Fibromyalgia – myth or reality? How to cope with pain?

Fibromyalgia is a chronic pain syndrome that occurs due to a genetically determined phenomenon, neurobiological factors or environmental influences. In addition to feeling pain, other signs may be present. The disease can be found in men and women, very rarely in children.

Symptoms of fibromyalgia:

• feeling of muscle pain;
• cephalgia;
• insomnia;
• fast fatiguability;
• depression;
• panic attacks;
• dizziness,
• problems with the gastrointestinal tract and musculoskeletal system;
• numbness and tingling of various localizations;
• In parallel, mental abnormalities and emotional instability may be observed.

The etiological factor in the development of the disease has not been fully studied; scientists put forward a large number of theories, which include: sleep disturbance, being female (women are more often affected), genetic predisposition, stress, pathologies of metabolic processes.

Fibromyalgia in women is diagnosed based on the clinical picture, which excludes the possibility of organic genesis of pain. A comprehensive examination includes: a medical interview with the patient, an assessment of his neurological status, painful points are studied, laboratory tests are taken and a tomography is performed. Based on a complete diagnosis, differentiation is made from similar types of ailments and appropriate therapy is prescribed.

Treatment of fibromyalgia will include medicinal and non-medicinal methods, the latter consisting of courses of psychotherapy, physical therapy, acupuncture, and hydrotherapy.

The following medications are prescribed to the patient: antidepressants, anticonvulsants, analgesics and anesthetics. The medicine for fibromyalgia is selected individually, the dosage is prescribed, which must be followed without fail.

The prognosis will depend on the implementation of medical recommendations, timeliness of taking medications, taking into account the prescribed dosage.

What is fibromyalgia

Doctors say that fibromyalgia is a manifestation of an extensive chronic symptom complex caused by pathological changes in the nervous and endocrine systems. They are caused by a deficiency of a number of hormones and insufficiently active action of neurotransmitters responsible for the human psyche. As a result, the pain sensitivity threshold decreases. As a result, various types of exposure, usual for a healthy person, cause a violent psycho-emotional reaction with severe pain in a patient with fibromyalgia.

Scientists are also considering the possibility of autoimmune and hereditary causes of fibromyalgia. In this case, the provocateurs are:

• Stress.
• Surgical intervention.
• Injury.
• Viral diseases.
• Malfunctions of the endocrine glands, for example, hypothyroidism.
• Systemic pathologies.
• Lack of serotonin.
• Vaccines and taking certain medications.

The disease most often affects women in the middle age group (40–45 years), although it occurs in 2–4% of the world's population, regardless of gender and age.

Causes

The process of studying the causes of fibromyalgia is still ongoing. Some researchers are studying hormonal and biochemical disturbances that may affect receptor sensitivity. Other experts believe that fibromyalgia, with its characteristic deep muscle pain, is related to stress, illness or injury. Still others believe that there are hereditary reasons. But due to the fact that there is no clear explanation for the causes of this syndrome, all researchers agree that fibromyalgia occurs due to a combination of several factors, and not just one (physical and emotional stress). Recently, studies have appeared on the role of neurotransmitters such as serotonin (low levels in the brain reduce the threshold of pain sensitivity). A decrease in the threshold of pain sensitivity may also be due to the ineffectiveness of neuropeptides such as endorphins and, as a result, an increase in substance P, which enhances pain impulses. Perhaps because women have 7 times less serotonin in their brains than men, fibromyalgia is much more common in women than in men. It is also possible that hormonal factors play a role in women, especially during menopause.

Stress, as well as insufficient sleep, can lead to decreased serotonin levels, which leads to increased sensitivity to pain.

Genetic determination may have a role in the development of fibromyalgia, as pain sensitivity is determined by certain genes. But so far these genes have not been isolated or identified.

Symptoms of fibromyalgia and how it manifests itself

The disease develops unnoticed. Its peculiarity lies in the variability of characteristic features.

Pain localized in one or several places of the muscular-ligamentous apparatus.

As a rule, people consult a doctor with this symptom only after 6-8 years from the moment of its first appearance. The cervical and occipital areas, points on the knees, hips, elbows, and back have increased sensitivity. Their number reaches 18 or 9 pairs, but when 11 of them are detected, the diagnosis of fibromyalgia is confirmed.

Symmetrical pain can be throbbing or monotonous with numbness or tingling in some areas. The intensity of unpleasant sensations is affected by weather conditions, nervous breakdowns, infection, and physical overload.

