This syndrome is not well understood, but the pain and fatigue it causes are real and disrupt everyday life. Some patients feel they suffer “a flu that never ends.”
Pain around the joints, fatigue of up to exhaustion and sleep disturbances. These are the main symptoms of fibromyalgia. This little known and sometimes controversial syndrome is not life-threatening, but it is very painful to bear and can disrupt work and daily activities to the point of disabling.
Fibromyalgia named both the Latin fibra, meaning fiber, and Greek myos and algos – and muscle pain. It affects indeed “soft tissues – the muscles and tendons – so the environment of the joints,” says Iohn Michael Norberg, senior doctor of physical medicine and rehabilitation of the Lausanne University Hospital (CHUV) and doctor- head medical Center of Lavey-les-Bains. This is a syndrome, as they are called diseases characterized by a set of symptoms. Among them, there is especially widespread pain can migrate from one body part to another, accompanied by fatigue. “Patients tell us they feel like a flu that never ends,” says the doctor CHUV. To speak of fibromyalgia,
Sign that a certain vagueness and bustle around this entity, its definition has changed in 2010. Before, it was characterized by pain in eighteen points. We now speak of painful areas: elbows, shoulders, neck, hips, etc. (See infographic). Also, now “we take into account not only the pain but also other clinical manifestations – fatigue, sleep problems and other related problems – and assessing the severity of symptoms.”
Women are most affected
This does not stop the controversy, some doctors considering it is an imaginary disease. “We must believe the patient and listen to his complaints, says Iohn Michael Norberg. This is not because one finds no injury and that its normal radiographs that the patient does not suffer. “Especially since this syndrome can hide various diseases, including thyroid disorders, diabetes or rheumatic arthritis. It has also been recognized as a rheumatic disease by WHO in 1992 (but in Switzerland, it is not taken into account by disability insurance).
This condition relates to 2 to 4% of the population, mostly women (who constitute 80 to 90% of cases). One explanation for this inequality is in the brain. In people with fibromyalgia, brain imaging (fMRI) has indeed revealed the existence of “dysfunction pain control centers that increases susceptibility to the latter and which is probably related to hormonal processes “.
Besides hormonal disturbances, other physiological factors (such as abnormalities of the nervous system) could be the cause of fibromyalgia. As for accidents or injuries caused by bereavement or separation. “These events are without doubt rush things: they act like a match on a ready to flame state.”
Those affected often have a psychological profile characterized by a propensity to catastrophism and kinesiophobia (afraid to make certain movements for fear they cause pain). They also often suffer from depression or anxiety, but it is unclear whether this is a cause or consequence of the syndrome. Indeed, neurotransmitters (chemical messengers that allow neurons to exchange information) involved “in depression and pain are the same.”
To the extent that we can not determine the origin of the syndrome (unless it is the result of another disease), one can only relieve symptoms. simple analgesics are used (such as paracetamol), anti-inflammatory and background processing, “very low doses of antidepressants,” says the specialist. Cognitive and behavioral therapies also bring benefits, as well as physiotherapy or occupational therapy.
“The management is multidisciplinary and requires considering the whole patient,” said Michael Norberg Iohn. The important thing, he said, is “to stay active and moving,” by walking or endurance exercises. One can also take hot baths, spa treatments and make practice all the activities that relax because “associated with exercise, they can help.”
Anyway, do not hesitate to consult a doctor “when symptoms begin to disrupt daily activities,” advises the specialist in chronic pain. For, it is important to repeat that fibromyalgia is not a fictional evil.
Dysfunctions in the brain
Between 60 to 80% of people with fibromyalgia also experience depression. The hypothesis has therefore been suggested that the pain syndrome could just be a kind of depression that is expressed physically. “We thought this was not the case,” said Chantal Soelch Martin, professor of psychology at the University of Freiburg. With reason: its work, conducted in collaboration with doctors from the University Hospital Zurich, have shown that the two entities have different neurobiological origins.
The researcher examined dopamine. This neurotransmitter (chemical messenger that allows communication between neurons) released when we expect to receive a reward, is indeed involved in both fibromyalgia and depression. She appealed to fifty volunteers (some with fibromyalgia alone or accompanied by depression, other constituting a control group). Using a brain imaging technique (PET scan), she measured the production of dopamine in the brain of these people who were first at rest and that should do a task leaving them dangling a reward.
They were playing with a sort of “slot machine” which sometimes allowed them to receive money. “Our previous studies had shown that among depressed people, the promise of a reward is virtually not release dopamine,” says the psychologist. But among those with chronic pain, “we found that the response of the dopamine system is very strong, it is even aberrant, suggesting that in their brain, the neurotransmitter malfunction of the control system.”
These results bring water to the mill of those who believe that one of the causes of fibromyalgia comes from changes taking place in the brain. They might also have therapeutic implications. “By using psychological methods, such as those based on mindfulness, it should be possible to train the people reward system fibromyalgia,” says Chantal Martin Soelch. And perhaps thus relieve their pain.