Introduction
The recent news about the famous singer Lady Gaga having to stop her career because of fibromyalgia and my professional experience last year in a pain clinic has given me the idea to write about this disease which is both rare and not fully understood.
Fibromyalgia is a long-term condition which causes musculoskeletal pain all over the body. One of the important features in this disorder is that the pain is located in 18 “tender points” (Padin Galéa, Fernadez-Acerero, & Moreno de la Fuente, 2017). These tender points are well known by the doctors who use them to diagnose the illness. Among the criteria for a positive fibromyalgia diagnosis, at least 11 out of the 18 tender points must be painful when pressure is applied. The pain is accompanied by other disabling symptoms, including sleep disorders, cognitive symptoms, and psychological suffering. The literature review conducted by Pasqual Marques and her collaborators (2017) shows that the prevalence of fibromyalgia in the general population is between 0.2% and 6.6%. Women seem to be more affected by the disorder than men.
Biological data
Changes in the central nervous system, particularly in the central processing of nociceptive input may be the neurobiological cause of the disorder (Sawaddiru, Paiboonworachat, Chattipakorn, & Chattipakorn, 2017), though it is not clearly understood why the brain starts to malfunction.
In some cases, brain activity changes after a very traumatic physical experience causing the fibromyalgia to appear. These physical experiences include very long surgery, remaining stuck in the vehicle after a violent car crash… It seems as if the brain malfunctions after having suffered severe pain over a period of several hours.
Psychological data
Although advances in medicine allow us to understand how the brain malfunctions and causes the chronic pain to occur in patients suffering from fibromyalgia, it is not clearly understood why brain activity changes.
It seems that psychological trauma and repeated abuse in very early childhood may be one of the important causes of the disorder. One of the key findings of the study conducted by Varinen and his collaborators (2017) is that preventing traumatic childhood experiences would help to diminish the prevalence of fibromyalgia in the general population.
Many patients report having suffered from different types of abuse during their childhood: neglect, physical, psychological or sexual abuse. In most cases this abuse is not taken care of, and the child who is now an adult is not recognized as a victim. Like in many cases of childhood abuse the grown-up patients still experience numerous adverse events in their adult lives. The negative feelings generated by negative experiences causes the pain to increase.
In the pain clinic where I worked last year, about 80% of the patients who engaged in a psychotherapy had been diagnosed with fibromyalgia, and two thirds of them had suffered multiple psychological trauma but no physiological injury which could explain the pain symptoms.
Treatment
Patients suffering from fibromyalgia often have to take a large number of drugs. These include very active pain killers, especially ones which have an effect on glutamatergic activity because they are more effective at reducing chronic, widespread body pain (Sawaddiru, et al., 2017). Some antidepressants, for example Cymbalta (duloxetine) are used because of their analgesic effects and because they can also influence the mood of the patient in a positive way.
Psychotherapy can reduce the activity of the brain, especially in the insula, thereby reducing the pain (Sawaddiru, et al., 2017). In addition to psychotherapy, other non-pharmalogical treatments can help to deal with day to day pain and stressful situations: relaxation, hypnosis and sophrology are often proposed. Some patients also say that yoga can be very beneficial.
Case study
In this part, I am going to introduce a patient that I met during my internship last year. Her name and personal details will be changed so as to respect her privacy.
When I met Irene for the first time at the pain clinic for her weekly appointment with the therapist, my first thought was that she was a very good looking young woman, who dressed very well and smiled a lot. I was quite stunned when I realized she was in her late forties and that her youngest daughter was twenty years old as I thought that she was about twenty-five or thirty at the most.
She had been undergoing psychotherapy for a couple of years, since she received the diagnosis of fibromyalgia. She seemed very keen on the work she was doing with the psychotherapist as she would often say during the sessions that she better understood herself and that she sometimes noticed she could go through a whole day without having too much pain. She couldn’t recall a single day without physical pain for many years.
Irene had had a very difficult childhood. She and her sibling were often locked up in a small room while their mother brought men home. She recalled having to stay in there for hours, forcing her to urinate in a bucket and then pour it from the balcony of the apartment in which she lived. Her mother tried to commit suicide multiple times during Irene’s childhood, each time she broke up with a lover. For a few months when she was about ten, Irene also suffered from sexual abuse committed by a neighbor. She finally talked about it and the man was arrested and sentenced to six months in prison. Her parents were separated and their father was kind but used his children to get at their mother.
When she was twenty, she suffered from depression after having an abortion. She felt forced to take the decision by her family and her then boyfriend.
She is now in a difficult relationship. Her husband drinks a lot and is sometimes verbally violent. The psychotherapy helps her distance herself from all the stressful events she is now going through and this has a beneficial effect on the pain. She is also working on her past, putting a distance between herself and her traumatic past thanks to hypnosis, relaxation, and other therapies.
Conclusion
Although the etiopathogenesis of fibromyalgia remains unclear, this disorder needs to be treated both by medication to relieve pain and by psychotherapy so that the patients can work on their past and in particular on their traumatic experiences. Psychotherapists can help the patients both to elaborate on these traumas therefore allowing pain relief and also on the psychological effects of the disorder. The systemic and psychoanalytical approaches seem to be the most successful for treating fibromyalgia patients as they focus on family history and transgenerational aspects as well as on childhood experiences.
Bibliography
Padin Galéa, J., Fernadez-Acerero, M., & Moreno de la Fuente, J.L., (2017). Characteristics of patients with fibromyalgia. The foot, 32, 27-29.
Pasqual Marques, A., De Sousa Do Esperito Santo, A., Assumpçao Berssaneti, A., Akemi Matsutani, L., & Lee King Yuan, S. (2017). Prevalence of fibromyalgia: literature review update. Sociedad Brasileira de Reumatologia, 57(4), 356-363.
Sawaddiru, P., Paiboonworachat, S., Chattipakorn, N., & Chattipakorn, S.C., (2017). Alterations in brain activity in fibromyalgia patients. Journal of Clinical Neuroscience, 38, 13-22.
Varinen, A., Kosunen, E., Mattila, K., Koskela, T., Sumanen, M. (2017). The relationship between childhood adversities and fibromyalgia in the general population. Journal of Psychosomatic Research, 99, 137-142.
