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X Watch the video on youtubeWhat is fibromyalgia?
The term "fibromyalgia" means pain ( algos ) coming from the muscles ( myo ) and from the fibrous tissues ( fibro ), such as tendons and ligaments. Fibromyalgia is therefore a rheumatic disease that affects the musculoskeletal system, characterized by the presence of:
- chronic and widespread pain ;
- increased muscle tension;
- rigidity in numerous locations of the locomotor apparatus.
In addition to the state of hyperalgesia, many patients have a number of other symptoms, which include:
- Asthenia (chronic fatigue and debilitating fatigue);
- Mood and sleep disorders ;
- Irritable bowel syndrome .
Furthermore, fibromyalgia is often associated with other disruptions, including:
- Psychiatric disorders, such as depression and anxiety;
- Stress-related disorders, such as post-traumatic stress disorder.
Causes
The exact cause at the origin of fibromyalgia is not known, but several factors are believed to be involved (biochemical, genetic, neurochemical, environmental, hormonal, psychological, etc.). The pathogenesis of the disease is, in fact, a much discussed topic: definitive data do not yet exist, but many studies try to deepen the multifactorial interaction existing at the base of the disease.
In particular, researchers believe that fibromyalgia amplifies painful sensations (or reduces their inhibition), influencing the way the brain processes pain signals. Symptoms sometimes begin after physical trauma, surgery, infection or significant psychological stress. In other cases, the signs of fibromyalgia accumulate gradually over time, with no single event of obvious activation.
Epidemiology
Women are more likely to develop fibromyalgia than men, with an incidence ratio of around 9: 1 (F: M).
The disease affects approximately 1.5-2 million Italians and the age group most affected extends from 25 to 55 years.
Diagnosis and Treatment
Diagnosis and clinical features are controversial and therapeutic possibilities are of interest to continuous studies. At the moment, there is no cure for fibromyalgia, but there are several treatment options available to help control and alleviate symptoms: drugs (eg antidepressants and painkillers), exercise and relaxation techniques (cognitive-behavioral therapy).
Insights on Fibromyalgia
CausesFibromyalgia and painFibromyalgia: is it a serious disease? Symptoms of Fibromyalgia Diagnosis of Fibromyalgia Treatment and Treatment Diet, Lifestyle and Alternative Therapies For greater clarity, it is possible to approach the knowledge of the disorder with some preliminary considerations:- Fibromyalgia is a chronic (persistent) condition.
- Muscles in constant tension cause localized or diffuse pain. Often, the condition reported by the patients is that of fatigue and easy fatigability, as if the muscles worked continuously. The areas mainly affected by pain are: vertebral column, shoulders, pelvic girdle, arms, wrists and thighs.
- Muscle tension causes joint stiffness, which can limit movement and cause a sense of swelling, as well as reflecting at the level of tendons, which become painful at their insertion points. These tendon painful points constitute, with some muscular points, the " tender points ", fundamental during the diagnostic evaluation.
- The indexes of inflammation are normal and the disease does not show significant muscle and tendon alterations. Although it may resemble an articular pathology, it is not arthritis and fibromyalgia does not cause a degenerative condition (unlike rheumatoid arthritis, systemic lupus erythematosus and polymyositis).
- Fibromyalgia tends not to respond to traditional painkillers : drugs that have proven effective act at the level of the central nervous system.
Over time, the main element of discussion has always been the definition of the nature of the disease. The official name of the disease was coined in 1976, when the modern concept of fibromyalgia was able to accurately define the symptoms and the neurobiological nature of the disease.
Please note. Fibromyalgia is associated with a pain processing disorder, which causes some neurobiological abnormalities that interfere with the transmission of signals to the central nervous system. Fibromyalgia can therefore be essentially considered a pathology of cellular communication .
Causes
The causes that induce fibromyalgia have not yet been completely defined, but it is very likely that the disorder has a multifactorial genesis . In almost all cases, a triggering event related to the onset of fibromyalgia can be identified, even when this does not seem apparently associated with the disorder: a physical or mental trauma, a disease with a viral etiology, etc. Currently, there are many hypotheses that seek to interpret the onset of the painful symptom or disease. One of the most supported theories highlights an anomaly affecting some neurotransmitters (chemical mediators involved in communication between nerve cells) and the intervention of particular hormonal substances .
The main factors that have been associated with fibromyalgia are:
- Alterations in the level of neurotransmitters:
- A strong chronic endogenous or exogenous stress alters the way some brain neurotransmitters (serotonin, dopamine, noradrenaline, Gaba ...) work, contributing to the onset of painful symptoms that occur in fibromyalgia.
- At the same time, the endocrine and immune systems are also progressively affected by the malfunctioning of neural-cerebral networks.
- Another effect of neurotransmitter dysfunction, in particular serotonin and norepinephrine, is the hyperactivity of the neurovegetative nervous system (site of control of the involuntary mechanisms of the organism), which induces a deficit of blood supply to the muscular level which in turn translates in hyperalgesia (pain, muscle tension and asthenia). The hyperactivity of the sympathetic nervous system therefore induces an incorrect interpretation of painful stimuli.
