The fibromyalgia (FM) is a chronic and systemic syndrome , whose main symptom is severe and widespread pain the musculo-skeletal system. For this reason, this disease, which affects a variable percentage between 1 and 3% of the world population (about 2 million in Italy), especially female, is classified as a rheumatic pathology of an extrarticular nature . It can be confused with arthritis, but unlike this it does not produce internal inflammation or joint damage. This is because FM affects the connective tissue of the whole body , in particular those structures that are made up of fibers: muscles, tendons, nerves.
The word fibromyalgia, in fact, unites three words: the Latin fiber (same meaning as in Italian), mus (muscle, from the ancient Greek) and algia (pain, always from the ancient Greek). Never as in this case, etymology assists us in defining not only the disease, but its main symptom. Let’s see how this highly disabling syndrome manifests itself and what are the criteria and means to reach a diagnosis.
Symptoms and diagnosis
ibromyalgia is, as anticipated, a chronic painful syndrome , but physical suffering is certainly not limited to muscles or tendons, since all the musculoskeletal system and its “soft” parts are affected, and that the repercussions are had also from a cognitive and neurological point of view.
We see all the primary and secondary disorders associated with the disease:
- acute and burning widespread pain , similar to stabbing, or deep and continuous pain, or an alternation of both forms of suffering for at least three continuous months. The affected areas are all the quadrants of the body;
- bone pain involving at least one of the following areas of the skeletal system: cervical vertebrae, dorsal or lumbosacral vertebrae, anterior thorax;
- pain on palpation in at least 11 of the areas called “tender points” , 18 points located in all areas of the body according to a mapping that coincides with the energy joints that are stimulated in acupuncture, from the head to the feet. In general, the disease “turns on” the various tender points with a progressive course, starting from a quadrant and then “lighting” them all, or almost;
- cramps ;
- joint stiffness in the morning;
- joint swelling of a non-inflammatory nature;
- intercostal pangs ;
- neuralgia (including sciatica and trigeminal nerve);
- sense of profound exhaustion ( chronic fatigue );
- headaches ;
- paraesthesias (numbness or tingling sensation along the limbs);
- menstrual pain (dysmenorrhea);
- sleep anomalies sometimes accompanied by restless legs syndrome, a neurological disorder that occurs at night with spasms and the need to continuously move the legs, and by night apneas;
- mastodynia (breast pain);
- irritable bowel syndrome ;
- interstitial cystitis (inflammation of the bladder of non-infectious origin) and generally pain when urinating (dysuria);
Consult the Centers of Reference for rare disease Interstitial cystitis
- pelvic pain ;
- sense of dizziness and sometimes nausea or dizziness ;
- cognitive fog . It is thus defined a symptom of fibromyalgia syndrome which affects neurocognitive abilities and which implies concentration difficulties, mental confusion and mnemonic deficits;
- depression . Not infrequently connected with the impossibility of communicating one’s malaise in the belief of not being believed. Unfortunately, in fact, it often happens that the fibromyalgia sufferer is taken for hypochondriac or “whining”;
- temporomandibular pain often mistaken for toothache.
With such a wide and varied sample of aches and pains, getting to the diagnosis of fibromyalgia , which allows you to combine all the symptoms under a single common denominator, is not automatic . In fact, initially the patient “suffers” without understanding the reasons, trying to buffer the various ailments with symptomatic drugs, without ever getting to grips with them. However, such a pronounced symptom as chronic widespread pain in the musculoskeletal system – which lasts for at least three months increasing in intensity – must at least make your doctor suspicious.
In this case we will proceed step by step, going to a rheumatologist specialistwho will first palpate the tender points to check their tenderness. This objective analysis is fundamental to understand if we are faced with a fibromyalgia syndrome, because in one fell swoop it allows to eliminate almost all other possible causes. It is also important to evaluate the general health of the patient and carry out blood tests to analyze both the composition of the blood and to detect the presence of any rheumatoid factor or thyroid dysfunction. Once we proceed by elimination, and thanks to the tender points technique, it is finally possible to arrive at a single diagnosis of fibromyalgia .
