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Fibromyalgia: What it is, How to endure it and How to treat it.

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The fibromyalgia (FM) is a disorder characterized by widespread chronic pain of muscular origin in different parts of the body such as neck, shoulders, arms, forearms, back, legs, etc.
The fibromyalgia is not either a pathology or an illness. It is a condition created by different causes and reasons. Etymologically, fibromyalgia means painful fibre. In this case, we refer to the striated muscle fibre.

Fibromyalgia, How to treat it.

Fibromyalgia, How to treat it.

From the epidemiological point of view, the FM is one of the most common chronic muscular disorders. It mainly affects female sex with an incidence of 95% of the diagnosed cases comparing with the 5% in the male sex case, although in this last one the percentage is increasing.

Within the female population group, the symptoms appear between ages 35 to 65, having a higher incidence between 40 and 55 years old, although in some cases they start at earlier ages.

Fibromyalgia patient profile

One of the most common clinical features of the fibromyalgia patient when he visits the doctor are the widespread muscle tensions or contractures in all the body together with pain and other resulting symptoms as irritability, depression, sleep disturbance, etc.

Since we are 4 years old approximately, we start to become aware of all around us, how we are treated by our parents, how we are treated by our teachers at school, the way our friends behave towards us, etc. From that moment on, all the emotions lived until we become adults in addition to our daily work, sports, jobs with repetitive movements, the way each one faces everyday life problems, create in many people a state of stress, anxiety, muscular tension that, if it is not treated shortly, it will accumulate throughout the entire life. And, once the contractures are formed, several symptoms appear in each part of our body where these tensions are such as headache and/or vertigo, if tension is located in the neck muscles; painful shoulder, if the tension is located in the arm muscles; if it is in the forearm, it causes tingling, lack of strength in the hand, cramps; lumbago of lumbar muscular origin and the same can occur in any part of our body. All this can trigger a fibromyalgia disorder.

There are different profiles in what we can call the fibromyalgia patient type that can be classified in three groups named by us A, B and C and in group A, which is the largest one, we can distinguish 2 subgroups that we will call A-1 and A-2:

  • Group A: As an example, the girls that began to work when they were 15, 16 or 17 years old in the late sixties and the early seventies. When they started to build hotels all over the Costa del Sol and tourism came to Spain, these girls started to work as maids cleaning an average of 20 rooms daily. And so on every day during many years. When they started to suffer from arm, back or hip pain, they visited their doctor or the mutual society and, in a 90% of the cases, they were prescribed painkillers, muscle relaxants, anti-inflammatories and, in some cases, even anxiolytics without any previous medical evaluation or exam.
    In this group, we can distinguish two subgroups:

    • Subgroup A-1: Fibromyalgia patient that wants to get better, recover and go back to work.
    • Subgroup A-2: Fibromyalgia patient with no intention of either recovering or getting better in order to return to work, due to his only purpose is to get retired or other economic interests.
      These patients usually go for a medical consultation and when they feel better after three or four sessions, they decide to give up treatment. Any excuse is good enough to justify it. But it is also well known that many of these patients are litigating against the Administration in order to get retired.
      A good example of this second subgroup is the following: we tried to give a talk to a fibromyalgia women’s association of more than 100 subjects. We met the president of the associaton to inform her that we needed a number of people big enough in order to get a sample as homogeneous and large as possible and therefore the minimum bias with the intention of carrying out a research in the Medical School of Granada University together with the department of neurosciences of that University.
      A few days later, the president of this association called me to tell me that there wasn’t any patient interested either in this lecture or in participating in the study.

 

  • Group B: People with emotional problems.

    This type of patients are people that are not happy with their lives. Many of them have marital problems, they live situations that they can not change because of fears, attachments, dependence or the economic situation, problems with their children, grief for the death of a relative impossible to overcome, etc.

    When this kind of situations continue for many years, the patients get depressed. They stop from doing their daily activities such as going out and shopping, they spend most of the day in bed and so on for many years in most of the cases. This inactivity creates a widespread atrophy of all the muscles and, as a result, widespread pain appears along with the apathy concerning life.

    In this second group there is a percentage of patients that take the victim’s role.They are not interested in getting better because in that case there will be no longer any neighbour or relative asking them every single day how they spent the night or how they feel. They need that someone takes care of them or asks them about their health.

