Dealing With Chronic Pain

Fibromyalgia: Definition

Fibromyalgia is a pain syndrome. In addition to muscle pain, it brings with it other symptoms such as tiredness, exhaustion and sleep disorders. In the event of a severe fibromyalgia attack, the performance of a person affected can be massively restricted. It is typical of this disease that no organic causes for the symptoms can be identified when the affected body parts are examined (e.g. using MRI or ultrasound ).

Because of the diffuse chronic pain that can occur anywhere in the body, fibromyalgia is sometimes referred to as “generalized soft tissue rheumatism .” It affects around two out of 100 people in Germany. In 80 percent of cases these are middle-aged women.

Fibromyalgia: symptoms

The term “fibromyalgia” stands for fiber-muscle pain. This already describes the central symptom of fibromyalgia: deep muscle pain. These last longer than three months and are accompanied by other symptoms, especially sleep disorders and exhaustion. Many of those affected also suffer from psychological symptoms such as depression or anxiety

Main symptom: Pain

The main symptom of fibromyalgia is chronic, diffuse pain. Those affected often describe it as deep muscle pain, which can be accompanied by stiffness, burning, throbbing, numbness band tingling. In addition, joints or muscles sometimes feel swollen.

The pain occurs in several areas of the body. Typically, people with fibromyalgia report pain in the neck or middle back or lower back and at least one other location in both arms and legs.

Variable pain intensity: Pain severity and intensity in fibromyalgia are influenced by weather, temperature, time of day, stress level, and physical activity. For some patients, the pain is particularly intense in the morning and then improves throughout the day. In general, warmth and moderate activity can usually improve fibromyalgia symptoms.

Headaches & more: In addition to the muscular pain, people with fibromyalgia often suffer from headaches or migraines. Irritable bowel symptoms such as frequent abdominal pain, diarrhoea or constipation are also common. Others suffer from pain similar to that of a urinary tract infection.

Facial pain: A special variant of fibromyalgia manifests itself as so-called temporomandibular joint syndrome, in which the face and jaw hurt. Those affected can only move the latter to a limited extent, which causes them problems when chewing.

Fibromyalgia pain points: For a long time, painful pressure points (tender points, fibromyalgia pain points) on certain parts of the body were considered typical of fibromyalgia. If mechanical irritation caused pain in at least 11 of these 18 pressure points, the diagnosis of “fibromyalgia” was confirmed. However, according to the current state of science, the tender points are no longer sufficient criteria for the diagnosis of fibromyalgia. Instead, a specific symptom complex must be present in order to diagnose the disease.

Main symptoms fatigue and sleep disorders

In many cases, fibromyalgia syndrome also includes tiredness and exhaustion. Sleep disorders are often added – those affected have light sleep and often wake up at night.

In addition, fibromyalgia patients are more likely to suffer from sleep apnea. Repeated short pauses in breathing occur at night. As a result, sleep is not very restful and the risk of cardiovascular diseases increases.

Fatigue in fibromyalgia: The sleep disorders can lead to chronic fatigue syndrome (chronic fatigue syndrome, CFS). Fatigue is the technical term for chronic tiredness. In fact, most fatigue sufferers meet the criteria for fibromyalgia. Conversely, the majority of fibromyalgia sufferers suffer from CFS.

Restless Legs Syndrome: A condition that also often occurs in fibromyalgia patients is the so-called restless legs syndrome. Those affected suffer from excruciating pulling or tingling in their legs when they are at rest. The symptoms can only be relieved through exercise. This can also cause significant sleep disturbances and subsequent fatigue. Patients with fibromyalgia symptoms should therefore be examined to determine whether restless legs syndrome is also present.

Other fibromyalgia symptoms

Sometimes people with fibromyalgia also report symptoms in the eyes: swelling or fluid accumulation (edema) in the eye area is possible. In addition, fibromyalgia can cause visual disturbances such as flickering in front of the eyes.

It is not uncommon for the disease to be associated with psychological problems. For example, nervousness, inner restlessness, depression and loss of drive are particularly common. Between 62 and 86 percent of patients even develop depression during their lifetime. Anxiety disorders can also occur in connection with fibromyalgia.

Hypersensitivity is another common feature: people with fibromyalgia are often particularly sensitive to stimuli such as smells, noise or light.

Further fibromyalgia symptoms occur as a result of the disturbed body regulation. Such vegetative symptoms include increased shaking (tremor), excessive sweating (hyperhidrosis), reduced salivation and cold fingers.

