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Treatment of fibromyalgia fibromyalgia

Treatment of fibromyalgia

Fibromyalgia can be difficult to treat and usually have better results if treatment is managed by physicians from various disciplines familiar with this condition and its treatment , a multidisciplinary treatment approach called.

Some specialists involved in treating fibromyalgia include physicians, general internists, rheumatologists, physiotherapists, among others. Some large cities have clinics for pain or rheumatology clinic where you can get specific treatment for fibromyalgia.

has to take into account that many people with fibromyalgia has been part of his life going from one doctor to another without knowing what was wrong. Health education, information and communication with other affected persons are an important form of therapy. The customized treatment plan is usually effective to suit the individual needs of each patient. Some patients have mild symptoms and need very little treatment once they understand the disorder sufferers and what worse. Others, however, need a program of comprehensive care, including medications, exercise and training on techniques for pain management.

Pharmacotherapy

anti-inflammatory drugs used to treat many rheumatic diseases are not useful for people with fibromyalgia, as a defining feature of it is not conditions exist in the muscles despite the patient's pain. However, it has been reported that moderate doses of NSAIDs (NSAIDs) or analgesics can relieve some pain but has not assessed the extent of placebo effect in these cases, probably important when dealing with patients with a long history of contacts with the health system.

A subset of NSAIDs, especially the selective inhibition of COX-2, can also provide pain relief, causing fewer side effects on the stomach and intestines than traditional NSAIDs. Most doctors refuse to prescribe narcotic painkillers or tranquilizers type, except in the most severe cases of fibromyalgia.

drugs that facilitate sleep and help relax the muscles to rest in many people with fibromyalgia. Doctors also prescribe drugs, commonly known as antidepressants, to treat fibromyalgia. These drugs work by raising the active level of serotonin, norepinephrine or both in the brain. Low serotonin levels are not linked only to clinical depression, but also with sleep disorders associated with fibromyalgia. At lower doses than prescribed to treat major depression, antidepressants appear to relieve pain in people with fibromyalgia and increasing, so the chances of achieving a restful night.

There are three main classes of antidepressants: tricyclic antidepressants, selective inhibitors of serotonin reuptake inhibitors (SSRIs) and dual (recapture several neurotransmitters). Sometimes also prescribed a drug called cyclobenzaprine (Flexeril, Yurelax), classified as a muscle relaxant but similar to tricyclic antidepressants. In recent months are being implemented programs to verify the usefulness of SNRI antidepressants, ie, selective inhibitors of serotonin reuptake norepinephrine.

Although many people sleep better and feel more comfortable when taking antidepressants, the observed improvement varies widely from one person to another (which again raises the possibility that the placebo effect is playing an important role .) These medications can have side effects such as daytime sleepiness, constipation, dry mouth and increased appetite which in turn can generate energy malnutrition. Some SSRIs or SNRIs may make sleeping difficult. These side effects are rarely serious, but can be annoying. Some studies have suggested that by combining antidepressants tricyclics with SSRIs, may increase the benefits of each drug, while the side effects of both drugs cancel each other.

have recently been conducted to the successful use of anticonvulsants or antiepileptic; pregabalin (Lyrica) ® and gabapentin (Neurontin) ® been used successfully in the treatment of acute pain in neurological diseases such as Guillain-Barre syndrome, peripheral polyneuropathy and multiple sclerosis, and fibromyalgia. These drugs cause adverse side effects on the digestive system (stomach, intestine and liver). Its main side effect is weight gain, which in turn promotes greater fatigue and pain at certain points such as knees, ankles, back, etc.

There recommendations of the herb St. John's Wort it can function as antidepressants, but with fewer side effects. The herb St. John, who comes from the flower of an herb of the same name, is frequently prescribed in Europe. Little is known about the long-term effects produced by different brands of St. John's wort. should not ever use the St. John's wort if you are taking other antidepressants and should always consult with a specialist, because it has many incompatibilities with drugs and foods.

not be forgotten that the treatment of fibromyalgia is based on a three-legged stool (exercise, psychotherapy and medication) and, if broken or unbalanced some of these legs, the treatment is ineffective.

currently considered the treatment to be carried out is multidisciplinary, with the collaboration of various medical specialties. research groups exist on this disease in Spain (Barcelona and Granada in particular) and also in Mexico and other Latin American countries.

nonpharmacologic treatments

Some options are massage, aerobics and stretching exercises (yoga), acupuncture, massage clinic, occupational therapy, cognitive therapy, Reiki, etc. Also, food supplements that provide nutrients and cellular free radical release in the body can help greatly with the pain and fight disease. A widely used dietary supplement is magnesium.

