What is fibromyalgia?
Fibromyalgia (fiber muscle pain) is a chronic and incurable disease. It is characterized by widespread pain with varying localization in the muscles around the joints and back pain and pressure pain sensitivity (to another under Diagnostics) and accompanying symptoms such as fatigue, sleep disturbances, morning stiffness, concentration and lack of drive in the weather, feeling of swelling of the hands, feet and face and many other ailments characterized. Fibromyalgia is not "soft tissue" synonymous with the term. However, an important differential diagnosis is rheumatoid arthritis.
The encryption key is changed to the ICD-10-GM version 2005 M79.7 (until then was the key M79.0).
Fibromyalgia symptoms
In the German Interdisciplinary Association for Pain Management (DIVS) coordinated guideline is necessary for diagnosis between main symptoms and often some adverse symptoms differed (see also section Fibromyalgia: Guideline).
Main symptoms: chronic pain in different body regions, lasting fatigue (general weakness, impaired concentration) to the point of exhaustion (fatigue syndrome), and sleep disorders. Of the pain particularly affected are back, neck and chest as well as the joints in the arms and legs, headaches through to migraine before coming. The symptoms should have occurred over a period of at least three months.
In addition Symptoms: Symptoms include swelling often vorzufindenden accompanying feelings in the hands, feet or face, morning stiffness, irritable bowel syndrome, functional dyspepsia, headache, dryness or hypersensitivity of the mucous membranes and increased anxiety and depression.
While for some fibromyalgia patients are mainly the pain in the foreground, while others mainly complain of fatigue, tension, difficulty concentrating and unnaturally long recovery periods after physical, mental or emotional stress. Have been scientifically demonstrated an increased noise, light and cold sensitivity.
For each patient, various vegetative symptoms can occur under certain circumstances also, for example, cardiac arrhythmias and even heart attacks, severe dizziness, sensitive skin (excessive reactions when touched by related parties), Hautexantheme, inflammatory feeling throughout the body, pain in the kidneys, increased venous character, hair loss, difficulty breathing, diffuse chest pain associated with shortness of breath, susceptibility to infections, slightly elevated temperature, slightly elevated erythrocyte sedimentation rate, occasionally a few bands in CSF (cerebrospinal fluid), but not yet considered as pathological, numbness, nervous extremities (restless legs), cramps in the leg muscles, hands trembling, irritable bladder, irritable bowel syndrome, period pain, lessening of sexual interest, impotence, hoarseness, difficulty swallowing, feeling of a lump in the throat, toothache, pain in the masticatory muscles, disorders of the sense of hearing, blindness, tinnitus (ringing in the ears), tendency to increased perspiration, water retention, irritability, mood swings, word-finding problems, pain in the spine, changing areas such pain. including any day right hand and left foot, the next day left arm and right leg. Depression and fatigue and tiredness, fatigue, muscle and joint pain all over the body can also be associated with the disease.
Organ and tissue damage are not yet detectable, although massive disturbances in the function of internal organs may occur, particularly at the beginning of the disease. Fibromyalgia can erupt suddenly, for. Example, after a flu-like illness, slinky be used, eg due to burnout, due to excessive physical exertion over the years, overstimulation of the nervous system.
Fibromyalgia disease
The onset is often insidious and unobtrusive. In the beginning, most are nonspecific findings such as fatigue, sleep disorders or gastrointestinal complaints. Later get pain in the lumbar or - more rarely - the cervical spine added. Only then the typical pain in arms and legs and other accompanying symptoms and complaints develop. In general, the disease worsens not continuous. Violent attacks of pain are relieved of pain-free intervals. Cold, wet or external loads, even strong sunlight can lead to aggravation. Until the full-blown disease emerged, it takes an average of seven to eight years. The individual episodes and acute phases follow a certain pattern and are therefore difficult to predict, but they most frequently occur after acute infectious diseases (influenza, pneumonia, Lyme disease, etc.). However, stress is also a serious factor. Many sufferers complain of increased symptoms (physical and mental), after they had stress. It does not matter whether it is "positive stress" or "negative stress" is. For this reason, stability for those affected is extremely important.
To a disease-related bone destruction - as in the case of rheumatoid arthritis - it comes through the fibromyalgia itself usually does not, however, the partially massive movement restriction to capsule shrinkage and other irreversible consequences hinge apparatus lead. However, this is rare.
Fibromyalgia diagnosis
The diagnosis of fibromyalgia is pretty difficult, since both X-rays and laboratory values give no clear answer. A diagnosis can therefore ultimately be made not always safe. Most "tender points" (engl. About: sensitive areas) are taken to help (ACR [American College of Rheumatology] - Classification criteria 1990). If, at 11 or more of 18 "tender points" increased tenderness, so it is very likely to fibromyalgia. These diagnostic points are mostly near the joint of the tendon muscle approaches.