Severity levels of fibromyalgia

The severity and variety of fibromyalgia symptoms vary greatly from patient to patient. Doctors divide the disease into different degrees of severity:

In addition to the pain in various parts of the body, those affected with milder forms have little or no other physical complaints and no psychological symptoms. They often experience longer symptom-free intervals and their quality of life is hardly affected.

In other cases, chronic pain is accompanied by other physical and psychological symptoms of varying degrees of severity. The everyday life of those affected can be moderately to significantly affected.

Fibromyalgia: therapy

There is no cure for fibromyalgia. However, with the right treatment, the symptoms of fibromyalgia can be controlled. However, there is no checklist of generally effective therapeutic measures. Rather, each patient receives individually tailored treatment:

Appropriate therapeutic measures are selected, tailored to the type and extent of the symptoms and the course of fibromyalgia, by the doctor and patient together. Because it is crucial for the success of the therapy that the patient actively supports all measures.

Movement training

The focus of fibromyalgia treatment is usually on permanently relieving muscle pain. Movement. Doctors recommend that patients do endurance training two to three times a week at low to medium intensity. The aim is to stay in the so-called aerobic range when exercising, in which the body does not use more oxygen than it currently absorbs. A good indication of this is if you still have enough breath during training to be able to carry on a conversation easily.

Examples of sports suitable for endurance training for fibromyalgia include:

• Hike
• To swim
• Ride a bike
• Dance
• Training on the ergometer
• Aqua jogging
• Walking

Such sports train cardiovascular fitness. In addition, targeted training of joint and muscle function as well as flexibility, strength and coordination is recommended for fibromyalgia , namely through:

• Water aerobics (two to three times a week)
• Dry gymnastics (two to three times a week)
• Functional training (twice a week)

Physical therapy

Heat treatment can improve the symptoms of fibromyalgia syndrome.

Cold , on the other hand, worsens the symptoms – at least in most cases. However, some patients report a positive effect of whole-body cryotherapy. You stay in a cold chamber with extremely low temperatures for a few minutes.

So-called balneotherapy with medicinal baths also has a soothing effect on many patients.

On the other hand, massages are expressly not recommended for the treatment of fibromyalgia.

Psychotherapy

How severe pain is perceived depends on the inner attitude towards the symptoms. As part of cognitive behavioral therapy, patients learn to re-evaluate pain. It is then still there, but is no longer the focus of consciousness.

To do this, the therapist, in collaboration with the patient, also uncovers thought and perception patterns that negatively influence the course of the disease. If they are broken, it can significantly change the perception of pain.

Relaxation procedures

Stress increases the symptoms of people with fibromyalgia. Therefore, relaxation techniques are important elements of fibromyalgia therapy. These include autogenic training and progressive muscle relaxation according to Jacobsen. Far Eastern relaxation techniques such as Tai Chi, Qigong and yoga can also help.

Medical therapy

There are no medications in Germany that are explicitly approved for the treatment of fibromyalgia. However, if the disease is severe, therapy can be supplemented with medications that were developed for other diseases: antidepressants and anticonvulsants.

Antidepressants

Many patients with fibromyalgia develop psychological comorbidities such as anxiety disorders or depression. In addition to cognitive behavioral therapy, antidepressants can then be prescribed. They influence the messenger metabolism in the brain and thus have a mood-enhancing, anti-anxiety and – depending on the active ingredient – depressant (sedating) or activating effect.

Antidepressants can also reduce pain and fatigue and thus increase general well-being. That is why they are often prescribed to patients who do not have depressive symptoms.

Some antidepressants from the group of selective serotonin-norepinephrine reuptake inhibitors (SSNRIs) such as duloxetine or tricyclic antidepressants such as amitriptyline are recommended.

Antidepressants should only be used over the long term if they are effective.

Anticonvulsants

Another important group of medications for fibromyalgia therapy are the so-called anticonvulsants. They were developed to treat nerve pain and epilepsy , but can also be used as part of fibromyalgia therapy.

Some patients receive the anticonvulsant pregabalin, which also has a pain-relieving effect – it blocks certain messenger substances that are responsible for the transmission of pain. This can be particularly helpful for patients whose illness is characterized by severe pain.

Mostly ineffective: painkillers

Although pain is the main symptom of fibromyalgia, most common painkillers are not recommended for fibromyalgia therapy – they have little or no effect.

Since fibromyalgia is not associated with inflammatory changes, anti-inflammatory painkillers such as ibuprofen, acetylsalicylic acid or paracetamol do not make sense. The strong anti-inflammatory cortisone is also not used.

Painkillers containing opioids are also unsuitable for fibromyalgia therapy. Most don’t work. An exception is Tramadol. It is primarily prescribed to patients with severe pain symptoms.

