Fibromyalgia: what life is like when pain and fatigue become chronic

It is estimated that between 2 and 6% of the world population suffers from this disease, characterized by generalized musculoskeletal pain, which manifests after 30-40 years and mainly affects women. Why early diagnosis and interdisciplinary treatment are two key points in its approach

“I’m fine, but I feel exhaustion.” “They are the cervicals, I have a hard neck”. “My head breaks.” “Everything hurts!”. “I do not give more!”  This and many other phrases associated with pain and fatigue seem to be part of the daily life of many people subjected to the demands of today’s world. But when these go from being a simple annoyance and become chronic, you may be in the presence of something else.

Since 1992, the World Health Organization (WHO) recognized within its International Classification of Diseases fibromyalgia,  one of the most common conditions of chronic pain, which is nine times more frequent in women than in men .

What symptoms should be alert? The psychiatric doctor and coordinator of the clinic of patients with fibromyalgia and chronic fatigue of the Institute of Cognitive Neurology (Ineco), Evangelina Melgar (MN 133.847), gave some clues to understand these pathologies that can affect the activities of daily life and relationships interpersonal experiences of those who suffer from it.

 90% of patients experience fatigue, 70-80% sleep disorders and up to 25% anxiety or depression

“Although the causes of both diseases are unknown, genetic factors could predispose to the development of fibromyalgia, while for Chronic Fatigue Syndrome (CFS) there are many theories, ranging from their relationship with viral infections to psychological stress,” noted the specialist.

About what signs should consult the doctor, the expert pointed out that “usually fibromyalgia manifests from 30-40 years although, in a lower percentage, can appear in childhood and adolescence. The main symptom is generalized musculoskeletal pain, which worsens at the pressure of tender points . ” “The intensity of pain varies influenced by climate changes, physical activity, psychological stress or lack of sleep. It usually begins in one region of the body and migrates through different areas, until it becomes generalized over time, “he explained.

Fibromyalgia is a Psycho-Neuro-Immuno-Endocrine disease (Getty)
Fibromyalgia is a Psycho-Neuro-Immuno-Endocrine disease (Getty)

And after noting that “90% of patients experience fatigue, 70-80% sleep disorders and up to 25% anxiety or depression”, Melgar went on to say that “poor tolerance to exertion is also frequent; the feeling of heaviness in the limbs; generalized rigidity (especially when getting up in the morning); feeling of inflammation and ill-defined tingling in the hands and feet. ” Symptoms may be associated with headaches, dizziness, cognitive failures in memory and attention, bruxism, gastrointestinal symptoms, such as irritable bowel syndrome, dyspepsia, nausea . The presence of these symptoms or associated syndromes varies in each person.

In addition, external factors, such as environmental cold, humidity, stress, excess or lack of activity, exacerbate the symptoms. On the other hand, heat, dry weather, relaxation and rest, reduce their intensity.

As noted by the psychiatrist Sergio Czerwonko (MN 77456), between 2 and 6% of the world population suffers from fibromyalgia, and may present as the only alteration-what is called primary fibromyalgia-or associated with other diseases-concomitant fibromyalgia.

 Pain is not the only symptom. The difficulty to render intellectually, called fibrofog can be even more serious than the pain itself

The disease is part of the central sensory syndromes, which are those pathologies from which no data appear in laboratory analysis or radiographs and only the expert in the field, under a thorough examination, manages to obtain the diagnosis.

“Pain is not the only symptom. The difficulty to render intellectually, called fibrofog can be even more serious than pain itself, “said the professional of the Institute of Neurosciences Buenos Aires (Ineba), for whom” a great challenge is that the patient finds the right professional to your diagnosis and treatment. “

Fibromyalgia is a Psycho-Neuro-Immuno-Endocrine disease (PNIE) , which must be diagnosed and treated by a chronic pain team, since it is a chronic condition. “The population most prone to this disease is the female, since throughout life is the one with greater hormonal oscillations and faces numerous traumatic instances and when occurring in a fertile period we must take particular care in the proposed treatments” , explained Czerwonko, who said that “it can also occur in children and adults, especially in those who have gone through stressful and traumatizing situations. It is a disease that usually appears after viral processes, hospitalizations or situations of grief or important losses “.

“We must understand that it is a condition that exists despite the resistance in some areas of disbelief in its existence, as at the time it was doubtful of depression or panic attacks. Today we know that it is not a psychiatric disease, it is not traumatological, it is not rheumatic, it is not neurological or psychological but it has a precise clinic and must be assisted by a multidisciplinary team that encompasses all these specialties, “the specialist emphasized.

Early diagnosis and interdisciplinary treatment, two key points

The treatment must be comprehensive and coordinated by an expert and qualified team (Getty)
The treatment must be comprehensive and coordinated by an expert and qualified team (Getty)

Although the cause, as stated, of the pathology is unknown, genetic factors could predispose to the development of fibromyalgia.

“The diagnosis is eminently clinical. At the moment, there are no complementary studies that confirm it, it is established in an interview with the professional, in which the patient describes the symptoms. Some scales are used: questionnaires on pain in the different regions of the body and on the severity of the symptoms, where the presence of cognitive alterations, sleep, fatigue and other somatic symptoms is  evaluated – described Melgar-. It is recommended, in addition, the evaluation of a rheumatologist specialist to rule out pathologies that are associated or that share similar symptoms “.

And he considered that “early diagnosis is the main challenge presented by these diseases, to avoid their chronicity and greater impact on the functionality of the person, improving their quality of life.”

 There is consensus that physical exercise programs should be one of the basic treatments for all patients with fibromyalgia

“The treatment must be comprehensive and coordinated by an expert and qualified team. No data should be left to chance, ruling out rheumatic, neurological, psychiatric and clinical problems. It requires patience on the part of the treating professional and understanding on the part of the family and society, so reporting on the pathology and raising awareness is very important, “said Czerwonco.

On the other hand, Melgar observed that “to correctly inform about these pathologies must be the first step of the treatment”. “The patient must know from the beginning the characteristics of the disease, its evolution, as well as the positive and realistic expectations that enhance its collaboration with the therapies, trusting in a probable improvement”, he added.

And after ensuring that “there is consensus that physical exercise programs should be one of the basic treatments for all patients with fibromyalgia,” the specialist noted that ” the morning stiffness, characteristic symptom, is due to alterations in the microcirculation that generate the sensation of numbness and cause difficulty and pain when moving  after long periods of stillness “. In this regard, he stressed that “daily stretching and oxygenation exercises (such as Tai Chi and yoga) are indicated, as well as aerobic, non-intense physical activity (walking, dancing, cycling, water exercises). The anaerobic ones are not recommendable, since they would worsen the sensation of heaviness and pain “.

Stretching and daily oxygenation exercises such as Tai Chi and yoga are highly recommended in the treatment of the disease (Getty)
Stretching and daily oxygenation exercises such as Tai Chi and yoga are highly recommended in the treatment of the disease (Getty)

” Mindfulness and cognitive behavioral therapy demonstrated efficacy in mood improvement, emotional regulation and stress management . This is vitally important to avoid episodes of worsening pain and contribute to functional capacity, “said Melgar.

And he concluded: “Within the pharmacological treatments for fibromyalgia, certain antidepressants are approved that would be effective in reducing the increased perception of pain. There is no medication that alone eliminates all symptoms, but some drug combinations may help reduce pain and fatigue, as well as improve sleep. But, equally, the aforementioned care is essential to achieve, as a whole, the improvement and control of symptoms. Gradually you can achieve these changes until they become habits. “

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