The Fibromyalgia (FM) is a chronic pathology, characterized by the presence and development of painful points throughout the musculoskeletal system and, in addition, affects mostly women (Guinot et al., 2015).
People with fibromyalgia describe their medical condition as a constant pain situation, with significant increase in sensitivity at various body sites and continuous physical fatigue (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2014).
Although its etiologic causes are not known with accuracy, its pathological course has been related to a dysfunction of the nociceptive system, responsible for the processing of information related to pain (Ministry of Health, Social Policy and Equality, 2011).
At the clinical level, episodes of pain are usually accompanied by persistent fatigue and tiredness, alterations related to sleep-wake cycles, headaches, intestinal and genitourinary pathologies, or cognitive symptoms (Laroche, 2014).
In addition, this medical picture supposes a serious alteration of the quality of life, since it has a strong impact on the labor capacity, the daily activities or the social interactions (Guinot et al., 2015).
As for the diagnosis of fibromyalgia, it is based essentially on the identification of the symptoms, according to the diagnostic criteria of the American College of Rheumatology. However, there is no diagnostic test that allows us to confirm its presence unequivocally (García, Martínez Nicolás and Saturno Hernández, 2016).
The treatment of fibromyalgia, like other chronic pain, requires a multidisciplinary approach, characterized by pharmacological-analgesic therapy, physical therapy and psychological therapy (Laroche, 2014).
Definition of fibromyalgia
Fibromyalgia (FM), is a chronic medical disorder that is characterized by the presence of generalized musculoskeletal pain at the body level, accompanied by fatigue, altered sleep patterns, cognitive and mood deficits, among others (Mayo Clinic, 2015) .
Specifically, the term fibromyalgia derives from the Latin term fibro, used to designate fibrous organic tissue and the Greek terms mio, used to refer to muscle and algias, to refer to pain (Natio- nal Institute of Arthritis and Musculoskeletal and Skin Diseases, 2014 ).
The first inclusions of the term fibromyalgia in the medical literature, appeared in 1975, by Dr. Kahler Hench, who used it to refer to the presence of muscle-type pain without a clearly established organic origin (Institute of Cognitive Neurology, 2016) .
However, it was not until 1990, when the clinical criteria for the classification of this medical entity were accurately established, they were developed by the American College of Rheumatology (Institute of Cognitive Neurology, 2016).
Thus, fibromyalgia, became a medical problem with a high prevalence, with a course highly disabling for people who suffer.
Apart from this, it is not until 1992 that all the international medical organizations, and especially the World Health Organization, recognize this medical entity as a disease (Institute of Cognitive Neurology, 2016).
Because of this, fibromyalgia is currently a poorly understood pathology, with an ill-defined etiologic origin and a complex therapeutic approach (García, Martínez Nicolás and Saturno Hernández, 2016).
About us
Numerous clinical studies indicate that fibromyalgia is the most prevalent chronic and diffuse painful disease in the general population (Laroche, 2014).
In the case of the United States, fibromyalgia affects approximately 5 million people, with an age of 18 years or more. In addition, more than 80% of clinically diagnosed cases have been performed on women (Natio- nal Institute of Arthritis and Musculoskeletal and Skin Diseases, 2014).
In addition, fibromyalgia is a medical condition that can affect both sexes and any age group, although several risk factors have been described, associated with an increased chance of occurrence (Natio- nal Institute of Arthritis and Musculoskeletal and Skin Diseases , 2014).
On the other hand, in the Spanish population, fibromyalgia presents an estimated prevalence of 2.3% in residents over 20 years of age, in addition, presenting a clear predominance in females, with a ratio of 21 to 1. In addition, in As for age distribution, a prevalence peak around 40-49 years has been identified (Gelman et al., 2005).
Signs and symptoms
Different specialists point out that fibromyalgia is defined by the presence of three central medical symptoms or events: episodes of pain, fatigue and generalized fatigue and, finally, Disturbances and sleep-related disorders (Guinot et al., 2015).