When pressing on painful areas, the unpleasant sensations intensify, but do not radiate. This symptom is characteristic of fibromyalgia. Control points are located on the middle part of the forehead and thigh, the volar surface of the middle forearm, and on the nail of the first finger of the hand. Psychosomatics is accompanied by pain in these areas. Pressing on them in healthy people does not cause any discomfort.

Other characteristic signs of the disease:

• Fatigue (mild or severe). “Non-restorative” sleep occurs.
• Migraine.
• Muscle stiffness in the morning.
• Poor memory, impaired concentration, perception, and processing of new information.
• Bursts of brain activity that can interrupt the deep sleep phase.

Taking medications over time affects the functioning of the liver, leading to secondary immunodeficiency. Patients also complain of intestinal or motor disorders, photophobia, and painful menstruation. At the same time, the joints and internal organs remain healthy.

Differential diagnosis

A number of other diseases of various nature are also characterized by pain in one or another part of the body, as well as other symptoms that accompany the course of fibromyalgia. These are:

• systemic connective tissue diseases (polymyositis, ankylosing spondylitis, rheumatoid arthritis and others);
• diseases of the endocrine system (autoimmune thyroiditis or other diseases accompanied by hypothyroidism syndrome, diabetic polyneuropathy, and so on);
• degenerative-dystrophic diseases of the spine (the most famous among them is osteochondrosis);
• metabolic diseases (enzymopathies, vitamin D deficiency and others);
• some viral infections;
• malignant neoplasms (paraneoplastic syndrome);
• myopathies that occur while taking certain medications (anaesthetics, glucocorticoids, allopurinol, aminocaproic acid and others).

If a patient exhibits clinical or laboratory changes characteristic of any of the above diseases, he is not diagnosed with fibromyalgia.

Accurate diagnosis

A standard examination does not always give a clear answer. Differential methods are used to exclude other identical pathologies. The doctor checks for the presence of a set of diagnostic criteria characteristic of fibromyalgia:

• Widespread muscle pain throughout the body that does not subside for 3 months.
• Number of painful areas (11 out of 18) that appeared during the last week. More than one diagnostician is involved in their determination in order to eliminate the factor of subjectivity.
• Absence of other pathologies causing pain. We are talking about intoxication, chronic mental disorders, malignant neoplasms, rheumatism, and diseases of the endocrine system.

Some doctors warn their colleagues against overdiagnosis, call fibromyalgia a diagnosis of exclusion and recommend monitoring the patient for a year. Sometimes they send the patient to a psychiatrist, believing that the causes of the condition are most likely in the head.

Symptoms

With fibromyositis, the symptoms manifest themselves quite clearly, which causes serious inconvenience that interferes with everyday activities. Painful sensations are the main symptom of this disease. They can occur in joints, tendons, muscles, upper and lower limbs, back, and even on the surface of the face or throughout the body. The pain ranges from pressing to throbbing, and is often accompanied by a feeling of numbness, tingling, or goosebumps. Some compare it to the burning or aching sensation associated with a bad cold. In most cases, the patient also experiences muscle contractions, during which individual muscles or limbs may twitch. The pathology is not limited to this and causes a number of additional symptoms.

Secondary signs:

• headaches, dizziness;
• dry or burning mouth;
• swelling of different parts of the body;
• decreased quality of sleep, insomnia;
• stiffness of movement in the morning;
• increased fatigue;
• sensitivity to weather changes;
• changes in body temperature;
• gastrointestinal disorders with pain inside the abdomen;
• temporary drop in the quality of attention and memory;
• periodic static-dynamic disturbances;
• worsening mood, depression;
• anxiety;
• bladder irritation.

Sometimes fibromyalgia presents with a full range of symptoms, but most often only a portion of them are detected. Although manifestations of pain, cramps and discomfort always remain an integral part of this disease.

