fibromyalgia
GENERAL ASPECTS
WHAT IS FIBROMYALGIA?
Fibromyalgia is considered a disease by the World Health Organization (WHO). It presents with chronic generalized musculoskeletal pain. It is often associated with chronic fatigue, sleep disturbances and cognitive problems.
In Spain, it affects 2.5-3% of the population (4% women; 0.2-0.5% men).
It is not a genetic disease, although the risk in first-degree relatives is 8.5 times higher than in the general population.
HOW AND WHY DOES IT APPEAR?
We do not know what the cause is, but we know more and more about the risk factors and the mechanisms by which it is triggered.
Historically it has been considered as a musculoskeletal disorder, but nowadays we relate fibromyalgia to an alteration in the pain processing mechanisms in the central nervous system (CNS). It is, therefore, a central sensitization syndrome. Probably, there is an increased response of nociceptors (pain receptors located in the dermis) to stimuli, as well as a hyperactivation of different brain areas related to pain that is maintained over time. There has been speculation about the possibility of an underlying immunological mechanism, but this has not been demonstrated and there is insufficient evidence.
HOW DO WE DIAGNOSE IT?
The diagnosis is clinical. A proper differential diagnosis is essential to rule out other rheumatologic, systemic and/or neurologic diseases. For this reason, the specialist may request different complementary studies.
HOW DO WE TREAT IT?
The approach must be multidisciplinary to be successful in controlling the disease. It is important to know that this is not a serious disease but it is a chronic disorder that can greatly affect the quality of life. Therefore, it is necessary to take a series of therapeutic measures that must be maintained over time.
- Physical activity. A therapeutic exercise program guided by a physical therapist is highly recommended to address both chronic pain and fatigue.
- Stress management measures. Emotional factors are closely related to abnormal pain processing in the CNS and central sensitization. Relaxation techniques, cognitive-behavioral therapy, therapeutic yoga or mindfulness can help in symptom control.
- Pharmacological treatment. Tricyclic antidepressants and dual antidepressants, among others, are effective in the treatment of chronic pain. The increase of neurotransmitters such as serotonin, noradrenaline and/or dopamine could act by interfering with central sensitization mechanisms. Other drugs such as gabapentin and pregabalin are also widely used.
FREQUENT QUESTIONS
Is it normal for me to have memory problems?Cognitive problems are very common in fibromyalgia. Of particular note are “mental fog”, attentional deficits and problems in executive functions (planning, mental flexibility and decision making). We should be reassured that we cannot establish any relationship between these problems and the risk of developing neurodegenerative dementia. An evaluation and a cognitive stimulation program by neuropsychology may be advisable if the cognitive alterations affect the social or occupational level.
Can insomnia and fibromyalgia be related?
Yes, according to current evidence, sleep disturbances could, along with other factors, favor the development of fibromyalgia. On the other hand, insomnia is a common problem in people with fibromyalgia and is included in the diagnostic criteria, as is fatigue. It is therefore necessary to address and treat sleep problems in consultation.
Links of interest
https://inforeuma.com/enfermedades-reumaticas/
These contents are merely informative.
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