Patients with fibromyalgia need to see not only physical suffering, but also the distrust of their relatives and even health professionals

The eyebrows, the red of the clothes, the flowers in the hair and the experience of the pain are inseparable signs of Frida Kahlo. His self-portrait with the whole body piercing nails,     The broken pillar  , one of his most famous paintings, is also an indication that the Mexican artist was suffering from fibromyalgia. Some authors report that Frida suffered from post-traumatic fibromyalgia characterized by persistent generalized pain, chronic fatigue, sleep disorders and pain points. in well-defined anatomical regions. This concept of fibromyalgia, as it is currently understood, was probably not widespread among 20th century physicians: in their self-portrait “The Broken Column” of 1944, Mexican artist Frida Kahlo expresses her pain through nails over his entire body ( Photo: Internet reproduction)

When Frida painted     The Säule  The connection of painful stings with rheumatism has been cited for at least 120 years. In 1824, Scottish surgeon William Balfour first described patients with hypersensitive muscle points on palpation that could trigger radiated pain. Fibromyalgia is not a new disease, as many people imagine. Historically, it has been presented under various names: fibrositis (1904), myofibrositis (1929), fibrositic syndrome (1952), fibromyalgia syndrome, and finally fibromyalgia (1981). Appointed in 1992, he was recognized by the World Health Organization (WHO) as a rheumatic disease. But even if it is long after, it is always questioned by the society, the patients’ relatives and even some health professionals.

Rheumatologist Luiz Severiano Ribeiro of the Department of Rheumatology of the State Pension Institute of Minas Gerais (Ipsemg) recalls a time when patients themselves did not believe in the diagnosis, even if it was justified. The pain they considered “inexplicable” , was the size of the trouble. “They complained of pain and fatigue but did not take the diagnosis seriously. First, they did not understand the name. In addition, the clinical trials showed nothing and we prescribed antidepressants. They thought the fibromyalgia was crazy and when they found another doctor and told them what the rheumatologist said, they realized that they really needed to be psychiatrists. It was the classic trajectory of fibromyalgia 20 years ago. They jumped from one doctor to another without explanation, and when they were diagnosed they did not believe. “

Association   For fibromyalgia, people more sensitive to pain than the general population, such as mistrust and doubt are equally bad. Sandra Santos, 53, retired, was diagnosed in 2005 and founded in a positive attitude to suffering the Brazilian Association for Fibromyalgia (Abrafibro) with other patients. To treat a spine problem, she was referred to a treatment she could not continue. “I came in and out of a wheelchair. I insist until the eighth session, but the doctor found it strange that my pain threshold is so low. The companion who accompanied him suspected that it was fibromyalgia and during the clinical examination he told me that I had eleven pain points of 18. She had fibromyalgia,

INCREASED SENSITIVITY

In recent years, the understanding of fibromyalgia is considered a syndrome because it covers a range of clinical manifestations, such as pain, fatigue, and sleep disorders. Eduardo Paiva, Chairman of the Committee on Pain and Fibromyalgia of the Brazilian Society of Rheumatology, Professor at the Federal University of Paraná (UFPR) and Head of the Fibromyalgia Outpatient Department at the Hospital das Clínicas. Ufp is becoming increasingly established fibromyalgia awareness is a nervous system problem that is programmed to feel more pain. Investigations, such as functional magnetic resonance, showing brain function in real time, show the amplified pain intensity reported by patients.

learn more

  • Fibromyalgia affects 3% of the Brazilian population, but the diagnosis is difficult
  • The research suggests new treatments for chronic pain that affect 30% of people in the West
  • The therapy can block chronic pain
  • Chronic pain can have a natural origin
  • Research strengthens the relationship between chronic pain and depression
  • For every kind of pain there is a suitable technique: to know the possibilities of physiotherapy

People with fibromyalgia have a lower pain threshold. Stimuli that normally do not cause pain in other people, such as Conditions, can be painful in fibromyalgia. According to Roberto Heymann, a rheumatologist at the Albert Einstein Hospital and a professor at the University of São Paulo (Unifesp), this is due to a failure of the pain control mechanisms in the central nervous system. “The causes of such inadequate control of the pain mechanisms are unknown. It is believed that a genetic predisposition exposed to certain environmental factors produces fibromyalgia. What we know

