Understanding Fibromyalgia: A Biopsychosocial Approach
Foundations of Modern & Contemporary Medicine
Historical Context
From the 17th to 19th centuries, a methodical doubt shaped medical understanding, dividing human nature into body and mind. Newtonian physics viewed the body as a biological machine governed by classical laws. Contemporary medicine, however, recognizes the universe as an interconnected system where chance and chaos play a role (quantum physics, uncertainty principle, relativity). This holistic, ecological perspective allows medicine to address complex problems beyond traditional biomedicine.
Biomedical vs. Biopsychosocial Models
Biomedical Model
This model sees the body as a well-defined anatomical structure. Health problems arise from physicochemical alterations, often with a molecular, genetic, or external basis. The doctor acts as a technician, repairing these alterations based on “substantial evidence” and aiming for a cure following Evidence-Based Medicine.
Biopsychosocial Model
This model acknowledges blurred lines between health and disease, viewing them as a continuous process. Health is multidimensional, influenced by biological, psychological, social, familial, environmental, and cultural factors. The physician supports patients throughout this process, promoting health, preventing and treating illness, and providing rehabilitation and support. Patient-centered care is paramount, considering the patient, family, and society as an interactive system.
Fibromyalgia
Overview
Fibromyalgia is characterized by widespread musculoskeletal pain, multiple tender points, sleep disturbances, fatigue, joint stiffness, morning paresthesias, subjective swelling, and psychological factors like anxiety and depression. It’s prevalent among women, accounting for a significant portion of rheumatology and primary care consultations.
Diagnosis
Widespread pain must persist for at least three months, affecting both sides of the body, above and below the waist. Pain in 11 of 18 specific “trigger points” upon digital pressure is a key diagnostic criterion. These points include: suboccipital muscle insertion, anterior C5-C7 space, trapezius, supraspinatus, 2nd costochondral junction, lateral epicondyle, buttock, greater trochanter, knee, and iliac crest.
Clinical Management
- Establish a strong patient-physician relationship.
- Provide clear and simple information about the condition.
- Offer psychosocial support.
- Administer pharmacological treatment.
- Monitor symptom evolution and impact on the patient’s life.
- Minimize disability and encourage activity.
- Address symptom exacerbations and potential work limitations.
Treatment
Pharmacological
- Antidepressants (tricyclics like amitriptyline, SSRIs like fluoxetine and sertraline)
- Analgesics (cyclobenzaprine, ibuprofen, acetaminophen, tramadol)
- Benzodiazepines (zolpidem for sleep improvement)
Non-pharmacological
- Aerobic exercise
- Cognitive-behavioral therapy
- Self-help groups
- Acupuncture, hypnosis, spa therapy
Avoid: massage, chiropractic, electrotherapy, ultrasound, infiltration, anaerobic exercise.
Common Patient Experiences
Patients often experience localized and generalized pain, anxiety, stress, fatigue, and a general feeling of being unwell, often accompanied by increased adrenaline.