  • Group C: Patients with a high purchasing power( this is the minority group, between 5-10 % of the cases).

    In this case, they are people with very high goals and addicted to shopping. For these type of patients the role they play in their club of friends is very important. When those goals are not achieved or their social status decreases with regard to their club of friends, they can’t accept this situation and many of them fall into depression and, after that, they become fibromyalgia patients as well.

Treatment for the fibromyalgia patient

Because fibromyalgia causes indirectly very high expenses due to work absenteeism caused by the chronicity of the symptoms or directly for the health services, since patients with FM are 10-20% of the rheumatology consultations and 7% of the primary health care consultations, it is necessary to treat this kind of condition from the very beginning working together from the primary health care services with other specialised professionals such as the osteopaths.

In general, up to 80% of this pain is caused by muscular tensions, commonly known as contractures. These contractures, as mentioned before, can be produced by emotional or physical stress and even by both ones at the same time.

The contractures, once they are formed, don’t disappear. It is required a muscle discharge treatment that must be developed by a certified and qualified professional. If the patient is at rest or lives a quiet and relaxed life, he feels no pain, but that doesn’t mean that it has disappeared.

When patients present a pure fibromyalgia condition (not contaminated by other diseases as the rheumatoid ones), the pain they are suffering from is exclusively due to their muscle tensions and consequently it doesn’t show any evidence in any complementary exam such as laboratory tests (blood analysis), radiological ones(scanner and x-rays), MRI, scan, etc. That is why when the fibromyalgia patients see that time goes by and they don’t have a diagnosis or a solution to their problem, after two or three years, they get depressed, in some cases even earlier. From that moment onward, patients are prescribed anxiolytics and antidepressants in addition to the long list of drugs that they are already taking in an attempt to alleviate pain.

What can be done from now on, the truth is that it is complicated. We could change, improve and increase the service portfolio from the public health system but at present this problem doesn’t seem to be a priority.

Medical action protocol on fibromyalgia patient

  • Joint action between primary health care staff and other certified and qualified professionals such as osteopaths, physiotherapists, etc.
  • Continuous training for the family doctors in this medical cases. They must be capable of making the difference between a normal muscle, tonic and elastic and a hypotonic, hypertrophic or contractured one after a medical examination by palpation.

    JUST IN THIS MOMENT ALL IS LOST AND ALL STARTS.

    Allow me to make one thing clear about this sentence. All is lost because if the doctor doesn’t palpate or, even if he does it, he is not able to find out how the patient muscles are, he can’t know the reason of his pain. Therefore, the only thing he can do for him is to prescribe a treatment as mentioned before usually based on painkillers,
    anti-inflammatories and muscle relaxants.
    And all starts because, without knowing what is happening to the patient and why he is feeling pain, he is sent to different specialised doctors such as rheumatologists, traumatologists, neurologists, internists…with no diagnosis at all. Many of them end up in mental health consultations.

Given this situation, I consider that it is necessary to keep the following in mind:

  • The importance of the continuous training in primary health care, so that professionals can keep up with the latest medical achievements in this field of fibromyalgia, chronic fatigue or chronic pain, because it is sad that patients go to see their family doctor and tell him that they are visiting an osteopath and doctors don’t even know what it is an osteopath or the osteopathy itself, although the college degree of doctor of osteopathy exists since 1897 in the United States.
  • The need to spend enough time with patients. The primary health care consultations are usually saturated due to the large number of patients that have to be seen for a certain period of time. This implies a limitation in order to examine and diagnose patient condition because doctors generally don’t dedicate the time needed to their patients. But this would be a problem with the Administration rather than a medical one.
  • Appropriate treatment. When a fibromyalgia patient comes to an osteopathy consultation, a physical examination of the painful muscular area is required in addition to a number of questions about his habits, if he suffers from any other disease, if he brings some complementary tests… .
    Once diagnosis is made and, if there is nothing counterproductive, the patient undergoes a muscle discharge treatment called ” Rafael Bosch Technique”, a technique that I have developed and applied for more than 25 years and with which it has been possible to prove that the fibromyalgia patients that follow this treatment in a proper and complete way manage to recover or to decrease up to 80% the pain felt before treatment, improving dramatically their quality of life.

 

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