In addition to physical suffering, patients with fibromyalgia must face the distrust of their loved ones and even health professionals

The eyebrows, the red of the dresses, the flowers in the hair and the experience of the pain are indissociable marks of Frida Kahlo. His self-portrait with nails piercing the whole body,    The Broken Column   , one of his most famous paintings, is also an indication that the Mexican artist was suffering from fibromyalgia. To explain the reasons for the chronic pain that has accompanied it for years, some authors suggest that Frida suffered from post-traumatic fibromyalgia, characterized by persistent generalized pain, chronic fatigue, sleep disorders and pain points. in well-defined anatomical regions. This concept of fibromyalgia, as it is currently understood, was probably not widespread among 20th century physicians.

In her self-portrait ‘The Broken Column’ of 1944, Mexican artist Frida Kahlo expresses her pain through nails scattered all over her body (photo: Internet Reproduction)

When Frida painted    The Broken Column  In 1944, the association of painful stitches with rheumatism had already been cited for at least 120 years. In 1824, the Scottish surgeon William Balfour was the first to describe patients with hypersensitive muscle points on palpation that could trigger radiated pain. Fibromyalgia is not a new disease, as many people imagine. Historically, it has been presented under different names: fibrositis (1904), myofibrositis (1929), fibrositic syndrome (1952), fibromyalgia syndrome and, finally, fibromyalgia (1981). Appointed in 1992, he was recognized by the World Health Organization (WHO) as a rheumatic disease. But even if long after, it is always questioned by society, relatives of patients and even some health professionals.

Rheumatologist Luiz Severiano Ribeiro of the Rheumatology Department of the Minas Gerais State Pensioners’ Institute (Ipsemg) remembers a time when the patients themselves did not believe in the diagnosis, even if it justified the pain, which they considered “inexplicable”, Size was its nuisance. “They complained of pain and fatigue, but they did not take the diagnosis seriously. First, they did not understand the name. In addition, the clinical examinations indicated nothing and we prescribed antidepressants. They thought that fibromyalgia was crazy and when they found another doctor and told them what the rheumatologist had said, they realized they really needed to be psychiatrists. It was the classic trajectory of fibromyalgia 20 years ago. They jumped from one doctor to another without explanation, and when they were diagnosed, they did not believe. “

 

ASSOCIATION  For fibromyalgia, people more sensitive to pain than the general population, such mistrust and such disbelief also hurt. Retired Sandra Santos, 53, was diagnosed in 2005 and, in a positive attitude to suffering, founded the Brazilian Association of Fibromyalgia (Abrafibro) with other patients. To treat a spine problem, she was referred to a treatment she could not continue. “I came in and out of a wheelchair. I insisted until the eighth session, but the attending physician found it odd that my pain threshold was so low. The specialist who accompanied him suspected that it may have been fibromyalgia and, on clinical examination, he revealed to me that I had 11 points of pain out of 18. She had fibromyalgia,

INCREASED SENSITIVITY

In recent years, the understanding of fibromyalgia is considered a syndrome because it covers a number of clinical manifestations such as pain, fatigue, sleep disorders. According to Eduardo Paiva, head of the Committee on Pain and Fibromyalgia of the Brazilian Society of Rheumatology, an assistant professor at the Federal University of Paraná (UFPR) and head of the Fibromyalgia Outpatient Clinic at the Hospital das Clínicas. ‘UFP, it is increasingly established fibromyalgia is a problem of sensitization of the nervous system, which would be programmed to feel more pain. Exams such as functional magnetic resonance, which can show how the brain works in real time, reveal the intensity of the amplified pain reported by patients.

