Fibromyalgia

Description

What is Fibromyalgia Syndrome?

Fibromyalgia; It is a chronic musculoskeletal disease
characterized by widespread pain and sensitive points in certain parts of the
body. 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 not known, stress, anxiety,
depression, perfectionist personality, neurohormonal disorders, immune system
disorders, muscle problems, flu-like viral infections, noise, physical
injuries, physical and psychological trauma (car accident, childhood sexual
abuse, divorce, It is thought that many conditions such as the death of a
person), heavy work pace, damp environment, sleep disorders, and long-term
computer use cause fibromyalgia in those with a genetic predisposition.

What is the prevalence of Fibromyalgia and who is it seen?

It affects about 2% of the society. Although it can be seen in
all ages and both genders, it is most common in women between the ages of 25-55
and more 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 diverse. The main signs and symptoms are chronic
widespread pain, stiffness, fatigue, tender and painful points, and sleep
disturbance.

What are the physical examination findings?

Painful points: It is pain in 11 of 18 special points in various parts of the
body by applying a pressure of 4 kg with the finger defined by the American
Rheumatology Association (ACR).

Dermo graphism: It is a form of urticaria (hives) that occurs
following the scratching or rubbing of the skin with a hard object or where
clothes and underwear squeeze the body.

Cutis anserine: Skin condition
characterized by the erect hair on it due to cold or fear; goose skin.

Cutis marmaratus: Red-purple lines on the skin caused by circulatory
disturbance resulting from infection or sudden temperature changes.

How is Fibromyalgia diagnosed?

Laboratory tests and radiological examinations in fibromyalgia
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 inflammatory rheumatic diseases or signs of neck and lumbar
hernia, radiological examination is not required. Fibromyalgia is diagnosed by
anamnesis and clinical examination. Fibromyalgia is diagnosed with widespread
pain in the right and left half of the body, lower and upper waist for more
than 3 months, as well as pain in the spinal axis and detection of 11 painful
points on examination.

What are the conditions 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 Fibromyalgia treatment?

Today, there is no treatment that provides full recovery of
fibromyalgia. Treatment is aimed at reducing complaints, preserving and
improving quality of life and functions.

What are the treatment approaches in Fibromyalgia?

Treatment in this disease can be done with 4 main approaches.
Medication. physical therapy, psychosocial approach and complementary therapies

Psychosocial approach

In treatment, as in any 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, to gain the ability to
cope with complaints, and to positively change negative perceptions such as
frustration and helplessness. 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 not a deforming or disabling illness.

Treatment begins with the patient getting rid of mechanical
stresses. Then, it is necessary to try to reduce harmful habits such as alcohol
and smoking because 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 perfectionist personality of
the patient and his meticulousness in daily life activities 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 job should not be sitting or standing for a long time, and the
patient’s workplace and working conditions should be regulated.

Medication

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.

Physiotherapy

Physical therapy sessions and exercise programs, which occupy
the most important place in treatment, are applied.

In physical therapy, currents to reduce pain such as hot
application, TENS or interference, ultrasound, laser, hil therapy, cupping
therapy, massage, taping, dry needling, trigger point injections, mobilization
and manipulation applications can be performed.

With hydrotherapy, a decrease in the pain threshold and the
number of painful points and an increase in quality of life are provided.

Exercises

The main objectives of exercise are to reduce stress, maintain
and increase muscle strength and endurance, and provide proper posture. It is
known that patients with fibromyalgia have a decrease in muscle strength and
muscle condition. Poor condition also increases the risk of muscles being
affected by microtraumas, causing pain and fatigue. In general, cardiovascular
(aerobic), strengthening, stretching, relaxation and exercises in water have
been found to be beneficial in fibromyalgia. Studies have found that
cardiovascular (aerobic) and strengthening exercises improve 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. The exercise program can be gradually
increased as the condition and muscle strength increase over time. The type and
intensity of the exercise should be adjusted according to the patient. These
exercises should be done 3-4 times a week for 20-30 minutes.

Posture exercises are important for these patients to evaluate
posture and correct poor posture. Patients should be advised to sleep in an
orthopedic bed and use orthopedic pillows.

Complementary treatments

Nutrition, Ozone therapy, acupuncture, hypnosis, clinical Pilates and
meditation techniques (TAI chi, Yoga, Qi gong) can be applied as part of the
treatment in fibromyalgia patients, in accordance with the clinical condition
and conditions of the patient.