DOCTOR, I don’t know what’s wrong with me. For several months, just after the dislocation I had in my shoulder, the pain was no longer just there and has spread to the rest of my body. My legs, arms, back, neck hurt, and I can even tell you that sometimes I feel like my eyelashes hurt. Is that possible
, is it bone cancer
. The people around me tell me that they see me well, that I have no reason to complain, that I have nothing. But doctor, I promise you that I suffer pain 24 hours a day, that prevent me from sleeping and that keep me sunk in constant suffering. Even for fear of being criticized, when the pain becomes more intense I try to escape to a place where there is no one so I can cry and let off steam. Please help me, I don’t want to continue living like this”. Fibromyalgia is a very controversial disease today in our society. It is estimated that up to 5% of the Spanish population (more than 1 million people) suffer from it, mostly women in their 40s and 50s.
Etymologically, its name means muscle fiber pain, and it is that those who suffer from it usually come to our consultation referring generalized pain of more than 3 months of evolution, often presenting other accompanying symptoms such as insomnia, fatigue, morning stiffness, depression and anxiety. Unfortunately, the cause of this disease is still unknown, and it can be triggered after an infectious process or even after a physical or emotional trauma. Among the multiple theories that exist, one of the most widespread defends the presence of an alteration in the concentration of certain types of substances at the level of the nervous system of these patients, although there is really no established evidence.
Faced with these symptoms, the professional must carry out an adequate anamnesis and examination (being able to assess, among others, the famous but unreliable trigger points of fibromyalgia), including, if considered appropriate, carrying out complementary tests (from analytical tests to imaging and neurophysiological studies), with the aim of ruling out and excluding other different diseases that could produce similar symptoms. However, in most cases, these analyzes usually present non-pathological results, that is, they are within normal limits.
Diagnostic difficulties are complicated by those ‘simulators’ who, taking advantage of this weakness, manage to be wrongly diagnosed and sometimes obtain economic benefits from the institutions (sick leave, permanent disability, etc.).
That is why this picture is currently so criticized, and on numerous occasions, these patients who suffer from it, who must live with pain, resign themselves and get used to it, are usually labeled as liars, complainers, and even suffering from it. ‘the disease of the bums’, leading to social exclusion not only by health professionals, but also by their own co-workers, friends and family.

A bioethical problem for many professionals
As health professionals, we are therefore faced with an important bioethical problem: on the one hand, we have to avoid making value judgments with these patients, but at the same time, and in an almost contradictory way, we should be able to identify and exclude from this diagnosis those who simulate their symptoms in order to profit from it. As physicians, before any patient who enters our office asking for help (regardless of whether their symptoms correspond to one or another entity), it is our duty to apply the Hippocratic Oath: “…in any house where I enter, I will have no other objective than the good of the sick: I will free myself from voluntarily committing injurious offenses or corrupting actions…”.

Treatments.How is fibromyalgia treated
The treatment of this disease should include a pharmacological approach based on analgesics that act on neuropathic pain, avoiding, as far as possible, prolonged use of anti-inflammatory drugs, opioids and benzodiazepines. Predominantly low-intensity aerobic physical exercise, such as yoga or taichi, at least twice a week is also essential. Likewise, psychological therapies predominantly of a cognitive behavioral type are also recommended, in which, among others, positive reinforcement and various coping and problem-solving strategies are worked on.

Course of the disease. It is not degenerative and can fluctuate over time
Even with adequate treatment of this disease, the natural evolution of this entity is usually towards the persistence of symptoms indefinitely or chronically, remission and complete disappearance of the same being infrequent. Despite this, the symptoms do not worsen gradually, so it is not a degenerative disease, but rather a condition that fluctuates over time, presenting limited periods of improvement and worsening (frequently associated with the patient’s mood, being able to worsen before certain stressful life events that increase stress and emotional tension).

Context. Frustration and mistrust among professionals

Ignorance of the etiology, the subjectivity of the symptoms that characterize it, the
normality of the complementary tests that are carried out and the poor response to the recommended treatment, not only produce great frustration for the patient with fibromyalgia and for the doctor, but have also led many professionals to doubt and question their true existence ( despite the fact that the World Health Organization, since 1992, recognized it as a disease with the code M79.7 in the ICD-10 or, what is the same, in the International Classification of Diseases).

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