Answers to the most frequent questions (FAQs)
1.- What is Fibromyalgia?
2.- What causes the pain?
3.- What is the principal symptom?
4.- How does pain manifest and in which parts of the body?
5.- Which other discomforts does it produce in the locomotive system?
6.- Does it cause fatigue?
7.- Does it also affect sleep?
8.- Which other symptoms appear more often? ?
9.- Which factors may worsen the symptoms?
10.-Is it possible to suffer from fibromyalgia along with other conditions?
11.-Which can be the causes of the disorder?
12.-What research is been done on the cause of the disorder or the mechanisms that cause the disorder?
13.-Does a "fibromyalgic personality" exist?
14.-Is it a frequent illness?
15.-Is it a new disease?
16.-Is it a disabling illness?
17.-What is the relationship between age and sex and the incidence of fibromyalgia?
18.-Are there any other alterations to be found during examination in addition to the painful points?
19.-Is there any evidence to confirm the diagnosis?
20.-Is there a cure for fibromyalgia?
21.-Is physical exercise important?
22.-Is it necessary to lose weight?
23.-Are medicines effective?
24.-What does the treatment consist of?
25.-What is the prognosis of fibromyalgia?
1. What is Fibromyalgia?
Recognized by the WHO in 1992. It is classified with the code M79.7 of the International Classification of Diseases. It is a complex, chronic condition which causes widespread pain not articulate, deep exhaustion, and also a variety of other symptoms. Pain and sensitivity tend to come and go, and feel throughout the body . Very often people with this disease have difficulty sleeping . The diagnosis is made by a careful examination and is characterized by painful pressure points of specific sensitive feeling.
Fig. 1. Points that are painful to the touch in patients with Fibromyalgia
Occiput: at the suboccipital muscle insertions.
Low cervical : at the anterior aspects of the intertransverse spaces at C5-C7.
Trapezius: at the midpoint of the upper border.
Supraspinatus: at origins, above the scapula spine near the medial border.
Second rib : at the second costochondral junctions, just lateral to junctions on upper surfaces.
Lateral epicondyle: 2 cm distal to the epicondylesl.
Gluteal: in upper outer quadrants of buttocks in anterior fold of muscle.
Greater trocanter:posterior to the trochanteric prominence.
Knee: at the medial fat pad proximal to joint line.
The 2010 American College of Rheumatology (ACR)
diagnosis criteria for Fibromyalgia:
1. Pain and symptoms present during the previous week, based on the total of:
- Number of painful areas in 19 body parts
- Plus a level of severity of these symptoms:
b. wake up tired;
c. cognitive problems (memory or thought);
- Plus several other general physical symptoms.
2. Symptoms remaining three months, at least, at a similar level.
3. No other health problems that could explain the pain and other symptoms.
2. What causes the pain?
The human body is provided by mechanisms that usually protect it from pain. Without these mechanisms, we would be constantly conscious about our organism, our muscles and joints. It is considered that in people affected by fibromyalgia these mechanisms have an abnormal performance increasing thus the pain perception. Overloading a part of the body is enough to feel painful sensations. Therefore, we are facing a Disorder of the Nerve System, specifically of the mechanisms that process pain stimuli, leading to an extremely low pain threshold.
3. What is the principal symptom?
Musculoskeletal pain lasting at least for three months, with a diffuse location and in different parts of the body, such as lumbar region, neck, shoulders, pelvic region, elbows and hands, and which also affects both sides of the body (left and right) and both below and over the waist.
4. How does pain manifest and in which parts of the body?
The pain of FM usually consists of aching or burning described as "head-to-toe" and muscle spasm. Pain can vary in severity from day to day. Sometimes, it can be so intense that it interferes with the performance of even simple tasks, while other times it may cause only moderate discomfort. Likewise, the fatigue of FM also varies, ranging from a mild, tired feeling to the exhaustion of a severe, flu-like illness. Though FM does not cause deformities or affect longevity, until the patient can manage through treatment(s) and drug(s) appropriately, FM may hinder life on many levels.
5. Which other discomforts does it cause in the locomotive system?
It may cause widespread stiffness, especially when waking up in the morning, and bloating sensation in hands and feet. It is also common to feel a rather undefined tingling that specially affects hands. Muscular contractions, the trapezius muscle in particular, are also very frequent.
