Enigmatic pain: what helps with fibromyalgia?

Severe pain, sleep disorders, physical and mental fatigue: The symptoms of fibromyalgia syndrome (FMS) are manifold. And recognizing the disease is anything but easy. There is no specific blood test and no X-ray examinations for the diagnosis of FMS, explains Winfried Häuser from the Department of Internal Medicine at the Klinikum Saarbrücken.

To diagnose fibromyalgia, clinicians need to take a close look at the patient's history and do a full physical exam and multiple lab tests. This is the only way to make sure they do not overlook other physical illnesses as the cause or cause of pain and fatigue.

Pain and anxiety

Literally, fibromyalgia means fiber-muscle pain. According to the official guideline for the treatment of FMS, the disease occurs in about two percent of the population in western industrial nations - mostly in women between the ages of 40 and 60, according to the guideline. But it can also affect other age groups as well as men and children.

Patients often suffer from prolonged pain, difficulty falling asleep and staying asleep. Added to this are psychological problems: "About 60 to 80 percent of them meet the criteria for a depressive or anxiety disorder," says Häuser. "But not every FMS patient has a mental disorder, and not every patient with a depressive or anxiety disorder has chronic pain in multiple parts of the body."

The causes of the disease can be manifold. Experts believe that genetic predisposition and various biological and psychological factors are responsible for the fibromyalgia syndrome. These factors include infections, depression, traumatic events and lifestyle factors - lack of exercise and overweight, for example.

It is also striking that many sufferers have similar personality traits: "Most fibromyalgia patients are very sensitive, willing to perform and ambitious," explains Thomas Weiss from Mannheim, a specialist in general medicine, psychiatry and psychotherapy and psychosomatic medicine. "Often in the course of life there is an excessive demand, the people are pushed to their limits - and then something happens that is difficult for them to understand."

Suddenly those affected no longer sleep well, they are more sensitive to stimuli and have vegetative complaints - nervousness, for example. "We assume that the patients' bodies shut down the stimulation threshold, which is evolutionary meaningful behavior in stressful situations," says Weiss. For example, it was not necessary to sleep at night - as protection against danger. "Essentially, therefore, there is an activation of innate, epigenetically inherited programs that were actually necessary for survival in an original environment."

Meditation and muscle relaxation

This explanation may help patients understand the condition. However, the symptoms do not eliminate them. "We often give very low-dose antidepressants for treatment," says Weiss. "This does not mean that fibromyalgia is a disguised depression, but the remedies have a mild analgesic effect." Relaxing techniques can also help - for example, meditation and progressive muscle relaxation. And as difficult as it often is for patients with severe pain and permanent fatigue: exercise can help alleviate the symptoms.

Ulrike Eidmann from Wuppertal has also had this experience. In 1990 she was diagnosed with fibromyalgia. "I had previously been on sick leave for a long time due to back and muscle pain, but no doctor had an explanation," she says. "Only a three-week hospital stay brought me a diagnosis."

First, the doctors prescribed painkillers, but that hardly helped. For four years, the patient waived these drugs. "In a rehab I started moving a lot for the first time since my diagnosis," says Eidmann. "I started nordic walking and cycling and I swam a lot."

Despite pain cycling?

The symptoms got better and eventually disappeared. In phases, she is now completely painless. Today she says: Every patient has to find out for himself what helps him. "For me it was very important to listen to me and to recognize what is good for me." In addition, one should experience for oneself, that movement is worthwhile. "I, too, have to keep trying, but I know that I feel better afterwards," says Ulrike Eidmann. "Once you've learned that, it's easier to get on your bike despite the pain."

It is important in the opinion of Internist houses but not to exaggerate it in the movement. "Training with moderate and high levels of exercise causes pain in many patients," he says. Exceptions exist only in persons who were already very well in endurance training before the onset of the disease. Some patients could also help to change the diet - even if the effect is again very individual.

"There is no FMS diet," says Häuser. "As for healthy people, a balanced diet with lots of vegetables, fruits, fiber and low meat is recommended." Individual patients benefit from a vegetarian diet or gluten-free diet. Whether that relieves the symptoms, everyone has to find out for themselves. "If after four weeks no noticeable improvement for the patient has occurred, the diet should be stopped."