HERE'S WHAT YOU KNOW ABOUT FIBROMYALGIA
- On 14/08/2020
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Fibromyalgia is an underdiagnosed disease that causes pain, trouble sleeping, and severe fatigue. How to treat her? Which exams to take?
Definition: what is fibromyalgia?
Fibromyalgia or fibromyalgia syndrome is defined by the French National Authority for Health as widespread, diffuse pain that goes from head to toe associated with lack of sleep and severe asthenia. “Before 2006, fibromyalgia was classified among the somatic disorders… The pathology has long been qualified as 'imaginary disease', even as 'disease of a good woman'.
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Today, many studies find pathophysiological changes in patients suffering from fibromyalgia, "but its image remains tinged with negativity: it is still suspected of being purely psychological". The disease can be managed within the framework of an ALD (long-term illness) under the title of "non-list ALD", but obtaining this recognition remains complex. If women are more frequently affected, more and more men are being diagnosed (up to 20% of patients are men, according to the latest data).
Symptoms and Pain
The disease generates during flare-ups a strong disability linked to stiffness and swelling of the joints, which cause difficulty in moving. It is responsible for asthenia (weakening of the body, physical fatigue) and diffuse pain, the location of which may change. "But contrary to what has often been said, the disease is not only a disease of pain which consists in having pain all over." Some of the main symptoms are:
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- sleep disorders (hypersomnia or hyposomnia),
- attention and memory disorders,
-sensory disorders (hypersensitivity to sounds, smells, light).
"The perception of pain is altered: we see on MRI that it suffices to touch the patient with fibromyalgia for the area of the brain associated with pain to activate."
Symptoms can appear continuously, but also in the form of fibromyalgia attacks. These are intense attacks that last two to three days, "flu-like, with a rise in temperature, diffuse muscle pain, severe fatigue and sleep disturbances." The triggers for these crises are not known.
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As a disabling disease, fibromyalgia can induce a significant psychological handicap (depression, anxiety, mood disorder, etc.), associated with repeated sick leave, significant social and family isolation.
Physiological and psychosomatic causes
Among the identified causes of fibromyalgia are:
-A muscle abnormality characterized by an overproduction of inflammatory cytokines (peptides produced in response to different stimuli).
-An abnormality of the hormonal and endocrine system, or the immune system.
-A viral infection can be the cause of the disease. For example, "after a flu, or a mononucleosis, one can suffer from fibromyalgia".
In addition, studies have shown a link between an alteration of the intestinal flora and the emergence of fibromyalgia. An imbalance of the microbiota could thus be at the origin of the disease.
Psychological causes are also identified. "There are cases of fibromyalgia following stress or an accident."
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Treatments: how to treat fibromyalgia?
Mechanical pain (joint and inflammatory) associated with fibromyalgia can be treated with pain relievers such as paracetamol and nonsteroidal anti-inflammatory drugs. Level 2 analgesics (codeine, tramadol) are also used, "but they must be limited", explains Dr Piano. On the other hand, opioids are not recommended, and even contraindicated in the long term. "They increase hyperalgesia and worsen the disease".
Non-medicated: thermal cures ...
Among the non-drug treatments, patients can resort to balneotherapy and thermal cures. "Recent work has established a link between the climate and the effectiveness of these therapies: they should be provided in an area characterized by a hot and dry climate." Transcutaneous neurostimulation on painful areas is also part of the therapeutic arsenal. This method can be performed at home using a machine that the patient rents and can then purchase.
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