Fibromyalgia
Fibromyalgia is the term for a syndrome long known as the idiopathic syndrome polyalgic diffuse (SPID), or FMS in English (for Fibromyalgia Syndrome). The word fibromyalgia comes from the Latin fibra ("filament"), ancient Greek myos ("muscle") and ancient Greek algos (pain).
This condition is characterized by a painful muscle disease (diffuse myalgia) extended or localized to various regions of the body, particularly in the form of tactile allodynia, as well as asthenia (fatigue) persistent.
History
Fibromyalgia has been studied since the early eighteenth century, under many names, such as muscular rheumatism or fibrositis. Some, considering the fact that it affects mostly women, rank among the group since then challenged women of hysteria.
W. Graham made the first modern description of the disease in 1953. In the years 1970 and 1980, it is considered a psychiatric illness with a depressive side. It was assumed from the fact that muscle pain resistant to conventional painkillers at the time.
Dr. Muhammad B. Yunus in 1981 published the first controlled clinical symptoms of fibromyalgia. The work of Dr. Yunus validation known symptoms and tender points typical of this disease. He proposed diagnostic criteria based on fact, failing a blood test reliable. In 1984, Yunus suggested a relationship between fibromyalgia and other diseases (such as chronic fatigue syndrome), and in 1986 demonstrated the effectiveness of drugs based on serotonin and norepinephrine.
The term "diffuse idiopathic syndrome polyalgic (SPID) was created by Professor Kahn in the 1980s, but the term Anglo-Saxon fibromyalgia prevailed in medical conferences and has been in Frenchified" fibromyalgia. " This term was introduced in 1976 to better describe the symptoms, from Latin fibra (fiber), and the Greek myo (muscle) and algos (pain).
The disease has been recognized by the American Medical Association as a debilitating disease in 1987, naming fibromyalgia. [Citation Needed] In The Same Article year year, the Journal of the American Medical Association aussi Called The disorder fibromyalgia.
The American College of Rheumatology committee defines the criteria in 1990. The RTA developed a theory based on a disorder causing neurohormonal sensitization centrale.1990s.
It was not until 1992 that the World Health Organization has recognized this as rheumatic disease, whereas it was previously considered a psychiatric illness by doctors because of its scarcity, affecting primarily women, can give some encroachment behavioral and having no biological trace, this "syndrome" was wrongly attributed to female hysteria. A supposed cause is psychosomatic now abandoned.
Recent scientific discoveries have proven neurological aspect, related to deficiencies in neurotransmitters such as dopamine, serotonin and norepinephrine. Indeed, in the years 1990 and 2000, several studies show these impairments in people with fibromyalgia. And in 2006, studies show by functional MRI abnormal activity in the brain that processes pain in fibromyalgia, different activity in people without diabetes. Cause psychiatric and / or psychological abuse is now excluded.
Fibromyalgia 70.0 million was coded as unspecified rheumatism in the International Classification of Diseases (ICD). Since January 2006, it is now coded in 79.7 million under his own name, indicating that the disease is fully recognized.
Epidemiology
A mean (World) from 2 to 10% (by country) population "industrialized countries is affected by this disease (2% of the U.S. population with a marked female predominance).
In France, a government report of 2007 gives a French prevalence estimated at 3.4% in women and 0.5% in men.
It affects about 900,000 people in Canada (2008), about 2% to 3% of adults.
Fibromyalgia is 10 to 20% of the reasons for consulting services in some of Rheumatology.
Diagnosis
Fibromyalgia is sometimes regarded as a controversial diagnosis, some authors claiming that it is a "no diagnosis," insofar as it selects fibromyalgia often having excluded all other common rheumatic diseases.
Indeed there is still no test current, specific and 100% reliable for validation of fibromyalgia. The difficulty comes mainly from the fact that people can see all their lab tests come back normal and that many of the symptoms found in other diseases (rheumatoid arthritis, osteoporosis, ...). In most cases, the physician's conclusion is based on differential diagnosis, taking into question all the other options, symptoms, and patient profile.
This disease usually occurs in early to mid-adulthood but can occur in childhood. It involves a significant work-related disability in 10% to 30% of those affected.
