Fibromyalgia: symptoms, how to calm an attack?

Fibromyalgia causes chronic and diffuse pain which has a strong psychological impact. She was recognized as medical entity by the World Health Organization (WHO) in 1992 and classified as chronic widespread pain in the latest international classification of diseases (ICD). It is estimated that almost1.5 million people in France are affected by fibromyalgia. This prevalence would increase with age, peaking between 40 and 50 years. “The disease affects often hyperactive women who don’t listen to their body” tells us Dr Virginie Piano, general practitioner specializing in pain.

Definition: what is fibromyalgia?

There fibromyalgia Or fibromyalgia syndrome is clinically defined as “A syndrome consisting of chronic symptoms of moderate to severe intensity including chronic diffuse pain without apparent cause and sensitivity to pressure, associated with fatigue, cognitive and sleep problems and numerous somatic complaints“.”Before 2006, fibromyalgia was classified as a somatic disorder… The pathology has long been described as an ‘imaginary illness’, or even a ‘good woman’s illness’. “, explains Dr Virginie Piano, general practitioner specializing in pain, who participated in drafting the recommendations on the use of opioids in fibromyalgia. Today, numerous studies find physiopathological changes in patients suffering from fibromyalgia, “but its image remains tinged with negativity: it is still suspected of being purely psychological“.

What are the causes of fibromyalgia?

• 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 even of the immune system.
• A viral infection may be the cause of the disease. For example, “after a flu, or mononucleosis, you can suffer from fibromyalgia“, specifies Dr Virginie Piano.
• Furthermore, studies have demonstrated a link between an alteration of the intestinal flora and the emergence of fibromyalgia. An imbalance in the microbiota could thus be the cause of the disease.
• Psychological causes are also identified. “We observe cases of fibromyalgia following stress or an accident“.

What are the symptoms of fibromyalgia?

“Contrary to what is often said, the disease is not only a pain disease which consists of having pain everywhere“, insists Dr. Piano. The disease generates during flare-ups or seizures :

• Severe disability linked stiffness and swelling of the jointswhich cause difficulty in moving.
• Chronic asthenia (weakening of the body, physical fatigue): 3 out of 4 patients would be affected.
• Diffuse painwhose location may change.
• Neurological symptoms: Chronic diffuse spontaneous pain, mainly in the muscles, tendons or joints, tingling, tingling or hypersensitivity to sensory stimulation are sometimes associated.
• Sleep disorders (hypersomnia or hyposomnia),
• Attention and memory problems,
• Sensitive disorders (hypersensitivity to noise, smells, light).
• Anxiety or depressive disorders

“The perception of pain is altered: we see on MRI that it is enough to touch the patient who has fibromyalgia for the brain area associated with pain to activate.“

Symptoms can appear continuously, but also in the form of fibromyalgia attacks. These are intense crises that extend over two to three days“similar to a fluwith a rise in temperature, diffuse muscle pain, intense asthenia and sleep disturbances“The triggering factors for these crises are not known.

What are the 18 pain points associated with fibromyalgia?

The disease is associated with 18 pain points determined by the American College of Rheumatology. For these specialists, the existence of a fibromyalgia syndrome must be recognized when two criteria exist together:

1. diffuse pain lasting at least three months. Pain is considered diffuse when all of the following characteristics are present: a. pain on both sides of the body, b. pain below and above the waist. In addition, axial skeletal pain (cervical spine or anterior thorax or thoracic spine or lumbar spine) must be present (lumbar spine pain is considered lower body pain);
2. painful points under pressure, located very precisely at the level :

• occipital: at the occipital insertion of the suboccipital muscles (right and left)
• lower cervical: at the anterior part of the intertransverse spaces at C5-C7 (right and left);
• trapezius: at the middle part of the upper border of the muscle (right and left);
• supraspinatus: at the insertion above the spine of the scapula, near the inner edge (right and left);
• 2nd rib: just next to the chondrocostal junction, at the top (right and left);
• epicondylar: 2 cm below the epicondyles (right and left);
• buttocks: in the upper outer quadrant of the buttock (right and left);
• trochanteric: behind the projection of the greater trochanter (right and left);
• knee: next to the internal fat pad, near the joint line (right and left).

The search for these points is debated in the scientific community.

“HAS To date, there is no organic lesion or biological biomarker that can provide a diagnosis of fibromyalgia. The criteria used are therefore symptom-based“, explains Inserm. The diagnosis of fibromyalgia takes into account a diffuse pain score (which is based on the intensity and location of pain) as well as a severity score of associated symptoms (listed above). The First self-questionnaire allows the patient to quickly assess whether he or she may have the disease, but does not allow a diagnosis to be made.

What are the treatments to calm a fibromyalgia attack?

Level 2 analgesics (codeine, tramadol) are also used, but they must be limited

Mechanical pain (joint and inflammatory) linked to fibromyalgia can be treated with analgesic medications such as paracetamol and non-steroidal anti-inflammatory drugs. THE level 2 analgesics (codeine, tramadol) are also used, “but we must limit them”, specifies Dr. Piano. On the other hand, opioids are not recommended, and even contraindicated in the long term. “They increase hyperalgesia and worsen the disease“.

What are the natural treatments for fibromyalgia?

Among non-drug treatments, patients can use:

• there balneotherapy and thermal cures
• transcutaneous neurostimulation on painful areas
• there physiotherapy (in a swimming pool for example): “Short, non-algogenic sessions are required.“.

It is imperative to continue to move, stay active. “Rest causes disadaptation to exercise and aggravates symptoms“But over-revving should be banned!”Hyperactive women must fragment their activities, take regular breaks to move if they work on a computer, for example“. Finally, a psychological support must often be considered to live better with this disease. Other therapies such as self-hypnosis, meditation, Pilates, Qi qong… bring good results. “The idea is to empower people in the face of their illness“. The disease can be managed within the framework ofan ALD (long-term condition) under the title of “off-list ALD”, but obtaining this recognition remains complex.

Thanks to Dr Virginie Piano, general practitioner specializing in pain.