Often the diagnosis is made only after eight to ten years, so it has already come to full-blown disease before the patient is adequately treated. Because for most patients it takes a relatively long time to the final diagnosis, almost all participants have a real medical odyssey behind. Because some people will be stamped at this time as a hypochondriac, often worsen symptoms and self-doubt.
Diagnostic criteria:
-Spontaneous pain in the muscles and tendons in the course of tendons which are present at least three months to three different regions.
-Tenderness of "tender points" - see above
-Accompanying vegetative and functional symptoms (insomnia, fatigue, headache / migraine, cold hands / feet, dry mouth, hyperhidrosis (excessive sweating), circulation problems, dizziness, gastrointestinal symptoms (stomach, intestinal problems), globus sensation, functional breathing difficulties, abnormal sensations ("pins and needles "), cardiac functional disorders, dysuria and / or dysmenorrhea)
Fibromyalgia patients have to be problematic because of the diagnostic difficulties often recognized as incapable of work, which often leads to major social or financial difficulties. The disease is not fatal, but can cause severe impairment of quality of life.
Root cause of fibromyalgia
Both the cause of fibromyalgia as well as the mechanisms of disease (pathogenesis) are unclear. There is a variety of findings relating to genetic, hormonal, neurophysiological, psychological and other factors. In the synopsis of the findings predominantly a disorder pain-processing systems is currently being discussed in the central nervous system, resulting in a lowered pain threshold.
With regard to hormonal and neurophysiological factors such as a lack of the neurotransmitter serotonin, which plays an important role in pain processing and the regulation of sleep are discussed. Thus, in patients with fibromyalgia were noted among other things, in the cerebrospinal fluid decreased levels of serotonin metabolites. In addition to serotonin, the role of other hormones and neurotransmitters such as substance P or the growth hormone somatotropin in the development of fibromyalgia is examined.
Tissue studies of the subcutaneous connective tissue in fibromyalgia patients indicate a change in the number and composition of the sensory nerve endings in this tissue layer. Thus, the number of free nerve endings in general compared to normal patients seem to be significantly reduced. At the same time a special category of these nerve endings is particularly abundant. These are those which relate to the regulation of blood flow in the subcutaneous connective tissue and are located near the so-called arteriole-venule shunts (AVS). These shunts are small arterioles and venules vascular connections between and provide regulation of body temperature in this layer of tissue. It is believed that the frequently observed perturbations in the temperature sensation of fibromyalgia patients are consistent with this altered innervation of subcutaneous connective tissue related.
In patients with fibromyalgia often than average mental disorders such as depression and anxiety are. It is unclear and the subject of scientific debate to what extent these mental disorders are themselves a result of chronic pain or symptoms of fibromyalgia reflect an underlying mental disorder. In studies, a higher prevalence of physical abuse and sexual abuse in history was found in fibromyalgia patients.
Studies of the NIAMS (a component of the "National Institutes of Health" - National Institute of Arthritis and Musculoskeletal and Skin Diseases) show in fibromyalgia patients an abnormally low cortisol levels in urine. In the Brigham and Women's Hospital (Women's Hospital in Boston), Massachusetts and the University of Michigan in Ann Arbor Center examined the researchers regulation and function of the adrenal gland (it produces cortisol) in fibromyalgia patients. People for whom too little cortisol is released in the body, many of the typical symptoms of fibromyalgia. It is hoped that these studies will lead to a better understanding of the fibromyalgia disease and that therefore soon result in new treatment options.
Although the causes of fibromyalgia are known to date, researchers have gained some theories and forth. Some scholars assume a primary and secondary fibromyalgia, wherein in the primary fibromyalgia causes are largely unknown. Be adopted, inter alia, a genetic predisposition (fibromyalgia occurs to run in families, studies on this topic are in preparation), a disturbed processing of pain and altered pain perception, hormonal disorders, a disturbance of the hypothalamic-pituitary-adrenal axis and growth hormone-system, changes in the dopaminergic and the serotonin system , psychological factors, and psychosocial stress and possibly changes in the immune system. In secondary fibromyalgia is assumed that another disease is preceded which has triggered the fibromyalgia, eg by an injury or surgery, mental or physical trauma and orthopedic diseases.
When fibromyalgia often consist psychological symptoms such as depression - the person feels sick. It is known that change in fibromyalgia the control systems of pain sensation in the brain. Some neurotransmitters of the brain, such as serotonin, downregulate itself. In contrast, other leave as substance P (a specific pain messenger that "reports" the pain to the brain) demonstrate increased. Despite these organic, that is, physical changes in the brain but is still not clear whether the fibromyalgia syndrome is a psychosomatic illness ultimately, in which the changes in the chemical messengers in the brain arise secondarily, or whether it is a metabolic disease of the brain, with the result deals with pain and psychosomatic disorders.
Affected
Are affected - according to sources - from 0.6 to 4 percent of the population, of which 85 to 90 percent of women. The disease generally begins in late 20, is fully developed at about mid 30's and has a frequency in women climax during and after menopause. Rarely, children and young people are affected by it; in the elderly, it could mistakenly be subsumed under "age-related complaints."
