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Fibromyalgia is a condition that is part of the so-called central sensitization syndromes. There is a hyperexcitation of the central nervous system with a lowered pain threshold, which causes pain to appear earlier and become more intense, longer-lasting, and more widespread.
Generalized pain is often accompanied by other symptoms, such as fatigue or sleep disturbances. It is diagnosed based on criteria that rely on symptoms and physical examination. There is no specific medical test.
Fibromyalgia is a common condition, affecting 2.4 % of the general population, and is part of the so-called central sensitization syndromes. It is mainly characterized by widespread pain. There is hyperexcitation of the central nervous system with a lowered pain threshold, causing pain to appear earlier and be more intense, longer-lasting, and more diffuse. There is an exaggerated response to painful stimuli (hyperalgesia) and pain in response to normally non-painful stimuli (allodynia). Its cause is unknown, but sometimes there are clear triggers such as physical or emotional trauma or infections.
It is a chronic condition with a fluctuating course, with periods of improvement and others of clinical worsening.
The main symptom is widespread pain, but it is often accompanied by other symptoms such as fatigue, insomnia, tingling in the limbs, headache, dizziness, memory and concentration problems, anxiety, or depression.
It usually affects middle-aged women, with a peak between 40 and 49 years, but it can affect people of all sexes and ages.
Diagnosis is based on criteria that rely on the patient’s clinical presentation, according to the presence of characteristic symptoms and signs.
There is no specific medical test.
Laboratory tests and sometimes imaging studies help rule out other conditions that are often concomitant (present at the same time).
Treatment of fibromyalgia should be based on four pillars: patient education (general information about the disease and attitude toward it), physical exercise according to tolerance, cognitive-behavioral therapy if appropriate, and pharmacological treatment.
1. Patient education and attitude toward the disease
The disease should be explained, providing general advice to improve well-being.
2. Physical exercise according to tolerance
There is evidence of its effectiveness on pain, well-being, and physical function.
It is recommended to start with low-impact aerobic exercise: walking, swimming, stationary cycling, aquagym, tai chi, or pilates.
Exercise should be performed regularly and progressively.
It is recommended to do 20–50 minutes per session, at least three days per week.
In cases of lower tolerance, start with ten minutes per session, four to six days per week, and gradually increase duration, frequency, and intensity, if possible, each month.
3. Cognitive-behavioral therapy
Provided by clinical psychologists in cases of accompanying anxiety or depression.
Although fibromyalgia is not a psychological condition, anxiety and depression can trigger and perpetuate symptoms.
4. Pharmacological treatment
Can help manage some symptoms such as pain, fatigue, or sleep disturbances, although its effectiveness is limited in a large percentage of patients.
Currently, analgesics, muscle relaxants, anticonvulsants, and some groups of antidepressants are used.
The risk/benefit and potential side effects of any medications should be carefully evaluated.
A healthy lifestyle is recommended, maintaining weight with aerobic exercise according to tolerance and a balanced diet, organizing and prioritizing daily tasks with short breaks, and avoiding physically and emotionally stressful activities.
Health advice for people with fibromyalgia is provided.
Treatment with the drug levodopa allows many of the functions deteriorated or lost due to the disease to be restored. It is the most effective treatment, but it also has limitations: as the disease progresses, its effect becomes transient and fluctuates. When the medication is working, the patient feels well, in the "On" state. When the effect wears off, the patient enters the "Off" state, and symptoms reappear.
To improve the effects of levodopa, different routes of administration have been investigated (inhaled, transdermal, intrajejunal) and various pharmaceutical formulations have been developed. Administration via gastrostomy with a levodopa gel infusion has been particularly successful.
There are also other pharmacological and neurosurgical treatments, such as electrical stimulation of specific brain areas, which provide good results. Research is ongoing to target the diseased brain using stereotactic ultrasound, avoiding trepanation and traditional surgery.
New avenues of research have opened in Parkinson’s disease to determine its causes, prevent its progression, and maximize symptom management.
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