Chronic Pain

Fibromyalgia: strategies to better manage pain

Management by Charbel Kortbawi, osteopath in Paris 16, at the Cabinet Victor Hugo — 7 rue Georges Ville (75016).

Definition and characteristics

Fibromyalgia, or fibromyalgia syndrome, is a chronic condition characterised by persistent widespread pain and tenderness on pressure. Most often, this pain is associated with other suggestive signs such as persistent fatigue and sleep disturbances.

Fibromyalgia is also accompanied by psychological disorders (anxious-depressive syndromes) and cognitive disorders (difficulties with concentration and attention, forgetfulness, "memory lapses").

In patients with fibromyalgia, there is a deterioration in physical fitness, a significant increase in the perception of effort and a reduction in activities of daily living.

The exact origin of fibromyalgia remains unknown, but scientific research is evolving and has shown an alteration of pain-control pathways in the nervous system.

Symptoms of fibromyalgia

Fibromyalgia manifests itself through a range of symptoms whose intensity can vary. The most common are:

• Generalised pain: the characteristic symptom is pain throughout the body, often described as a dull, diffuse pain that persists for three months or more.
• Fatigue: people with fibromyalgia often feel tired, even if they sleep enough.
• Cognitive difficulties: often called "fibro fog", they include problems with memory, concentration and attention.
• Sleep disturbances: many people with fibromyalgia have difficulty falling asleep or staying asleep due to pain or other associated disorders.
• Painful trigger points: certain parts of the body, such as the neck, shoulders, back and hips, may be particularly sensitive to touch.
• Other symptoms: headaches, irritable bowel syndrome (IBS), anxiety and depression are often associated with fibromyalgia.

Treatment of fibromyalgia

Recommendations of the European League Against Rheumatism (EULAR)

The European League Against Rheumatism (EULAR) published its recommendations in 2016 for the management of fibromyalgia, emphasising a comprehensive approach:

• Education and self-management: patients should be informed about fibromyalgia, in particular about its symptoms, therapeutic options and coping strategies.
• Multidisciplinary approach: treatment should involve a team including rheumatologists, physiotherapists, psychologists and occupational therapists.
• Physical activity: regular physical activity can help reduce pain and improve physical function.
• Cognitive behavioural therapy (CBT): helps patients manage stress, anxiety and depressive symptoms.
• Sleep management: education on sleep hygiene and interventions where necessary.
• Complementary therapies: acupuncture, mindfulness, yoga and massage in addition to conventional treatment.

Osteopathy and fibromyalgia: how to relieve the pain?

An osteopath specialising in chronic pain understands the neurophysiological particularities of fibromyalgia: central sensitisation, fluctuations of the pain threshold, and the impact of stress on pain. Thanks to this expertise, they adapt their techniques (gentle mobilisations, visceral approaches, breathing exercises) to provide relief without over-stimulating already sensitive tissues.

Above all, this practitioner integrates therapeutic patient education (TPE): they explain to you the mechanisms of fibromyalgia, teach you to identify your triggers, to manage effort, posture, sleep and stress, and give you simple self-exercises to prolong the relief between sessions.

Mr Charbel J. Kortbawi, in addition to his osteopathic care, is qualified thanks to his specialist training to deliver therapeutic patient education for the fibromyalgic patient, and to help them find a physical activity programme adapted to their condition.