The disease usually runs out for decades. The severity of symptoms and the consequent health problems is individual, in severe cases, but live determinative or very restrictive way to permanently bedridden.
Typical "patient careers", ie those subject to diagnosis visited a variety of doctors and many different, sometimes unnecessary diagnostic and / or therapeutic measures behind. Because of this unclear situation have affected, especially in countries with developed social system, difficulties actually enforce its legal claim in social law. In Switzerland, the Federal Court dealt with fibromyalgia as other somatoform pain disorders (see I 455/06 of 22 January 2007). It is assumed a prevalence (morbidity) of up to four percent of the total population.
Fibromyalgia Treatment
Fibromyalgia is during medical treatment only a limited influence. Basically, there is a risk of drug abuse, addiction and unforeseeable damages resulting from term medication with various painkillers.
A treatment plan is now the multimodal pain therapy according to the findings of modern pain research. The activities here are the maintenance or improvement of everyday functioning and therefore quality of life as well as the reduction and / or alleviation of symptoms. Since it can be a life-long existing clinical picture, especially management is recommended, which can be carried out independently of the person concerned (self-management) that have little or no side effects and their long-term effectiveness should be secured. Thus, the current concept usually includes patient education, the use of drugs in conjunction with sports and functional training, physical therapy and psychotherapy and relaxation techniques.
Medication
The largest experience exists with the tricyclic antidepressant amitriptyline, which can be limited in time used for the treatment of chronic pain as part of an overall treatment strategy. In addition or instead, the latest findings to antiepileptic drugs pregabalin and gabapentin or effective against neuropathic pain antidepressant duloxetine be used. From the group of antidepressants fluoxetine or paroxetine also frequently used. Other individual, but not entirely secure, impact evidence is there from the group of antidepressants sertraline, moclobemide, venlafaxine, mirtazapine and milnacipran. The latter has even received an approval for the indication fibromyalgia in the US, but not in Europe. For the use of nonsteroidal anti-inflammatory drugs (NSAID) are no indications of efficacy in fibromyalgia.
Great expectations are based on currently the antiemetic tropisetron, which showed a pain reduction of 40 to 50% at about 50 to 70% of subjects in several studies. The effect was maintained for up to 9 months without a permanent income had to be done.
In the case of muscle relaxants, there is only proof of efficacy for cyclobenzaprine is not, however, available in Germany. From the group of opioids tramadol far only been tested in detail, which reduced the pain in studies and did not have serious side effects.
Further proof of efficacy exists for the dopamine agonist pramipexole, the antipsychotic olanzapine and intravenous ketamine.
Sports therapy and functional training
The cardiovascular system is not very efficient for many sufferers. A cardiovascular workout that increases carefully over a period of months, with a proportion of those affected can reduce pain and fatigue and improve quality of life. Recommended endurance sports are walking, cycling, swimming and aqua jogging.
A functional training, work specifically on muscles and joints of the motion therapeutic exercises in dry and water gymnastics, improved the situation in some of the persons concerned.
Physical Therapies
A Turkish study showed an effect of Stanger bath in combination with amitriptyline. Compared to patients who were treated with amitriptyline alone, patients had a higher quality of life. Because of the limited number of studies, this combination therapy in the current S3 guideline was neither endorsed nor rejected. Thermal baths (balneotherapy, spa and thalassotherapy) should then be used against. Massages are not recommended.
Relaxation methods
Relaxation techniques such as progressive muscle relaxation, autogenic training, meditation, laughter yoga and other stress management techniques are recommended in combination with aerobic exercise. As a sole therapy, these methods are however unsuitable. Meditative movement therapies such as Taijiquan, Qigong and Yoga are also recommended.
Natural Remedies and Complementary Medicine
Heat treatments such as. the natural mud application, but also warm thermal baths and saunas are often used because of its analgesic properties. A similar effect can be achieved for a short time by a whole-body cryotherapy.
While the guideline in the past did not recommend acupuncture, according to the 2012 edition of the "temporary use" should be considered. It is an evidence-based recommendation with open grade of recommendation. Reason was the methodological quality of the underlying studies and the fact that side effects were rarely considered systematically.
Nutrition therapies
The transition to raw food vegan showed significant improvements within six weeks in different subjective parameters of fibromyalgia (morning stiffness, pain at rest and general condition). If the patients resumed their normal eating habits again, the symptoms returned to their original strength. Similar results were obtained when the diet consisted largely of only vegetarian raw food (including linseed oil, carrot and barley grass juice). Thus, the symptom index of the FIQ already improved significantly after two months. After seven months each examined symptom (eg. As physical limitations, depression, fatigue) had improved. This was one of the best results in the treatment of fibromyalgia at all, but there was no control group. A mostly vegetarian diet (Mediterranean diet), however, showed no significant improvement. All studies only a slight statistical relevance due to the small number of participants.