In addition, to this basic symptom set, other findings are often added, including: Cognitive impairment Or digestive pathologies, Urogynecological or otorhinolaryngological (Guinot et al., 2015).
Therefore, the clinical course of fibromyalgia is characterized by a diffuse involvement with the presence of several symptomatological events (Guinot et al. Al., 2015; Mayo Clinic, 2016, National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2014):
Pain
The sensations of pain usually affect the muscle, joint, tendon or show a neurological character. In addition, it is usually Generalized, that is to say, affects both corporal sides and to the areas superior and inferior to the waist.
The affected people usually define the pain as a sensation of palpitation, pressure, burning or púnzate, located in some corporal area Specific.
The body areas most affected by typical fibromyalgia pain usually include: left shoulder, right and left forearm, left arm, Right and left hip, right and left thigh, right and left calf, jaw, thorax, abdomen, back and neck.
As for its course, it usually has a conical and persistent character, accompanied by a sudden or progressive onset, associated, in a good part of the Cases, a traumatic event (physical or psychological) or a pre-existing pathology related to painful symptoms.
Generally, the pain tends to get worse after the accomplishment of some motor activity or physical effort. In addition, it is usually much more intense during Morning or at night, as a result of the development of significant muscle stiffness in rest state.
Asthenia
The asthenia , Ie persistent fatigue or general weakness, is one of the most common symptoms in fibromyalgia, is present in more than 90% Of the diagnosed cases.
Inactivity or recurrent tiredness are usually present since the person concerned wakes up, although they may improve during the day, they have Appear in a short period of time.
In addition, asthenia tends to worsen with physical activity, Psychological stress And / or emotional, therefore, is an important source of limitation functional.
Sleep disorders
Both pain and persistent tiredness contribute to the development of disturbances related to sleep-wake cycles. Thus, disorders Of sleep are widespread in people affected by fibromyalgia, usually characterized by episodes of non-repairing sleep, Constant awakening or difficulty of conciliation.
Although affected people often have long periods of sleep, in most cases, these cycles are interrupted by Presence of localized pain, episodes of Sleep apnea Or due to the condition of the restless legs syndrome.
Diffuse symptomatology
In addition to the alterations described above, a good part of the affected can present other type of symptoms related to the sphere Sensory, cognitive, digestive or genitourinary.
In the case of the cognitive area, there is usually a marked difficulty in maintaining concentration, alternating attention or performing tasks that require A high mental effort.
In most cases, this is due to the disruptive nature of pain and the presence of headaches and headache persistent.
As for the sensory area, the affected persons may present episodes of cramps or sharp sensations in corporal areas, especially in The abs. In addition, it may be possible to develop Paresthesia In most cases.
Generally, the clinical course is characterized by the development of an increased sensitivity to pain, that is, hyperalgesia, accompanied by some Auditory symptoms, mainly related to the threshold of sounds and noises.
Causes
As we have pointed out, the specific causes of fibromyalgia have not yet been accurately known. Despite this, much of the research Clinical and experimental studies have related their clinical course with dysfunction or poor functioning of the nociceptive system (Ministry of Health, Social Policy and Equality, 2011).
The nociceptive system is responsible for the perception, processing and regulation of stimuli related to pain.
Specifically, the nociceptive system has the essential function of detecting potential threats, through the modulation of painful stimuli and, Therefore, through the activation of the various mechanisms of alertness and stress and consequently the physiological responses (Ministry of Health, Social Policy and Equality, 2011).
This system is capable of detecting auditory, mechanical, psychological, electrical or thermal stimuli. However, it is hypothesized that in People suffering from fibromyalgia, there is a dysfunction that diminishes the minimum threshold of stimulation necessary to transfer a noxious stimulus like Possible threat and thus generate a defensive response (Ministry Health, Social Policy and Equality, 2011).
On the other hand, a deficient functioning of the suprarenal hypothalamic-pituitary axis has also been proposed, as responsible for the development of the Fibromyalgia. This axis is considered the center of stress response, that is, it is responsible for the production of regulation of hormones that control Our responses to stress situations (Institute of Cognitive Neurology, 2016).