- Physical and / or emotional stress
- Stress can be an important trigger for the development of fibromyalgia. The disease is frequently associated with disorders related to this condition, such as chronic fatigue syndrome (CFS), post-traumatic stress disorder, irritable bowel syndrome and depression.
- Even physical trauma can increase the risk of developing fibromyalgia (example: trauma to the brain or spinal cord, surgery, cervical whiplash ...).
- Hormonal disequilibrium
- In patients with fibromyalgia, alterations of the hypothalamic-pituitary-adrenal axis were observed in association with stress-induced neurotransmitter hyperactivity. The development of fibromyalgia, therefore, could derive from the disturbance of this endocrine system. In particular, some studies have shown a lower adrenal response to stimulation with adrenocorticotropic hormone (ACTH) and the presence of lower levels of cortisol.
- Sleep disorder
- In fibromyalgia, some neurotransmitters that participate in pain modulation are also involved in regulating sleep and mood.
- Genetic predisposition
- There is a family predisposition, but the transmission mechanisms are not yet completely known (probably it is polygenic).
- Some genetic mutations can make people more susceptible to developing the disease. Research has also shown that fibromyalgia is potentially associated with polymorphisms of the serotonergic, dopaminergic and catecholaminergic system genes. However, these alterations are not specific for fibromyalgia, but are genetic abnormalities shared with a variety of other disorders (eg major depressive disorder, chronic fatigue syndrome and irritable bowel syndrome). These individuals may be more vulnerable to psychological stress or other pathological conditions and easily encounter abnormalities in the mechanisms that regulate mood and pain.
- Infections
- Some diseases, often of a viral etiology, appear to trigger or aggravate the symptoms of fibromyalgia. Some examples are represented by the infectious mononucleosis caused by the Epstein-Barr virus (EBV), by the Lyme disease or by the Bacterial Contamination Syndrome of small intestine (SIBO).
Fibromyalgia and pain
Premise. The main symptom of fibromyalgia, chronic and widespread pain, appears to be the result of a series of neuro-chemical imbalances in the brain, with the consequent alteration of neurotransmission. The malfunction of these brain areas induces an incorrect interpretation of painful stimuli.
At the brain level, patients with fibromyalgia have some functional and structural differences compared to healthy individuals. It is not yet clear if these biological alterations are at the basis of the disease or if they represent the product of a common cause and are thus implicated in second course in the typical disorders of the pathology.
Several pathophysiological hypotheses have been developed to try to interpret the onset of the painful symptom or disease. A theory called " central sensitization " shows that patients with fibromyalgia have a hypersensitivity to pain signals : they would have a lower threshold due to greater reactivity than signals transmitted in the spinal cord and / or brain. Researchers believe that repeated nerve stimulation produces some particular alterations in the brain, including an abnormal increase in neurotransmitter levels, chemicals responsible for transmitting messages between nerves (nervous system) and between the cellular component of the brain. Furthermore, pain receptors, present in the brain, seem to develop a sort of stimulus memory and tend to become more sensitive, in the sense that they can overreact to subsequent pain signals. The process that triggers or sustains these functional alterations is not yet known.
Major alterations of neurotransmission:
- Decreased dopamine levels;
- Serotonin-related deficiency;
- Reduced concentration of 5-hydroxy-tryptophan in the liquor and plasma;
- Reduced melatonin production;
- Over three-fold increase in the concentration of substance P in the liquor (substance P is a neuropeptide that acts as a neurotransmitter).
The sympathetic hyperactivity translates in particular into:
- Alteration of peripheral and central microcirculation, especially at the level of muscle tissue, with hypervascularisation of tender points (ie the points where it is possible to evoke localized pain with acupressure);
- Raynaud's phenomenon: an excessive vasospasm caused by a physiological stimulus of vasoconstriction, induced by sympathetic stimuli. The reaction is evidenced by the change in the color of the fingers, which can become pale to cyanotic.
- Perfusional alterations (of the cerebral flow) in the encephalic areas delegated to the transmission and modulation of pain.
Fibromyalgia can therefore be defined as a disorder of the central nervous system, described as a " central sensitization syndrome ", caused by neurobiological abnormalities and endocrine alterations that act to determine a condition of physiological and cognitive pain, as well as a symptomatology neuro-psychological.
Is it a serious condition?
Fibromyalgia can be associated with other rheumatic conditions, but unlike many of these it does not cause damage to tissues and internal organs, a fairly common consequence for diseases such as rheumatoid arthritis or polymyositis. Therefore, in the case of fibromyalgia there is no mention of possible degeneration over time, nor of impaired life span. In some cases, the symptoms resolve after a few months. However, in many cases, the disease maintains a chronic (persistent) course, which tends to progressively worsen, making healing an uncommon condition.
Fibromyalgia generally does not induce other diseases. Permanent pain associated with fibromyalgia can affect quality of life. Furthermore, the state of fatigue and sleep disturbances can interfere with daily and professional activities, causing alterations in memory and concentration difficulties (in English, these manifestations are called "fibro-fog", fibromyalgia).