Treatment with medications

For proper sleep and pain relief, the following is prescribed:

• Non-hormonal anti-inflammatory drugs . They are taken topically, since prolonged oral administration irritates the mucous membrane of the digestive canal. The pain subsides with single or systemic infusions of Lidocaine (5 to 7 mg/kg body weight).
• Painkillers: Ibuprofen, Acetaminophen . Dependence can occur after prolonged use of narcotic analgesics such as Tramadol. It reduces pain and improves the patient's well-being, but is associated with serious side effects.
• with muscle tone .
• To eliminate anxiety, drugs from the group of atypical and tricyclic antidepressants (Amitriptyline), as well as Duloxetine and Fluoxetine are prescribed to immediately increase the level of neurotransmitters. The course of treatment lasts 1.5 months.
• Antiepileptic compounds (anticonvulsants), such as Pregabalin (Lyrica), which have a wide therapeutic range, relieve neuroleptic pain of various natures. Specially developed and officially approved for the treatment of fibromyalgia. The dosage, depending on the symptom complex, is selected by the doctor. In case of intolerance, Gabapentin is prescribed - a drug that relieves musculoskeletal pain, but has a long list of side effects.
• Benzodiazepines and other tranquilizers affect slow-wave sleep, so the advisability of their use has recently been called into question.
• Vitamins C and E as antioxidants.

From non-medicinal methods:

• Massage – relieves muscle tension, anxiety, and stress.
• Manual therapy – reduces the intensity of muscle pain and increases joint mobility.
• Reflexology - affects the speed of blood flow and regulation of the level of neurotransmitters responsible for pain.
• Exposure to cold reduces pain, normalizes nerve function, blood microcirculation in muscle tissue, relieves spasms, and restores sleep.
• Local impact of laser irradiation. The method has shown high effectiveness in combination with antidepressants and non-steroidal anti-inflammatory drugs.
• Therapeutic exercise – improves muscle condition, improves mood, normalizes the functionality of the central nervous system. With regular exercise, it is possible to prevent atrophic changes in muscle tissue, improve sleep and well-being, and relieve fatigue and soreness. A set of exercises is selected individually for each patient. At the initial stage, the process is monitored by a rehabilitation doctor, and subsequently performed at home. You can start with water aerobics, stretching exercises, and walks in the fresh air.
• Meditation – promotes deep breathing and helps in controlling fibromyalgia symptoms.

German researchers have reported the effectiveness of acupuncture. And doctors from Volgograd have developed their own method, which also includes in such sessions the local effect of NSAIDs, as well as dimethyl sulfoxide. At the same time, the number of painful points decreased and all clinical signs, including mental disorders, also received positive dynamics.

Lasting relief of the patient's condition is achieved using effective methods of biofeedback and cognitive behavioral therapy. Classes are conducted with the goal of teaching patients to live regardless of pain.

Causes of fibromyalgia

To date, the real etiology of the primary syndrome is still unknown. Several reasons can be assumed; below are the most reliable ones.

• Changes in blood perfusion in the region of the brain responsible for the perception and subsequent processing of pain.
• Changes in peripheral circulation and, in particular, deficiency in blood supply to muscles, caused by problems of the autonomic nervous system and dysfunction of the neurotransmitters serotonin and norepinephrine.
• Changes in certain neurotransmitters, in particular dopamine, which plays an important role in the perception of pain.
• Sleep disorders, in particular, stage 4 sleep - the deepest and most refreshing.
• Stress. These could be illnesses, losses, work problems, emotional stress, physical injuries, viral infections, etc.
• Serious hormonal imbalance. For example, with thyroid dysfunction.

The causes of secondary fibromyalgia are well known; it is a complication of diseases such as:

• Infections;
• Hypothyroidism.

Localized fibromyalgia is often the cause of muscle cramps.

Treatment with folk remedies

Symptoms of fibromyalgia are relieved by using alternative medicine recipes. To activate the vital forces of the body and normalize the functioning of the nervous system, people used tincture of Chinese lemongrass. To do this, take 50 g of leaves, pour a glass of 70° alcohol, keep it in the dark for 2 weeks and take it starting with 5 drops 2 times a day.

Insomnia and excessive irritability were combated with the help of dandelion juice. It was obtained from the whole crushed plant. Stored refrigerated. They drank 30 drops 4 times a day for six months.

A mixture of olive oil (1 l) and 50 g of dry thyme powder. Simmering time on fire is 2 hours. After infusion, use it to massage the back area. Course 2 weeks.

But you shouldn’t rely only on folk remedies. They are not able to cope with the symptoms of fibromyalgia on their own, but are used as an addition to drug and non-drug therapy.

Medical assistance is required already at the “first bells”. Its volume and duration are determined by the doctor, taking into account the severity of the disease, concomitant pathologies, and the patient’s well-being.

Tests confirming muscular fibromyalgia

Diagnosis of fibromyalgia is very difficult and for many years this disease may remain undiagnosed, since patient complaints are attributed to psychosomatic disorders.

