Fibromialgia: Sindrome del Dolore Muscolare Diffuso

The symptoms of fibromyalgia vary greatly from person to person. That is why physicians prefer to speak of a “fibromyalgia syndrome”. All patients have the leading symptom “chronic pain” in common. This is reflected in the literal translation of fibromyalgie: “fibrous muscle pain.” Although the vernacular sometimes refers to “soft tissue rheumatism,” strictly speaking this is a collective term under which fibromyalgia falls as one of several disorders. If we take a look at the past, we notice that fibromyalgia has been a known disease for quite some time. Thus, corresponding diagnoses already existed in the 19th century. At that time, doctors still increasingly assumed that the symptoms were the manifestation of depression on a physical level. And this approach is not so far-fetched! As you will see in a moment, the psychological component still plays an important role in the diagnosis and treatment of fibromyalgia today. HOW TO RECOGNIZE FIBROMYALGIA? The leading symptom of fibromyalgia syndrome is pain. They usually begin insidiously in the back, increase over time, and progress to the arms and legs. Typical for the course of the disease is an alternation of almost pain-free phases and those with severe symptoms. In addition, those affected report symptoms that are sometimes very different. These can be physical as well as psychological in nature. In 1990, the American Council on Rheumatology (ACR) established the following four criteria for the presence of fibromyalgia: - pressure pain in at least 11 of 18 trigger points (tender points). - fatigue, exhaustion (fatigue) - sleep disorders - the complaints must have been present for at least three months. In addition to these four points, there are a variety of other symptoms, depending on the severity. For a long time, the so-called “tender points” served as important indicators in making a diagnosis. These are a total of 18 paired points distributed over the body between the muscle insertion at the back of the head and the knee joints. All tender points are located at the transition from muscles to tendons. Fibromyalgia patients often have palpable indurations in these areas. To meet the diagnostic criterion, severe pain must be felt in at least 11 of these 18 points as soon as pressure is applied to them. In 2010, the ACR changed its diagnostic criteria and continued to refine them in subsequent years. The basis is now the Widespread Pain Index (WPI) and the Symptom Severity Scale (SSS). The WPI asks about a total of 19 areas of the body where pain can occur. On the SSS, the severity of the three symptom domains “fatigue,” “non-restorative sleep,” and “cognitive symptoms” (e.g., ability to concentrate and remember, depression, anxiety) is mapped on a scale of 0 to 4. In addition, it is queried whether abdominal pain, depression, and headache are present. The resulting fibromyalgia scale ranges from 0 to 31. If a person reaches a score of 13 or more, he or she is most likely suffering from fibromyalgia. DIAGNOSES OF EXCLUSION The diagnostic criteria for fibromyalgia are very reminiscent of those for chronic fatigue syndrome (CFS). However, the low resilience as well as the prevailing state of exhaustion are in the foreground in this disease. Some researchers suggest that CFS and fibromyalgia may be two different manifestations of the same condition. Others assume similar causes leading to CFS or fibromyalgia depending on the individual constitution. Due to the completely different manifestations of fibromyalgia syndrome, doctors often find it difficult to make the correct diagnosis. To make matters worse, there are few measurable parameters in fibromyalgia. Thus, it is primarily a diagnosis of exclusion. This means that various examinations do not reveal any causes for the patients’ complaints. For example, no abnormalities can be detected in the blood test as well as in MRI or CT. In the end, the only explanation left is fibromyalgia. Diseases that should definitely be excluded in the course of diagnosis are: - CFS, - Muscular rheumatism (polymyalgia rheumatica), - Rheumatoid arthritis, - Myopathies, - purely mental illnesses. WHAT DOES "FIBROUS MUSCLE PAIN" FEEL LIKE? Fibromyalgia is what experts like to call a “generalized, non-inflammatory pain syndrome.” The pain can occur in different places and with varying intensity. The neck, back and chest are usually particularly affected, as are the joints of the arms and legs. Patients themselves find it very difficult to localize the pain precisely. They describe its quality as “deep-seated,” “pungent,” “burning,” and “wandering,” among others. Outsiders can probably imagine this pain as being similar to sore muscles or aching limbs due to a fever. In some cases,