In addition, external factors influence transmission and pain perception. Emotional state and cold are part of it. Depression, as with many other chronic diseases, can be one of the consequences of fibromygia, but also the trigger that was lacking to trigger a picture of fibromyalgia in the genetically predisposed person. According to Heymann, emotional health has a direct impact on all diseases, not just fibromyalgia. For example, how many people have high blood pressure because they have become nervous and anxious? In fibromyalgia, where pain is subjective, the influence of emotion on its intensity often creates prejudices. The fact is that a depressed person actually feels more pain than the normal population, because their sensitivity to pain is increased. In this way

Any picture of chronic pain also damages sleep, with the patient often waking up with pain. However, in fibromyalgia, hormonal changes and neurotransmitters are also responsible for the superficiality of sleep and the feeling of fatigue. Consequently, most people with fibromyalgia have superficial and light sleep in which they do not rest. This makes them tired and without energy. The main symptoms of the condition are generalized pain, sleep disturbance or a tired waking up, and you feel tired or tired during the day. Maria Joana das Mercês, 84, doubted that she had really slept at night or whether it was a dream. Participant in the fibromyalgia patient education group, Ipsemg, has been around for over 20 years and today she is better able to treat symptoms, but they have not stopped worrying. “I sleep and wake up and think if I’m really asleep. And the pain is unbearable. Nobody deserves it, “he complains.Watch the video of patients reporting fibromyalgia:

THE BROKEN COLUMN
Rodrigo Siqueira Batista and his co-authors are looking for the cross between his art and his pain experiences in the biography and works of the Mexican artist in 2014’s article “Art and Pain in Frida Kahlo”. For the authors, The Broken Column, in which she describes herself with the steel vest to control the pain picture, describes the nails inserted in her naked body an endless martyrdom. “Frida’s body is split, bleeding, nailed and isolated. She translates the physical torture that she has never left her entire life, “as it was before the pain. “The loneliness, metaphorized by the desert landscape, intensifies the suffering. The open body is an indication of the various surgeries in which you have repaired the spine without improving your discomfort. Implanted nails, however, indicate the typical pain points of fibromyalgia. For researchers, this hypothesis would explain the chronic pain and deep fatigue of the painter.

Julia de Oliveira Fonseca, medical student at the Federal University of Viçosa (UFV) and Rodrigo Siqueira-Batista, doctor, philosopher and professor at the Department of Medicine and Nursing of the UFV  

LIFE AND ART

The image of Frida Kahlo is very much related to the suffering. What were your main sources of pain? The polio and the accident are undeniable, but was she diagnosed with fibromyalgia, or was this finding found after her death and due to a greater knowledge of the syndrome?

The painter Frida Kahlo suffered both physically (organically) and emotionally. In fact, one of the artist’s greatest sufferings is related to his relationship with fellow artist Diego Rivera, for whom she was deeply in love. The couple had a great affection for each other; However, there were also fights and betrayals, which made Frida very sad. One of those arguments was the result of Diego’s betrayal of Frida’s sister Adriana. Frida also suffered from the fact that she could not experience a spontaneous abortion at the time of pregnancy. A famous painting called Henry Ford Hospital (La cama volar) describes in a remarkable and strong way an episode in which Frida had to be hospitalized after an abortion. No case of fibromyalgia was diagnosed in life, although at that time the name “fibromyalgia” did not exist (much later, back to the 70s). This diagnostic hypothesis was established after his death and is suggested by his clinical picture of chronic pain, as described in the article Fibromyalgia in Life and Art by Frida Kahlo (article by Manuel Martinez-Lavín, Mary-Carmen Amigo, Javier Coindreau and Juan Canoso). published in the journal Arthritis & Rheumatism, March 2000). as suggested in the article Fibromyalgia in Life and Art by Frida Kahlo (article by Manuel Martinez-Lavin, Mary Carmen Amigo, Javier Coindreau and Juan Canoso). published in the journal Arthritis & Rheumatism, March 2000). as suggested in the article Fibromyalgia in Life and Art by Frida Kahlo (article by Manuel Martinez-Lavin, Mary Carmen Amigo, Javier Coindreau and Juan Canoso). published in the journal Arthritis & Rheumatism, March 2000).