Alternative healing methods

In addition to conventional medical methods, some fibromyalgia patients use alternative healing methods. These include methods of Traditional Chinese Medicine (TCM) such as acupuncture, but also osteopathy.

Other fibromyalgia patients rely on homeopathy. Depending on the type of symptoms, various homeopathic remedies can be used. For example, Rhus Toxicodendron is said to relieve pain.

Alternative medical methods can at best complement conventional medical treatment but cannot replace it. The concept of homeopathy in particular is controversial and not clearly proven by studies. Talk to your doctor about how you can best support the therapy yourself.

Patient education

Training can be very helpful when starting fibromyalgia therapy. Patients learn more about their illness and the treatment. You will receive information and suggestions for self-management (physical activity, stress reduction, etc.) and can exchange ideas with other affected people. This can help each individual to deal with the disease better.

Rehabilitation measures

Some patients suffer so much from symptoms such as pain, severe exhaustion, depression or anxiety that they often miss work. In extreme cases, some people with fibromyalgia retire early.

With such severe impairments and loss of performance, rehabilitation therapy in a clinic can make sense. A variety of treatment approaches are offered bundled as multimodal fibromyalgia therapy (e.g. patient training, physical measures, relaxation procedures, psychological or psychotherapeutic care).

Fibromyalgia: Diet

There is no specific diet that has been proven to help with fibromyalgia symptoms. However, there is evidence that a diet with a focus on plant-based foods can have a positive effect on the course of the disease.

Fibromyalgia: causes and risk factors

The causes of fibromyalgia are still not fully understood. There is usually no clear trigger for the pain disorder. What is certain is that it is not an inflammatory rheumatic disease of the muscles or joints or pain caused by wear and tear.

Impaired pain processing

The most important hypothesis about the causes of fibromyalgia is currently that the patient’s central nervous perception of pain is altered. The threshold for pain perception is lower than usual for those affected by fibromyalgia, so that the brain perceives even mild stimuli as pain and attaches greater importance to it. One possible explanation for this is low serotonin levels , which have been demonstrated in some studies in fibromyalgia patients.

Genetic predisposition

Fibromyalgia often runs in families. This suggests a genetic component – certain gene changes could result in increased pain sensitivity, but have not yet been identified.

Altered nerve fibers

Studies by the University of Würzburg have produced an organic finding in fibromyalgia, i.e. initial evidence of physical changes in those affected: The researchers found that the small nerve fibers in the muscle tissue of patients with fibromyalgia were changed. Further study results from the university also suggest that the severity of fibromyalgia symptoms depends on how severely the cutaneous nerves are damaged. However, the researchers’ findings do not yet have any impact on the diagnosis and treatment of fibromyalgia.

Psyche, stress and trauma

Since there is usually no organic explanation for the pain, those affected were long considered imaginary patients. Or it was wrongly assumed that the symptoms of fibromyalgia were the purely psychosomatic expression of depression.

This hypothesis has now been refuted, even though the psyche can certainly play a central role in the development of the disease. Stress and physical or emotional injuries (trauma) can promote fibromyalgia. The disease often occurs during periods of great stress. In addition, people who were abused or sexually abused in childhood or as adults are more likely to develop fibromyalgia.

Last but not least, the high level of stress that accompanies a serious illness can promote anxiety and depression.

Unhealthy lifestyle

An unfavourable lifestyle can also promote your fibromyalgia. These include smoking, obesity and low physical activity.

Middle age, female gender

Fibromyalgia can occur at any age. However, it most often develops between the ages of 40 and 60. Gender also plays a role: 80 percent of those affected are female.

Secondary fibromyalgia

In some cases, fibromyalgia appears to develop in conjunction with another disorder. This is then referred to as secondary fibromyalgia – in contrast to primary fibromyalgia, in which no other illnesses can be considered as the cause.

The diseases that can promote fibromyalgia include:

• other rheumatic diseases
• Infectious diseases, mostly viral infections with Epstein-Barr viruses (pathogen of Pfeiffer’s glandular fever ), hepatitis viruses and HI viruses
• certain tumor diseases
• Disturbances of the hormonal balance

Fibromyalgia: Diagnosis

If you suspect fibromyalgia syndrome, your family doctor is the first point of contact. If necessary, he treats the disease in collaboration with colleagues such as specialized pain therapists, neurologists, psychotherapists and physiotherapists.

It often takes a long time until the diagnosis of fibromyalgia is made because the clinical picture is very diverse and difficult to define. It is not uncommon for those affected to go from doctor to doctor for years and suffer from the fact that their symptoms cannot be assigned to a diagnosis. This unsettles those affected, delays treatment and thus worsens the prognosis.