Causes and risk factors
The exact causes that lead to the development of FM are unclear. What is known is that there are several predisposing factors that can contribute to the pathogcenesis of the disease and its painful symptoms. These factors are both internal (endogenous) and environmental (exogenous), and include:
- genetic causes and heredity . Since members of the same family are more at risk of getting fibromyalgia, there is likely to be a genetic mutation still to be discovered at the origin of the syndrome;
- comorbidity . Suffering from autoimmune rheumatic diseases such as rheumatoid arthritis , ankylosing spondylitis, lupus, predisposes to FM. This suggests that autoimmunity is also implicated in the etiopathogenesis of fibromyalgia syndrome;
- repeated trauma, disease and infection . Often FM in predisposed subjects starts right after a viral infectious disease with fever, or after an accident or surgery. These events constitute a sort of “trigger” factor;
- psychological trauma , post traumatic stress syndrome. They act as a trigger factor in the same way as physical trauma.
FM is not a peripheral disease but a systemic one, as we have seen, which therefore originates in the central nervous system. Who develops the syndrome also presents an alteration of neurological activity , in particular an abnormal activity of the “pain” neurotransmitters, to which the deputy brain receptors respond, becoming particularly sensitive and in turn hyper reactive.
In light of the above, we summarize the main risk factors of FM:
- female : being a woman is undoubtedly the main risk factor;
- familiarity : having one or more people with fibromyalgia in their family circle “of blood” increases the probability of getting sick in turn;
- suffer from rheumatic disease , especially if of an autoimmune nature.
How does the blood and the immune system work?
Fibromyalgia is not cured , this is the first thing to keep in mind about therapies. Having clarified this, it is however possible to manage pain and keep the most disabling symptoms at bay even with an appropriate drug therapy, which includes or may include:
- non-steroidal anti-inflammatory drugs (paracetamol, acetylsalicylic acid or ibuprofen) in low doses to be used if necessary;
- antidepressants , selective serotonin reuptake inhibitors (SSRIs) and muscle relaxant drugs, all prescribed in low dosages, are useful for improving sleep quality and inducing a relaxing effect on the muscles;
- analgesic drugs for chronic slow-release pain (tapentadol).
In principle, it has been shown that the active ingredients that work directly on the central nervous system are more effective than common over-the-counter analgesics. Unlike other rheumatic diseases, FM should not be treated with cortisone because it is not an inflammatory syndrome.
Does Acupuncture Work?
L ‘ Acupuncture – an ancient healing technique is part of traditional Chinese medicine – is the first among the “alternative” therapies (the medicine), recommended to patients with fibromyalgia syndrome. Indeed there are notable analogies. We have seen how the pain spreads in the body following the map of the 18 tender points , which are the same that the acupuncturist needles go to stimulate to “unlock” the energy flows and bring the organs and systems connected with it back into balance areas.
This technique – as emerged from several experimental studies carried out by western medical researchers – alters the production of different neurotransmitters both in the brain and in the spinal level.
And this is probably the reason why many FM patients within 2 years of diagnosis rely on acupuncture, benefiting greatly from it where drug therapies have failed. An improvement that does not involve side effects, which is far from negligible.
Centers specialized in Acupuncture
Below is the link to consult the list of health facilities that have declared to be specialized in Acupuncture. The list is not exhaustive of all the structures that deal with it in Italy.
Discover the specialized centers in Acupuncture
Alternative treatments for pain
FM therapies must necessarily be based on a holistic approach , because the disease is so disabling because of the chronic pain it produces, that it requires a global intervention “calibrated” on the person. Here, depending on the severity of the symptoms and the characteristics of these, which can vary greatly from subject to subject, the following treatments will be tested:
- Massages . Professional manipulation of muscles and soft tissues can relieve pain and relax the body, as well as reduce anxiety levels and fight depression.
- Physiotherapy . Through appropriate postural and stretching exercises, painful symptoms are countered and the body is strengthened, improving both the elasticity of muscles and skeleton and balance. Physiotherapy in water is particularly beneficial.
- Yoga and tai chi . These are ancient practices that are based on exercises and slow movements of the body, associated with relaxation, breathing and meditation techniques. Also in this case many patients derive enormous benefits, both from a purely physical, mental and psychological point of view.
In everyday life, it is then possible to relieve pain and get better by following some behavioral rules that turn into a daily routine , including:
- Make a list of a few daily tasks and respect it by avoiding excessive accumulations and stress
- Do motor activities every day, even gentle, like a good half-hour walk. Compatibly with your health, you can gradually increase physical activity
- Give your daily tasks a regular rhythm so you don’t make too many efforts once
- Take care of sleep hygiene and, if necessary, take mild natural sedatives (e.g. valerian-based)
- Follow a balanced and healthy diet, avoiding eating too much in individual meals
- Learn how to delegate and ask for the support of family, friends and work colleagues, refer to associations of fibromyalgia patients and possibly join self-help groups
- Follow the instructions of your doctor and do the rehabilitation exercises
- Try, as far as possible, to maintain a positive attitude, and take time to take care of your hobbies
- Spend as much time as possible in nature
Do you die from fibromyalgia?
