The mystery of fibromyalgia
The mystery of fibromyalgia
diffuse pain in muscles, joints, tendons, intense fatigue … The symptoms of fibromyalgia can be extremely debilitating. In France, the treatment of this unknown disease remains very variable from one patient to another. A parliamentary commission of inquiry will look into this pathology to develop recommendations for better patient care.
◾ Points highly targeted pain
◾ Cause: hypersensitivity
◾ Relaxation therapy: learning to manage pain
◾ Fibromyalgia: the therapeutic role of sport
◾ Fibromyalgia can it be cured?
◾ Fibromyalgia: cryotherapy to relieve pain
◾ Fibromyalgia interest of osteopathy in the study
Points highly targeted pain
In France, fibromyalgia affects more than a million and a half people. In 90% of cases, they are women. Fibromyalgia is characterized by diffuse pain, sometimes felt like burns and which affect the muscles, the tendons, the joints …
Fibromyalgia is a dysfunction of the modulation of pain. When bumping, for example, the nerves transmit an electrical message to the brain that converts it into a sensation of pain. In the case of fibromyalgia, the circuit of the pain is deregulated. He is hyperactive. The brain is no longer able to decode the sensations, which leads to continuous and diffuse pains.
If there is no significant biomarker for fibromyalgia, a clinical diagnosis can be made. In patients with fibromyalgia, 18 pressure points are particularly sensitive to touch, such as the neck, trapezius, elbows, hip joint or knee. When 11 of these 18 points are painful, it is called fibromyalgia.
Continuous fatigue and disturbed sleep may also be part of the symptoms. The origins of fibromyalgia are still blurred. It has long been considered an imaginary or psychological illness. Since 1992, fibromyalgia is now recognized by the World Health Organization and classified in musculoskeletal diseases.
The pain of fibromyalgia …
They fluctuate from one day to another, both in intensity and in their location. Often important in the morning, they associate with a stiffness that diminishes in the late morning and early afternoon. The cold and wet weather tend to decrease. The points of Yunus (the 18 points defined by the American College of Reumatology) are a diagnostic aid.
Before being recognized in 1992 as rheumatic disease by the World Health Organization, fibromyalgia was considered a psychiatric disorder by doctors. The biological examinations of the patients are normal and the entourage often find it difficult to believe that they really suffer, hence the difficulty of the doctors to put a name on this pathology.
Viral? Psychological? For more than a quarter of a century, several theories have been advanced to explain it. Some speak of a viral origin, such as herpes, or shingles, which could also be triggering factors. Others have thought of biochemical disorders or even psychological disturbances. But what is certain is that people with fibromyalgia have a hypersensitivity to pain.
Poor transmission of sensations. Normally, pain is perceived through a nerve that acts as a receptor and transmits this sensation to us as an electrical message. Then, the brain decodes this information and then the module, and it is only at that moment that we really perceive the painful sensation. In fibromyalgia, this circuit is very active, the brain is no longer able to correctly analyze the messages of pain, it is deregulated and therefore the patient has pain permanently.
Fibromyalgia greatly affects the quality of life of patients. To better accompany them, the pain treatment center at the Cochin Hospital in Paris offers therapeutic education workshops. Called “Fibroschool”, they allow small groups of patients to share their experiences and implement strategies for behavioral and cognitive therapy to better manage the disease and fight pain.
Relaxation therapy: learning to manage pain
How can relaxation therapy help in the case of fibromyalgia?
Roseline is 57 years old. She suffers from fibromyalgia and practices sophrology, sessions that allow her to better manage muscle pain.
Fibromyalgia: the therapeutic role of sport
Physical activity and fibromyalgia are not incompatible
Patients with fibromyalgia often arrested sport for fear of having more pain after exercise. But at the CHU in Grenoble, the sports rehabilitation center has taken this problem against the foot and offers patients to gradually resume a sporting activity to fight fatigue and pain.
Before starting the sports program, patients are subjected to a stress test in order to evaluate possible contraindications and also to determine the level of physical condition of the patient. On the program: balneotherapy, relaxation and exercise bikes … These exercises aim to increase the muscle tone of the patients, to restore their confidence in the movement and thus to improve their quality of life.
Each year, 80 patients follow this 6-month course. 50% reported a significant reduction in pain and fatigue and 25% showed moderate improvement.
Fibromyalgia: Can we cure it?
For Laure, 62, fibromyalgia is just a bad memory.
Today there is no way to cure fibromyalgia. Treatment is intended only to relieve pain and other symptoms such as sleep disorders.
Although psychological causes are not always the cause of fibromyalgia, psychotherapy is often associated with treatment. Chronic pain seriously alters the quality of life and often has an impact on mood.
Fibromyalgia: cryotherapy to relieve pain
long term, the analgesics can be problematic. An alternative to relieve pain is cryotherapy, in other words the use of cold.
Cryotherapy is a technique that exposes the body of patients suffering from chronic pain to temperatures as low as -160 ° C. “Patients spend three minutes chilling inside a cabin. This is the maximum time at which they can be left indoors, knowing that the first therapeutic effects are obtained at -110 ° C. We are in survival mode in the cold and our brain releases mediators that will allow us to protect ourselves, including analgesics, anti-inflammatories and antioxidants, “explains Vincent Jacquet, physiotherapy. But this intense cold is hard to bear.
There are contraindications to cryotherapy and this practice must be very framed. The contraindications are mainly cardiovascular (no pacemaker, heart failure, problems with arteries …). Kidney problems are also a contraindication. It is therefore imperative to consult a doctor before any cryotherapy session.
Under the effect of cold, the blood flows into the vital organs which drains the muscles of their toxins. And to warm up, the body intensifies the blood circulation, which relaxes the muscles, eliminates fatigue and reduces pain.
In total, 10 consecutive sessions are needed to reduce the pain caused by fibromyalgia. Generally, the benefits of this treatment can last up to six months.
Fibromyalgia: osteopathy interest in the study
What is the interest of osteopathy in case of fibromyalgia?
To mitigate the very specific pains of fibromyalgia, patients often resort to medications but also to various manual therapies. The Public Assistance – Hospitals of Paris recently launched a study to evaluate the interest of osteopathy in the management of patients with fibromyalgia.
A clinical study is currently underway on the value of osteopathy in the management of fibromyalgia. Each participant completes a specific questionnaire: medical history, intensity of pain and impact on the quality of life … Many parameters are evaluated. “Unfortunately in pain, there is no biological element or radiological examination to assess improvement. The only way we have these questionnaires is. At the end of each questionnaire, a score and an interpretation of this score are obtained. This allows us to compare two groups, “says Terkia Medkour, Clinical Research Associate.
This is a double-blind study. One group will benefit from sessions of osteopathy supported and the other of manipulations lighter. The objective will be to measure the effects. Patients are unaware of the osteopathic treatment.
By a mechanical work of pressure and stretching, the physician seeks to attenuate the muscular tensions due to fibromyalgia: “There is a complete disorder of the nervous system of pain, which makes on the one hand that the threshold of perception is Very low, people experience pain in situations that are not normally painful. And on the other hand, this dysregulation is such that in some cases one can make oneself sorrows that have no logical reason to exist. With manual treatments, there is a part of stimulation that is exerted in joints, muscles, bones … which can act on the nervous system and inhibit in some way this manufacture of pain. This is what we hope in any case, “warns Dr. Jean-Yves Maigne, rheumatologist. Protocol obliges, the patient has 48 hours to describe his feelings on his book of liaison.
To participate in the study, the diagnosis of fibromyalgia must be made for at least one year. 150 patients will be recruited. The team hopes to publish the results of the study in 2018.
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