The article by     Art and Pain in Frida Kahlo    * speaks of a possible connection of the nails by the body in the broken column with the pain points of fibromyalgia. Can this image be considered as clear evidence of your experience with fibromyalgia? Because

The image     The Broken Pillar,     in which the nails are stuck to the artist’s body, describes Frida’s connection with the aftermath of the accident he had suffered in his youth – several fractures in the spine – as well as his report painful. In terms of the pain points of fibromyalgia, this seems to be a plausible hypothesis, but this certainly is not “obvious evidence,” especially considering a painter of the category and intensity of Frida Kahlo.

What significance does pain have for the work of the Latin artist?

Frida Kahlo painted many self-portraits and considered herself very self-confident. It is assumed that the artist has depicted many moments of pain on his canvas – physical and emotional – that were part of his life. In this way it can be assumed that in art Frida somehow finds the meaning of pain itself.

* The article by Rodrigo Siqueira-Batista, Plínio Duarte Mendes, Julia de Oliveira Fonseca and Marina de Souza Maciel was published in 2014 in the journal Dor.

WITHOUT ESTIGMAS

In order to live with the syndrome and maintain quality of life, it is important that the person with fibromyalgia treat them seriously and engage with professionals who are familiar with the subject.

Presse Euler Junior / EM / DA% u2013 02.07.14
Jorge Luiz Dutra, 59, was interviewed several times because he was in pain (Photo: Euler Junior / EM / DA Press% u2013 02/07/14)

On the 12th we celebrate the World Day of Fibromyalgia. The date strengthens the struggle of patients for better access to treatment and, above all, for more visibility of the syndrome. Only public awareness can change the panorama of unbelief about chronic pain that marks the problem. The retired bricklayer Jorge Luiz Dutra, 59, has been diagnosed since 2004 and still lives with mistrust. He lives in the countryside and is tired of hearing that fibromyalgia is just an excuse. “Many people say that I have nothing, that I do not want to work. They look at me and say that when I’m fat, I’m healthy, “he says. But it is Jorge, who knows the suffering of a threatening pain, a symptom that is affected by social, cultural,

According to Roberto Heymann, a rheumatologist at the Albert Einstein Hospital and a professor at the University of São Paulo (Unifesp), pain assessment is complex because there are no precise measures such as high blood pressure and diabetes. Patient, professional or family information. “If they do not have enough information, there will certainly be a wrong judgment. That’s why we often see family members, employees or even health professionals who do not believe in their suffering. This increases the degree of fibromyalgia disease and even affects the development of the clinical condition. “The lack of sufficient knowledge about this syndrome in society often creates absurd preconceived ideas. Family and social support is essential, “he said.

The pain of fibromyalgia can cause a lot of suffering that is enough to disrupt your daily and habitual activities. But even when patients and institutions are fighting for the possibility of a vacation or even a retirement, leaving the work is a complex issue, said Heymann. “There is no data to show that this benefits, and removal from work usually worsens the situation,” he says. For the specialist it is in most cases quite possible to live with the syndrome and to maintain its quality of life. For this it is important that the person with fibromyalgia takes this seriously and works with professionals who are well prepared and competent.

RESPONSE   Personal Trainer  Michele Barreto, 42, was diagnosed 14 years ago. Medication, therapy, altered eating habits, and regular physical activity make it possible to coexist without major problems with fibromyalgia. “Today is good, but at the time of diagnosis I had to sit down and cry. But I had two choices: Either it would break me or I would react. The patient needs to understand that the condition improves if he adheres to the treatment, “he said. Michele, a former volleyball athlete, was surprised to see that the benefits of relaxation were told through a massage. “Because I squealed in pain instead of relaxing. I also stopped sleeping and was already tired, “he recalls.

Edésio Ferreira / Presse MS / DA
Personal trainer Michele Barreto, 42, was confronted with fibromyalgia and persisted in physical activity even in days of great pain (Photo: Edésio Ferreira / EM / DA Press)

In volleyball Michele had wounds that improved more slowly. At the time this had become a mistrust, because some people imagined it would be soft. However, fibromyalgics are often patients with a history of pain prior to diagnosis. According to Eduardo Paiva, head of the Pain and Fibromyalgia Commission of the Brazilian Society of Rheumatology, there are several ways to achieve fibromyalgia. “This could, for example, be the result of untreated localized pain. It can also start after a physical or mental trauma. The most common is, however, that it is a localized pain that synchronizes and takes over the entire body, “explains the specialist.

