Fibromyalgia

What is Fibromyalgia?

Fibromyalgia is a disease 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.

How common is Fibromyalgia in our population?

Its prevalence in the general adult population is estimated at 2.4%, being more common in women than in men (21:1 ratio) and most prevalent in the 40-49 age group. It is currently considered one of the major public health problems in our country. Its high prevalence in the population, the insufficient understanding of its causes, and the lack of curative treatment give it this status.

What is the cause of Fibromyalgia?

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

What symptoms occur in Fibromyalgia?

Patients with fibromyalgia frequently experience hypersensitivity to pain in multiple locations of the musculoskeletal system.

Pain and fatigue are the primary symptoms.

The pain appears in multiple locations: cervical, 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/evening, when it worsens again.

Regarding fatigue, it 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 onset, with frequent awakenings that are not restorative. It usually precedes the pain.

Other common symptoms:

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

What situations worsen Fibromyalgia pain?

Sustained positions, physical overload, climatic or emotional changes are factors that can worsen the pain.

How is Fibromyalgia diagnosed?

Its 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 neck, trapezius, supraspinatus, second intercostal space at the costochondral junction, epicondyle, gluteal, greater trochanter, and knee.

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

How is Fibromyalgia treated?

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

1. Pharmacological treatment:

The use of drugs for fibromyalgia is aimed at improving symptoms, not curing the disease. Currently, there is no FDA-approved treatment for fibromyalgia. The most commonly used are:

• Analgesics and nonsteroidal anti-inflammatory drugs: There is no evidence of the effectiveness 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 useful for 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) to improve 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.

2. 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 controlling 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.

 

3. Physical Exercise:

Multiple studies support the fact that any physical activity, or increased activity, produces significant effects on pain relief in patients with fibromyalgia, 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?

Recommendations regarding pain:

Physical activity practiced regularly, with progressive increases in load, in sessions of 45 to 60 minutes, two or three times a week: strength training, aerobic exercise, aquatics, dance, or tai chi.

Recommendations regarding sleep quality:

It is recommended to combine aerobic or strength exercise with relaxation in 60-minute sessions, two days a week, for example, tai chi.

Recommendations for depression, anxiety, and low mood:

Regular aerobic and flexibility exercises in 45- to 60-minute sessions.

Recommendations for quality of life:

60-minute aerobic training and activities that involve dynamic mobilization of the entire body, including dance or tai chi three times a week.

Are supplements useful in the treatment of Fibromyalgia?

In recent years, there has been a proliferation of scientific articles discussing the use of supplements to counteract the symptoms of fibromyalgia. This is the case with 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.