Fibromyalgia, symptoms, cures and remedies

Fibromyalgia, one of the most common rheumatic diseases (it is estimated to be second only to osteoarthritis), causes localized pain mainly in the muscles and fibrous connective structures (tendons and ligaments).

It is a chronic problem, with symptoms of varying intensity, but it is not a degenerative disorder, does not damage tissues and does not trigger other diseases. However, permanent pain and other symptoms related to fatigue and sleep disorders can heavily affect the quality of social and professional life and daily activities. This results in a physical disability that eventually worsens the symptoms of fibromyalgia syndrome and can favor the appearance of anxiety and depressive states.

Although there is no cure for fibromyalgia, as the cause of the disease is still unknown, symptoms can be controlled and alleviated through medication, physical activity and relaxation techniques.

Signs and symptoms of fibromyalgia

Chronic and widespread pain is the main symptom of fibromyalgia. Most often it is more intense in the morning and localized in muscle groups that are used repetitively and can manifest itself in different ways, such as a burning sensation, but also a cramp or stabbing pain. Some variables, such as stress, variation in weather conditions, activity, hormonal fluctuations (menstrual cycle and menopause) and much more, can contribute to increasing or decreasing symptoms.

Often when fibromyalgia syndrome is at its inception, it first affects certain areas, such as the neck, shoulders and upper or lower back, or areas around the joints. With the passage of time and the progress of the disease, the pain frequently spreads to the entire musculature.

Asthenia, or the state of fatigue, is another important symptom. Lack of energy, physical fatigue, mental fatigue, difficulty concentrating, memory lapses can be so intense as to prevent work, study and even simple and ordinary daily activities. This feeling of mental confusion is defined with the English term fibro fog, ie clouding from fibromyalgia, or brain fog, or brain fog.

Frequent in those suffering from fibromyalgia syndrome are also sleep disorders. In particular, the continuous interruption of deep sleep with episodes of brain activity similar to waking up is common, but sleep apnea and restless legs syndrome can also occur frequently, which causes nocturnal contractions of the muscles and involuntary movements.

In other words, sleep is often not restorative and we get up with the feeling of not having slept enough, already tired and without energy to face the day.

In addition, some disorders of the central nervous system can also be a symptom of fibromyalgia, such as numbness and tingling sensations (paresthesias), dizziness and coordination disorders (ataxia), cognitive or memory disorders, mood disorders, anxiety and depression.

Other common symptoms are painful menstruation (dysmenorrhea), constipation, diarrhea, abdominal pain, nausea.

Causes and risk factors of fibromyalgia

The causes of fibromyalgia are not yet clear, but some events could trigger its onset in individuals with a genetic predisposition, such as an infection (viral or bacterial), trauma, surgery or the development of another disorder (such as rheumatoid arthritis, lupus or hypothyroidism). In other cases, however, the symptoms gradually accumulate over time without being able to find, at least apparently, a single triggering event.

Many experts believe that fibromyalgia amplifies painful sensations by influencing how the brain processes pain signals. The cause should be sought in an alteration of the genes that regulate:

• certain neurotransmitters, particularly serotonin, norepinephrine and substance P (linked to pain perception)
• The function of the immune system
• The physiology of sleep
• hormonal control.

Among the risk factors are gender (fibromyalgia is much more frequent in women than in men), the presence in the family of people with fibromyalgia syndrome and certain diseases such as osteoarthritis, rheumatoid arthritis or lupus.

There are also other pathologies that are often found in patients with fibromyalgia and that appear related to this disorder, such as irritable bowel syndrome, chronic headaches and chronic fatigue syndrome.

A difficult diagnosis

Fibromyalgia is a difficult disease to diagnose, as its symptoms are not specific, but are superimposable to those of many disorders, and there are no specific tests that allow to identify its presence.

Very often we arrive at a diagnosis by exclusion, that is, after carrying out investigations to exclude other diseases, such as rheumatoid arthritis, polymyalgia rheumatica, spondyloarthritis, myopathies, myasthenia gravis, multiple sclerosis, polymyositis.

