The work "Mujer Llorando" by the Colombian artist Fernando Botero. source: https://www.efesalud.com/fibromialgia-una-muerte-a-fuego-lento/

Fibromyalgia

The word fibromyalgia (FM) means pain in the muscles and fibrous tissue (ligaments and tendons). Fibromyalgia is characterized by generalized musculoskeletal pain and painful sensation at pressure at specific points (painful points). This pain is similar to that originating in the joints, but it is not a joint disease.

Fibromyalgia is common, affecting between 2% and 6% of the population, mainly women. It can present as the only alteration (primary fibromyalgia) or associated with other diseases (concomitant fibromyalgia).

Symptoms

In general terms we can say that fibromyalgia consists of an anomaly in the perception of pain, so that they are perceived as painful, stimuli that usually are not. In addition to pain, fibromyalgia can cause generalized stiffness, especially when getting up in the morning, and ill-defined sensation of inflammation in hands and feet. There may also be poorly defined tingling that affects the hands in a diffuse manner.

The person who seeks the doctor's help often says "everything hurts", but other times it is referred to as burning, discomfort or discomfort. Pain often varies in relation to the time of day, activity level, climate changes, lack of sleep, or stress.

In addition to pain, fibromyalgia causes many other symptoms: 90% of patients are tired, 70-80% sleep disorders and up to 25% anxiety or depression. Symptoms such as poor stress tolerance, general feeling of stiffness (especially when getting up in the morning), ill-defined feeling of inflammation in hands and feet, tingling that affects hands diffusely, migraines, menstruation pains, irritable colon, dry mouth and eyes are also very common.

Causes

The cause of this alteration is not known, but it is thought that there are many factors involved. There are people who develop the disease without apparent cause and in others it begins after identifiable processes such as a bacterial or viral infection, a car accident or in other cases it appears after another known disease limits the quality of life (rheumatoid arthritis, lupus erythematosus, etc.).
These triggering agents do not appear to cause the disease, but what they probably do is wake it up in a person who already has a hidden abnormality in the regulation of his ability to respond to certain stimuli.

Diagnosis

Fibromyalgia is recognized as a syndrome, which means that the rheumatologist identifies it when he finds in a certain person some alterations that agree with those that have been previously fixed by experts for their diagnosis.

It is very important to establish a firm diagnosis because it saves a pilgrimage in search of diagnoses or treatments, improves the anxiety caused by feeling ill without knowing why and allows realistic objectives to be set.

Treatment

There is no definitive cure for the disease. The aim of the treatment is to improve the pain and treat the accompanying symptoms in order to achieve a great improvement in the quality of life of these patients.

Fibromyalgia is not an invented disease. For years the suffering of many people has been underestimated, despite the fact that it has been recognised by the WHO since 1992.

According to the Spanish Society of Rheumatology, it affects almost one and a half million Spaniards (95% of them women), and although it is known to be caused by an alteration in the perception of pain at brain level, its treatment alleviates symptoms, but does not cure.

Unfortunately, diagnosing it becomes an odyssey that lasts, on average, 7 years.
It is important to know the nature of the illness and which are the factors that trigger outbreaks, to carry out treatment of the associated psychological alterations if any (anxiety and depression) and soft physical exercise on a daily basis.

The central symptom is the generalized pain in muscles, joints and ligaments, accompanied by:

Severe tiredness and muscular rigidity that appear in the morning ("I can't get up") and that worsen with rest.
Sleep disturbances.
Loss of memory and difficulty concentrating.
Headache.
Anxiety and sadness, derived from the inability to lead a normal life.

Although the pain is constant, the symptoms of fibromyalgia appear as outbreaks. There are phases of stability and others in which they worsen. Each person evolves in a different way. Therefore, it is difficult to define the causes of fibromyalgia and a single treatment that works in all cases.

HOW THE DIAGNOSIS IS MADE?

If you suspect that the constant pain may be fibromyalgia, see your family doctor. After assessing your situation, he or she may refer you to the specialist fibromyalgia hospital unit in your area.

There are no specific analytical tests to validate the diagnosis. The physical examination serves to rule out other ailments, and consists of blood, thyroid and immune tests, bone x-rays of the parts of the body that hurt, chest and electrocardiogram.

There is no analysis to confirm the disease but locating the "trigger points" is effective.

So how is the diagnosis of fibromyalgia made? Doctor Joaquim Fernández- Solà, expert in Fibromyalgia, Multiple Chemical Sensitivity and Chronic Fatigue Syndrome at the Hospital Clínic in Barcelona, gives us some clues.

Currently, for the most defined diagnosis possible, the clinical criteria of the American College of Rheumatology are followed:

There are 18 locations in the body (called "trigger points") that are more sensitive to pain in people suffering from fibromyalgia. If 11 of these points react, it is a signal to consider.

The Generalized Pain Index (GPI), which groups these trigger points into more general areas, is also applied.
It combines the control of painful points with checking for symptoms such as fatigue, unrepairing sleep and lack of mental agility that are not related to a pathology and that last more than 3 months.

Checking the eyes. Published in the magazine "PLoS ONE", it observes if there is a thinning of the layer of nervous fibers of the eye, by means of a tomography. The visual loss gives clues as to whether there is an irregularity in the central nervous system, which is what regulates the changes in the regions of the brain associated with pain.

A thumb test. Based on applying pressure, heat and cold, and clamping on a thumb for 1 minute, and explained in the "Journal of Pain Research". It is a simple and comfortable way of both detecting the disease and measuring its degree (mild, moderate or high).