Anamnesis interview

The first step in clarifying possible fibromyalgia is a conversation between doctor and patient to take a medical history (anamnesis). Typical questions asked by the doctor include:

• Where exactly do you have pain?
• How does your pain feel?
• Do you have any known rheumatism?
• Is your everyday life affected by the symptoms?
• Do you suffer from sleep disorders?
• Do you have gastrointestinal problems?
• Is your mood affected?

Cornerstone of diagnosis

For a long time, the so-called tender points or fibromyalgia trigger points played a central role in the diagnosis. These are certain points on the body that can hurt when pressure is applied. If at least 11 of a total of 18 tender points in a patient react to pressure with pain, this was considered an indication of fibromyalgia syndrome.

However, diagnostics based solely on tender points are now considered outdated. Instead, experts recommend making the diagnosis based on the following symptoms:

• chronic pain in several areas of the body for at least three months
• physical and/or mental exhaustion/fatigue
• not restful sleep
• Feeling of stiffness in the hands and feet
• reduced physical and/or mental performance

Further information is provided by information from the anamnesis:

• similar chronic pain in multiple areas of the body in family members
• Pain in the musculoskeletal system, head or stomach in childhood or adolescence
• high level of suffering
• increasing pain during massage
• unsuccessful orthopedic treatment

Pain diary as a diagnostic aid

The doctor will ask the patient to keep a pain diary in which, in addition to the type, duration and location of the pain, he will also record any accompanying abnormalities. These include, for example, gastrointestinal complaints or problems with urination.

Psychological stress such as concentration or sleep disorders and lack of drive should also be noted and discussed with the doctor. Such accompanying symptoms are typical of fibromyalgia syndrome.

Exclusion of other diseases

The symptoms that fibromyalgia patients suffer from also occur in other diseases. This includes:

• Rheumatoid arthritis (RA)
• Systemic lupus erythematosus (SLE)
• Bechterew’s disease (ankylosing spondylitis, AS)
• Polymyalgia rheumatica (PMR)
• Hyperthyroidism and other hormonal diseases
• Muscle inflammation
• Diseases of the central or peripheral nervous system

With the help of various examinations, the doctor can rule out or reveal such diseases as the cause of the symptoms, for example by:

• Roentgen
• Computed tomography (CT)
• Magnetic resonance imaging (magnetic resonance imaging, MRI)
• Blood test, including for the so-called rheumatoid factors

If no pathological changes are discovered during these examinations, this indicates fibromyalgia.

Mentally related pain disorders

There is also a risk of confusion between fibromyalgia symptoms and “persistent somatoform pain disorder” and “chronic pain disorder with psychological and somatic factors”. In these clinical pictures, the pain is caused by strong psychological stress – which does not mean that it is just your imagination! In the case of fibromyalgia, however, severe psychological stress is not the cause, even if it can make the symptoms worse.

Fibromyalgia tests for self-diagnosis?

You can find various online questionnaires for the fibromyalgia self-test on the Internet. However, they are not very informative; for example, they often only contain individual symptom areas such as pain. However, diagnosing the complex clinical picture of fibromyalgia belongs in the hands of experienced doctors!

Fibromyalgia: course and prognosis

There is currently no cure for fibromyalgia. However, it does not cause any permanent damage to muscles and joints, so fibromyalgia patients are not at risk of severe disability. The life expectancy of those affected is not shortened either.

However, the chronic pain and other fibromyalgia symptoms can significantly affect the quality of life of those affected. The treatment therefore aims to reduce the symptoms as much as possible. In order for this to be successful, close cooperation between doctor and patient is necessary – fibromyalgia treatment is usually complex and difficult.

Starting early can increase the chances of success: If treatment is initiated within two years of the onset of symptoms, it can largely relieve up to 50 percent of those affected from their pain. After the age of 60, the symptoms of fibromyalgia often improve on their own.

Chronic Pain Management in the UAE

There is a growing emphasis on multidisciplinary approaches to fibromyalgia management in the UAE. Healthcare professionals recognize the importance of addressing the physical, psychological, and social aspects of the condition. Treatment plans may include a combination of medication, physical therapy, cognitive-behavioral therapy, and lifestyle modifications tailored to each patient’s needs.

Support groups and online communities also play a vital role. These platforms allow individuals to connect with others who understand their experiences, share coping strategies, and offer mutual support. By fostering a sense of community, these initiatives help combat the feelings of isolation often associated with chronic conditions like fibromyalgia.

Looking ahead, continued efforts to raise awareness, improve access to care, and destigmatize fibromyalgia are essential in the UAE.