To arrive at the diagnosis, the rheumatologist collects the patient’s clinical history and family pathologies, listens to the reported symptoms and visits the patient for a physical examination. In particular, it carries out the manual control of the 18 tender points, i.e. specific points of the body that cause pain when subjected to acupressure. The tender points are arranged in pairs symmetrically in 9 zones: at the base of the skull, at the base of the neck, between the collarbone and spine, on the chest, forearm, on the upper hip, on the upper part of the buttocks and on the knee.

Chronic symptoms for at least three months, widespread pain and a painful reaction in at least 11 of the 18 tender points are the most common diagnostic criteria for fibromyalgia.

How fibromyalgia is treated

There is no definitive cure, but there are several therapeutic options, both pharmacological and rehabilitative, which can be associated and which give excellent results to alleviate symptoms and improve the quality of life.

Medicines are usually prescribed to promote sleep quality and to reduce pain. The drugs that increase the level of serotonin and norepinephrine in the body are tricyclic antidepressants and selective serotonin reuptake inhibitors, used at low doses in the treatment of fibromyalgia. Serotonin and norepinephrine are, in fact, the neurotransmitters that modulate sleep, pain and many functions of the immune system.

These drugs are often associated with muscle relaxants to reduce muscle tension and stiffness.

Some drugs created to combat epilepsy seizures can also be used, which have also proved effective in reducing the painful symptoms of fibromyalgia.

Finally, in some cases of mild pain, non-steroidal anti-inflammatory drugs (NSAIDs) have proven useful, while a centrally acting opioid analgesic that modifies serotonin and norepinephrine levels is sometimes prescribed in cases of moderate and severe pain.

Non-pharmacological therapies of fibromyalgia

A program of stretching and aerobic exercise to maintain muscle tone, dissolve stiffness and promote relaxation is an integral part, in combination with medications, of the treatment of fibromyalgia.

Although the therapeutic effects of a regular exercise routine have now been proven, it is difficult to follow it for fibromyalgia sufferers due to the pain and fatigue caused by exertion. Also for this reason it is good that the program is developed by a physiotherapist who assesses the physical condition and takes into account the intensity of the pain.

In general, it can be said that 20 minutes of physical activity, 3 times a week, at 70% of the maximum heart rate (which is calculated indicatively by subtracting the patient’s age from 220), combined with gentle stretching before and after the activity are sufficient for optimal training. The recommended activities are those with very low impact, such as walking, swimming, water aerobics and cycling. Activities such as running, basketball, football and so on are not recommended.

Learning to manage the disease

Living with fibromyalgia can be very frustrating at first, and learning how to manage symptoms is important to see improvement quickly. Here are some tips for everyday life.

• Fibromyalgia sufferers quickly become aware of the movements and conditions that worsen pain and stiffness. A great help can be to keep a sort of diary where you can write down your observations. Generally, pain occurs more easily when making repetitive gestures or maintaining a position for a long time. It can be useful, for example, to use a timer that, ringing every 20 minutes, reminds you to stop the activity you are doing and change position for a few minutes before continuing.
• Reducing stress is another fundamental point to learn how to manage the disease. Easier said than done, it’s true, but relaxation techniques or deep breathing exercises can help. And if possible, it is good to carve out time for the day to relax.
• Although there is still no scientific certainty about the relationship between nutrition and fibromyalgia, for many patients following a healthy diet and avoiding certain foods improves the symptoms of fibromyalgia. In addition, keeping a food diary can help identify any “bad” foods and check the improvements brought by a healthy and balanced diet.
• The quality of sleep plays a very important role in controlling fatigue. It is important to establish a routine as regular as possible, going to bed and getting up at the same time, avoiding exercise in the evening and eliminating the consumption of stimulants (coffee, tea, energy drinks, etc.) in the hours before sleep.