Fibromyalgia: the challenges of an invisible disease.

Although it is not identified in laboratory tests, severe pain can greatly harm people’s routine. The main treatment is with regular physical exercise.
Feel intense pain throughout the body and still deal with the distrust 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 spreading to various parts of the body and causing fatigue, sleep disturbances and depressive episodes.
“At the beginning it is very difficult for you to accept the disease, and it is also bad because people think you are making a soft body,” says the public official 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 considered a psychologically unique disorder. “Because many 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 Martínez, rheumatologist and coordinator of the Committee of Pain, Fibromyalgia and Other Syndromes of the Broken Muses of the Brazilian Society of Rheumatology (SBR).
Although not all patients with fibromyalgia have 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 presents alterations in the nervous system to control pain. “The 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 from nothing, until I imagined it was a muscular pain to sleep badly. I tried physiotherapy, massage, acupuncture, but did not, and began to radiate to other parts of the body, “he recalls.
“Normally there are two ways 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, eventually generalizes over time.

Another form is chronic stress, which leads to muscle tension, which generates muscle pain, which ends up in a pain out of control and widespread, “he says.
According to data from the Department of Health of the United States, it is observed that 31% of the population has some chronic pain, which results in a total or partial disability in 75% of the 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 injuries or excess fatigue. SBR estimates that, in Brazil, the disease affects around 3% of the population.

Diagnosis and treatment
With persistent pain, Hélvio Sodré looked for a rheumatologist. Through an examination in which the patient must manifest pain in at least 11 of the 18 expected sites of painful muscle points, and the exclusion of other clinical conditions, such as rheumatic diseases and primary sleep disorders, he was 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 the crisis, 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 al- lows pleasure to improve health. “At first I was a little on the side, and my health was very different,” admits the public official, who went swimming, bodybuilding and aerobics in the gym before discovering an activity that he really liked. “Since 2010 I have followed fight channels. I always had a great fascination, but I did not think I could practice, I was limited by fibromyalgia, “he says.

Only after gaining more confidence and muscle strength in bodybuilding Hélvio decides to venture into a class of muay Thai. “I decided to go at my pace. I explained my condition to the teacher and he told me that he had other students with fibromyalgia and that they had 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 illness does not limit me to practicing sports,” he says.

“Without a doubt, practicing physical exercises is the most important and effective intervention that the literature has shown in the treatment of fibromyalgia. It is important and effective because physical exercise reduces 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.

As for medications, chronic pain PCDT indicates the use of muscle relaxants only for short periods of time, in cases of acute pain, and 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, phytotherapeutic and phytotherapeutic plants, traditional Chinese medicine / acupuncture, anthroposophic medicine and social crenotherapy were institutionalized in the Unified Health System (SUS). These therapies, along with conventional treatments, help to minimize side effects, providing a better quality of life to the patient during treatment and helping to give positive results.

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

The General Coordination of Specialized Care of the Ministry of Health conducted a survey last year with 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 assist the SUS. Of the 27 states, only Amazonas and Piauí have no pain centers by the SUS or private.

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