And it’s just a trauma that caused Michèle’s fibromyalgia. She drove when she had a serious car accident in which two friends were very injured. “It was my fault. At first, I thought back pain was the result of the accident. I had to wear a collar for a while, but the pain continued, “he says. The first reaction after the discovery of fibromyalgia was the search for all kinds of resources to cope with the disease: massage, acupuncture, homeopathy, therapy. The latter was important for her to change her approach to the disease. “I’ve learned that it would make things worse when it somatised.” Also, physical activity was important. “I’ve heard that many doctors said that it was over 50% of the treatment. Sometimes It’s so painful that we do not want to do anything. But it takes perseverance. “

Due to personal experience with fibromyalgia, the professional is much sought after by people who want to use physical activity to control their symptoms. “I think they trust me to train with me because I know how they feel on the skin. In addition, the physical activity of fibromyalgia must be specific and very targeted, “he warned. For Paulo Paiva, physical activity may be more effective than medication in some cases. Without treatment, fibromyalgia can lead to a significant loss of quality of life. In addition to medicines (neuromodulators and dual antidepressants that are most suitable) and physical activity, the treatment also includes the education of patients and families.

ALTERNATIVE AND ADDITIONAL THERAPIES

A review of controlled trials evaluating the effectiveness of massages in the fibromyalgia approach showed that five weeks of the resource could promote immediate benefits such as improved pain, anxiety, and depression. , Susan Lee King Yuan, a physiotherapist, holds a master’s degree in science from the Faculty of Medicine of the University of São Paulo and a researcher in the field. Therapeutic massage could be one of the alternative and complementary therapies (CT) in the treatment of fibromyalgia.

The myofascial relaxation massage can improve pain, fatigue, stiffness, anxiety, depression and quality of life. Some data show that manual lymphatic drainage is superior to connective tissue massage in terms of stiffness and depression. There is evidence that connective tissue massage improves depression and quality of life, while Shiatsu improves the threshold for pain, fatigue, sleep and quality of life. “Studies suggest that most massage therapy styles improve the quality of life for patients with fibromyalgia, but further research is needed to confirm the benefit,” he says.

Reading on the internet

Functional magnetic resonance imaging compares the brain activity of a normal person to a fibromyalgia patient. Both were exposed to a stimulus of 4 kg, which can cause pain (Photo: Reproduction of the Internet).

In theory, the alleviation of pain can theoretically be due to increased blood flow that promotes oxygenation and excretion of toxins from the muscles, relaxation and release of endorphins. “The pain only disappears with the massage therapy. The massage is best suited as an adjunct to other therapeutic adjuncts as part of a multidisciplinary treatment to control the symptoms of the syndrome. “

No study has unequivocally determined the ideal frequency of massage for fibromyalgia. Some researchers suggest a treatment duration of more than five weeks. For Susan, the CTs advocate a holistic view of the patient and appreciate the connection between the therapist and the patient. Importantly, this massage respects the threshold of painful sensitivity of the patient to palpation. “The use of CATs as a complement to multidisciplinary treatment is ideal: it is particularly important that this treatment includes patient education, psychotherapeutic techniques, and therapeutic exercises that are the greatest evidence of efficacy in treating patients. Treatment of fibromyalgia. “

NAME

Epidemiology

  • The prevalence of fibromyalgia in the world is between 0.7% and 5% compared to the general population.
  • In Brazil, this is probably the second most important rheumatic disease with a prevalence of about 2.5%.
  • This can range from children to the elderly, but their symptoms usually start between 25 and 65 years, with a median age of 49 years.
  • It affects more women than men in a ratio of 8: 1 when using the criteria of the 1990 American College of Rheumatology

INTERVIEW    
A new look

Personal Archives
Manuel Martinez-Lavín, Rheumatologist and Master of the American College of Rheumatology (Photo: Personal Archive)