Differential Diagnosis:
* Myofasciitis macrophages by muscle biopsy, cognitive
The twenty-first century, scholars prefer the term multi-fibromyalgia, some biological research showing sub-categories.
Criteria of the American College of Rheumatology
The classification criteria most commonly accepted were developed in 1990 by the American College of Rheumatology, often nicknamed criteria "ACR 1990". They define fibromyalgia according to the presence of the following:
* A history of widespread pain throughout the body for over three months, and affecting all four quadrants of the body (both sides, and below and below the belt).
* Painful points, 18 in number (although the patient may have hurt other parts of the body). During diagnosis, the physician must exert a force of 39 newtons on these points. The patient should feel a sharp pain on at least 11 of these points for fibromyalgia can be confirmed. Note that the location and number of tender points can vary depending on the period, the circumstances ...
This set of criteria was created to classify individuals as having fibromyalgia, for research purposes. Its margin of error considered low, and the lack of another more accurate test of this test have established de facto the clinical setting.
Symptoms
Fibromyalgia come in various forms of chronic pain (pain free, widespread pain, burning, beating, bruising, crushing, pulling, etc..) Skeletal muscles, tendons and less frequently joints, which may affect the whole body or part (quadrant), most commonly the back, legs and arms. These symptoms vary throughout the day, week, month, year. The fibromyalgia patient has some or all of the following symptoms:
* Aching muscles, bones, joints, tendons;
* Physical fatigue;
* Mental fatigue, emotional emptiness, vacant look;
* General irritability (touch, stress, noise, light, presence of others, unusual odors, the smell of food, etc..) And impatience;
* Constant suicidal thoughts, depression;
* Need to consume carbohydrates (cakes, bread, potatoes, chips, etc.).
* Pretty severe disorders of memory (short or long term);
* Burning, beatings, blue crush, tear, etc.. ;
* Digestive system disorders (diarrhea, bloating);
* Dryness and burning eyes;
* Insomnia, difficulty sleeping great and regenerate during sleep (stage 4 sleep, deep sleep phase regenerator, is absent or too short);
* Heat in the palms and soles (need to pass his hands or his feet under the tap to relieve pain);
* Great difficulty concentrating, especially for reading, focus on what a speaker says;
* Worsening of symptoms with consumption of sugar and sugary foods or hunger;
* At least 11 tender points on the 18 listed in the ACR test
* Tremor, feelings of weakness;
* Sensation of the body rusted, stiff aching.
These disorders are often associated with gastrointestinal problems (like the gluten allergy, or irritable bowel syndrome ...) and headache. The daily life of a fibromyalgia can be easily compared to that of a person with rheumatoid arthritis.
Abnormalities of cerebrospinal fluid
Discovering the most consistently replicated in the laboratory is a high concentration, in patients, levels of substance P, a neurotransmitter associated with pain perception. The presence of metabolites for the formation of monoamine neurotransmitters, serotonin, norepinephrine, and dopamine, which play a role in the body's natural analgesic, has been proven to be abnormally low, while the concentration endogenous opiates (such as endorphin and enkephalin) appear to be higher than normal. High concentrations seen in nerve growth factor (Nerve Growth Factor) has been proven. This substance is known to participate in the structuring and plasticity of the interconnections between the brain and spinal cord. There is also evidence of an increased stimulation of amino acid in the cerebrospinal fluid, with a proven correlation between levels of metabolites of glutamate and nitric oxide and the sensation of pain.
Hyperactivity and hypoactivity in some areas
Evidence of an abnormal reaction of the brain as part of fibromyalgia has been demonstrated by functional brain imaging. The first discoveries indicate a decreased blood flow in the thalamus, basal ganglia and medial areas of the brain. Compared with healthy people, these areas are less active (hypo) to equal pain, and have a delayed activation in response to pain . Some areas of the brain, however, show a deficit hyperactivity disorder (compared to normal people) to painful stimulation, particularly areas related to pain as the primary and secondary somatosensory cortex, insular cortex and cingulate cortex before. Patients also show abnormal neural activity in brain areas associated with pain perception associated with non-painful stimuli (eg mental pain), as in the prefrontal cortex, premotor cortex, the insular cortex, cingulate cortex, the .