 

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  • For each type of pain, there is an adequate technique: to know the options in physiotherapy

People with fibromyalgia have a lowered threshold of pain. Stimuli that normally do not cause pain in other people, such as conditions, can be painful for fibromyalgia. According to Roberto Heymann, rheumatologist at Hospital Albert Einstein and professor at the Federal University of São Paulo (Unifesp), this is due to failure of the pain control mechanisms in the central nervous system. “The causes of such inadequate control of the mechanisms of pain are unknown. It is thought that a genetic predisposition that, exposed to certain environmental factors, generates fibromyalgia. What we know,

In addition, external factors influence the transmission and the sensation of pain. Emotional state and cold are part of it. Depression, for example, may be one of the consequences of fibromyggia, as in many other chronic diseases, but also the trigger that was lacking to trigger a picture of fibromyalgia in the genetically predisposed person. According to Heymann, emotional health has a direct influence on all diseases, not just on fibromyalgia. “How many people have high blood pressure because they have become nervous and anxious, for example? But in fibromyalgia, the pain being subjective, the influence of the emotion on its intensity often generates prejudices. The fact is that a depressed person actually feels more pain than the normal population because his sensitivity to pain is exacerbated. Like this,

 

Any image of chronic pain also harms sleep, with the patient often waking up with pain. But in fibromyalgia, hormonal changes and neurotransmitters are also responsible for the superficiality of sleep and the feeling of fatigue. As a result, most people with fibromyalgia have superficial and light sleep in which they do not rest. As a result, they become tired and without energy. The main symptoms of the disease are generalized pain, difficulty sleeping or waking up tiredly and feeling tired or tired during the day. Maria Joana das Mercês, 84, doubted she had really slept at night or if it was a dream. Participant in the Fibromyalgia Patient Education Group, Ipsemg has been around for more than 20 years, and today she is better able to manage symptoms, but they have not stopped worrying. “I sleep and wake up thinking if I’m really sleeping. And the pain is unbearable. Nobody deserves it, “he laments.

THE BREAKED COLUMN
In the 2014 Art and Pain in Frida Kahlo article, Rodrigo Siqueira Batista and his co-authors look for the cross between his art and his experiences of pain in the biography and work of the Mexican artist. For the authors, in The Broken Column, in which she describes herself using the steel vest to control the image of pain, the nails inlaid in her naked body reflect an endless martyrdom. “Frida’s body is divided, bleeding, nailed and isolated, so it translates the physical torture that has never left her throughout her life” as it was before the pain. “Loneliness, metaphorized by the desert landscape, reinforces suffering. The open body is a reference to the various surgeries you have undergone to repair the spine without improving your complaints. But implanted nails suggest the typical pain points of fibromyalgia. For researchers, this hypothesis would explain the chronic pain and deep fatigue felt by the painter.

 

Julia de Oliveira Fonseca, medical student at the Federal University of Viçosa (UFV) and Rodrigo Siqueira-Batista, doctor, philosopher and professor at the Department of Medicine and Nursing of the UFV 

LIFE AND ART

 

The image of Frida Kahlo is very much related to suffering. What were your main sources of pain? The polio and the accident are indisputable, but she was diagnosed with fibromyalgia or was this finding found after her death and because of a greater knowledge of the syndrome?

The painter Frida Kahlo suffered a lot, both physically (organic) and emotionally. In fact, one of the greatest sorrows of the artist is related to the relationship with his companion, the painter Diego Rivera, for whom she was deeply in love. The couple had a great affection for each other; however, also lived through fighting and betrayal, which made Frida very sad. One of these quarrels was the result of Diego’s betrayal with Frida’s sister, Adriana. Frida also suffered from the fact that she could neither conceive nor undergo spontaneous abortion at the time of gestation. A famous painting, called Henry Ford Hospital (La cama volar), describes, in a very remarkable and strong way, an episode in which Frida had to be hospitalized following an abortion. In life, no case of fibromyalgia was diagnosed, even though, at the time, the name “fibromyalgia” did not exist (much later, going back to the 1970s). This diagnostic hypothesis was raised after his death and is suggested by his clinical picture of chronic pain, as proposed in the article Fibromyalgia in the life and art of Frida Kahlo (article by Manuel Martinez-Lavín, Mary- Carmen Amigo, Javier Coindreau and Juan Canoso). published in the journal Arthritis & Rheumatism, March 2000). as proposed in the article Fibromyalgia in the life and art of Frida Kahlo (article by Manuel Martinez-Lavin, Mary-Carmen Amigo, Javier Coindreau and Juan Canoso). published in the journal Arthritis & Rheumatism, March 2000). as proposed in the article Fibromyalgia in the life and art of Frida Kahlo (article by Manuel Martinez-Lavin, Mary-Carmen Amigo, Javier Coindreau and Juan Canoso). published in the journal Arthritis & Rheumatism, March 2000).