Manuel Mantinez-Lavín is acknowledged as an authority in the field of fibromyalgia and explains the mechanisms of the disease based on the original hypotheses, which are scientifically confirmed and often cited by other authors around the world. In the book Fibromyalgia Without Mystery – A Guide for Patients, Family Members and Doctors (MG Editores), he offers a holistic treatment for the relief of fibromyalgia symptoms, which in addition to the drug treatment, various effective measures such as a positive attitude to disease, group therapy, yoga, Meditation, body and breathing exercises, cognitive behavioral therapy, differentiated nutrition and the use of techniques to improve sleep. In an interview with the state of Minas Gerais He comments on this new approach and discusses the most important advances in the understanding and management of the disease. Lavín studied medicine at the National Autonomous University of Mexico, is a postdoctoral fellow in internal medicine at the University of St. Louis (Missouri) and rheumatology at the Scripps Clinic (California). Since 1983, he has been Director of the Department of Rheumatology at the Ignacio Chávez National Institute of Cardiology in Mexico, and Professor of Rheumatology at the National Autonomous University of Mexico and a member of the National Academy of Medicine. In 2013, he graduated from the American College of Rheumatology. and Professor of Rheumatology at the National Autonomous University of Mexico and Member of the National Academy of Medicine. In 2013 he graduated from the American College of Rheumatology. and Professor of Rheumatology at the National Autonomous University of Mexico and Member of the National Academy of Medicine. In 2013, he graduated from the American College of Rheumatology.
What is the procedure for analyzing the variability of the heart rate has it made the approach of fibromyalgia?
The analysis of heart rhythms with the help of computers makes it possible to efficiently study the functioning of our main system of internal regulation and adaptation to the environment called the autonomic nervous system. This system is responsible for the stress response, and our research has shown that the function of the autonomic nervous system is impaired in patients with fibromyalgia. For example, adrenaline production is increased day and night. Our studies have been confirmed by researchers from other parts of the world. With this knowledge, the concept of fibromyalgia is radically changing. The treatment should aim to harmonize the functioning of the autonomic nervous system, which usually requires a significant change in the lifestyle of the patients.

If the pain caused by fibromyalgia radiates in the body, would that be explained by this function of the autonomic nervous system? 

Exactly. Our theory explains the reason for generalized pain, as small nerve fibers are distributed throughout the body. We have confirmed that patients with fibromyalgia had impaired nerve fibers in their skin and eyes, which we call small fiberneuropathy. It must be understood that fibromyalgia is a true neuropathy and causes as much pain as the neuropathy of diabetics and patients with shingles. 

And what is the progress in understanding the causes of fibromyalgia?

The most important advance is explaining how different types of stress (physical, infectious and emotional stress) can become a true neuropathic pain. We have received evidence that constant stress can damage the so-called dorsal root ganglia, nerve centers along the spine. After a physical or infectious trauma, shorts are formed between the autonomic nervous system and the fibers that transmit the pain. The changes in the autonomic nervous system explain the many diseases that are affected by people with fibromyalgia such as fatigue, insomnia and intestinal problems. 

What is the holistic treatment that you advocate? Why is it more effective?

First of all, I would like to explain that it is a holistic treatment based on the complexity sciences. There is a new scientific paradigm called “complexity” far removed from the linear and reductionist model that currently dominates medicine. Complexity makes it necessary to holistically study the adaptation systems of the human body to the environment. In the case of fibromyalgia, holistic, science-based treatment requires that patients and their families know the multiple syndrome rations. Feedback techniques make it possible to harmonize the function of the autonomic nervous system. Also, the food is important: you have to find out if a particular substance is incompatible,


Are drugs like pregabalin a big step forward? Are there any prospects for a new class of drugs? 

Pregabalin is a breakthrough. It is an antineuropathic medicine that works in some cases, but it must be acknowledged that it is a primitive drug. We have shown that some sodium channels bound to the dorsal root ganglia can play an important role in the pain of fibromyalgia. Very specific drugs are being developed to block these sodium channels. In the near future, we will also have more effective analgesics for fibromyalgia, but full treatment will still be needed.

In Brazil, there is a range of body massages designed exclusively for fibromyalgia that are designed to end the symptoms. Could the massage change the course of the syndrome? 
I am not familiar with this type of therapy, but before treatment is recommended, it should have been proven by controlled scientific studies. In my book I talk about alternative medicine, placebo effect and quackery. A gentle massage can help. However, some people with fibromyalgia feel pain even with light pressure on the skin.

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