In the case of people suffering from fibromyalgia, this axis could present an abnormal functioning, characterized by a hyperproduction of two Hormones ( Cortisol Y Adrenocorticotrophin ) That would increase the perception of pain (Institute of Cognitive Neurology, 2016).
However, all these postulates are still in the experimental phase, so there are no clear conclusions about the etiology of the Fibromyalgia.
Despite this, at the clinical level, it has been possible to associate the development of fibromyalgia with different factors and events, among which are found National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2014):
- Physical trauma, such as bodily injury or cranioencephalic trauma.
- Suffering from recurring physical injuries.
- Suffering from other pathologies related to pain: rheumatoid and spinal arthritis.
Diagnosis
The diagnosis of fibromyalgia is basically clinical, at present there is no laboratory test that confirms Unequivocal the presence of this pathology.
In addition to the individual and family medical history, specialists pay special attention to the description of the events Painful, their characteristics, presentation and duration. In addition, an essential point is the detection of other comorbid symptoms and pathologies (Laroche, 2014).
Previously, the diagnosis of fibromyalgia was confirmed based on the presence of 18 different medical findings. However, at present, Can be confirmed based on the presence of generalized pain over a period of more than 3 months and without an underlying medical cause (Mayo Clinic, 2016).
On the other hand, some experts, such as the American Pain Society (APS), recommence some complementary tests, such as the analysis For the determination of other possible pathologies. Normally, antinuclear antibodies, iron, vitamin D, Platelets or the presence of thyroid hormones (Laroche, 2014).
Treatment
The treatment of fibromyalgia, like other chronic pain, requires a multidisciplinary approach, characterized by the therapy Pharmacological-analgesic, physical therapy and psychological therapy (Laroche, 2014).
Pharmacological treatment is mainly used for the improvement of symptoms and secondary complications, some of the drugs Employees include: Antidepressants (Amitriptyline, Duloxetine or Fluoxetine), cyclobenzaprine, Pregabalin, tramadol, paracetamol, anti-inflammatories (Glucocorticoids, non-steroidal anti-inflammatory drugs) (Ministry of Health, Social Policy and Equality, 2011).
In the case of physical therapy and rehabilitation, there are usually several physical exercise programs (aerobic exercises, muscular strengthening Or flexibility and stretching exercises).
In addition, other types of therapies can also be used, such as Thermotherapy , Nerve stimulation Transcutaneous, ultrasound, laser, or magnetotherapy (Ministerio Sanidad, Política Social y Igualdad, 2011).
In the case of the psychological area, the most common approaches usually include Cognitive-behavioral therapy And operant behavioral therapy, used Fundamentally for the work with the behaviors related to the episodes of pain, the different strategies of coping and the Self-efficacy (Ministry of Health, Social Policy and Equality, 2011).
References
- García, D., Martínez Nicolás, I., & Saturno Hernández, P. (2016). Clinical approach to fibromyalgia: synthesis of recommendations based on Evidence, a systematic review. Reumatol Clin, 65-71.
- Gelman, S., Lera, S., Caballero, F., & López, M. (2005). Multidisciplinary treatment of fibromyalgia. A prospective controlled pilot study. Rev Esp Reumatol, 99-105.
- Guinot, M., Launois, S., Favre-Juvin, A., & Maindet-Dominici, C. (2015). Fibromyalgia: pathophysiology and therapeutic support. EMC.
- INECO. (2016). FIBROMYALGIA. Retrieved from"Institute of Cognitive Neurology".
- Laroche, F. (2014). Fibromyalgia. EMC.
- Mayo Clinic. (2016). Fibromyalgia. Obtained from Mayo Clinic.
- Ministry of Health, Social Policy and Equality. (2011). Fibromyalgia.
- NIH. (2014). Questions and Answers about Fibromyalgia. National Institute of Arthritis and Musculoskeletal and Skin Diseases.
- NIH. (2014). What Is Fibromyalgia? Retrieved from the National Institute of Arthritis and Musculoskeletal and Skin Diseases.