Fibromyalgia: the challenges of an invisible disease

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Although not identified in laboratory tests, the severe pain can greatly harm the routine of people. Main treatment is with regular physical exercise

Feel intense pain throughout the body and still deal with the mistrust of those who do not understand the symptoms. The double challenge is constantly being told among people diagnosed with fibromyalgia, a chronic pain characterized by spread to various parts of the body and cause fatigue, sleep disorders and depressive episodes.

“At first it’s very hard for you to accept the disease yourself, and it’s also bad because people think you’re doing a soft body,” says the public servant and musician Hélvio Sodré, 33, 10 of them under the diagnosis of fibromyalgia.

Because it is silent, undetectable in laboratory tests and does not cause any external transformation in the person, often fibromyalgia is viewed as a psychologically only disorder. “Because a lot of patients suffer a lot because they have chronic pain, they end up being imputed as psychological patients, which is not true. They feel the same pain, “says José Eduardo Martinez, a rheumatologist and coordinator of the Pain, Fibromyalgia and Other Syndromes of Broken Muses Committee of the Brazilian Society of Rheumatology (SBR).

Although not all patients with fibromyalgia present with depression, the doctor emphasizes the existence of a relationship between the diseases. “Chronic pain leads to depression and depression leads to chronic pain. Today we consider depression as an aggravating factor for those who have fibromyalgia, “explains the rheumatologist.

The origin of the disease is not yet fully known. However, it has been observed that fibromyalgia present alterations in the nervous system to control pain. “Genetic predisposition is one of the possible explanations, but there is also a relationship with stress. Patients who have a life in which they have been subjected to a greater number of stressors tend to have more pain, “argues José Eduardo.

In the case of Hélvio, the pains began under the left scapula. “It started out of nowhere, until I imagined it was a muscle ache for sleeping in a bad way. I tried to do physiotherapy, massage, acupuncture, but it did not, and it began to radiate to other places in the body, “he recalls.

“There are usually two avenues that lead people to have pain in their bodies,” says José Eduardo. “Either the person already has some disease that causes pain, such as a shoulder problem, or a rheumatic disease, and in the non-resolution of this localized pain, it eventually generalizes over time. Another way is chronic stress, which leads to muscle tension, which generates muscle pain, which ends up culminating in an out-of-control and generalized pain, “he points out.

According to the US Department of Health’s Chronic Pain Clinical Protocol and Therapeutic Guidelines (PCDT), North American data show that 31% of the population has some chronic pain, resulting in total or partial disability in 75% of cases. Fibromyalgia affects more women in the age group of 30 to 55 years, but there are some cases in older people, children and adolescents. Therefore, society warns of the importance of parents to observe symptoms such as pain disproportionate to injury or excess fatigue. SBR estimates that, in Brazil, the disease affects about 3% of the population.

Diagnosis and treatment

With persistent pain, Hélvio Sodré sought a rheumatologist. Through an examination in which the patient should manifest pain in at least 11 of the 18 expected sites of painful muscular points, and from the exclusion of other clinical conditions, such as rheumatic diseases and primary sleep disorders, he was eventually diagnosed with Fibromyalgia.

“I had a lot of problems at work, I had to get a medical license. This is very bad in your process of overcoming crises, but the first step is to understand that you have this condition and that it is possible to have quality of life even with the disease, “says Helvio. For him, the best way out was through physical exercise – the primary medical recommendation for the treatment of fibromyalgia.

The challenge was, then, to find an exercise that would ally pleasure to improvement in health. “At first I was a little sideways, and my health was very different,” admits the public servant, who went swimming, bodybuilding and aerobics at the gym before discovering an activity he really liked. “Since 2010 I have been following channels of struggle. I always had a great fascination, but I did not think myself able to practice, I was limited by fibromyalgia, “he says.

Only after gaining more confidence and muscle strength in bodybuilding did Hélvio decide to venture into a muay thai class. “I decided to go at my pace. I explained my condition to the teacher and he said that he had other students with fibromyalgia and that they got a good result. I started slowly, knowing the limits of my body and gaining security, “he recalls. “It was good for my self-esteem, to know that the disease does not limit me to practicing the sport,” he says.

“Without a doubt practicing physical exercises is the most important and effective intervention that literature has shown in the treatment of fibromyalgia. It is important and effective because physical exercise decreases pain, improves depression, anxiety, sleep and fatigue, which are very important components of fibromyalgia, “says the rheumatologist at SBR. “The patient with fibromyalgia has to start with a light activity and progress slowly,” he adds.

Regarding medications, PCDT of chronic pain indicates the use of muscle relaxants only for short periods of time, in cases of acute pain, and the continuous use is discouraged. In general, the disease is treated with the use of antidepressants. In addition, with the publication of the National Policy on Integrative and Complementary Practices, homeopathy, herbal and phytotherapeutic plants, traditional Chinese medicine / acupuncture, anthroposophic medicine and social-crenotherapy were institutionalized in the Unified Health System (SUS) . These therapies, coupled with conventional treatments, help minimize side effects, bringing greater quality of life to the patient during treatment and helping to deliver positive results.

The strategy for the optimal treatment of chronic pain is a multidisciplinary approach combining non-pharmacological and pharmacological treatment modalities. The treatment should be elaborated, in discussion with the patient, according to the intensity of their pain, functionality and their characteristics, being also important to take into account biopsychosocial and cultural issues. Chronic pain is a state of persistent health that modifies life. The goal of your treatment is control, not elimination.

The General Coordination of Specialized Attention of the Ministry of Health carried out a survey last year, with the states that have hospitals in oncology, and located 13 states (AC, AL, BA, ES, MA, MG, MT, RO, RR , RS, SC, SP and TO) with pain centers that attend SUS. Of the 27 states, only Amazonas and Piauí do not have pain centers by SUS or private…

 

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