As a disease of the soft tissues, fibromyalgia syndrome (ICD code M79.70) is characterised by the following symptoms:
- Hardened muscles,
- Muscle pain,
- Painful joints,
- Pain in other parts of the body (for example, the back).
In addition, non-specific complaints such as
- Fatigue,
- Physical and mental exhaustion,
- Sleep problems and
- Concentration problems
can occur.
Some patients also have psychological (nervousness, restlessness, loss of drive, etc.) and physical symptoms (irritable bowel irritable bladder, etc.). Increased sensitivity to some stimuli (light, sounds, smell) also occurs occasionally.
© Andrey Popov / Fotolia
In the western world, about 3-4 % of the population is affected by this chronic disease, mainly women between 40 and 60 years of age. The complaints are regarded as chronic if they persist for at least 3 months.
The severity of the symptoms can vary greatly from patient to patient. Some hardly show any symptoms. In others, however, the disease takes a more severe course with severe pain and significant impairments.
The causes of fibromyalgia are not yet fully understood. However, it is believed that it does not take just one cause for fibromyalgia syndrome to develop. Rather, it is said to be a confluence of different factors – biological, psychological and social – for the development of FMS.
Since the disease occurs more frequently in some families, genetic predisposition seems to play a certain role. But certain diseases are also said to favour the development of fibromyalgia syndrome:
- Autoimmune diseases
- Rheumatological diseases
- Tumours
- Infections
In addition, injuries and operations are suspected of triggering the disease. Smoking, obesity and lack of physical activity, physical and sexual abuse, and stress also increase the likelihood of fibromyalgia.
In addition to the personal medical history (anamnesis), the physical examination is particularly important for the diagnosis of fibromyalgia. At pressure points (trigger points or tender points), the doctor checks whether the muscles and attachment points of tendons are painful (pressure painfulness). These pain pressure points are located at the
- Neck,
- Back,
- Shoulders,
- Arms,
- Legs and
- Hips.
The principle of trigger point treatment is shown in the video:
If at least 11 of the 18 pressure points react painfully to pressure and have done so for more than three months, fibromyalgia is an obvious diagnosis. This is especially true if the laboratory values are unremarkable. Imaging examinations (such as X-rays) are not usually done when fibromyalgia is suspected, at most to rule out other diseases.
The primary contact for patients with symptoms that point to fibromyalgia is the family doctor. However, at the latest when there is a suspicion that
- an internal (e.g. inflammatory rheumatic disease),
- an orthopaedic (e.g. wear and tear of joints) arthrosis),
- a neurological (e.g. muscle disease) or
- a mental disorder
is responsible for the symptoms, the affected person should consult a specialist for more detailed clarification. This can be done, for example, by a rheumatologist, neurologist, orthopaedist or internist.
There is no causal treatment for fibromyalgia. The focus of fibromyalgia therapy is therefore on alleviating the symptoms and maintaining or improving the ability to function in everyday life. This should also improve the patient's quality of life.
Patients with mild forms of fibromyalgia syndrome should exercise regularly (stamina training), further treatment is then usually not necessary. In more severe forms, drug therapy is also used for a limited time in addition to body-related therapies. Typical fibromyalgia medications are antidepressants and anticonvulsants that relieve spasms.
Physical-based therapies include
- Endurance training,
- Functional training,
- Strength training with stretching exercises and
- Relaxation techniques (Tai-Chi, Qi-Gong, Yoga, Feldenkrais, etc.).
© elnariz / Fotolia
Although pain is the dominant symptom in fibromyalgia, painkillers or anti-inflammatory substances are usually ineffective. This is because fibromyalgia is not an inflammatory disease. That is why psychotherapy and exchange in self-help groups are also of particular importance. Here, patients learn how to cope better with the pain and thus with the disease.
If patients do not make progress despite the measures, multidisciplinary and multimodal treatment may be considered. In addition to the treatment of concomitant mental illnesses, also
- physical therapies and
- physical measures as well as
- psychotherapeutic and
- drug therapies
are used.
Fibromyalgia syndrome is a complex clinical picture. Several specialists are often involved in the diagnosis and treatment.
A good contact person when fibromyalgia is suspected is the rheumatologist. Rheumatologists deal with the diagnosis and treatment of diseases that are classified as rheumatic diseases. In addition to polyarthritis, this also includes fibromyalgia. A rheumatologist can be an internist with an additional qualification in rheumatology or an orthopaedic surgeon with additional training in rheumatology.
Pain therapists play an important role in the treatment of fibromyalgia in particular. For a long time there was no official training as a pain therapist in Germany. Since the end of the 1990s, however, doctors have been able to complete further training and then hold the additional title of "special pain therapy". Pain therapists are specially trained in the areas of pain anamnesis, pain analysis and the use of pain therapy procedures.