Evidence of mal-function of the hippocampus, indicating the presence of reduced metabolites were also found by studies using magnetic resonance imaging, A significant correlations was found between the density these metabolites and an index of severity of clinical pain commonly used.
Concentrations of neurotransmitters
The correlation between the severity of clinical pain felt and the concentration of an amino acid neurotransmitter stimulating glutamate, has also been demonstrated by MRI. Accelerated atrophy usually related to age has been shown using a voxel-based morphometry (voxel-based morphometry, VBM) with areas of gray matter smaller than normal in the cingulate cortex, the insular cortex and parahippocampal gyrus.
Studies using positron emission tomography showed reduced synthesis of dopamine in the brain stem and the center of the limbic system. A correlation between the severity of pain and lack of synthesized dopamine was also demonstrated in the insular cortex. A study showed later, after a painful stimulus, the reactive synthesis of dopamine was wanton and grossly delayed in the basal ganglia.
This study confirmed a link between "18 tender points" recognized by the CRA and the dopamine D2 less available, specifically in the right putamen.
Finally, a decreased availability of opioids receptors in the striatum, forebrain and cingulate cortex has been demonstrated, with a link between the sensation of pain, and lack of available receptors in the nucleus accumbens.
Recent genetic studies attempting to confirm the link between genes for the synthesis of some neurotransmitters and fibromyalgia.
Sleep disorders detected by EEG
The first objective findings associated with the disease were reported in 1975 that were demonstrated the presence of alpha waves (usually associated with phases of light sleep) abnormal phase 4 (deep sleep) during the EEG of patients with fibromyalgia.
In fact, interrupting sleep phase 4 constantly on young and healthy, Moldofsky and his team were able to reproduce muscle tension allegedly comparable to that of fibromyalgia patients. However, these feelings have disappeared when the subjects were able to regain a normal sleep.
Since that study, many studies confirm sleep abnormalities in various subgroups of fibromyalgia patients.
Polymodal sensitivity
Several experimental studies resulting stimulation showed that fibromyalgia patients demonstrate increased sensitivity to pressure, the sensations of heat and cold, electrical stimulation and chemical. Of experiments on the regulatory systems of pain showed that fibromyalgia patients also show dysregulation of different inhibitory mechanisms of pain. They also show an exaggerated response to repeated stimuli, and decrease or absence of the analgesic response induced by physical effort. Together, these results point to a disruption of the central nervous system.
Neuroendocrine disruption
Studies of fibromyalgia patients have shown abnormalities in neuroendocrine functions as a conventional hypocortisolaemia, excessive secretion of adrenocorticotropic hormone in response to stimulation and resistance to glucocorticoid feedback. A gradual reduction in the presence of human growth hormone has also been demonstrated in some patient groups, while most show reduced hormone secretion in the face of intense physical exertion, or pharmaceutical stimulation. Other anomalies include a response time reduced TSH and thyroid hormones during hormonal stimulation. An increase relatively high levels of prolactin, with a disinhibition of prolactin secretion during hormonal stimulation and inadequate secretion of hormones produced by the adrenal glands were also found.
These changes could be attributed to the effects of chronic stress that causes the disease, which after having been received and processed by the central nervous system, activates the secretion of hormones neuronal corticotrophins hypotalamiques. This would result in a disruption of communication pituitary-adrenal gland, and an excess of hypothalamic somatostatin, which in turn inhibit the secretion of a number of other hormones.
Hyperactivity of the sympathetic nervous system
An analysis showed impaired activity and excessive sympathetic nervous system. with sympathetic reactivity glands reduced to various stressors, whether physical or mental. Patients with fibromyalgia have a variability of their heart rate down, the index of the balance nice / parasympathetic indicating sustained sympathetic overactivity, particularly at night. In addition, levels in neuropeptide Y (NPY) in plasma are low in patients, this neuropeptide is localized with norepinephrine in the sympathetic nervous system. Unlike the circulatory levels of epinephrine and norepinephrine were sometimes described as high, low and normal.
