Related articles: Fibromyalgia syndrome
Definition
Fibromyalgia is a disease that affects the musculoskeletal system, causing widespread pain, marked fatigue with easy exhaustion and increased muscle tension.
The underlying causes of the disorder have not yet been completely defined, but it is likely that several factors may be involved (biochemical, genetic, neurochemical, environmental, hormonal, psychological, etc.). One of the most supported theories highlights an anomaly affecting some neurotransmitters, ie the chemical mediators involved in the communication between nerve cells, and the intervention of particular hormonal substances.
In almost all cases, however, a triggering event related to the onset of fibromyalgia can be identified, even when this does not seem apparently associated with the disease (eg physical or emotional trauma, hormonal imbalances, sleep disorders and infectious diseases).
Most common symptoms and signs *
- Tinnitus
- Adynamia
- Asthenia
- Dry mouth
- dizziness
- palpitations
- coxalgia
- Muscle cramps
- cruralgia
- Depression
- Difficulty concentrating
- Dismennorea
- Mood disorders
- Neck pain
- Pain in the sternum
- Pelvic pain
- Muscle pains
- Muscular collation
- Fotofobia
- Insomnia
- Heat intolerance
- Hyperalgesia
- Hyperesthesia
- Backache
- Headache
- Paresthesia
- Dry skin
- Loss of coordination of movements
- Loss of balance
- pollakiuria
- Joint stiffness
- Eye dryness
- Cold sensation
- Raynaud's syndrome
- Confusional state
- Strangury
- Blurred vision
Further indications
Fibromyalgia can present with a wide range of symptoms, but is commonly characterized by the coexistence of:
- generalized and persistent musculoskeletal pain (sometimes severe);
- tenderness of muscles, areas adjacent to tendon insertions and soft tissues;
- muscle stiffness;
- constant and limiting fatigue
- poor local relaxation.
These manifestations can be exacerbated by emotional anxieties and stress, excessive muscle activity, reduced sleep or lack of rest, trauma and exposure to moisture or cold. Fibromyalgia tends to be chronic, but may have a spontaneous remission or the symptoms may recur at frequent intervals.
Rigidity and pain often begin gradually, diffusely, with a dull character. To be considered "widespread", the pain must involve the right and left sides of the body, both above and below the waist, and the axial skeleton (cervical spine, thorax and lumbar region).
In addition to the state of hyperalgesia, many fibromyalgic patients present allodynia (ie they perceive pain in response to stimuli that are not normally painful) and tender points. The latter correspond to specific and limited muscle and tendon insertion zones that evoke a particularly acute response in the patient, when subjected to palpation.
Rest is often disturbed by pain and many subjects have insomnia and frequent nocturnal awakenings. Fatigue and lack of restful sleep can be associated with memory changes and difficulty concentrating (in English, these manifestations are called "fibro-fog", that is "fibromyalgic fogging").
Fibromyalgia can cause alterations of normal sensitivity (numbness in the fingers and / or toes, thermal dysesthesia and paresthesia), fasciculation (spontaneous contraction, rapid and at regular intervals of one or more motor units, without motor outcome), decrease in strength muscle in hands and arms and cramps (especially at night).
Also, sufferers tend to be anxious or depressed. Many patients also present with a concomitant irritable bowel syndrome or a tension headache. Other possible disorders variably associated with fibromyalgia include chronic pelvic pain, Raynaud's phenomenon, dysmenorrhea, palpitations, urological problems (partial incontinence, urinary frequency and painful urination), blurred vision and photophobia (excessive sensitivity to light), hypersensitivity of the skin with rashes, dry eyes and mouth, tinnitus, coordination disorders, dizziness and temporomandibular disorders.
Diagnosis is suspected in patients with the following criteria: asthenia as the predominant symptom; generalized myalgia for at least 3 months, especially if disproportionate to clinical signs; negative laboratory tests (eg VES, C-reactive protein and CK) despite the symptoms. The differential diagnosis must be made with respect to chronic fatigue syndrome, polymyalgia rheumatica and aggravation of rheumatoid arthritis or systemic lupus erythematosus.
The treatment of fibromyalgia includes aerobic exercise (eg, brisk walking, swimming and exercise bikes), hot local compresses, massages and improved sleep quality. Important is the management of stress in general with deep breathing exercises, meditation and psychological support. In addition, the administration of drugs to facilitate local relaxation and analgesics to reduce muscle pain may be indicated. Low doses of tricyclic antidepressants or drugs from the cyclobenzaprine family can be prescribed to promote night rest.
Usually, the functional prognosis is favorable in patients followed with a full support program, although the symptoms tend to persist to some extent.
