Fibromyalgia

What Is Fibromyalgia?

Fibromyalgia;  It is a chronic musculoskeletal system disease characterized by widespread pain and tender points in certain parts of the body, the cause of which is unknown. It is a chronic disease that does not cause limitation of movement and deformity in the joints but disrupts the quality of life of the person.

What are the conditions that cause fibromyalgia?

Although the cause of the disease is unknown, those who have genetic predisposition to many conditions such as stress, anxiety, depression, perfectionist personality, neurohormonal disorders, immune system disorders, muscle problems, flu-like viral infections, noise, physical injuries, physical and psychological trauma (such as car accident, sexual abuse in childhood, divorce, death of a loved one), heavy work tempo, damp environment, sleep disorders, long-term computer use  it is thought to cause fibromyalgia.

What is the incidence of fibromyalgia and who does it occur?

It affects about 2% of the population. Although it can be seen at any age and in both sexes, it is most commonly seen between the ages of 25-55 and more common in women than men. This disease is also seen in children and the elderly.

What are the symptoms of fibromyalgia?

The signs and symptoms that make up the clinical picture in fibromyalgia syndrome are very diverse. The main signs and symptoms are chronic widespread pain, stiffness, fatigue, sensitive and painful spots, and sleep disturbance.

• Diffuse Pain and Stiffness: Chronic, diffuse, and bilateral. It is often localized on the waist, neck, shoulders and buttocks. It is flammable, gnawing and spreading in style, and it is rare for it to disappear completely. It varies throughout the day. While the cold increases with stress, fatigue, humid air, insomnia, anxiety, car travel, family problems, environmental and workplace conditions and physical and emotional trauma; It decreases with hot baths, warm and dry air, vacations, restful sleep and exercise.
• Fatigue: The patient gets out of bed tired in the morning. Fatigue lasts all day, it is serious, and even a light activity increases fatigue. Patients describe weakness and weakness in performing their daily tasks.
• Sleep Disorders: Patients often complain of insomnia, light sleep and inability to rest in sleep.
• Headache: Tension and migraine type headache are very common.
• Subjective swelling sensation: Not visible on examination, but the patient's joints are swollen
• Raynaud's Phenomenon: In the cold, patients have bruising and whitening on their hands.
• Irritable Bowel Syndrome: There may be constipation or diarrhea along with abdominal pain, bloating, and excess gas.
• Irritable Bladder Syndrome: Although there is no urinary infection, complaints such as frequent urination, burning during urination and pain in the lower abdomen are frequently seen in patients.
• Dry Mouth: It is not due to the use of any medication.
• Anxiety and Depression: Anxiety is reported in 50-70% and depression in 30%.

What are the physical examination findings?

• Painful spots: Applying a pressure of 4 kg with the finger defined by the American Rheumatological Association (ACR) is the pain in 11 of the 18 specific points in various parts of the body.
• Other examination findings:
• Dermography: It is a form of urticaria (hives) that occurs by scratching or rubbing the skin with a hard object or in places where clothes and laundry squeeze the body.
• Cutis anserina: Marked skin condition with the erection of feathers due to cold or fear; goose skin.
• Cutis marmaratus: Red-purple streaks on the skin caused by circulatory disorders that develop as a result of infection or sudden temperature changes.
• Excessive sweating
• Hypersensitivity on the upper scapula

How is fibromyalgia diagnosed?

In fibromyalgia, laboratory tests and radiological examinations are not performed for diagnosis, but to exclude diseases that may be confused with other fibromyalgia. Laboratory tests give normal results in fibromyalgia. If there are no signs of inflammatory rheumatic diseases or cervical and lumbar hernia, there is no need for radiological examination. The diagnosis of fibromyalgia is made by anemnesis and clinical examination. Fibromyalgia is diagnosed with widespread pain in the right and left half of the body, in the lower and upper part of the waist for more than 3 months, as well as pain in the spinal axis, and the detection of 11 painful points on examination.

What are the conditions that are confused with fibromyalgia?

Inflammatory rheumatic diseases, hypothyroidism, neuropathic pains, chronic fatigue syndrome, myofascial pain syndrome and some neurological diseases and cholesterol-lowering drugs (Statins)

What are the goals in the treatment of fibromyalgia?

Currently, there is no treatment that can cure fibromyalgia completely. Treatment aims to reduce complaints, protect and improve quality of life and functions. What are the treatment approaches in fibromyalgia? Treatment in this disease can be carried out with 4 main approaches. Drug therapy. physical therapy, psychosocial approach and complementary therapies

Psychosocial approach

In treatment, as in every disease, it is very important to inform and educate the patient about the disease. The aim of the training is to improve the patient's self-management and self-efficacy and to gain the ability to cope with complaints and to change negative perceptions such as inhibition and helplessness in a positive way. In addition, the patient's compliance with the treatment should be increased with education. The patient should be told that his illness is "real", but that it is not a deformifying or disabling disease.

Treatment begins with the patient's recovery from mechanical stresses. Then, it should be tried to reduce harmful habits such as alcohol and smoking, as they both increase pain and weaken the muscles. Excessive caffeine intake disrupts sleep quality and increases the patient's complaints.

In treatment, the patient should be taught some behavioral changes. Patients should be told to stay away from stress and excessive excitement and try to reduce their tension. The patient's perfectionist personality and meticulousness in the activities of daily living should be shown to him and he should be told that he should take a break while doing physical activity, housework and hobbies. The patient should be motivated to work and be active. . However, the patient's work should not be in the form of long-term sitting or standing, and the patient's workplace and working conditions should be regulated.

Drug treatment

In the treatment of fibromyalgia, pain medications, antidepressants, anti-epileptics, muscle relaxants and sleep regulating drugs are used according to the patient's condition and the patient.

Physical therapy

Physical therapy sessions and exercise programs that occupy the most important place  in the treatment are applied. In physical therapy, hot application, currents to reduce pain such as TENS or interference, ultrasound, laser, hiltherapy, cupping treatment, massage, taping, dry needling, trigger point injections, mobilization and manipulation applications can be performed. With spa treatment, a decrease in the pain threshold and the number of painful points and an increase in the quality of life are achieved.

Exercises

The main objectives of exercise are to reduce stress, maintain and increase muscle strength and endurance and to provide appropriate posture. It is known that patients with fibromyalgia have a decrease in muscle strength and muscle condition. Low fitness also increases the risk of muscles being affected by microtraumas, causing pain and fatigue. In fibromyalgia, cardiovascular (aerobic), strengthening, stretching, relaxation and exercises in water have been shown to be beneficial.

Studies have shown that cardiovascular (aerobic) and strengthening exercises provide improvements in physical functions, quality of life and pain. Since the pain and fatigue of these patients increase when they start exercising, light activities such as walking, swimming, cycling can be done first. As condition and muscle strength increase over time, the exercise program can be gradually increased. The type and intensity of exercise should be adjusted according to the patient. These exercises should be done 3-4 times a week and for 20-30 minutes. In these patients, evaluation of posture and posture exercises to correct poor posture are important. Patients should be advised to lie in an orthopedic bed and use orthopedic pillows.

Complementary therapies

Nutrition, A special nutrition application is not recommended except for healthy nutrition and nutritional recommendations that support the achievement of the target weight in fibromyalgia.
Ozone therapy, acupuncture, hypnosis, clinical pilates and  meditation techniques (TAI chi, Yoga, Qi gong) can be applied as part of treatment in fibromyalgia patients, in accordance with the clinical condition and conditions of the patient.