Injection of interleukin 6 (a cytokine that stimulates the production of hormone secretion of corticotropin hypotalamique, which in turn stimulates the sympathetic nervous system activity) causes a sharp increase in circulatory levels of noradrenaline and an increase heartbeat. These increases are higher in patients with fibromyalgia than in healthy people.
Aggravating factors
The symptoms of fibromyalgia are known under the following conditions, stress, and can trigger reactions in the neurotransmitters or hormones:
* Trauma, stress and emotional trauma;
* Other disease;
* Noise;
* Circle of people;
* Lack of protein in the diet;
* Insufficient quantity of food;
* Poor management of sleep (too little or too much);
* Fatigue or physical stress too much;
* Heat and heat waves;
* Cold
* Use of influencing neurotransmitters.
For some patients, the cycles correspond to:
* A barosensibilité - reaction to changes in atmospheric pressure;
* A moisture sensitivity - reaction to humidity;
* A thermosensitivity - response to temperature.
It speaks broadly of hypersensitivity.
Chronic fatigue
Common symptoms associated with fatigue often called "chronic" reaction (not to be confused with chronic fatigue syndrome, can have some more FMS). This fatigue is described as reactive as fluctuating depending on the environment and circumstances, could disappear completely and then reappear.
Chronic fatigue syndrome is not related to an excess of substance P. The mechanisms of pain are probably different for these two conditions.
Variability of symptoms
There are various forms of severity in fibromyalgia, which may possibly correspond to various causes, or variants of the disease. The problem is to find a ladder (marker) severity of reliable, non-existent because no marker has yet been updated. However, some research work would tend to prove that a correlation exists between levels in substance P and the severity of symptoms.
Given the involvement of neurotransmitters in the disease, each FMS has its cycles, its symptoms, intensities and durations. Variants of fibromyalgia are very broad, a little severe fibromyalgia to keep a life almost "normal" severe disabling fibromyalgia there is a plume of very difficult variants classifiable.
Subjectivity, the interpretation of symptoms, the physician's interpretation, the pain tolerance, the vagaries of symptoms, remissions, intensities, amplitudes, psychological management, chronicity, treatment failures, failures of dialogue, understanding, and so on, bring a very complex disease for the patient, and even more complex to convey.
However, we find some common ground as a predominance of stiffness and tiredness on waking up to subside more or less independently of each long-term symptom (from minutes to hours or even continuing the day, several days), fatigability exacerbated sleep disturbances (no deep sleep support points bothersome / painful, agitation), then a whole series of other satellites whose symptoms are most common headaches, impaired concentration (variable) of impaired memory (short term), blurred vision (fog, shift), irritability, mood swings, behavioral problems (attitude), speech (concentration, memory, fatigue) , digestive disorders, the restless leg syndrome, Raynaud's disease, tinnitus, tingling, itching, restlessness, etc..
A third of fibromyalgia have a depression or a neurotic state of hysterical type, for some type of reaction (psychological, neurological severe). The prevalence of depression is higher in patients with fibromyalgia in the general population, but remains comparable to that observed in other contexts of chronic pain. As is the case in other chronic diseases, these elements of anxiety and depression do not, however, prejudge a morbid personality pre-existing, they may well be the consequence of chronic pain.
This syndrome remains poorly recognized and poorly received, both by those around him by the government and some doctors, it can push people sick in isolation, even depression and / or guilt to suffer and become disabled by this condition painful and exhausting.
Treatment
Although there is no treatment that has demonstrated an overall efficiency, there are solutions with proven clinical effects, including certain medications, exercise and patient education. In 2008 there is no cure, no treatment is guaranteed a long-term effectiveness.
Contrary to what is indicated some therapists, no treatment is based mainly on a diet, homeopathy, psychoanalysis or psychotherapy is effective proven superior to the placebo effect. These techniques are de facto unable to process the neural aspect of the disease. However they may reduce feelings of stress, depression that can induce the disease.
For optimal management, the Canadian Agency for Drugs and Technologies in Health recommends a combination of painkillers, education about fibromyalgia, exercise, evaluation and treatment of mood disorders and sleep.
See also Osteoporosis
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