The Art and Pain article    in Frida Kahlo   * talks about a possible relationship of the nails by the body in the broken column with the pain points of fibromyalgia.Can this image be considered as clear evidence of your experience with fibromyalgia? Because?

The image    The broken column    – in which nails are stuck by the body of the artist – describes Frida’s connection with the after-effects – multiple fractures in the spine – of the accident suffered in his youth, as well as his report painful. Regarding the pain points of fibromyalgia, this seems like a plausible hypothesis, but this certainly does not constitute “obvious evidence”, especially when considering a painter of the category and intensity of Frida Kahlo .

What is the importance of pain for the work of the Latin artist?

Frida Kahlo painted many self-portraits, considering herself as very self-conscious. It is assumed that the artist has depicted on his canvas many moments of pain – both physical and emotional – that were part of his life. In this way, it can be assumed that Frida finds somehow in art the meaning of pain itself.

 

WITHOUT ESTIGMAS


To live with the syndrome and maintain the quality of life, it is essential that the person with fibromyalgia treats her seriously and deals with professionals who are knowledgeable about the subject.

Euler Junior Press / EM / DA% u2013 7/2/14
Jorge Luiz Dutra, 59, was questioned several times because he was in pain (photo: Euler Junior / EM / DA Press% u2013 02/07/14)

On the 12th, we celebrate World Fibromyalgia Day. The date strengthens the struggle of patients for more access to treatment and, above all, for more visibility of the syndrome. Only public awareness can change the panorama of disbelief around chronic pain that marks the problem. The retired bricklayer Jorge Luiz Dutra, 59, has been diagnosed since 2004 and still lives with suspicion. Residing in the countryside, he is already tired of hearing that fibromyalgia is just an excuse. “Many people say that I have nothing, that I do not want to work. They look at me and say that if I’m fat, I’m healthy, “he says. But it is Jorge who knows the suffering of living an impending pain, symptom influenced by social, cultural,

According to Roberto Heymann, a rheumatologist at the Albert Einstein Hospital and a professor at the University of São Paulo (Unifesp), the assessment of pain is complex because there are no precise measures, such as hypertension and diabetes. patient, professional or family information. “If they lack adequate information, there will certainly be a wrong judgment. And that’s why we often see family members, co-workers or even health professionals who do not believe in their suffering. This increases the degree of fibromyalgia disease, even influencing the evolution of its clinical condition. “The lack of sufficient knowledge about this syndrome in society often creates absurd preconceived ideas. Family and social support is essential, “he said.

The pain of fibromyalgia can cause a lot of suffering, enough to disrupt your daily and usual activities. But even if patients and entities struggle for the possibility of a leave or even a retirement, leaving work is a complex issue, Heymann said. “There is no data to prove that it generates any benefit and the removal of work usually leads to a deterioration of the situation,” he says. For the specialist, in most cases, it is perfectly possible to live with the syndrome and maintain its quality of life. For this, it is essential that the person with fibromyalgia takes it seriously and deals with professionals well prepared and competent in the matter.

REACTION   Personal trainer Michele Barreto, 42, was diagnosed 14 years ago. Medications, therapy, changes in eating habits and regular physical activity allow it to coexist with fibromyalgia without major problems. “Today is fine, but at the time of diagnosis, I had to sit down and cry. But I had two options: either it would break me, or I would react. The patient needs to understand that the condition improves when they adhere to treatment, “he said. A former volleyball athlete, Michele was surprised to see that the benefits of relaxation by a massage were narrated. “Because I screamed in pain instead of relaxing. I also stopped sleeping and was already tired, “he recalls.