6. Does it cause fatigue?
Yes, in most cases. People who suffer from fibromyalgia have little tolerance to physical effort and feel a lack of energy. Any exercise of unusual intensity becomes painful and, for this reason, patients try to avoid physical efforts. The result is that the less effort is made, the more muscle mass is reduced diminishing even more the level of tolerance to exercise. Hence, it is essential to be perseverant in the practice of moderate physical exercise.
7. Does it also affect sleep?
Yes. Between a 70-80% of people with fibromyalgia complain about bad quality sleep and also about the fact that the pain gets worse when they do not sleep well. Researchers believe that these patients fall easily asleep but that they present alterations during the deep sleep phase. Electro-encephalic registrations present alterations during this phase and, similar waves to the ones that maintain the brain in an alert state are also detected. It is unknown whether these waves have a relationship with the origin of the disorder or if they are a consequence of it. In any case, sleep disorders are very relevant in fibromyalgia and it is essential to treat them in order to achieve further improvements.
8. Which other symptoms appear more often?
Anxiety, irritability and depression, as a result of suffering chronic pain and fatigue, are very frequent. Other frequent symptoms are: migraine, circulatory disorders in extremities, irritable colon syndrome, tension type headaches, voiding urgency, temporomandibular joint malfunction, myofascial pain, chronic pelvic pain, dry mouth and eyes and, in women, painful menstrual periods. Cognitive disorders are also frequent (attention, memory and concentration problems).
9. Which factors can worsen the symptoms?
Changes in temperature and in humidity, increasing physical activity, stress, depression, anxiety and hormonal fluctuations (premenstrual and menopausal states).
10. Is it possible to suffer from fibromyalgia alongside other conditions?
Yes. Fibromyalgia may be the only condition but, most frequently, it is suffered alongside other rheumatologic conditions such as arthrosis, arthritis or lupus, among others. Moreover, suffering from fibromyalgia does not dismiss other conditions. For this reason, people affected from fibromyalgia must consult their doctors if they feel any type of discomfort that they do not relate to fibromyalgia.
11. Which can be the causes of the disorder?
There have been cases in which the illness started after a particular event, as a bacterial or viral infection, a car-crash, a divorce, family problems, etc. In other cases it appears when the patient's quality of life has already been limited by some other acknowledged diseases, such as arthritis or erythematous lupus. In any case, it is most probable that these be not the true causes of the illness but that they would be the factors that triggered off the symptoms in people who already suffer from a disorder -"concealed" until then- in their mechanisms of regulation regarding the capacity of response before pain and stress.
12. Is there any ongoing research about the cause or the mechanisms that cause the disorder?
Many works are published every year in medical literature on this subject. Studies have focused in analyzing if the patients' muscular system and immune system are affected, any psychological anomalies, hormonal problems or alterations in the regulation of pain. Results seem promising but there is no concluding evidence yet.
13. Does a "fibromyalgic personality" exist?
It seems that the deficient response before stressful situations is a relevant trait of people with fibromyalgia. With respect to anxiety and depression, although many doctors believe that these are fundamental factors, they appear with the same frequency in other chronic illnesses such as lumbago or rheumatoid arthritis. There are theories defending the existence of a "fibromyalgic personality", but they are not based on any scientific evidence and, some times, these criteria can go against the necessary advance that will permit reaching true knowledge about the illness.
14. Is it a frequent illness?
According to population studies it affects between the 2% and the 4% of the population (these data are variable depending on the consulted study).
15. Is it a new disease?
It does not seem so since in the 18th century European doctors already commented on the existence of articular and non-articular rheumatisms and, in 1904, Sir William Gowers mentioned a rheumatic illness that affected the fibrous tissue. In spite of this, investigation about its causes did not start until the mid 1980's and criteria for its diagnosis date from 1990. Fibromyalgia or FMS (Fibromyalgia Syndrome) was acknowledged as an illness by the WHO (the World Health Organization) in 1992.
16. Is it a disabling illness?
Not in the sense of irreversible disability due to deformation or destruction of the joints. However, fibromyalgia can be highly disabling with respect to the difficulty in the performance of many activities. Studies made in this sense have concluded that fibromyalgia can be as disabling as arthritis and more than other processes such as chronic bronchitis or "diabetes mellitus".
17. What is the relationship between age and sex and the incidence of fibromyalgia?
Nine out of ten patients are women. The most frequent initial age ranges between 35 and 50, although it has been diagnosed in children, adolescents and people older than 60.