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fibromyalgia

The nine paired red circles are recognized as common tender points associated with fibromyalgia.

Given the nature of fibromyalgia, there are no laboratory tests available for diagnosis of it, in fact the results of x-rays, blood tests and muscle biopsies are normal.

The clinical diagnosis is established by exclusion of other pathologies and the presence of characteristic symptoms and signs.

To diagnose fibromyalgia, rheumatology doctor should assess the patient's clinical history and symptoms, studies and analysis.

The differential diagnosis must rule out other conditions with symptoms similar to fibromyalgia.

Fibromyalgia is often confused with other rheumatic different, such as lupus erythematosus, rheumatoid arthritis, spondyloarthropathies, osteoarthritis, chronic fatigue syndrome, deficiency of vitamin D or vitamin B12, polymyalgia rheumatica or Sjögren syndrome and neurological disorders (transverse myelitis, multiple sclerosis, peripheral polyneuropathy.

Therefore, the differential diagnosis is essential to the patient's future, as both the diagnostic approach and prognosis and even therapy are different for each condition.

It is therefore essential to make tomography, magnetic resonance, electrical study members (conduction velocity and EMG), evoked potentials, blood tests (VCR, CRP, rheumatoid factor, antinuclear antibody).

After ruling out other diseases, it verifies the existence of so-called tender points, which is not the same as trigger points or myofascial trigger points syndrome.

There are a total of 18 points

can be considered to have fibromyalgia if, by applying a pressure of nine pounds on those points The patient reported pain in 11 or more of them. This technique was developed by American College of Rheumatology .

These points are distributed throughout the body: knees, shoulders, neck, buttocks, elbows, hips, etc..

However, this approach was initially adopted as a form of "case definition", which is why the diagnosis requires a thorough evaluation by a physician who specializes in rheumatic disease (rheumatologist).

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PATHOGENESIS CLINICAL

symptoms of fibromyalgia

Pain

The main element that characterizes fibromyalgia is diffuse and widespread musculoskeletal pain or stiffness prominent affects at least 3 anatomic locations for more than 3 months, without which there can diagnose the disorder.

The pain is usually severe and often difficult described, and generally gets worse with physical exertion, cold and emotional stress.

common sites in which they develop symptoms of fibromyalgia include the lumbar (lower back), neck, chest and thighs.

Altered muscle refers to a localized painful cramping and is sometimes associated with other problems (pregnancy, for example).

In some cases there is localized muscle spasm.

Other symptoms may include urinary incontinence, headache, migraine, abnormal periodic movements of the extremities (paroxysmal movements), especially of the legs (leg syndrome trigger), difficulty concentrating and difficulty remembering things ( bad memory) but it is often an increased sensitivity to touch, generalized itching, dry eyes and mouth, ringing and ringing in the ears (tinnitus), vision disturbances (phosphenes) and some neurological symptoms of motor incoordination.

has associated with Raynaud's disease as a clinical manifestation of rare presentation during the course of the disease.

mental disorders

Between 70 and 90% of fibromyalgia sufferers sleep problems also concern expressed as a restless sleep, light and unstable.

is often associated also a heterogeneous group of symptoms including severe weakening (adynamia) and even disabling (fatigue), changes in bowel habits, rigidity in the upper or lower limbs, and frequently accompanied by depressive episodes panic attacks.

Sleep disorders are very common in patients with this disease. These disorders consist primarily of abundant nightmares, restless sleep, which may be causing a condition known as excessive daytime sleepiness, and a lot of painful shocks in the muscles during sleep.

Tiredness and fatigue

The in the extreme fatigue is present in all the activities of people with fibromyalgia, making daily tasks are inevitably more difficult. Depending on the severity and the degree of variation, this fatigue can range from tolerable to an almost insurmountable disability which limits their tasks in both the family and professional.

inseparably Coupled to this fatigue, as it increases and causes severe, is the poor quality of sleep, which prevents persons with this disorder have a restful sleep and therefore prevent the break as exacerbate the fatigue and fatigue in the future.

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Fibromyalgia Fibromyalgia causes of fibromyalgia

Pathogenesis of fibromyalgia

long been erroneously assigned to the character of fibromyalgia psychological or psychosomatic illness to the point that was called psychogenic rheumatism . However, MRI studies performed in patients with health problems have revealed that the pains are expressed as low-intensity stimulation, unlike healthy people, the brain areas responsible for pain, such as primary and secondary somatosensory cortex somatosensory, prefrontal cortex, inferior parietal lobe, the anterior cingulate cortex, insula, lymph baseline, the putamen and cerebellum. It is likely that such a low threshold of tolerance of pain causes the patient with fibromyalgia this tenderness, a state of excessive pain, pressure and other stimuli.

