Treatment of fibromyalgia abroad
Fibromyalgia means muscle pain of a non-inflammatory nature that lasts for 3 months or more. This syndrome is a second or third reason by frequency of which causes people go to the rheumatologist in the developed countries. Its incidence among population is approximately from 4 to 8%.
Pain can be so severe that it often requires the intake of narcotic pain medications.
Causes of fibromyalgia
There are no clear facts about the development of fibromyalgia. Basic risk factors of the illness are:
- Genetic predisposition. About 25-50% of people suffering from fibromyalgia also have relatives with this illness, this is much higher than the average population.
- Female sex. 80-90% of all the patients suffering from fibromyalgia are women.
- Not trained (weak) muscles. The less muscle tone a person has the more skeletal muscles are susceptible to the micro traumas. Constant micro injuries cause pain and reduce the contractile ability of muscles.
Less significant risk factors are:
- Lack of sleep
- Irritable bowel syndrome
- Celiac disease
- Serotonin deficiency
Trigger factors that provoke the onset of the chronic muscle pain are:
- Severe stress
- Operations in the medical history
- Severe illness in anamnesis
- Hepatitis C
- Infectious mononucleosis
Symptoms of fibromyalgia
Main symptom of fibromyalgia is muscle pain. Peculiarities of the pain syndrome are:
- Monotonous character of pain, absence of light intervals
- Increased pain on the background of stress, physical activity, hypothermia
- Reduction of pain under the influence of massage, heat, rest
Neck, back, waist and shoulders are the most common location of the pain. Pain is rarely detected in the limbs and chest area. Special spots when pressed are identified during the objective exam that increase pain. Spots are symmetrical and represent areas where muscles are connected to the tendons. 20% of patients have painful nodules that are defined by touch and consist of fibrous tissue.
All the rest of symptoms:
- Decreased appetite
- Sleep disturbance
- Morning or evening stiffness
- Muscle weakness
- Depression (observed in 64% of patients with fibromyalgia, often precedes it)
- 40% of patients report swelling of soft tissues
- Paresthesia (numbness, tingling, sensation of "crawling") are detected in 50% of patients
- Tension headaches (56% of patients)
- Irritable bowel syndrome (43% of patients)
- Disorders of the menstrual cycle (noted in 43% of female patients)
- Malfunctioning of peripheral microcirculation (30% of patients)
Patients, having fibromyalgia, often experience the cold and pale hands, dry mouth, increased sweating, dizziness when changing the position of the body and other vegetative disorders are found.
Diagnostics of fibromyalgia
Fibromyalgia is diagnosed when there is pain in the muscles, but there are no other signs of the possible pathology that could provoke this symptom. Thus, almost all the laboratory and instrumental tests are aimed at the exclusion of different disease able to cause muscle pain.
Standard survey plan is as follows:
- Clinical analysis of urine and blood
- Biochemical blood test (for creatinine, creatine phosphokinase, hepatic enzymes)
- Blood tests for thyroid hormones
- Rheumatoid factor, antinuclear antibodies (if symptoms of systemic autoimmune connective tissue damage are present)
- X-rays of the joints and spine
- CT scan
Criteria for the diagnosis of fibromyalgia is based on clinical examination:
- Pain is noted in all four quadrants of the human body (upper and lower, right and left parts of the body)
- Pain lasts no less than 3 months
- Soreness of at least 11 of 18 increased pain sensitivity points are detected
First two criteria are mandatory and the third one is additional. Fibromyalgia is diagnosed by a doctor even if there are less than 11 pain sensitivity spots.
Treatment of fibromyalgia abroad
Fibromyalgia is treated conservatively. Main directions of therapy are:
- Drug therapy
- Cognitive-behavioural therapy
- Spa treatment
- Therapeutic exercise (walking, swimming, aerobics, gymnastics)
Manual therapy was previously used, but in recent years it has been used less and less often because of low efficiency. It provokes an increase in the pain in a number of patients.
Non-pharmacological methods of treatment are:
- Thermal baths
- Infrared rays
Medication therapy includes the use of:
- Muscle relaxants
Severe pain may require the use of the opiates (narcotic analgesics).
New treatment techniques of fibromyalgia are now available in German hospitals:
- Phototherapy presupposes the exposure to bright white light. Usually, they conduct courses of 10 sessions lasting 30 minutes in the morning. As a result, pain decreases, depression goes away and sleep normalises.
- Introduction of botulinum toxin into painful points relaxes the muscles and promotes relief of the pain for a period of several months.
- Hyperbaric oxygen therapy. Course duration of 2 months (5 sessions of 90 minutes per week) can reduce pain and reduce the need for painkillers.
- Laser therapy. Laser exposure to painful points gives not only a short-term, but also a long-term analgesic effect. It stimulates microcirculation and improves the filling of tissues with oxygen. It stops the pain impulses.
Prognosis for fibromyalgia
Life prognosis is favourable. Fibromyalgia has an impact on the life quality, but it doesn’t reduce its span.
30% of patients lose the capacity to work. This is due to the constant pain that cannot be blocked by the analgesic drugs.
The majority of patients have a stable clinical course of fibromyalgia: without progression, but also without reducing the pain.