18. Are there any other alterations to be found during examination in addition to the painful points?
Yes. Muscular contractures and spasms can be detected during physical examination. On the other hand, the skin is usually prone to redness only by pressing any part of the body with the fingers (as a consequence of small alterations in the regulation of the skin's blood flow).
19. Is there any evidence to confirm the diagnosis of the illness?
Radiographies and analysis must be done although they only serve to set aside the presence of other pathologies, but they are not the main determinant for the illness' diagnosis. The same occurs with more modern methods such as CAT (Computerized Axial Tomography) or magnetic resonance, whose regular use does not allow the detection of any determinant alteration for the diagnosis of the illness. Today, there are numerous investigations taking place worldwide, whose aim is to find new evidence and new control tools that will make possible a more clear and definite diagnostic.
20. Is there a cure for fibromyalgia?
Fibromyalgia is a chronic illness for which, today, there is no cure. However, there are a series of measures which have demonstrated, in many occasions, an improvement in the quality of life of patients: a correct diagnosis, explanation to the patient about the nature of the illness (explain that there will not cause the destruction of the joints or irreversible damages or deformities), education to procure avoiding any worsening factors, treatment -if necessary- of psychological disorders, treatment of possible sleep disorders, changes regarding behaviour and life projects, moderate exercise, performance of muscle relaxing techniques, use of analgesics and medicines to increase the response to pain and also, in some cases, the use of complementary therapies such as acupuncture, homeopathy, naturopathy and phytotherapy.
21. Is physical exercise important?
Physical exercise and adequate muscle strengthening are, undoubtedly, of great effectiveness. However, it is necessary to work slowly, adapting the exercise to every patient, and performing moderate exercise in a gradual way, since the practice of exercise over the patient's physical capacity increases the pain and muscular tension doing little but invite to abandon the effort. Therefore, moderate aerobic activities are recommended (walking, treadmills, aqua gym or cycling) after the doctor's evaluation and with the help of physical therapists or specialized trainers. Moderate and progressive practice of some oriental disciplines, like tai-chi or Qi-gong, has also demonstrated their effectiveness in a great number of cases. However, each patient will have to learn, with perseverance and a strong will, which type of exercise provides him or her with better results.
22. Is it necessary to lose weight?
Obesity means an over charge for muscles and tendons, a fat that can worsen the illness' symptomatology. This is the reason why people affected with fibromyalgia are recommended to lose weight, that is, their weight should not be over that advised in relation to age, sex, height, constitution, etc. Patients should be informed about these factors by their doctor.
23. Are medicines effective?
Medicines for the treatment of fibromyalgia are usually only partially effective and a combination of different drugs is needed. Today, there is no specific medication for this disorder and other drugs already known to be effective for other illnesses are used in lower doses. Medication is usually based on an association of tricyclics (in lower doses than the ones used for depression disorders), analgesics, selective serotonin reuptake inhibitors, anxiolytics and muscle relaxants, among others. In any case, the doctor must determine which medication is best for each patient.
24. What does FM treatment consist of?
Treatment for fibromyalgia should contemplate diverse aspects: educational (having the necessary information about the illness and what it implies), pharmacological (commented on in the previous question), physical (commented on in question 21), and psychological (a cognitive-conductual therapy, with the aim of helping in the essential behavioural changes, and looking for a reinforcement of self-esteem and the mechanisms of control to be able to face the diverse aspects of daily life). It is very important the exchange of impressions and convivial with other affected people (particularly in the associative frame), as well as participation in mutual aid groups (GAM) and in collective workshops of functional recovery and physical wellbeing (tai-chi, Qi-gong, etc). Taking all these aspects into account, it is possible, in many cases, to achieve a significant improvement in the quality of life of people affected by fibromyalgia.
25. What is the prognosis of fibromyalgia?
Long-term studies on fibromyalgia have demonstrated that it is a chronic illness although their symptoms may be swaying (they may appear, disappear and reappear at different times). The impact of fibromyalgia on the quality of life of people who suffer from it differs in great manner from a person to another. However, by following all the explained guidelines it is possible to achieve an improvement of many of its symptoms. It is also expected that new discoveries will be made and new medicines, specific to the treatment of fibromyalgia, will be developed. All in all, we may hope that the quality of life of every affected person will improve day by day until science can contribute with a possible cure for this illness.
Sources: American College of Rheumatology (ACR). EEUU (2010)
National Fibromyalgia Partnership, Inc. (2006)