Additionally, there are no specific blood tests or other types of tests that can definitively confirm fibromyalgia . Therefore, the diagnosis is based solely on observations of the clinical picture, that is, on the analysis of symptoms and signs.

From the above, it is obvious that fibromyalgia syndrome is very difficult to diagnose. The situation is further complicated by the fact that many symptoms and signs are nonspecific in the sense that they are common to many other diseases, for example, they may indicate polymyalgia rheumatica, Sjogren's syndrome, and polymyositis.

The specialist in charge of the diagnosis is a rheumatologist, who acts in accordance with the diagnostic protocol:

Anamnestic analysis with palpation of 18 “painful” points, 11 of which should be painful.

Often, to exclude other conditions, a rheumatologist prescribes additional tests: radiography, MRI, scintigraphy.

Diet for fibromyalgia

Treatment at home takes place against a special background, which provides a diet that excludes:

• Plants from the nightshade family that aggravate symptoms of fibromyalgia. We are talking about eggplants, peppers, tomatoes and potatoes.
• Simple carbohydrates (sugar).
• Milk and its derivatives, regardless of the level of fat, worsen the dynamics of the pathological condition.
• Caffeine.
• Monosodium glutamate, aspartame.

The list is individual. It is determined by eliminating one product and observing changes in the condition. By recording this data in a diary, you can find out which of them work against a particular patient.

Consequences and prognosis of fibromyalgia

Despite the fact that fibromyalgia is burdensome for the patient and often has a very negative impact on the quality of life, however, this disease does not threaten the general health of the patient. The only consequence that may occur is pathologies of the gastrointestinal tract, in particular irritable bowel syndrome.

Treating fibromyalgia is a long and difficult journey that requires persistence and cooperation with a specialist, even if it is not dangerous to health, except for the psychological consequences.

In our country, unlike some European ones, fibromyalgia is not a basis for disability, despite the severe limitations that the disease can lead to.

Complications and prognosis

Fibromyalgia, as a lifelong diagnosis, has a favorable prognosis with qualified therapy. In childhood, the disease recedes faster. Without treatment, it limits the patient’s activity and reduces the quality of life, although it does not develop and does not affect the functioning of internal organs.

In severe forms of fibromyalgia, significant emotional losses cannot be avoided. Every third person with this diagnosis becomes unable to work. Other more severe disorders await those who abuse sleeping pills, narcotic compounds, and alcohol to reduce pain. Some people find help from Dr. Myasnikov’s forum, where they can share painful problems, read reviews of various medications, and simply find support.

Therapy: care and treatment

Considering the characteristics of the disease and the lack of a clear understanding of the causes of the disease, treatment is carried out individually (there is no specific treatment protocol) and quite often it turns out to be fruitless.

The most commonly used therapies are:

• Rest and physical therapy. It involves rest from the first days, and then the development of a physiotherapy program agreed with a specialist; Swimming usually gives the best results.
• Drug therapy. It is suggested to administer painkillers and anti-inflammatory drugs to keep pain under control. Muscle relaxants are also prescribed to stretch and relax the muscles and antidepressants to prevent the development of psychological problems.
• Psychological therapy. It must be understood that a patient who does not see real improvements may become a victim of depression.

Electromyography of nerves and muscles in fibromyalgia / ENMG in fibromyalgia

Our clinic can offer you specialists who are well acquainted with the topic of fibromyalgia and ENMG diagnostics using modern equipment. The main tasks of electromyography in fibromyalgia:

1. Rule out poliomyositis of an autoimmune nature, myopathy, amyotrophic lateral sclerosis;
2. Differential diagnosis of fibromyalgia and radicular pain caused by compression of the spinal cord roots;
3. Diagnosis of polytunnel syndrome, which often accompanies fibromyalgia (pinching of the nerves of the arms and legs by thickened entheses).

How to Prepare for Electromyography for Fibromyalgia

1. Before the examination, you should not treat the skin in the examination area (arms and legs) with greasy creams.
2. We recommend that you do not take tranquilizers and centrally acting painkillers the day before and on the day of the study (this must be agreed with your doctor).
3. If possible, take with you the results of previously performed studies, including tests, images, consultation data, this may be useful for choosing the most appropriate ENMG technique.
4. Come to us 15-20 minutes before the test to calmly fill out your medical card.

Forms and types of fibromyositis

Types of the disease can be hereditary in nature or appear due to injuries, poor hygiene, or heavy physical exertion. The form of the disease can be chronic and protracted or temporary. In the second case, complex therapy and the use of necessary medications will have a beneficial effect and allow the patient to return to normal life.

