Dr. Ammar Al-Maskati: Sleep and avoiding stress alleviate symptoms of "fibromyalgia"
Dr. Wala’a Hafiz: In recent years, awareness of fibromyalgia has increased, yet it remains one of the most misunderstood conditions. Patients suffer from chronic pain, severe fatigue, and disturbances in sleep and concentration, while blood tests and imaging studies are typically normal in most cases. To gain a closer understanding of this condition, we spoke with Dr. Ammar Al-Madkhouri, a consultant in internal medicine and rheumatology at Al-Salam Capital Hospital. In his interview with Al-Qabas, he emphasized that fibromyalgia is not a psychosomatic illness nor a sign of personality weakness, as some believe, but rather a globally recognized medical condition. He noted that accurate diagnosis and comprehensive management of pain, sleep, physical activity, and psychological state form the cornerstone of improving patients’ quality of life and minimizing the disease’s impact on their daily routines.
**«Fibromyalgia»**
Dr. Al-Madkhouri explained that fibromyalgia, or muscular rheumatism, is a chronic syndrome that affects how the brain and spinal cord process nerve signals related to pain. In other words, the body becomes more sensitive to pain, causing patients to feel intense pain even from minor stimuli that would not cause pain in healthy individuals. Therefore, it is not an inflammation of the muscles, nor degeneration of the joints, nor an autoimmune disease; rather, it is a disorder of pain regulation within the central nervous system.
**Prominent Symptoms**
According to Dr. Al-Madkhouri, the most common symptom is widespread pain throughout the body, but it is not the only one. Patients may also experience:
1. Persistent pain in muscles and tendons.
2. Severe fatigue, even after sleeping.
3. Sleep disturbances and frequent waking.
4. Morning stiffness.
5. Recurrent headaches or migraines.
6. Poor concentration and memory issues, known as “brain fog.”
7. Numbness or tingling in the hands and feet.
8. Irritable bowel syndrome.
9. Anxiety and depression in some patients.
10. Extreme sensitivity to cold, heat, sounds, or smells.
**Nature of the Pain**
Most patients describe the pain as burning, throbbing, or resembling bruises throughout the body. The pain may shift from one area to another during the day and worsens with:
• Lack of sleep.
• Psychological stress.
• Excessive physical exertion.
• Weather changes.
• Exposure to cold.
**Normal Test Results**
Dr. Al-Madkhouri emphasized that fibromyalgia does not cause inflammation or damage to muscles or joints; therefore, blood tests are usually normal, imaging studies are clear, and MRI scans do not reveal a clear cause. He stated, “This leads some patients to believe they are imagining the pain, whereas the reality is that the pain is very real, resulting from a malfunction in how the brain processes nerve signals.”
**Causes of the Condition**
He confirmed that, to date, there is no single confirmed cause for the condition. However, studies suggest that several factors may converge, including:
1. Genetic predisposition.
2. Exposure to severe psychological stress.
3. Psychological trauma.
4. Accidents and injuries.
5. Certain viral infections.
6. Chronic sleep disorders.
Researchers believe these factors increase the nervous system’s sensitivity to pain.
**Most Affected Groups**
Dr. Al-Madkhouri pointed out that women are more frequently affected, particularly between the ages of 30 and 60, although the disease can also affect men and children. It is also more common among individuals suffering from:
• Rheumatoid arthritis.
• Lupus.
• Migraines.
• Irritable bowel syndrome.
• Anxiety disorders.
**Misconceptions**
Dr. Al-Madkhouri noted that many believe fibromyalgia is a psychological illness, which is one of the most widespread misconceptions. It is an organic condition related to nervous system functions, though it can be influenced by psychological state. Furthermore, chronic pain may eventually lead to anxiety or depression. Unfortunately, many believe that patients exaggerate their complaints because the disease is not visible and does not cause deformities or swelling. Those around the patient may think they are feigning pain. However, studies have proven that pain-processing areas in the brains of fibromyalgia patients function differently than those of healthy individuals.
**Important Information**
Dr. Al-Madkhouri noted that diagnosis used to rely on the presence of 18 tender points in the body, but currently, doctors rely on widespread pain lasting for more than three months, accompanied by other symptoms such as fatigue and sleep disturbances. He highlighted several important facts often overlooked by many:
1. Poor sleep may be a primary cause of worsening the condition.
2. Patients may feel fatigue that exceeds the pain itself.
3. Vigorous exercise may initially worsen the condition.
4. The disease does not destroy joints or cause permanent disability.
5. Symptoms may fluctuate between good and bad days.
6. Psychological stress is one of the biggest triggers for pain episodes.
**Diagnosis**
Dr. Al-Madkhouri explained that diagnosis relies on medical history and clinical examination after ruling out other diseases, such as:
• Vitamin D deficiency.
• Hypothyroidism.
• Arthritis.
• Muscle diseases.
• Anemia.
He confirmed that there is no single test that confirms the diagnosis. He added that there is no cure that eliminates the disease entirely, but symptoms can be largely controlled, and most patients can live normal lives by following a comprehensive treatment plan.
**Latest Treatment Methods**
Dr. Ammar Al-Madkhouri emphasized that treatment relies on several pillars:
1. Health education: Understanding the nature of the disease reduces anxiety and improves outcomes.
2. Physical activity: Such as walking, swimming, stretching exercises, yoga, and Tai Chi. These are among the most effective methods in the long term.
3. Improving sleep: Good sleep significantly reduces the intensity of pain.
4. Pharmacological treatment: This may include medications that regulate pain signals in the nervous system, not just traditional painkillers, prescribed by the doctor based on each patient’s condition.
5. Cognitive behavioral therapy: Especially for those suffering from stress or anxiety associated with the disease.
**Impact of Painkillers**
Regarding the effectiveness of ordinary painkillers, he noted that their effect is usually limited because the problem is not inflammation or muscle injury, but a disorder in pain processing. Therefore, treatment relies more on medications that regulate the nervous system, combined with exercise and good sleep.
**Nutrition**
Dr. Al-Madkhouri clarified that there is no specific diet that cures the disease, but he recommends increasing the intake of:
1. Vegetables.
2. Fruits.
3. Fatty fish.
4. Whole grains.
5. Water.
And reducing:
• Sugars.
• Processed foods.
• Evening caffeine.
**Advice for Patients**
Dr. Ammar Al-Madkhouri provided important advice and guidelines for patients, as follows:
1. Do not ignore persistent pain; consult a specialist.
2. Ensure regular daily sleep.
3. Engage in light exercise regularly, even if starting gradually.
4. Avoid sudden physical exertion.
5. Learn relaxation techniques and stress management.
6. Do not rely solely on painkillers.
7. Follow a healthy diet.
8. Divide daily tasks and do not exhaust your energy all at once.
9. Seek support from family and loved ones; understanding alleviates the psychological burden.
10. Remember that fibromyalgia is not life-threatening, and successful coexistence is possible if diagnosed early and a comprehensive treatment plan is implemented.
