2023-04-21 04:24:23
Fibromyalgia is one of the most common pain syndromes. Since between 2% and 4% of the entire population suffer from fibromyalgia, it is likely that each and every one of the readers of this article has met or knows someone who suffers from fibromyalgia.
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Awareness of the characteristics of fibromyalgia syndrome has been increasing in recent years both among the medical community and the general population. At the same time, even today there are significant gaps in our understanding regarding the essence of fibromyalgia syndrome, the factors that cause it and the best treatment.
In recent years, a new understanding regarding the nature of the pain experienced by fibromyalgia patients has been taking shape, and this understanding reflects the comprehensive approach to chronic pain of various types.
What is fibromyalgia?
Fibromyalgia is a syndrome that is manifested by a combination of several main symptoms. Chronic pain is the main element that defines fibromyalgia, but certainly not the only one. The pain is chronic, meaning it lasts at least several months, and often – many years. It is a generalized pain, in all parts of the body, involving the muscles and joints and not located at a specific point.
In addition to pain, it is typical to encounter chronic fatigue, with significant sleep disturbances. These include difficulty falling asleep, very shallow sleep with multiple awakenings and a feeling of complete lack of freshness in the morning.
Other typical symptoms include, concentration and memory disorders (sometimes called “fibromyalgia fog” or Fibrofog), digestive system dysfunction with irritable bowel, abdominal pain, diarrhea and/or constipation, abdominal swelling and bladder dysfunction with frequency and urgency to urinate.
A significant number of people suffering from fibromyalgia (but certainly not all) may simultaneously suffer from symptoms of anxiety and depression. In some people these symptoms seem secondary to the physical condition, while in others the mental aspect seems more central.
Contrary to popular belief, fibromyalgia is easy to diagnose
Contrary to popular belief, fibromyalgia is easy to diagnose. In fact, once a person suffers from chronic generalized pain accompanied by significant sleep disturbances and fatigue, the diagnosis of fibromyalgia should be on the table.
However, it is important to emphasize that even when these symptoms are present, it is very important to perform a relevant medical examination in order to rule out other possible causes of the symptoms, such as arthritis, the effect of medications and other diseases.
Why and how does this happen?
Despite the abundance of research that has been carried out, the initial cause of the development of fibromyalgia syndrome is still not known with certainty. The accepted assumption is that in this situation, as in other complex syndromes, it is ultimately a combination of an innate genetic predisposition, which causes some people to be more prone than others to develop the syndrome, and exposure to various (and cumulative) triggers during life, which ultimately lead to the development of fibromyalgia. Such triggers include, among others, injuries, especially to the spine and head, infectious diseases, such as the kissing disease or corona, and mental stress.
Regarding the stress factor, many studies have pointed to the relationship between various types of stress, including traumatic events at a young age, and the development of fibromyalgia syndrome. At the same time, it is important to remember that such a relationship cannot be identified in every case and that the factors are most likely ultimately many and complex.
Regarding the question of how this happens, in recent years considerable research information has been accumulated, using advanced techniques of functional brain imaging, through which you can look at the central nervous system in real time and see how it processes pain.
Studies of this type show that in people suffering from fibromyalgia there is a general increase in pain transmission and in other words – a decrease in the natural ability of the nervous system to filter pain signals. In a very rough analogy it can be said that this is a situation where the volume knob of an amplifier is turned all the way to the right and makes every sound unpleasantly loud. Thus, in fibromyalgia patients, even a light touch or even a hug is processed in an increased way by the nervous system and turns into a feeling of pain.
How are you treated?
The treatment of fibromyalgia is complex and multidisciplinary. There are indeed a number of drugs that are used to alleviate the symptoms, but unfortunately these drugs are only useful for some patients, and even then not completely. Some patients also report improvement by being treated with medical cannabis, although more research is needed on this topic.
Today it is accepted to combine the drug treatment with other treatments that are very important. First and foremost, regular and gradual physical activity, but in addition complementary treatments such as hydrotherapy and treatments that combine movement and meditation (Tai Chi, Qi Kung, etc.). In addition, there is a place for psychotherapy with an emphasis on cognitive-behavioral therapy (CBT).
At the same time, attempts are being made to influence the central nervous system through advanced experimental treatments such as hyperbaric oxygen therapy (pressure chamber), neurofeedback and more.
Fibromyalgia can become a frustrating chronic condition, a condition that greatly impairs quality of life and function. However, there are patients who improve over time and there are even studies that show that after time, not all people diagnosed with fibromyalgia still meet this definition. It is important to persist in the treatment, with an emphasis on physical activity, and to try to maintain as high a level of function as possible.
Unfortunately, people suffering from fibromyalgia may sometimes encounter reactions of incomprehension and even distrust from those around them. Because fibromyalgia patients “don’t look sick”, don’t suffer from deformities of joints or other visible signs, they may hear statements like “It’s all in your head!”. There is nothing more frustrating than this for patients, and therefore it is important to increase awareness of the syndrome and knowledge about it.
What’s new?
In recent years there has been a revolution in the understanding of the issue of chronic pain which goes beyond the field of fibromyalgia and concerns all aspects of pain in general. In the past it was common to divide pain into two main types: nociceptive pain which originates from damage to peripheral tissues, and neuropathic pain which originates from damage to peripheral nerves. Now, another category has been added: Nociplastic Pain. This pain is a pain caused not by damage to the tissues and nerves, but by the processing of the pain within the central and peripheral nervous system.
Fibromyalgia is in fact the classic condition in which nociceptive pain plays a central role, but in fact today elements of nociplastic pain can be identified in many people suffering from pain for various reasons. In fact, in many cases there are several chronic pain mechanisms at the same time, and the doctor must try to find the causes of the different types of pain and treat accordingly. Thus, from the study of fibromyalgia, our understanding of the complexity of the phenomenon of chronic pain in general has expanded, and the ability to optimally treat pain in each and every patient has been refined.
What in the future?
The hope is that the more deeply we understand the mechanisms of nociplastic pain, both at the level of genetics, at the level of brain function, at the level of functional imaging, etc., it will be possible in the future to adapt specific treatment for patients suffering from fibromyalgia and complex types of chronic pain.
It is important to emphasize that we still do not have good enough treatments for these patients, so progress of this type is critical in order to bring relief to a large population of people suffering from this frustrating syndrome. However, there is no doubt that this is a fascinating and innovative field of research that is expected to bring results in the future.
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