Wondering if fibromyalgia can be an early death factor is entirely legitimate, since we are talking about a not only painful but chronic and disabling syndrome that often requires long-lasting drug treatment . Those who suffer from it experience symptoms so aggressive that they spend periods of life in which even getting out of bed becomes problematic, we do not talk about carrying out normal daily activities, including work tasks.
So let’s go back to the starting question: can we die from fibromyalgia ?
Is it a lethal disease ? Fortunately, the answer does not lead to misunderstandings.Fibromyalgia syndrome is not a fatal disease. It does not cause such damage to our organism as to speed up the death process.
The fears of many people, in particular, as we have seen, young women, is that in fact the symptoms of fibromyalgia are early signs of severe systemic rheumatic disease, such as systemic lupus erythematosus or rheumatoid arthritis.
There are many differences between these pathologies and fibromyalgia.
Lupus, arthritis, vasculitisetc. they are rheumatisms that have an autoimmune origin, that is they are chronic and progressive inflammatory syndromes caused by an abnormal reaction of the immune system against the healthy tissues of the body.
These pathologies are of a systemic nature , it means that although the symptoms can, very well and for a long time, be kept under control with the intake of immunomodulating or biological drugs, in combination (at least in the periods of acute inflammation) with daily doses of cortisone, internal inflammation can extend to vital organs such as the lungs, kidneys, heart.
Not so in the case of fibromyalgia, although the painful symptoms may appear superimposable. This is because in reality this syndrome does not involve internal inflammation, and does not harm the vital organs. So to the question: do you die of fibromyalgia? – we can answer negatively.
There is no direct link between the diagnosis of fibromyalgia and early death. But the quality of life decreases dramatically both because of the disabling symptoms and, often, because of the patient’s difficulty in finding the right diagnosis and, consequently, the appropriate treatments .
From “imaginary” disease to chronic disabling syndrome
Fibromyalgia has a controversial history : it probably exists for millennia, but for the scientific world it is really “very young”, since it was classified by the WHO as a disease with autonomous symptoms and characteristics only in 1992, in the so-called Copenhagen declaration.
Why this delay?
The reason is related to the specificity of the syndrome, which “is not seen”.The FM, in fact, mainly “feels”. The patient suffers, but his body apparently does not bear the signs, because his illness does not induce inflammation, does not damage bones, tendons, muscles or other tissues and systems, does not progress irreversibly until immobility or death. It is, above all, a chronic pain syndrome. This does not mean that it has not been studied and analyzed for a long time, precisely because of its “strangeness”.
The first to report curious “muscle calluses” (probably small edemas) then classified as symptoms of a form of “chronic joint rheumatism” was the German physician Robert Friedrich Froriep in 1842. Subsequently, in 1904, an English physician – William Richard Gowers – spoke of “fibrositis”, a term that was later abandoned because it was realized that the softness of the soft tissues was not associated with inflammation. In 1981 – finally – the “mysterious” disease found its name, fibromyalgia, in fact. But, as we have seen, the road to full recognition of its “status” was still long.
To date, in Italy, the procedure for the inclusion of FM in the LEA has started(essential levels of care), as a chronic / rare disease. The road, also in this case, appears long, but some regions – for example the autonomous region of Sardinia – have already approved specific regulations for the recognition of the rights of people affected by fibromyalgia in order to guarantee appropriate care .
How does our musculoskeletal system work?
Living with fibromyalgia: contact an association
A diagnosis of fibromyalgia can undoubtedly destabilize: difficult to disentangle between possible treatments , alternative medicine treatments, laws that protect their rights in the workplace and therefore the speech related to the application for disability , doubts about the course of the syndrome itself and the many related fears .
- Will I have a normal life with FM?
- Will I be able to have children / become pregnant without problems?
- Is fibromyalgia an inherited disease ?
- Are there definitive cures ?
- Are there any new pain medications , and if so who can tell me about them?
To these and many other questions, it is also possible to find an answer through the many associations of patients and specialists who are now – and fortunately – multiplying both nationally and regionally. In this regard, we point out just a few addresses, which may prove useful for those who are going through the difficult path of discovery of their fibromyalgia syndrome. Being part of an association helps to feel less alone in the face of the disease , precisely because fibromyalgia has long been classified as a minor disease, and this has also led many doctors to underestimate the negative impact that painful symptoms have.Share this