By the way of walking (speed, length of step, pressure of the foot). This is what you consider to be a reliable diagnostic method of the University of Granada.

IS THERE AN EFFECTIVE TREATMENT FOR FIBROMYALGIA?

There is no way to cure this disease but the treatment of fibromyalgia must be personalized and includes diet guidelines, exercise, psychological support and drugs to alleviate symptoms. Thus, a team of different specialists may be involved in planning and reviewing the treatment.

They will inform you and your family about the details of fibromyalgia and what it means to live with it.
They will recommend a varied and balanced diet that protects you from cellular wear and tear and from accumulating toxins.

A balanced diet protects you from cellular wear and from accumulating toxins that cause pain.

You should eat fresh fruit and vegetables (pomegranate, red fruits, orange, pineapple, apple for vitamins and fiber; green leafy vegetables that provide minerals such as calcium, iron, magnesium and potassium; virgin olive oil, blue fish and nuts, which are "good" fats; and an ounce of dark chocolate every day, because it contains tryptophan, which relieves pain and reduces stress.

Avoid additives and toxins. Try not to fry or eat processed products. Wash food well and, if you can, opt for organic.
Do gentle physical exercise: walk, dance or low-impact aerobic beam (also in water, which should be over 28º). The ideal is 30 minutes a day in blocks of 10 minutes, 3 to 5 days a week.

Practice physical activity respecting the rhythm of your body.

Yoga, taichi or pilates (without forcing your arms or stretching for a long time) 2 days a week help you take care of your posture and balance, and relax your mind.

Psychological therapy is a way of knowing how to deal with pain and its impact on daily life.
The drugs that can prescribe you act punctually on the symptoms. They are antidepressants to improve mood and reduce anxiety, and anticonvulsants to reduce pain.

For Dr. Joaquim Fernández-Solà it is advisable to accept and adapt to the illness, and to respect the body's rhythm: "The illness is there, but it is not degenerative. Take advantage of the good phases and don't anticipate the bad spells or focus on the fact that you always feel pain.

Dr. Cayetano Alegre, Doctor of the Rheumatology Unit of the Vall d'Hebron Hospital (Barcelona), also talks to us about this: "It is fundamental that fibromyalgia patients lead an active life. That they do moderate exercise and start slowly, that they try to work so as not to disconnect from the social environment, that they have an active intellectual and sexual life. That will help them improve their self-esteem and avoid depression, too.

It is important to establish the best conditions for a restful sleep. Have a bed that is not excessively soft or excessively hard, as well as a low pillow. Avoid the ingestion of stimulant substances and drinks, extreme temperatures and noises and lights.

Analgesics partially reduce pain and you should only take them if your doctor tells you to. Other groups of medications used are muscle relaxants that should be taken in short courses and some antidepressant drugs that increase serotonin levels and improve fibromyalgia symptoms, but all of them should be given under a doctor's prescription.

Evolution

In spite of having a benign character because it does not produce physical sequels (it does not destroy the joints, it does not cause irreversible injuries or deformities) nor influences the survival of the patient, the impact it causes in the quality of life of those who suffer from it is very variable from one person to another and can be limiting.

Other Treatments

Fibromyalgia treatments are not curative, as their causes are unknown, so they are aimed at relieving patients' symptoms.
Before starting treatment, experts must make sure that the diagnosis is correct. The specialists will then proceed to explain to the patients what the disease is and what exactly is going on. Finally, they must involve them in the approach and in the therapies by means of positive life guidelines, sport and pharmacological treatment.
As indicated by the SER, treatment has three fundamental aspects:

Drugs against fibromyalgia:

The patient can follow a treatment with analgesics or classic anti-inflammatory or incorporate pain modulating drugs: antidepressants and anticonvulsants mainly. The aim is to improve sleep, fatigue, depression, muscle spasms and pain. In the most severe cases, several of these drugs can be combined, under a doctor's prescription.

Sport:

Experts recommend progressive, gradual and constant aerobic physical exercise. Enrique Hornilla, rheumatologist at the University of Navarra Clinic, highlights the effectiveness of swimming pool exercises and hydrotherapy.

Psychological therapies:

This aspect of the treatment is fundamental to teach the patient how to deal correctly with fibromyalgia. Specifically, "meditation techniques and even hypnosis have been shown to reduce pain," says Dr. Hornilla.
Both sport and psychological therapies tend to improve some symptoms, mainly pain, depression, autonomy and the patient's quality of life.

On the other hand, in recent months there has been talk of the effectiveness of ozone therapy in treatment. However, experts point out that there are no scientific studies to support its effectiveness.

Other data

Forecast

Fibromyalgia is a chronic disease, therefore it will be maintained throughout the patient's life. In the course of the disease, the evolution of symptoms may improve or worsen depending on each case.
The studies that have been carried out so far on the prognosis are not good. However, SER points out that these studies were carried out before the introduction of new drugs and recommendations to treat this pathology.
Some patients may have some degree of disability. The prognosis in these cases will depend on treatment, especially non-pharmacological treatment.

Quality of life

At present there are a large number of people with fibromyalgia who lead a normal life. However, if the disease takes a long time to be diagnosed or the appropriate intervention is not carried out, the patient's quality of life gradually decreases.

The importance of this pathology lies in the fact that it affects all areas of the patient's life and the patient may develop a disability that may even interfere with his or her work environment. According to several studies, between 15 and 20 and up to 50 percent of patients have to leave their jobs.