• Maria R. de Almeida


Fibromyalgia it is a syndrome, a rheumatism of soft tissues. Its main symptoms are tiredness and specially, muscular pain. It is a chronic pain

that most of the time affects all the body. However, it can begin in a certain area: for example neck and shoulders and extend to other parts of the body. Intensity of the pain varies from patient to patient. In a patient, it varies depending on the time of the day, the level of physical activity… Most of the people suffering from fibromyalgia say they always have some pain, sometimes very severe.

It is estimated to affect around 2,4% of the world population. Approximately, 13% of the patients going to the GP have fibromyalgia and more than 10% of the patients who go to the reumathologist.

Traditional medicine cannot explain its origin. It is interesting to remark that there is no physical lesion which justifies the pain. The physical examination of the patient and all the tests performed: blood test, X-Ray … and any other tests are normal. There is no inflammation, nor joint alteration. Mobility is normal, other than the limitations due to pain. People suffering from fibromyalgia show increase sensitivity to pain: When pressing on those spots, they feel sore. These “tender points” on the body are one hallmark of fibromyalgia. Tender points can be located on the back of the head, elbows, shoulders, knees, and hips. There are 18 possible tender points in all.

These patients suffer from significant limitations in their everyday life due to the chronic pain which persists despite medical treatment. One of the most striking features is the intensity of the pain. Patients claim how intense and unbearable the pain is. They often describe it as exhausting and depressing.

Apart from the pain they suffer from fatigue, tiredness not related to psychical activity and which does not improve with rest. Sleeping disorders, headaches, hands paraesthesia and IBS are also very common.

In 1990, American School of Reumathology (ASR) established some guidelines to help to diagnose fibromyalgia. According to ASR, someone suffers from fibromyalgia if he/she has a history of generalised pain, without a lesion to justify it for at least 3 months and pain in 11 or more of the 18 tender points.

It is important to remark that they dont have an underlying physical lesion which justify those symptoms: fatigue, chronic pain, irritable bowel… The root of their disease is psychic.

If we include the unconscious psychic processes when we think about physical disease, we can figure out the different sicken processes remembering that we can not separate the psyche from the soma. All stimuli, psychic as much as somatic, have to be elaborated via psyche and via soma. Hysterical patients can not elaborate psychic stimulus via psyche. This is why, through the mechanism of conversion, they divert that psychic stimulus to the soma, creating symptoms in the body.

Could then fibromyalgia be a sort of hysteria? Main characteristic of hysteria is that there is no underlying physical injury which justify the physical symptoms, exactly the same as in fibromyalgia. Hysterical symptoms are the expression of sentences in the body. For example, blindness could be related to the sentence “ I do not want to see that” and Leg paralysis, to “I can not go any step further”. The underlaying sentence to chronic pain could be different for each patient.

From medical point of view, as the root of the disease is unknown, the treatment is symptomatic: painkillers to help ease the pain but they do not cure the disease. Thinking fibromyalgia as a sort of hysteria, would give as the chance to think how to cure it. Fibromyalgia can be cured with Psychoanalysis.

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