The doctor diagnoses the disease according to the appearance of various symptoms in the patient, the main indicator being pain. Discomfort in muscles and joints, the patient sleeps poorly and gets tired quickly. The symptoms are similar to other ailments of the muscles and joints; a specialist will need to conduct an examination. Nowadays blood tests or X-ray tests are done to identify pathology. For isolated fibromyalgia, testing for inflammation is the usual method.

Many patients have no reaction to palpation. At fibromyalgia points, sensitivity appears more in women, less in men.

Which doctor should I contact?

When symptoms of fibromyalgia appear, patients begin to unsuccessfully go from one specialist to another, and most often these specialists do not detect pathology that would be associated with their specialization. You need to contact a rheumatologist; it is this doctor who can make a diagnosis and prescribe treatment appropriate to the situation. In some cases, he may refer the patient for consultation to specialists.

There are no benefits for patients with fibromyolgia, since this pathology does not provide for exemption from work or a pension.

Fibromyalgia in women

Women of childbearing age (20 to 40 years) are diagnosed with fibromyalgia much more often.
This has led researchers to study the role of hormones in the development of this disease. Some scientists suggest that an imbalance of estrogen and progesterone is to blame, and point to shifts in these hormones during pregnancy, childbirth and menopause. Other causes in women may include:

• Genetics: Women who have relatives with this disease are more likely to be diagnosed with fibromyalgia.
• Viral infection: Viral infections such as herpes simplex virus have been associated with the development of fibromyalgia.
• Trauma: Physical or emotional trauma also correlates with an increased risk of this disease.
• Dysfunctional pain processing: Many researchers agree that one of the main causes of fibromyalgia is dysfunction in the central nervous system (CNS) pain processing.

The leading symptoms of fibromyalgia in women are:

• Increased pain, for longer periods of time
• Pain during sex
• Painful menstrual cycle
• Migraine
• Feeling tired and depressed
• Increased levels of irritable bowel syndrome and painful bladder syndrome
• Restless legs syndrome
• Increased general sensitivity to light, loud sounds, smells and temperature.

Women experience pain differently than men, and this often plays a big role in the diagnosis of this disease. The average diagnosis time is often two or more years.

Diagnosis of fibromyositis

Important diagnostic criteria include the presence of painful points. This sign allows you to differentiate fibromyalgia from other pathologies accompanied by musculoskeletal pain.

The symptom is considered positive if the subject experiences pain with finger pressure with a force of ≤ 4 kg. There are 18 possible points, located mainly in the lumbar region, sacrum, buttocks, back and shoulder girdle. If 11 or more of them are detected, the diagnosis of fibromyalgia is considered confirmed.

note

For greater objectivity, the study should be carried out by several diagnosticians. To identify the patient’s pain threshold, control zones are palpated (in particular, above the head of the fibula).

When making a diagnosis, anamnesis is taken into account (according to the patient). The doctor needs to pay attention to such manifestations as lack of motivation, difficulty moving, decreased ability to plan tasks, and a decrease in normal (household) activities.

Risk factors

Certain factors can make a person more susceptible to developing the disease, so it is worth knowing these risk groups:

1. Female. The disease progresses precisely in the body of the weaker sex, especially actively during menopause.
2. Injuries. At the same time, injuries are both physical and emotional, which are debugged in memory from childhood and lead to mental illness, and, therefore, fibromyalgia.
3. Increased state of psychological vulnerability. People who have a weak psyche are the main patients with fibromyalgia.
4. Age. Disorders of the muscular system predominate in people in the age group from 25 to 40–50 years. Activation and progression of the disease is also observed in children aged 12–15 years, presumably associated with emotional and physical trauma.
5. Genetic inheritance. The development of ailments and heredity cannot be ruled out. If people suffer from manifestations of muscle tissue disorders, then the occurrence of these symptoms in future descendants cannot be ruled out.

Pathogenesis

Chronic muscle pain that accompanies the disease is caused by prolonged overexcitation of neurons located in the spinal cord. This condition can occur due to injuries, peripheral syndromes, as a result of infectious processes, stress, and hormonal disorders. The main role in the pathogenesis of fibromyalgia is assigned to serotonin and noradrenergic systems. Since the hormone serotonin is responsible for a person’s mood, when its concentration decreases (which happens with fibromyalgia), the patient develops depressive states.