Dr Mehdi Chemal: Fibromyalgia is a chronic disease characterized by persistent diffuse pain throughout the body, often accompanied by intense fatigue, sleep disorders, morning stiffness, cognitive disorders, and sometimes migraines, intestinal disorders or mood disorders. What makes it particularly difficult to live is its invisible character. The biological analyzes are normal, the imaging too … but the suffering is very real. This is non -lesional, but functional pain, which deeply impacts the quality of life. And because this suffering is not seen, the patient often begins a real obstacle course. He consults several doctors, goes from one specialist to another, but leaves frequently with the feeling that nobody really understands it. This lack of recognition further increases the emotional load and strengthens isolation. Besides, it is also too often heard that fibromyalgia is a diagnosis of elimination. In reality, this is not quite correct. This approach, when it is pushed to the extreme, unnecessarily delays the diagnosis – and with it, the implementation of suitable care.
How does the diagnosis take place, knowing that there is no specific biological test to detect this disease?
Fibromyalgia should be actively considered when an evocative clinical picture has: diffuse pain, persistent fatigue, sleep disorders, cognitive disorders … All without biological or radiological abnormalities to explain these symptoms. The diagnosis is based on a structured approach: a body is presented to the patient representing the potentially painful areas, then we count the sensitive points. Then, an in -depth interrogation makes it possible to identify several associated symptoms, according to validated criteria, in particular those of ACR 2016 (diagnostic criteria established by the American College of Rheumatology in 2016 to identify fibromyalgia). A probability score is then established, which makes it possible to make a more objective diagnosis. It is therefore not a “default” diagnosis, but a clearly defined functional syndrome, with concrete clinical criteria. The more we take a long time to recognize it, under the pretext of excluding all other possible pathologies, the more the patient is exhausted, loses confidence in the care system, and sees his quality of life deteriorate.
What are the main hypotheses on the causes of fibromyalgia? Do we speak of neurological, inflammatory, psychological origin?
We do not yet know all the causes of fibromyalgia, but several serious tracks are emerging. The most likely, it is a disruption of the nervous system, which makes the brain perceive the pain in an exaggerated way, as if the volume of the pain was blocked on the maximum, even without real lesion in the body. Other factors seem to play an important role, such as chronic stress, emotional shocks, accumulated fatigue or even ancient trauma (physical or psychological). We also know that the disease sometimes affects several people in the same family, which suggests a genetic predisposition. Finally, some research suggests that there could be very low level inflammation in the nervous system, but that remains to be better understood. What is certain is that fibromyalgia is neither “in the head”, nor a simple consequence of stress. It is a complex syndrome, where several mechanisms are tangled and where pain becomes an invasive experience, without visible cause, but with a very real impact.
What is the real impact of this disease on the daily life of patients (fatigue, pain, social isolation, work, etc.)?
The impact is often major. Chronic pain ends up exhausting the body as much as the mind. Many patients speak of a feeling of misunderstanding, of isolation, sometimes even guilt: “I can no longer live as before, to take care of my family, to work normally …” Little by little, self-confidence crumbles, the entourage understands badly, and some end up withdrawing on themselves. On a professional level, many reduce their activity or stop working. Family life, social, intimate also suffers. It is a global suffering, invisible to the naked eye, but very real for those who live it. And as we have explained above, the fact that some practitioners still consider fibromyalgia as a simple “elimination diagnosis” aggravates this suffering. The patient, in medical wandering, ends up believing that no one understands it, that his pain only exists for him. And that, sometimes, hurts even more than the pain itself.
Is fibromyalgia today fully recognized by health authorities in Morocco and other countries?
Yes, in several countries like the United States, France or Spain, fibromyalgia is recognized as a real disease. It also appears in the International Classification of WHO diseases (World Health Organization) since 1992. However, even where it is recognized, care paths are often vague, and many patients are struggling to find suitable care. In Morocco, recognition is still partial. Fibromyalgia is often poorly understood, and patients find themselves without clear orientation, tossed between different specialists. But things are starting to change. Centers specializing in pain, like ours, undertake to offer modern, global and human care, based on international scientific recommendations. It is a start, and above all a sign of hope for many patients.
Some patients say that their symptoms have appeared or worsened after receiving a COVVI-19 vaccine. Is there an established or suspected link between vaccination and fibromyalgia?
There is no formal scientific evidence establishing a direct link between the vaccines against the COVVI-19 and the appearance of fibromyalgia. However, some patients make a worsening of painful symptoms after vaccination. This could be linked to transitional activation of the immune system or a context of latent stress and inflammation. It is important to keep a cautious and non -stigmatizing approach: the overall benefit of vaccination remains much higher than the risks, but you have to listen and follow these patients closely.
What therapeutic treatments or approaches are currently recommended to relieve patients?
The treatment of fibromyalgia is based on a global and progressive approach. In our center, we always start with general management, called systemic treatment. The idea is to act on the whole body, to alleviate several symptoms at the same time, such as fatigue, diffuse muscle pain, headache, sleep disorders or moderate joint pain. For this, we use complementary methods: a rebalancing in vitamins and minerals (in particular in vitamin D, magnesium, vitamins B1, B6, B12 …), very low dose ketamine infusions in certain resistant patients, or even major self-hemotherapy with ozone, which makes it possible to stimulate cellular oxygenation and modulate inflammation. This general treatment is often accompanied by gentle physical rehabilitation (such as walking, stretching or balneotherapy) as well as psychological support, to help the patient regain confidence in his body. It is only after this first phase that we consider, if necessary, more targeted treatments, for the areas of the body which remain painful. These may be local infiltration, specific drug injections, physiotherapy sessions (such as electrical neurostimulation or gentle radiofrequency), or local ozone applications. This two -step strategy – first global, then localized – allows a softer, more personalized approach, and often better tolerated by patients. The objective is not only to calm the pain, but also to restore autonomy, mobility, and above all, a quality of life.
