Fibromyalgia is a very serious social problem, defined as a syndrome of generalised pain that poses many difficulties, both diagnostic and therapeutic. It significantly reduces the quality of life of sufferers through chronic pain and other associated conditions, such as chronic fatigue and sleep disturbances. It often interferes with social functioning to the extent that the patient is unable to work or function normally in their environment.
Table of contents:
- What is FMS?
- How do we define fibromyalgia?
- Incidence of FMS
- Division of FMS
- Causes of FMS development
- FMS in the clinical picture
- Diagnosis
- Diagnostic criteria
- Therapy
Fibromyalgia is a very serious social problem. It is estimated that between 10% and 25% of people with this condition are unable to work or require special modification of their working conditions. In addition to the pain characteristic of the condition, mood disorders, sleep problems or a sense of chronic fatigue have a significant impact on reducing quality of life. [2]
What is FMS?
Fibromyalgia (FMS) is a condition in the group of rheumatic soft tissue diseases that can take both localised and generalised forms. The localised form of fibromyalgia can include myofascial pain syndrome, enthesopathies, inflammation of tendons and bursae, as well as conditions that cause compression of peripheral nerves, resulting in, for example, carpal tunnel syndrome. In the generalised form, there is a multifocal, chronic pain that causes chronic stress, which can lead to anxiety, sleeping problems or even depression.
How do we define fibromyalgia?
As defined by the American Society of Rheumatology, FMS is a syndrome of generalised pain with soft tissue tenderness. The pain may worsen, diminish or even disappear completely, as well as changing its location. FMS sufferers experience feelings of chronic fatigue and have significant sleep problems.
Incidence of FMS
The prevalence of FMS is estimated to be around 2% to 4% of the population, with a higher incidence in women than in men. Symptoms most often manifest in middle age, but it is not impossible for the first symptoms to occur in teenagers or the elderly. Risk groups at risk of developing FMS include people with rheumatological conditions such as osteoarthrosis, lupus erythematosus (TRU), rheumatoid arthritis (RA), people exposed to chronic stress, with high ambitions, but also unemployed people. A general incidence trend is outlined, which is directly proportional to age and education level.
Breakdown of FMS
The specialist literature distinguishes two categories of fibromyalgia. The first, primary fibromyalgia, is directly related to psychogenic factors. The second category is secondary fibromyalgia, which is associated with rheumatological diseases or inflammatory bowel disease. It is also thought that physical trauma may be a generating factor in the development of FMS.
Fibromyalgia, photo: panthermedia
Causes of FMS development
The aetiology of the onset and development of FMS is not fully understood or clear today. According to clinical studies, several factors predisposing to its development can be distinguished. These include HBV, HCV and HIV. There are also indications that genetic factors are involved, but so far three genes have been identified that are only correlated with the development of the disease, and are not directly responsible for its expansion. Genetic factors are, however, very important in relation to individual pain tolerance.
In people with FMS, some changes in the secretion of serotonin, dopamine and norepinephrine have been found, similar to changes in people with depression or anxiety disorders. Reduced levels of the aforementioned hormones are found in the cerebrospinal fluid of these individuals, indicating dysfunction of the central monoaminergic systems. Weakening of these systems leads to impaired perception of stimuli and increased pain perception. [1]
Research in recent years has indicated that immunological disorders may also be a factor responsible for the development of FMS. The study concluded that the body's inflammatory response can have a significant impact on the development of FMS. In addition, a correlation was found between the concentration of the relevant cytokinins and the severity of clinical symptoms, particularly pain. The researchers also emphasise the importance of personality traits, mood disorders and cognitive impairment.
Unfortunately, from a diagnostic point of view, fibromyalgia is an extremely difficult diagnosis to make and poses major problems. The nature of the complaints is largely subjective and difficult to verify or confirm by the physician in objective tests and examinations, further complicating the diagnostic process. [2]
FMS in the clinical picture
Fibromyalgia is a chronic condition that manifests as pain in various locations, often accompanied by tissue tenderness, a feeling of pressure in the affected joints, sensitivity to touch, increased muscle fatigue, a sense of chronic fatigue combined with sleep disturbances.
Sleep disturbances are characterised by a feeling of tiredness just after waking up. There may also be problems with memory function and concentration. Some patients may also experience episodes of symptoms related to depression, headaches (paroxysmal or migraine), gastrointestinal complaints such as gastrointestinal disorders or reflux. Bladder problems may occur, as well as associated conditions (such as Rajmund's syndrome) and various types of addiction.
Symptoms may be relieving or exacerbated by the stress experienced. The triggering factor is important for the onset of the disease, which may be back pain, joint inflammation or some other type of mechanical injury, but severe stress can also be a trigger in this situation. Acute pain may be relieved or relieved by analgesics, but chronic pain is not relieved by analgesics.
Diagnostics
To diagnose FMS, observation of clinical symptoms is necessary. Unfortunately, no additional tests, such as biochemical tests or imaging studies, are applicable in the diagnostic process of fibromyalgia, and their usefulness lies in the exclusion of other conditions. Previously, the number of tender points on touch was a diagnostic criterion, but this way of diagnosing FMS is now being abandoned, which does not change the fact that a physical examination is necessary to determine the tender points on the body. In the indication of the diagnosis, it is necessary to refer to the pain patterns in order not to confuse FMS with the similar symptoms of rheumatoid arthritis or systemic lupus erythematosus.
Fibromyalgia, photo: panthermedia
Diagnostic criteria
To make a diagnosis of FMS, the following symptoms should be observed:
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pain and other symptoms in 18 isolated parts of the body, occurring within 1 week prior to the examination,
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persistence of symptoms for at least 3 months,
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consideration of the severity of symptoms such as fatigue, impaired memory and thinking, concentration problems,
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exclusion of other medical conditions. [1]
Therapy
Like the diagnostic process, the therapeutic process is also fraught with difficulties, as it depends on many individual factors related to both the course of the condition itself and other associated ailments. Due to a lack of sufficient knowledge of the aetiology and pathogenesis, effective causal treatment is not possible. Therapy is therefore multidirectional, incorporating a variety of approaches. [2]
From a pharmacotherapy perspective, antidepressants (especially when the patient has a depressive disorder) and non-steroidal anti-inflammatory drugs (NSAIDs) can be used.
Due to the presence of symptoms such as fatigue or concentration problems, a psychiatrist plays a major role in addition to the rheumatologist, and appropriate psychological therapy is undertaken. Physical rehabilitation (physiotherapy) of such people is also effective, especially in terms of controlling the severity of pain and alleviating it to improve quality of life. [1]