Edésio Ferreira / EM / DA Press
Personal trainer Michele Barreto, 42, faced fibromyalgia and insisted on physical activity even in days of great pain (photo: Edésio Ferreira / EM / DA Press)

In volleyball, Michele had wounds that improved more slowly. At the time, this had become a mistrust because some people imagined it was playing soft. But fibromyalgics are often patients with a history of pain prior to diagnosis. According to Eduardo Paiva, head of the Pain and Fibromyalgia Commission of the Brazilian Society of Rheumatology, there are several ways to achieve fibromyalgia. “This could be, for example, the result of untreated localized pain. It can also begin after a physical or psychological trauma. But the most common is that it is a localized pain, which synchronizes and takes the whole body “, explains the specialist,

And it is precisely a trauma that triggered Michele’s fibromyalgia. She drove, when she had a serious car accident, in which two friends were very hurt. “I was guilty. At first, I thought that back pain was the consequence of the accident. I had to wear a cervical collar for a while, but the pain continued, “he says. The first reaction after the discovery of fibromyalgia was to look for all kinds of resources to deal with the disease: massage, acupuncture, homeopathy, therapy. The latter was essential for her to change her way of dealing with the disease. “I learned that if it somatized, it would make things worse.” Physical activity was also essential. “I heard a lot of doctors say that it was over 50% of the treatment. Sometimes, it’s so painful that we do not want to do anything. But it takes persistence. “

The personal experience of fibromyalgia makes the professional highly sought after by people who want to enjoy the benefits of physical activity to control their symptoms. “I think they trust to train with me because I know how they feel on the skin. In addition, the physical activity for fibromyalgia must be specific and very well targeted, “he warned. For Paulo Paiva, physical activity may be more effective than medication in some cases. If left untreated, fibromyalgia can result in a significant loss of quality of life. In addition to drugs (neuromodulators and dual antidepressants being the most appropriate) and physical activity, treatment involves patient and family education.

 

ALTERNATIVE AND ADDITIONAL THERAPIES

A review of controlled studies evaluating the effectiveness of massages in the fibromyalgia approach showed that five weeks of the resource were able to promote immediate benefits such as improved pain, anxiety, and depression. . Susan Lee King Yuan, a physiotherapist, holds a master’s degree in science from the Faculty of Medicine of the University of São Paulo and researcher in the field, therapeutic massage could be one of the alternative and complementary therapies (CT) used in the treatment of fibromyalgia.

 

The myofascial relaxing massage can improve pain, fatigue, stiffness, anxiety, depression and quality of life. Some data indicate that manual lymphatic drainage is superior to connective tissue massage with respect to stiffness and depression. There is evidence that connective tissue massage improves depression and quality of life, while shiatsu improves the threshold of pain, fatigue, sleep and quality of life. “Studies suggest that most massage therapy styles improve the quality of life for patients with fibromyalgia, but additional research is needed to confirm its benefits,” he says.

 

Internet reading
Functional Magnetic Resonance Imaging compares the brain activity of a normal person with a fibromyalgia patient. Both were subjected to a stimulus of 4 kg that can cause pain (photo: Reproduction of the Internet)

In theory, speaking of massage in general, the relief of pain may be due to increased blood circulation, which promotes oxygenation and elimination of toxins from the muscles, relaxation and release of endorphins. “The pain will only disappear completely with the use of massage therapy. The most appropriate is to use massage as a complement to other therapeutic resources as part of a multidisciplinary treatment to control the symptoms of the syndrome, “he says.

 

No study has conclusively determined the ideal frequency of massage application in fibromyalgia. Some researchers suggest a treatment duration of more than five weeks. For Susan, the CTs advocate a holistic view of the patient and value the link between therapist and patient. The important thing is that this massage respects the threshold of painful sensitivity of the patient to palpation. “The use of CATs as a complement to a multidisciplinary treatment is ideal: it is particularly important that this treatment includes patient education, psychotherapeutic technique and therapeutic exercise, which presents the greatest evidence of efficacy in the treatment of patients. treatment of fibromyalgia. “

NUMBERS

Epidemiology

 

  • The prevalence of fibromyalgia in the world ranges from 0.7% to 5% compared to the general population.
  • In Brazil, it is probably the second most important rheumatic disease with a prevalence of about 2.5%.
  • This can range from children to the elderly, but their symptoms usually begin between the ages of 25 and 65, with an average age of 49 years.
  • It affects more women than men, in a ratio of 8: 1, when used the criteria of the American College of Rheumatology of 1990

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