Anyway debate continues about whether fibromyalgia is a disease in itself or whether it is actually a set symptoms (ie, a syndrome) for rheumatic diseases, neurological or immunological diagnosis is difficult and expensive or, simply, this is the accentuation of a set of processes (fatigue, sleep disorders, pain, etc.). disease are not in themselves but their combination creates significant problems for the normal life of those suffering. Like many of the common symptoms of other disorders, patients with fibromyalgia who do not receive a correct diagnosis and those who are not informed in detail about their illness is often a cumbersome and costly provocárseles pilgrimage by different systems and services consequent health proposal for a list of paraclinical tests and specific therapies, sometimes aggressive and iatrogenic effects that worsen the prognosis of the process and returns the patient's future uncertain.

No physical abnormalities were detected in the points that the patient reports pain, which is why most current hypotheses about its causes are directed towards seeking neuroscience phenomena at the level of awareness central nervous system and maintenance of altered pain responses of neurotransmitters. Although the results of physical examination is usually normal and people have a healthy, careful examination of the muscles of people with fibromyalgia reveals touch-sensitive areas at specific locations called tender points. These are areas of the body that are painful when pressure is exerted on them. The presence and pattern of these points differ characteristically hypersensitive fibromyalgia from other conditions.

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Stress

Etiology of fibromyalgia

Although the causes have not been well clarified, is thought to be caused or aggravated by physical or mental stress, physical trauma, excessive exposure to moisture or cold, poor sleep or rheumatic disease. Many cases begin after specific events, such as viral or bacterial infections, car accidents, etc. Fibromyalgia can also occur without any predisposing factor.

have been integrated as well, covering the different theories and complex relationships between the mechanisms of sleep-wake (circadian rhythm disorders), the hypothalamic-pituitary-adrenal, the processing centers tracks pain (phenomena of central and peripheral sensitization of pain) and autonomic nervous system (alterations in autonomic tone or sympathetic-vagal, sympathetic hyperactivity with hyporeactivity sustained sympathetic response to stress).

Genetics

Graphical representation of the molecule catechol O-methyltransferase, COMT gene which is involved in the probable etiology of fibromyalgia.

Some hypotheses point to a genetic predisposition for fibromyalgia is 8 times more common among members of the same family, with emphasis on research on the COMT gene that synthesizes the catechol O-methyltransferase enzyme in the pathway of catecholamines, and serotonin-related genes and substance P. In many cases, patients with fibromyalgia have low levels of the metabolite of serotonin, 5-hydroxyindoleacetic acid (5-HIAA) and tryptophan (neurotransmitters responsible for regulation of nerve impulses) and high levels of substance P in cerebrospinal fluid. Has also found a low level of blood flow thalamic region of the brain, and abnormalities in cytokine function. However, these variations are not only present in fibromyalgia, because they have found similar patterns in other diseases, including chronic fatigue syndrome, irritable bowel syndrome and depression itself.

Other studies have found high levels of anti-polymer antibodies in patients with fibromyalgia, which could indicate that it is an autoimmune disease.

psychosomatic factors

anxiety and depression caused by emotional distress (marital separation, problems with children, loss of employment, professional failure, etc..) And the sadness that occur in response to continued unrest that causes the disease could also be triggers of this health problem. In 62% of patients in a study with a diagnosis of fibromyalgia were shown to have significant psychological problems requiring professional treatment, while among patients diagnosed with rheumatoid arthritis, had a prevalence of mental disorders of 28.6%.

Most likely, the relationship between stress and fibromyalgia is much less linear than suggested by some authors and is limited to a specific subgroup of patients still can not be identified.

A number of studies have shown that stress is an important predisposing factor in the development of fibromyalgia. Consequently, it is proposed that fibromyalgia is the result of stress-induced changes in hippocampal function and integrity. This proposal is based in part on observations preclinical studies in nonhuman primates that exposure to psychological duress resulting in changes in brain tissue, including atrophic changes and metabolic changes in the hippocampal complex. The evidence supporting this hypothesis have been generated mainly from two studies using magnetic resonance spectroscopy of single voxel or monovóxel (1H-MRS) to demonstrate the complex metabolic abnormalities in the hippocampus in patients with fibromyalgia with significant correlations between metabolic alterations hippocampus and the severity of clinical symptoms.

Sleep Disorders

Within current theories on the pathogenesis of fibromyalgia are alterations in sleep architecture (polysomnography characterized by fragmented sleep, reduced deep sleep stages non-REM, among others) alterations in the functioning of the autonomic nervous system (dysautonomia) and phenomena of abnormal pain processing (awareness of pain.)

