Fibromyalgia

Description

Fibromyalgia syndrome (FMS), or fibromyalgia for short, describes a pain syndrome that can cause discomfort in various parts of the body. Characteristic is a pressing pain at up to 18 fixed points (tender points), which are located in muscles, connective tissue and bones. Synonymous terms for this clinical picture are soft tissue and muscle rheumatism, as well as fibrositis.

So far, a connection with psychological (depressive mood), functional and vegetative disorders (e.g. irritable bowel syndrome) is also known. Exact triggers for these concomitant diseases as well as fibromyalgia itself are still unknown.

In Central Europe, about 1-2% of the total population suffer from FMS, among them women more often than men.

How and why FMS develops is still unclear. There are several theories, but they differ significantly from each other.

On the one hand, it is assumed that the processing of pain stimuli in the brain as well as in the spinal cord could have been impaired after trauma or operations. Others believe that a viral infection is the trigger; to date, no pathogen has been identified.

However, the increased concentration of substance P in the cerebrospinal fluid (nervous fluid) is regarded as certain. This is a messenger substance that is involved in pain conduction and sensitisation of nerve cells in the spinal cord. Investigations into this are currently ongoing.

Another striking feature is the generally low concentration of IGF-I (insulin-like growth factor I) in FMS patients, but this correlation has not yet been confirmed or explained.

For orientation purposes, the American Rheumatic Society (ACR) has established diagnostic criteria since 1990. According to this, at least 3 body regions must be affected by pain for longer than 3 months. In addition, at least 11 of the 18 tender points must be painfully palpable.

Tender points (TP) are found in muscles and tendon attachments. They are about 1 cm in size and cause pain with even light to medium tactile pressure. These can radiate either into the respective muscle or also into the associated region. With some experience, the examining physician can also palpate changes in the structure of the connective tissue in TPs.

Other symptoms:

• Difficulty concentrating
• General malaise
• Listlessness
• Sweating
• Cold toes and fingers
• Feeling of heaviness and stiffness in face, hands and feet
• Sleep disturbances
• Nausea
• Indigestion
• Heart and circulatory problems
• dry mouth
• Headache, migraine
• Difficulty swallowing
• Difficulty urinating
• Menstrual irregularity
• tremor

In order to diagnose fibromyalgia, the attending physician requires a detailed medical history (questioning) as well as a physical examination. This includes a documentation of all pressure-sensitive and painful tender points. These are located bilaterally in the following areas:

• Neck: Base of the neck muscles
• Cervical spine: transverse processes of the cervical vertebrae 5-7
• Shoulder muscles: upper edge of the M. trapezius, M. supraspinatus
• 2nd rib near sternum
• Elbow: near the sternum
• Pelvic bones: Below the iliac crest
• Hip bone: behind the palpable protrusion
• Knee: inside, directly above the joint

If 11 of the 18 TPs are palpable with pain for more than 3 months, fibromyalgia is very likely.

Blood tests and X-ray examinations are also useful, but serve rather to exclude or diagnose concomitant diseases. These can be e.g.: the following:

• Rheumatic diseases (rheumatoid arthritis, Bechterew's disease)
• Chronic inflammatory muscular diseases (dermatomyositis, EMS - eosinophilic myalgia syndrome, polymygalia rheumatica)
• Chronic viral infections
• Psychological diseases

The symptoms of fibromyalgia are similar to those of chronic fatigue syndrome (CFS). In both, laboratory values tend to be unremarkable.

It may be useful to involve an experienced psychotherapist in the treatment.

Due to the unexplained origin of fibromyalgia, no causal treatment is possible. However, symptoms and management of the disease can be optimized. The following methods (also combined) can be used for this purpose:

• Endurance sports or cardiovascular training (under the supervision of a sports therapist).
• Cognitive behavioural therapy (often achieves improvements over several months to years)
• Operant pain therapy
• Gymnastics
• Heat therapy
• Cold therapy (whole body)
• Connective tissue massages
• Relaxation exercises
• Bio-feedback

Classic or tricyclic antidepressants (e.g. the active ingredient amitriptyline) are particularly suitable for long-term treatment with medication. These relieve pain and at the same time improve sleep and general condition.

Alternatively, but less tested, preparations with serotonin reuptake inhibitors and specific antiepileptic drugs are available.

Targeted pain therapy is also possible through osteopathy, acupuncture or painkillers (especially tramadol).

The symptoms of FMS usually remain constant over the long term, it is a chronic disease. From the age of 60, the symptoms tend to decrease.

Improve lifestyle

Targeted preventive measures are not known, as the cause of fibromyalgia has not yet been identified. However, the following advice can help prevent symptoms from worsening if the condition is present:

• Avoid stress
• Plenty of physical exercise
• Relaxation (e.g.: with yoga or meditation)
• Healthy diet (lots of vegetables and fruit!)