bed can only be beneficial for sleep quality. Furthermore, it can be thought that a diet rich in magnesium and B vitamins (micronutrients that act on stress) and omega-3 fatty acids (effective against emotional disorders) will be beneficial in the long term for the patient. Only people suffering from symptoms related to the digestive system (irritable bowel syndrome) should adjust their diet accordingly to avoid exacerbating discomfort.
- Medications
Traditionally, the most effective medications in the treatment of fibromyalgia are tricyclic antidepressants, drugs traditionally used in the treatment of depression. Prescribed at a lower dose than in cases of confirmed depression, they seem to reduce fatigue, relieve muscle pain and spasms, while promoting deep and restorative sleep. More recently, drugs that simultaneously increase serotonin and norepinephrine levels have been approved for the treatment of fibromyalgia in adults. Studies have shown their effectiveness in reducing pain, as well as in treating depression and anxiety. Local injections of analgesics or cortisone, in the areas of pressure points, can also be useful in relieving pain, while muscle relaxants help reduce pain symptoms and improve sleep. Non-steroidal anti-inflammatory drugs (NSAIDs), although very useful in the treatment of other rheumatic conditions, are not suitable for fibromyalgia pain.
- Alternative medicines
Biofeedback, electroacupuncture, or standard acupuncture are used with some success for symptom relief.
The contribution of phytotherapy and nutritherapy
Complementary, these two natural medicines are competent in many areas, in a logic of overall health. They allow action on:
Sleep disorders (Valerian and Passionflower), morning fatigue (vitamin C, royal jelly
, multivitamin complex, ginger).
Emotional disorders (depression, irritability, anxiety): St. John's Wort, magnesium, omega-3, Griffonia, chaste tree.
Muscle pain and soreness: magnesium, blackcurrant, German chamomile, officinal scolopendra, gel for local application with blackcurrant, essential oils, or capsaicin.
The mystery of fibromyalgia has not yet been solved. Researchers continue to work on different avenues, with the goal of improving the lives of patients and perhaps even curing them!
References: Rao, Srinivas G., Judith F. Gendreau, and Jay D. Kranzler. "Understanding the Fibromyalgia Syndrome." Psychopharmacol Bull. 40.4 (2008): 24-56. Klippel, John H., et al., eds. Primer on the Rheumatic Diseases. 13th ed. New York: Springer and Arthritis Foundation, 2008. Medecinenet.com.