This syndrome remains poorly understood, but the pain and fatigue it causes are very real and disrupt everyday life. Some patients feel like they are suffering from “endless flu”.
Pain around the joints, fatigue that can go as far as exhaustion and sleep disturbances. These are the main symptoms of fibromyalgia. This misunderstood and sometimes controversial syndrome is not fatal, but it is very painful to endure and can disrupt professional and daily activities to the point of becoming disabling.
Fibromyalgia takes its name from both the Latin fibra, which means fibers, and the myos and Greek algae – muscle and pain. It affects “the soft tissues – muscles and tendons – and therefore the environment of the joints”, explains Iohn Michael Norberg, chief doctor of the physical medicine and rehabilitation department of the Center hospitalier universitaire vaudois (CHUV) and chief doctor in Lavey – the Les-Bains medical center. It is a syndrome, as we call diseases characterized by a set of symptoms. Among these, there are particularly diffuse pains which can migrate from one part of the body to another, accompanied by great fatigue. “The patients tell us that they have the impression of having an endless flu,” notes the doctor at the CHUV. To talk about fibromyalgia,
As a sign that a certain vagueness still reigns around this entity, its definition changed in 2010. Before, it was characterized by pain in eighteen points. We are now talking about painful areas: elbows, shoulders, neck, hips, etc. (see infographic). In addition, now “we take into account not only pain, but also other clinical manifestations – fatigue, sleep disturbances and many other associated problems – and we assess the severity of symptoms”.
Women are the most affected
This does not prevent controversy, some doctors consider it an imaginary disease. “You have to believe the patient and listen to their complaints,” says Iohn Michael Norberg. Just because you can’t find a lesion and his x-rays are normal doesn’t mean the patient doesn’t suffer. Especially since this syndrome can mask various pathologies, in particular thyroid disorders, diabetes or rheumatic arthritis. It was also recognized as a rheumatic disease by the WHO in 1992 (but in Switzerland, it is not taken into account by disability insurance).
This condition affects 2 to 4% of the population, mainly women (who represent 80 to 90% of cases). One of the explanations for this inequality is found in the brain. In people with fibromyalgia, brain imaging (functional MRI) has indeed revealed the existence of a “dysfunction of the centers of pain regulation which increases the sensitivity to the latter and which is probably linked to hormonal processes. “.
In addition to hormonal disturbances, other physiological factors (such as abnormalities of the nervous system) could be at the origin of fibromyalgia. As well as accidents or trauma caused by bereavement or separation. “These events probably only precipitate things: they act like a match against a state already ready to ignite.”
Those affected often have a psychological profile characterized by a propensity for catastrophism and kinesiophobia (fear of performing certain movements for fear of causing pain). They also often suffer from depression or anxiety, but it is not clear whether this is a cause or a consequence of the syndrome. In fact, the neurotransmitters (chemical messengers that allow neurons to exchange information) involved “in depression and pain are the same”.
The origin of the syndrome cannot be determined (unless it is the consequence of another disease), its symptoms can only be relieved. Simple pain relievers (such as paracetamol) are used, anti-inflammatories and, as background therapy, “very low doses of antidepressants,” says the specialist. Cognitive and behavioral therapies also offer benefits, as does physiotherapy or occupational therapy.
“The care is multidisciplinary and requires considering the patient as a whole,” emphasizes Iohn Michael Norberg. The important thing, according to him, is “to stay active and to move”, while walking or in endurance. You can also take hot baths, do thermal cures and practice all the activities that relax because, “associated with the exercises, they can help”.
In any case, do not hesitate to consult a doctor “when the symptoms begin to disrupt his daily activities,” advises the specialist in chronic pain. Because it is important to repeat, fibromyalgia is not a fictitious disease.
Malfunctions in the brain
Between 60 and 80% of people with fibromyalgia also suffer from depression. The hypothesis has therefore been put forward that the pain syndrome could only be a kind of depression which is expressed on a physical level. “We thought it was not the case,” says Chantal Martin Soelch, professor of psychology at the University of Friborg. For good reason: his work, carried out in collaboration with doctors from the Zurich University Hospital, has indeed shown that the two entities had different neurobiological origins.
The researcher examined dopamine. This neurotransmitter (chemical messenger allowing communication between neurons) released when we expect to receive a reward, is indeed involved in both fibromyalgia and depression. She called on around fifty volunteers (some suffering from fibromyalgia alone or suffering from depression, others constituting a control group). Using a brain imaging technique (PET scan), she measured the production of dopamine in the brains of these people who were first at rest, then who had to do a task by letting them hang down. reward.
They had to play with a kind of “slot machine” which sometimes allowed them to receive money. “Our previous studies had shown that in people with depression, the promise of a reward barely released dopamine,” says the psychologist. On the other hand, in those who suffer from chronic pain, “we have found that the response of the dopaminergic system is very strong, it is even aberrant, which suggests that, in their brain, the regulating system of neurotransmitter dysfunctions”.
These results bring water to the mill of those who consider that one of the causes of fibromyalgia comes from the changes that take place in the brain. They could also have therapeutic implications. “By using psychological methods, like those based on mindfulness, it should be possible to train the reward system for people with fibromyalgia,” says Chantal Martin Soelch. And maybe so relieve their pains.