Fibromyalgia

Fibromyalgia is currently considered one of the major public health problems in our country. Its high prevalence, insufficient understanding of its causes, and lack of curative treatment give it this status.
It is characterized by chronic, generalized musculoskeletal pain associated with symptoms as diverse as:

• Intense fatigue.
• Sleep disturbances.
• Depression, anxiety.
• Paresthesia in the extremities, swelling in the hands, joint stiffness, or headaches.
• Patients frequently experience hypersensitivity to pain in multiple locations of the musculoskeletal system. Its prevalence in the general adult population is estimated at 2.4%, being more common in women than in men (ratio 21:1) and peaking in the 40-49 age group.

Its cause is unknown. Various pathogenetic mechanisms have been suggested, but none have been proven: alterations in the hypothalamic-pituitary-adrenal axis, autonomic nervous system dysfunction, autoimmune processes, etc.

Pain and fatigue are the primary symptoms.

The pain appears in multiple locations: the neck, occipital, shoulders, hips, ankles, wrists, hands, and feet. Patients describe the pain as continuous, intense, and unbearable, predominantly in the morning, improving throughout the rest of the day until the afternoon or evening, when it worsens again.
Sustained positions, physical overload, and changes in weather or emotions are factors that can worsen the pain.
Fatigue is present in 70% of patients with fibromyalgia. It can appear as exhaustion lasting 24 to 48 hours, or more commonly, it can be continuous.

The third most common symptom is sleep disturbances, often affecting both sleep onset and sleep maintenance, with frequent awakenings that are not restful. It usually precedes the pain.

Other common symptoms:

• Sensory: paresthesia in the hands and feet, auditory hypersensitivity.
• Motor: stiffness, contractures, tremor, myofascial release.
• Vegetative: excessive sweating, dizziness, palpitations, dry mucous membranes.
• Cognitive: attention deficits, memory impairment.
• Affective: anxiety or mood swings.

Diagnosis of Fibromyalgia

The diagnosis is primarily clinical. The ACR (American College of Rheumatology) established diagnostic criteria for the classification of fibromyalgia:

• History of widespread pain lasting more than three months.
• Continuous pain on both sides of the body, above and below the waist.
• Pain in the neck, back, or lumbar region or anterior thorax.
• Pain must occur in at least 11 of the following 18 symmetrical points: occipital, lower cervical, trapezius, supraspinatus, second intercostal space at the costochondral junction, epicondyle, gluteus, greater trochanter, and knee.

The differential diagnosis must include other neuromuscular, autoimmune, endocrine, or malignant diseases.
Fibromyalgia is considered a chronic disease, with progression dependent on the degree of affectation of the patient, and with a significant impact on different areas of life: quality of life, work, family, etc.

Fibromyalgia Treatment

Patient awareness of the disease, pharmacological treatment, daily exercise, and, if necessary, psychological treatment are the main pillars of treatment for patients with fibromyalgia.

a) Pharmacological Treatment:
The use of drugs for fibromyalgia is aimed at improving symptoms, not curing the disease. There is currently no FDA-approved treatment for fibromyalgia. The most commonly used are the following:

• Analgesics and nonsteroidal anti-inflammatory drugs: There is no evidence of the efficacy of these drugs for the treatment of fibromyalgia, except for tramadol, which has weak evidence.
• Muscle relaxants: Low-dose cyclobenzaprine has been shown to be helpful in improving pain and sleep quality.
• Tricyclic antidepressants: Amitriptyline and nortriptyline show no differences between them, but both are useful in the short term (30% clinical improvement) for improving pain and sleep quality (moderate improvement) and fatigue (mild improvement).
• Selective serotonin reuptake inhibitors: such as fluoxetine, improve depressive symptoms but are of little use for pain if it is not accompanied by depressive symptoms.

b) Psychological treatment
The main objective of psychological treatment in the treatment of fibromyalgia will be to control emotional (depression and anxiety), cognitive, behavioral, and social symptoms that worsen the baseline symptoms of patients with fibromyalgia.
The treatment that has shown the greatest benefit in managing chronic pain, inflammatory pain, and fibromyalgia is cognitive-behavioral therapy, which produces improvements in the main symptoms (pain, fatigue, and mood). Relaxation and biofeedback techniques have also been shown to be useful.

c) Physical Exercise
Multiple studies support the fact that any physical activity, or an increase in it, produces significant effects on pain relief in patients with fibromyalgia, and especially in those with high levels of pain and disability.

What recommendations can we draw from the medical literature to mitigate fibromyalgia symptoms through physical exercise?

• Pain: Regular physical activity, with progressive increases in loads, in sessions of 45 to 60 minutes, two or three times a week: strength training, aerobic exercise, aquatics, dance, or tai chi.
• Sleep quality: It is recommended to combine aerobic or strength training with relaxation in 60-minute sessions, two days a week, for example, tai chi.
• For depression, anxiety, and low mood: Regular aerobic and flexibility exercises in 45- to 60-minute sessions.
• Quality of life: Aerobic training and activities that involve dynamic mobilization of the whole body in 60-minute sessions, three times a week, such as dance or tai chi.

Supplements

In recent years, there has been a proliferation of scientific articles discussing the use of supplements to counteract the symptoms of fibromyalgia. These supplements include vitamin D (at doses that maintain vitamin D levels above 50 ng/ml) or coenzyme Q10 (recommended intake of 300 mg/day), which appear to act on the body's energy metabolism and produce an antioxidant effect.

It appears that the use of these supplements can improve pain and enhance quality of life. Some studies link low levels of manganese and zinc with greater severity of anxiety and depression in patients with fibromyalgia, so monitoring these levels is recommended.

Make an appointment with Dr. Jordi Jiménez. He will see you in the center of Palma and help you regain your quality of life.