Studies electroencephalography (EEG) have shown that patients with fibromyalgia, have intrusion-wave sleep slow and that the circumstances that interfere with stage four sleep, such as pain, depression, serotonin deficiency, certain medications or anxiety can cause or worsen the condition. According to the hypothesis of sleep disturbance, an event such as trauma or illness causes sleep disorders so that start chronic pain that characterizes fibromyalgia. Hypothesized to stage four sleep is essential for nervous system function mediated by serotonin and tryptophan, as it is during this phase, some neurochemical processes in the body to "reset." In particular, pain causes the release of the neuropeptide substance P in the spinal cord, which has an amplifying effect on pain and causing nerves next to those who initiate the stimulus is more sensitive to pain. Entoces theory assumes that the lack of sleep, for whatever reason, can become a source of disease onset and symptoms.

environmental factors

Other hypotheses have proposed that fibromyalgia can occur due to environmental factors. Contact may cause an allergic reaction to metals, either by dental restoration, metal prostheses, cosmetics, tattoos, piercings or jewelry, vaccines and treatments with metal salts. Studies conducted in patients with allergies to metals who, by eliminating the source of metal, and still others have improved on that fibromyalgia is gone. Furthermore, ultrastructural alterations were found in biopsies of muscle, studied by electron microscopy in these patients.

There are descriptions of cases of fibromyalgia in clinical manifestations consistent with a viral infection such as Epstein-Barr virus, or bacterial (eg Lyme disease) that may lead to an aberrant immune reaction. However, has not yet been able to establish a definite correlation between symptoms and some of these health problems.

sometimes appears after you have diseases that weaken the body, such as rheumatoid arthritis and lupus erythematosus, but this does not seem to be the cause itself, but a circumstance that raises a hidden defect regulating the body's responsiveness to certain painful stimuli.

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HISTORY

History of fibromyalgia

Propaganda remedies including an apparent cure of neurasthenia, the name given in the nineteenth century to fibromyalgia.

The first description appears to have been Britain's Sir Richard Manningham in his publication of fever or fever and fatigue, citing descriptions similar to those made by Hippocrates.

In 1869 the American physician George M. Beard wrote a book called "American Nervousness' neurasthenia using the term applied to those who had loss of strength, fatigue or a chronic fatigue.

In 1843 the anatomist Robert R. Froriep described an association between rheumatism and stiff muscles, tender points: Musckelschwiele.

3 to 6% OF GLOBAL FIBROMYALGIA paced

Epidemiology of fibromyalgia

is known that Fibromyalgia affects more women than men by a ratio of 9 / 10:1 and could affect 3-6% of the general population. It is observed mainly between 20 and 50 years of age, although cases of children and the elderly suffering from this disease. It affects 4.5% of adult women in the general English population and 0.2 for adult males. This contrasts with a prevalence of around 10% in countries like Israel, America, Britain or Canada. Between 10 and 20% of revenues in rheumatology clinics are diagnosed with fibromyalgia, however it is estimated that about 90% of those who should be framed a table of fibromyalgia remain undiagnosed, either because of ignorance of the medical staff about it or because many professionals do not recognize them as a disease. People with rheumatoid arthritis and other autoimmune diseases are particularly likely to develop fibromyalgia.

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FIBROMYALGIA FIBROMYALGIA PATIENTS ASSOCIATIONS

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Fibromyalgia

Fibromyalgia (FM) is a term coined in 1976 (from the Latin fiber, fiber, which refers to the connective tissue, from the Greek myo, muscle, and severe pain, pain referred to a group of symptoms and musculoskeletal disorders poorly understood, which is mainly characterized by extreme fatigue, persistent pain, stiffness, variable intensity of the muscles, tendons and surrounding soft tissue, and a wide range of other psychological symptoms such as difficulty sleeping, morning stiffness, headaches and problems with thinking and memory, sometimes called "blackouts," which often prevent the routine operation of the subject. It is a disorder not contagious present in approximately 3 to 6 percent of young women, usually between 20 and 50 years of age.

Fibromyalgia is considered a controversial diagnosis, some authors claim should not be considered as a disease because, among other reasons, lack of abnormalities on physical examination, laboratory tests or objective medical imaging studies to confirm the diagnosis.

Although historically has been considered a musculoskeletal disorder and neuropsychiatric, evidence from research in the past three decades have revealed alterations in the central nervous system affecting the brain regions that may be related to both clinical symptoms as phenomena discovered during clinical investigations. Although there is no universally accepted cure for fibromyalgia, there are treatments that have been shown in controlled clinical trials to be effective in reducing symptoms such as patient education, exercise, behavioral therapies, and in some cases, consumption certain drugs.